Comparison of the efficacy of ramosetron and palonosetron for prevention of postoperative nausea and vomiting in patients undergoing gynecologic oncology surgery

BACKGROUND: Postoperative nausea and vomiting (PONV) is a major concern during the post-surgical period. 5-hydroxy-tryptamine (5-HT3) receptor antagonists may be useful for the prevention of PONV. The recently developed 5-HT3 receptor antagonists, ramosetron and palonosetron, have a greater receptor affinity and a longer elimination half-life. This study was designed to assess the efficacy of palonosetron and ramosetron for prevention of PONV in patients receiving intravenous patient-controlled analgesia (IV-PCA) with opioids after gynecological oncology surgery. METHODS: In this prospective trial, 290 female patients scheduled for elective gynecologic oncology surgery with IV-PCA with opioids were randomized to receive either 0.3 mg ramosetron or 0.075 mg palonosetron intravenously. The occurrence of nausea and vomiting and the use of rescue antiemetics were recorded immediately after the end of surgery, and 0-3 h, 3-24 h, and 24-48 h postoperatively. RESULTS: The total incidence of PONV was similar between the two groups 0-48 h after surgery, but the incidence of nausea was significantly lower in the ramosetron group 24-48 h postoperatively (11.5% vs. 22.0%, P = 0.036). The incidence of vomiting and the use of rescue antiemetics were not significantly different between the two groups during any of the time intervals. Pain intensity scores and total fentanyl consumption were significantly lower in the ramosetron group 24-48 h postoperatively compared to the palonosetron group (P = 0.021, P = 0.041, respectively). CONCLUSIONS: The prophylactic effects of ramosetron and palonosetron on PONV incidence in the postoperative 48 h were similar in patients undergoing gynecologic oncology surgery and those receiving opioid-based IV-PCA.

Cardiac arrest in a pregnant woman with pregnancy-induced hypertension: A case report

A 39-year-old woman with an intrauterine pregnancy and small-for-gestational-age fetus was admitted at 34 + 1 weeks for management of pregnancy-induced hypertension. On the 13th day of admission, the patient was found in the ward toilet with a cardiac arrest. Cardiopulmonary resuscitation (CPR) was initiated immediately and cardiac monitoring revealed asystole. Manual uterine displacement was performed for CPR to be effective. A return of spontaneous circulation was observed, but repeated cardiac arrest occurred subsequently. Twenty-one minutes after starting CPR, a peri-mortem cesarean section was started, and delivery occurred 1 minute later. After delivery of the fetus, the patients' blood pressure stabilized, but there was no spontaneous respiration. Emergency brain CT revealed a large subarachnoid hemorrhage. Neonatal brain ultrasound showed hypoxic-ischemic encephalopathy. The patient was transferred to another hospital for neurosurgical intervention, where she expired on the third day after cardiac arrest.

Immune responses of hepatitis B vaccination among very low birth weight infant / 소아과

PURPOSE: To evaluate the immunogenicity of hepatitis B vaccine among very low birth weight infants(VLBWI) who were vaccinated at 0, 1, 6 months of chronological age and to determine the factors associated with antibody formations. METHODS: A total of 243 VLBWI admitted to Seoul and Gangneung Asan Medical Center neonatal intensive care units from 1997 to 2004 were included. Of 243, 13 infants were born to HBs Ag positive mother. All infants were given DNA recombinant vaccine at 0, 1, and 6 months of chronological age. Infants born to HBs Ag positive mothers received hepatitis B immunoglobulin at birth and a total of 4 doses of vaccinations. An antibody level over 10 mIU/mL, tested at 3-4 months after last vaccination, was regarded as a positive seroconversion. RESULTS: The seroconversion rates were 84.4 percent and 84.5 percent for VLBWI and extremely low birth weight infants(ELBWI), respectively. Of 28 seronegative infants who were given revaccinations, 60.7 percent seroconverted, resulting in 95.3 percent, 97.5 percent seroconversion rates for VLBWI and ELBWI, respectively. 76.9 percent of infants born to HBsAg positive mothers seroconverted and none became hepatitis B carriers. Factors such as gestational age, sex, various neonatal illness, and kinds of vaccinations did not influence the formation of the hepatits B antibody, however, the higher the weight at time of first vacciation yielded better seroconversion rate. CONCLUSION: Revaccination of seronegative VLBWI after 3 doses of hepatitis B vaccinaton is very effective. Therefore, testing the immune status after the hepatitis B vaccination, a practice not routinely done, is highly recommended.

A Case of Renovascular Hypertension Controlled by Renal Artery Embolization / 소아과

Renal artery stenosis is a major cause of renovascular hypertension and the most common cause of treatable secondary hypertension. There are several methods to treat renal artery stenosis, including surgery, percutaneous transluminal renal angioplasty(PTRA), and renal artery stenting(RAS). But, renal artery embolization can be tried in atherosclerotic stenosis, multiple stenosis, microaneurysm, and stenosis difficult to try PTRA or RAS. We report a case of renovascular hypertension in a 14-year-old female who had multiple segmental renal artery stenosis. Hypertension was controlled by renal ablation therapy with renal artery embolization.

Intervention with Balloon Valvuloplasty followed by Patent Ductus Arteriosus Stent in a Patient with Pulmonary Atresia with Intact Ventricular Septum / 소아과

Pulmonary atresia with intact ventricular septum (PAIVS) is rare, less than 1% of congenital heart disease. It needs a therapeutic approach according to its individual morphologic feature. Surgical treatment of valvotomy and modified Blalock-Taussig shunt or non-surgical interventional catheter balloon valvuloplasty can be used for mild to moderate hypoplasia of right ventricle. Fontan operation can be considered for less optimum morphological substrate of two ventricular repair. A 3- day-old male neonate was admitted with cyanosis and cardiac murmur. On echocardiogram, he had membranous pulmonary atresia with intact ventricular septum, normal sized tripartite right ventricle, large atrial septal defect with right-to-left shunt, small sized patent ductus arteriosus, and moderate tricuspid regurgitation. He was treated with intravenous continuous infusion of prostaglandin E1 (PGE1) at once. On the third day of hospitalization, Balloon valvuloplasty was performed. After insertion of patent ductus arteriosus stent on the tenth day, PGE1 infusion was discontinued. On the fifteenth day, he was discharged. Now, he is 9 months old and has nearly normal cardiac structure and function with 97% of percutaneous oxygen saturation.

beta2 Microglobulin Levels of Cerebrospinal Fluid in Children with Meningeal Irritation Signs / 대한소아신경학회지

PURPOSE: A clinical diagnosis of meningitis is difficult because of the paucity of physical findings in children. Not all of the meningitis patients show nuchal rigidity, Kernig's sign or Brudzinski's sign. Lumbar punctures were done because of unexplained fever, changes in behavioral or mental status, seizures or skin petechiae in febrile patients. But sometimes cerebrospinal fluid(CSF) findings are not compatible with menigitis for those whose clinical symptoms indicate menigitis. Pediatricians are frequently confronted to the problem of a sick child whose CSF has no white blood cells but the child has a meningeal irritation sign. Therefore, the levels of CSF beta2 microglobulin from children with positive meinigeal irritation signs were examined to evaluate the diagnosis of meinigitis. METHODS: From March to August 2002, We examined the levels of CSF beta2 microglobulin from children with positive meningeal irritation signs by competitive radioimmunoassay in 35 suspected meingitis patients and 12 control patients in the Department of Pediatrics of Chungnam National University Hospital. RESULTS: In 35 suspected menigitis patients, 20 patients were diagnosed as meningitis and 15 patients were no evidence of meningitis in their CSF findings. In the WBC counts of the CSF, meinigitis patients had 268/mm3 and meningismus patient had 2.3/ mm3 on average. In the levels of the CSF beta2 microglobulin concentrations, the two groups were not different. For the 20 meningitis patiens, the average value was 0.193+/-0.054 while it was 0.169+/-0.028 for the 15 meningismus patients and 0.102+/-0.021 for the 12 control patients(P0.05) CONCLUSION: These data demonstrate that the meningeal irritation sign is a meaningful sign for meningitis but the initial CSF findings do not always confirm the diagnosis. So, if patients have a meningeal irritation sign, the patient should be carefully examined and additional diagnostic tools such as the CSF beta2 microglobulin concentration can be used.

The Study for Causes of Childhood Language Disorders / 대한소아신경학회지

PURPOSE: Language disorders are characterized by inadequate acquisition of language comprehension or expression. Language disorder involve the exclusion of etiologic or explanatory factors, such as sttutering, delayed speech and phonological disorders. It is important to rule out etiologic factors because delayed speech is often associated with other organic disorders or causes of secondary problems. There is no statistic analysis of the causes of language disorders in Korea. So, we analysed the causes of language disorders. METHODS: From March, 2001 to August, 2003, we examined 113 children with language disorders who had developmental and language tests in the language therapy center in Chungnam National University Hospital. RESULTS: In 113 children with language disorders, 77% are male and 23% are female. Average age is 51.3 months. The causes of language disorders are mental retardation (42.4%), tongue-tie(12.3%), sttutering(10.6%), developmental language disorders(9.7%), articulation disorders(9.7%), autism(5.3%), cleft lips or cleft palates(4.4%), hearing disorders (2.6%), lack of teaching(2.6%). CONCLUSION: These data demonstrate that mental retardation is the most common cause of language disorders. It is important to pediatricians that early diagnosis and early therapy can prevent developmental or learning disabilities of children with language disorders.

A Case of Exon 7 and 8 Deletion of Survival Motor Neuron Gene in Spinal Muscular Atrophy / 대한소아신경학회지

Spinal muscular atrophy(SMA) is a genetic disorder of the motor neurons that cause muscular weakness and muscular atrophy due to anterior horn cell degeneration. Classic spinal muscular atrophy patient is caused by mutation in the chromosome 5(q11.2-q13.3), and the majority of the patient shows homozygous deletion of the telomeric survival motor neuron(SMN) gene in the chromosome 5. Deletion of exon 7 and 8 of the SMN gene and deletion of exon 4 and 5 of the neuronal apoptosis inhibitory protein(NAIP) are typically observed in SMA patients. The SMN protein plays a role in an essential cell metabolism process, the splicing of pre mRNA in the spliceosomes. We report a 7 month old male with SMA. He showed rapidly aggrdvatial muscular weakness and died at 7 months. His DNA analysis proved deletion of exon 7 and 8 of the telomeric copy of the SMN gene.

The Importance of Initial Mechanical Ventilation Mode in Acute Respiratory Failure: Risk Factors for the Development of Cardiac Arrhythmias

BACKGROUND: The purpose of this article was to identify the risk factors related to development of hemodynamically significant cardiac arrythmias in patients with mechanical ventilation. METHODS AND RESULTS: Holter recording and echocardiogram were performed after 30 minutes of ventilator initiation in patients on mechanical ventilation(MV) owing to respiratory failure(RF) from various reasons. From 68 patients, hemodynamically significant cardiac arrythmias were detected in 18 patients(26.5%). Initial mean arterial pressure, maximal heart rate, and initial pH were identified as risk factors for hemodynamically significant cardiac arrythmias. Additionally, the patients with pressure-controlled ventilation as an initial ventilatory mode developed hemodynamically significant cardiac arrythmias less frequently than the patients with other modes(15.8% vs. 40%, p=0.03). In multivariate analysis, initial mean arterial pressure(120/min, OR:19.7;95% CI:2.0 to 190.0, p=0.01), and pressure-controlled ventilation(OR:0.13,95% CI:0.03 to 0.55, p=0.006) were associated with the development of hemodynamically significant cardiac arrhythmias. CONCLUSION: Theses findings suggest that during the early stages of mechanical ventilation with acute respiratory failure, hemodynamically significant cardiac arrhythmias are directly associated with tachycardia(>120/min), initial MAP(<70mmHg), and, inversely, the initial use of pressure-controlled ventilation.