Relations between Airway Narrowing and Prevertebral Soft Tissue Swelling after Anterior Cervical Spine Surgery: The Value of Lateral Neck Radiographs

OBJECTIVE: The authors attempted to evaluate the pattern of the airway narrowing due to prevertebral soft tissue swelling after surgery of the anterior cervical spine and their clinical significances using plain cervical X-ray images. METHODS: Twenty-four patients undergoing anterior cervical spine surgery were reviewed from January 2004 to December 2005. Postoperatively, in daily basis, lateral radiograph of the neck was obtained in neutral position. We measured the upper airway diameter above and below the epiglottis level and prevertebral soft tissue diameter everyday for a week and finally 2 weeks after surgery using their simple lateral cervical X-ray films. RESULTS: Both airway narrowing and prevertebral soft tissue swelling were maximum in postoperative 2 days, and decreased rapidly in postoperative 7 days. Airway narrowing was aggravated postoperatively but slowly decreased as prevertebral soft tissue swelling diminished. But, the severity of airway narrowing showed no clinical correlations with clinical symptom and radiologic severity. CONCLUSION: Not all patients who show severe airway narrowing and prevertebral soft tissue swelling on their plain cervical X-ray film complain respiratory insufficiency. But, the patients with undergoing anterior cervical spine surgery should be monitored carefully for respiratory insufficiency, especially during several days following operation because both airway narrowing and prevertebral soft tissue swelling become peak at postoperative 2-3 days.

Prognostic Factors in Premature Infants with Pulmonary Hemorrhage occuring after Surfactant Replacement

PURPOSE: Exogenous surfactant replacement therapy reduces morbidity and mortality rates for premature babies with respiratory distress syndrome (RDS). A significant increase in clinical pulmonary hemorrhage has been reported in premature babies treated with surfactant. Pulmonary hemorrhage, one of the major cause of death, may develop due to an increased pulmonary blood flow. We investigated the prognostic factors for mortality in premature infants with pulmonary hemorrhage after surfactant replacement, and to predict the survival of infants having RDS. METHODS: We investigated the characteristics and clinical courses of the 22 premature infants who developed pulmonary hemorrhage after surfactant therapy for RDS hospitalized at Seoul Red Cross Hospital between Dec 1994 and May 1998. We divided the patients into two groups ' Group I were those who survived (n=6) and Group II were those who expired after pulmonary hemorrhage (n=16). RESULTS: There were no differences in birth weight, gestational age and radiologic staging between two groups (P>0.05). Low Apgar score at birth was significantly related to mortality in premature infants with pulmonary hemorrhage (P<0.05). The interval between birth and onset of pulmonary hemorrhage and the interval between the surfactant replacement and onset of pulmonary hemorrhage were significantly longer in Group I than in Group II (P<0.05). CONCLUSION: The clinical conditions at birth, the interval between birth and onset of pulmonary hemorrhage, and the interval between surfactant replacement and onset of pulmonary hemorrhage were the prognostic factors of mortality in preterm infants with pulmonary hemorrhage.

Outcome in infants of mothers with systemic lupus erythematosus

A large proportion of patients with systemic lupus erythematosus (SLE) are women of reproductive age. Their fetal outcome is undoubtedly less favourable than in healthy women. Although there is no evidence of an increase in congenital anomalies, increased frequencies of miscarriage, stillbirth, growth retardation, and preterm delivery are recognized. It mainly depends on the compromise of uteroplacental circulation such as renal disease, hypertension and thrombopoietic action of antiphos-pholipid antibody. Besides a small proportion of the newborn infants get a neonatal lupus sydrome, the most serious component being congenital heart block. This complication occurs almost exclusively in the offspring of women with anti-Ro/SSA antibodies. In order to find out the effect on fetus and newborn infants born to SLE mother, we reviewed clinical records of 11 infants born to 9 mothers with confirmed or suspected SLE at Seoul National University Hospital between June 1981 and May 1991. The results obtained were as follows: 1) Seven mothers among 9 were confirmed as SLE and 2 were suspected. 2) There were 6 spontaneous abortions (20.0%) and 5 stillbirths (16.7%) in 5 mothers among thirty pregnancies of 9 mothers. 3) Among 11 newborns, 4 (36.4%) were premature and 2 (18.2%) were small for gestational age. 4) Six mothers had proteinuria, over 4+, in Albustix. Four of these, including 3 preeclampsia mothers, delivered preterm babies. Two of premature babies were born through Cesarean section due to fetal distress and expired of hyaline membrane disease and its complications. The other 2 had thrombocytopenia and leukocytopenia at birth. One of these had intracranial hemorrhage at birth and seizure. 5) There were 2 mothers who had positive anticardiolipin antibody with SLE or without SLE. One with SLE was continuing positivity of the antibody during pregnancy and delivered premature baby who expired of HMD and PDA. The other who had seroconversion to negativity during the first trimester developed intermittently sinus bradycardia without apnea for 3 days. 6) Two of 11 newborns had only talipes equinovarus. 7) One mother who had anti-Ro/SSA antibody delivered monozygotic twin. The first baby was neonatal lupus erythematosus with complete heart block and skin pigmentation. All of them were suspected to right aortic arch and Kommerell's diverticulum on echocardiogram. As the above results, SLE mothers can cause serious effect on fetus and newborn when accompanied with active renal impairment, hypertension and positive antiphospholipid antibody. So we should treat mother with SLE even during pregnancy and it may give better outcome to mother and fetus. It will be useful for diagnosis and treatment of neonatal lupus erythematosus that the prenatal test for anti-Ro/SSA antibody, fetal monitoring, fetal echocardiogram and postnatal close observation for skin are taken.

Twelve cases of nonimmune hydrops fetalis / 대한주산의학회잡지

No abstract available.