Meconium peritonitis: prenatal diagnosis and postnatal outcome / 대한산부인과학회지

OBJECTIVE: To detect meconium peritonitis for the fetal period is important for prenatal counseling. The aim of this study was to evaluate prenatal ultrasound finding for diagnosing meconium peritonitis and postnatal clinical course and outcomes. METHODS: The prenatal and postnatal medical records of all patients to our institutions with confirmed meconium peritonitis were reviewed, with emphasis on prenatal ultrasound findings, postnatal investigations, operative findings, outcomes of meconium peritonitis. RESULTS: Fourteen fetuses were confirmed to have meconium peritonitis at birth by operation. Eight cases were diagnosed correctly because of prenatal ultrasound showing ascites and calcification/dilated or hyperechoic bowel loops. In the other 6 cases, prenatal ultrasound showed only ascites. One patient was operated on first day of life and its intra-operative finding was malrotation of small bowel, volvulus with strangulation, perforation and jejunal atresia. Most cases were operated on 2nd or 3rd day of life. Intra-operative findings were ileal atresia and perforation in 11 cases and jejunal atresia and perforation in 3 cases. Four patients underwent ileostomy but all patients survived and prospered. CONCLUSION: All patients do not present typical prenatal ultrasound findings of meconium peritonitis. Therefore, even in pregnancies associated with isolated ascites, meconium peritonitis should be taken into consideration. Favorable outcome of intrauterine meconium peritonitis is reassuring in prenatal counselling and stems from multidisplinary team approach.

Comparative Analysis Between NTproBNP and BNP on the Prediction for Congestive Heart Failure

PURPOSE: The BNP (B-type natriuretic peptide) test is a widely used diagnostic tool to differentiate congestive heart failure (CHF) from other diseases in patients with acute dyspnea in the emergency department. However, limited data exist regarding the effects of the left ventricular ejection fraction (LVEF) on NT-proBNP and BNP levels in acute CHF. We compared NT-proBNP with BNP in relation to the LVEF and correlated these levels to the CHF severity. METHODS: We assessed 113 patients who underwent BNP testing and echocardiography (Echo) during April 2005 and 127 patients who underwent NT-proBNP testing and Echo during May 2005. There were minimal differences with regard to epidemiologic data, past histories, clinical symptoms, New York Heart Association (NYHA) classifications, and final diagnoses between the two groups. We compared the sensitivity between BNP and NT-(pro)BNP in the diagnosis of heart failure, the change in BNP levels according to severity of CHF, and the optimal cutoff values of BNP and NT-proBNP. RESULTS: NT-(pro)BNP (AUC 95% confidence interval 0.875 - 0.965) was found to be superior to BNP (AUC 95% CI 0.675 - 0.851) in predicting CHF, it trended to be statistically significant. The BNP value correlated both with the severity of CHF (classified by NYHA) and LVEF gradings. The cutoff values for BNP and NT-(pro)BNP were 129 pg/mL and 451 pg/mL respectively. CONCLUSION : NT-proBNP is a more powerful predictor of acute CHF in patients presenting to the emergency department with acute dyspnea. Furthermore, NT-(pro)BNP tests may be useful in diagnosing and evaluating the severity of CHF.

Comparative Analysis Between NTproBNP and BNP on the Prediction for Congestive Heart Failure

PURPOSE: The BNP (B-type natriuretic peptide) test is a widely used diagnostic tool to differentiate congestive heart failure (CHF) from other diseases in patients with acute dyspnea in the emergency department. However, limited data exist regarding the effects of the left ventricular ejection fraction (LVEF) on NT-proBNP and BNP levels in acute CHF. We compared NT-proBNP with BNP in relation to the LVEF and correlated these levels to the CHF severity. METHODS: We assessed 113 patients who underwent BNP testing and echocardiography (Echo) during April 2005 and 127 patients who underwent NT-proBNP testing and Echo during May 2005. There were minimal differences with regard to epidemiologic data, past histories, clinical symptoms, New York Heart Association (NYHA) classifications, and final diagnoses between the two groups. We compared the sensitivity between BNP and NT-(pro)BNP in the diagnosis of heart failure, the change in BNP levels according to severity of CHF, and the optimal cutoff values of BNP and NT-proBNP. RESULTS: NT-(pro)BNP (AUC 95% confidence interval 0.875 - 0.965) was found to be superior to BNP (AUC 95% CI 0.675 - 0.851) in predicting CHF, it trended to be statistically significant. The BNP value correlated both with the severity of CHF (classified by NYHA) and LVEF gradings. The cutoff values for BNP and NT-(pro)BNP were 129 pg/mL and 451 pg/mL respectively. CONCLUSION : NT-proBNP is a more powerful predictor of acute CHF in patients presenting to the emergency department with acute dyspnea. Furthermore, NT-(pro)BNP tests may be useful in diagnosing and evaluating the severity of CHF.

Blood Pressure and Heart Rate Changes and the Patient Response following I.V. Administration of Fentanyl during Awake Fiberoptic Nasotracheal Intubation / 대한마취과학회지

The purpose of this prospective study was to evaluate the patient response and the changes of blood pressure and heart rate following intravenous administration of various dosage of fentanyl during awake fiberoptic nasotracheal intubation. After verbal informed consent, the 44 ASA status I or II patients undergoing oral and maxillofacial surgery were randomly assigned to receive 0(N=11), 1(N=11), 2(N=11), 3(N=l1) ug/kg of fentanyl, On arrival to operating room, midazolam 2 mg and glycopyrrolate 0.2 mg were administered for premedication. And then, EKG, blood pressure and peripheral O2 saturation were monitored continuously. Local anesthesia was induced with the gargling of 4% lidocaine 10ml, the transtracheal injection of 4% lidocaine 3ml and nasal spray 10% lidocaine 0.5ml. After that each dose of fentanyl was given to each groups. And then fiberoptic intubation was performed with continuous verbal contact to confirm the patient response and ventilatory status during intubation. During fiberoptic intubation, the peak level of blood pressure and heart rate were recorded. We compare the difference of blood pressure and heart rate between the value of just before fiberoptic intubation and the peak value during fiberoptic intubation and discomfort score according to fentanyl dosage on the first day of postoperation. The change of blood pressure and the time required for intubation was less and shortest in the 2 ug/kg of fentanyl group. But there were no significant differences in heart rate and discomfort score. We conclude that 2 ug/kg of fentanyl minimize the change of blood pressure as well as intubation time. But the change of dosage of fentanyl was not helpful to decrease the discomfort score.