A Case of Protein Losing Enteropathy Associated with Henoch-Schonlein Purpura / 소아과

Henoch-Schonlein purpura(HSP) is an IgA mediated immune complex vasculitic disease characterized by non-thrombocytic purpura, arthritis, gastrointestinal manifestations, and glomerulonephritis. HSP related glomerulonephritis induces hypoproteinemia and edema in some cases. Protein-losing enteropathy is another rare but known manifestation of HSP leading to hypoproteinemia and edema. We report a 6-year-old girl with HSP who showed edema caused by intestinal protein loss, evidenced by elevated fecal alpha 1 antitrypsin clearance.

Cord blood Cytokines on the Development of Cerebral Palsy in Premature Infant / 소아과

PURPOSE: This study was performed to determine the relation between cord blood plasma cytokines responses and development of cerebral palsies in premature infants. METHODS: Interleukin-1beta(IL-1beta), Interleukin-6(IL-6), Tumor necrosis factor-alpha(TNF-alpha) were measured using ELISA kits in premature infants(n=60) who were admitted to St. Benedict Hospital from September 2001 to June 2003. Retrospective study was done by review of medical records. RESULTS: Cord blood levels of IL-1beta, IL-6 and TNF-alpha in the cerebral palsy group were higher, especially IL-6 but were not significant, compared with the control group. Cord blood levels of IL-6 in the cerebral palsy without asphyxia, sepsis, PROM, RDS and pneumonia were significantly different, compared with the control group. CONCLUSION: Cord blood levels of IL-1beta, IL-6 and TNF-alpha in the cerebral palsy group were increased, but concentrations of IL-6 increased significantly. Cord blood levels of IL-6 may be a useful value to predict the development of cerebral palsy, because they are related to IL-6 rather than to TNF-alpha & IL-1beta in this study.

Percutaneous Gallbladder Drainage for Delayed Laparoscopic Cholecystectomy in Patients with Acute Cholecystitis / 한국간담췌외과학회지

BACKGROUND/AIMS: It have been reported that operative mortality and morbidity rate rise significantly when emergency cholecystectomy is performed in critically ill patients with acute cholecystitis(AC), and many studies have also concluded that delayed or interval laparoscopic cholecystectomy(LC) in patients with AC demonstrated high conversion rate and complication rate compared with early LC. However, if the acutely inflamed gallbladder(GB) is decompressed by emergent percutaneous gallbladder drainage(PGBD), it may decrease the technical difficulty of LC allowing successful delayed LC or may decrease the wound complication of delayed open cholecystectomy, when the patient is in better condition. The purpose of this retrospective study was to assess the outcome of delayed cholecystectomy focused on LC following PGBD in patients with AC METHODS: A total of 181 patients with AC were divided into PGBD(n= 66) and non-PGBD group(n= 115), and each group were subdivided into PGBD-delayed LC(after 72 hours of admission, n= 32), PGBD-open cholecystectomy(n= 20), non-PGBD-early LC(within 72 hours of admission, n= 40), non- PGBD-delayed LC(n= 17), non PGBD-open cholecystectomy group(n= 58) and others. PGBD group had higher incidence of comorbidity compared with non-PGBD group. Outcomes of cholecystectomy was assessed by conversion rate and morbidity rate(chi2 test), LC time and hospital stay(median test) for LC, and morbidity for open cholecystectomy in PGBD group compared with those of non PGBD group. RESULTS: PGBD promptly relieved of symptom of AC in 94 % of patients and showed 3 % of technical failure and 4.5 % of complication rate. Compared with non PGBD-early and delayed LC group, the PGBD-delayed LC group showed longer LC time(median 110 min vs 82.5, p < 0.05, vs 95 min), a little lower conversion rate(12.5 % vs 22.5 % vs 17.6 %), similar morbidity rate(19% vs 17.5 % vs 29 %) and prolonged total hospital stay(median 12.5 days vs 7 days, p < 0.001, vs 10 days). In open cholecystectomy series, PGBD group showed lower morbidity rate compared with non PGBD group(5% vs 24 %, p < 0.05) CONCLUSION: Unlike to open cholecystectomy series, PGBD did not significantly improve the outcome of LC for AC as assessed by conversion and morbidity rate and hospital stay compared with non PGBD. Thus we can conclude that although PGBD is a safe and effective emergency procedure for AC, it should be limited to higher risk group such as elderly or critically ill patients and to acalculous cholecystitis.