Sudden Unexpected Death in Infancy: Analysis of 34 Cases Including 13 Autopsies

PURPOSE: The purpose of this study is to analyze the epidemiologic characteristics of sudden unexpected death in infancy and to evaluate the importance of postmortem autopsy. METHODS: We reviewed, retrospectively, medical records of 34 infants admitted to Kangnam General Hospital from January 1987 to December 2001 because of sudden unexpected death. We investigated the cause of death through medical history, death scene examination, autopsy findings, acylcarnitine and organic acid analysis. RESULTS: Among the total 34 infants, 18 were male(52.9%) and 16 were female(47.1%). Thirty infants(88%) were below the six months of age. Winter was the most affected season(38.2%). Eighteen infants(52.9%) died between 6 and 12AM. The prone sleeping position was observed more frequently than the supine position at death; nine cases in the prone position, six cases in the supine position. The cause of death of 23 cases could not be found by only history and death scene examination. Autopsy was done in 13 cases. Seven cases of them were thought to be SIDS. In six cases, we explained the cause of death with autosy findings. They were an endocardial fibroelastosis, a nesidioblastosis, a subdural hematoma, a bronchopneumonia and two fatty changes of liver. Metabolic screening tests performed in three cases to rule out metabolic disorder since 2000 were all normal. CONCLUSION: We concluded that autopsy and metabolic screening test should be performed to find out the cause of death in sudden unexpected death in infancy.

Classification and Risk Factors for Chronic Lung Disease(CLD) of Prematurity: Classical CLD Versus Atypical CLD

PURPOSE: We tried to classify the different type of CLD and assess the risk factors for classical CLD and atypical CLD. METHODS: Retrospective cohort analysis was done in 120 preterm infants with birth weights less than 1,500 g who were admitted to NICU in Seoul National University Children's Hospital between Jan. 1993 and Dec. 1998 and survived more than 28 days of life. RESULTS: CLD occurred in 44 of all infants(37%). The total subjects were classified into severe respiratory distress syndrome(RDS) group, mild RDS group, and non-RDS group. Multivariative logistic regression analysis was done for the assessment of risk factors for CLD in each groups. The analysis revealed that in severe RDS group, the significant risk factors for CLD were short gestational duration[OR 3.1(per 1 week decrement), 95% CI 1.4-7.0], male sex(OR 11, 95% CI 1.0-121), and poor response to surfactant(initial poor response to surfactant or relapse of RDS after initial good response to surfactant, OR 15, 95% CI 1.3-168). In non-RDS group, the significant risk factors for CLD were male sex(OR 8.9, 95% CI 1.5-51), chorioamnionitis(OR 7.5, 95% CI 1.4-38), and high mean airway pressure during the first 72 hours of life[OR 2.1(per 1 cmH2O increment), 95% CI 1.3-3.3]. CONCLUSIONS: It could be suggested that the poor response to surfactant of RDS might be one of the etiologic factors of classical CLD which occurs following severe RDS, and chorioamnionits might be one of the etiologic factors of atypical CLD which occurs without a history of RDS. Therefore CLD might be an etiologically heterogeneous disease entity.

An Experimental Study on the Intraarterial cis-platinum Chemotherapeutic Response of Musculoskeletal Tumor Using MR Imaging and Digital Subtraction Angiography

PURPOSE: To determine MRI features of tumor response in the early phase of preoperative chemotherapy in malignant tumors after intraarterial chemotherapy of VX-2 tumor in the rabbit thigh. MATERIALS AND METHODS: VX-2 tumors were induced in the thighs of eleven New Zealand white rabbits and intraarterial infusion of Cis-Platinum (3mg/kg) was performed in six. Pre- and post-contrast enhanced MR images and angiographies were obtained prior to and two weeks after chemotherapy. Five rabbits with VX-2 tumors were imaged at these same interval. Difference in MRI changes between the two groups were analysed and MRI findings were compared with angiographic and histologic findings. RESULTS: All VX-2 tumors showed rapid extensive necrosis, the most prominent MRI change in the chemotherapeutic group was decreased thickness of the enhancing rim which in the control group had increased (p = 0.083 and p = 0.374, respectively). The enhancing rim reflected the peripheral capsule with surrounding edema, inflammatory change, and tumors which were histologically viable. On angiography, it coincided with tumor staining. Change in tumor size was not significantly different between the two groups. In the chemotherapeutic group, a marginal necrotic band was the most prominent histologic feature. CONCLUSION: In the VX-2 tumor, chemotherapeutic response is seen on MRI as decreased thickness of the rim, and this reflects the tumor capsule and viable tumors. MRI can provide guidance in planning the treatment of malignant soft tissue tumors.

Spindle cell hemangioendothelioma: a case report

Spindle cell hemangioendothelioma is a rare vascular tumor which is presented with subcutaneous nodules and follows a benign indolent course but has a recurrent tendency, and is histologically resembling a cavernous hemangioma and Kaposi's sarcoma. We present a case of spindle cell hemangioendothelioma possessing clinical aggressiveness with painful bony erosion, histologic pleomorphism and mitoses. A 20-year-old man presented with a recurrent painful mass on the left ankle. The mass was dark brown and firm with irregular margins and measured 1.5 cm in diameter, which affected and eroded the underlying medial malleolus of the left tibia. Microscopically, the tumor was composed of cavernous endothelial-lined blood spaces and spindle cellular areas mimicking Kaposi's sarcoma. The spindle cells intermingled with plump epithelioid cells and showed a moderate degree of pleomorphism with occasional mitoses. Immunohistochemically, the spindle cells were focally positive for factor VIII-associated antigen and vimentin, and negative for S-100 protein, desmin, and epithelial membrane antigen.