Communicating Bronchopulmonary Foregut Malformation Type III with Pulmonary Sequestration Diagnosed in a Newborn: A Case Report

Communicating bronchopulmonary foregut malformation (CBPFM) is a communication between the respiratory and gastrointestinal tracts that can be difficult to differentiate from pulmonary sequestration or H-type tracheoesophageal fistula (TEF) because of the similarities in clinical features. A female neonate born at full term had been experiencing respiratory difficulty during feeding from the third day of life. The esophagography performed to rule out H-type TEF revealed that the esophageal bronchus directly communicated with the left lower lobe (LLL) of the lung. Lobectomy of the LLL, fistulectomy of the esophagobronchial fistula, and primary repair of the esophagus were performed. Finally, CBPFM type III with pulmonary sequestration was confirmed on the basis of the postoperative histopathological finding. We report the first newborn case of CBPFM type III with pulmonary sequestration in Korea.

Tolerability and Effect of Early High-Dose Amino Acid Administration in Extremely Low Birth Weight Infants

PURPOSE: The aim of this study is to examine the tolerability and effect of early highdose amino acid administration in extremely low birth weight infants (ELBWIs). METHODS: This retrospective cohort study included ELBWI (birth weight < 1,000 g, n=142). Biochemical, nutritional, and neurodevelopmental data were compared between infants who received conventional low amino acid (LAA; 1.5 g/kg/day) and those who received high amino acid (HAA; 3 g/kg/day) within the first 48 hours after birth. Neurodevelopmental data included weight, height, and head circumference at discharge, 12 to 14 and 18 to 24 months of corrected age and the Korean Bayley Scale of Infant Development II (K-BSID-II) score at 18 to 24 months of corrected age. RESULTS: The HAA group demonstrated higher peak plasma albumin (3.0±0.4 vs. 3.2±0.5, P < 0.05) and lower serum creatinine (1.7±0.9 vs. 1.4±0.8, P < 0.05) during the first 14 days than the LAA group. Full enteral feeding was achieved significantly earlier in infants in the HAA group than in infants in the LAA group (46.2±23.0 days vs. 34.3±21 days, P < 0.01). There was no difference between the two groups in the z score changes in all growth indicators from birth to discharge and at 12 to 14 and 18 to 24 months of corrected age, as well as in the K-BSID-II score at 18 to 24 months of corrected age. CONCLUSION: Aggressive administration of amino acids during the first 2 days of life in ELBWI was well tolerated and correlated with earlier full enteral feeding, but did not improve growth and neurodevelopment.

Mixed plant extract-dependent exercise-induced anaphylaxis

Food-dependent exercise-induced anaphylaxis (FDEIA) is a potentially life-threatening clinical reaction in which anaphylaxis develops when physical activity occurs within a few hours after ingesting a specific food. An 18-year-old girl experienced generalized urticaria, periorbital swelling, and dyspnea repeatedly by exercise after intake of a red ginseng health supplement. A confirmed diagnosis was established in this case by using an exercise challenge test after ingesting mixed-plant extract containing red ginseng health supplement. To the best of our knowledge, this is the first case of FDEIA caused by components in a red ginseng health supplement.

Experience with remifentanil/remifentanil - sevoflurane anesthesia for surgical ligation of patent ductus arteriosus (PDA) in premature infants in the neonatal intensive care unit: A case report

Surgical ligation of PDA is an effective treatment for symptomatic infants who do not respond to treatment with indomethacin. Transfer of unstable infants to the operating room has been shown to be associated with various problems. Thus, we describe the anesthetic management of 5 extremely low birth weight (ELBW) infants who underwent surgical ligation of PDA in a neonatal intensive care unit (NICU). General anesthesia was induced by ketamine 1 mg/kg IV. Rocuronium was used for muscle relaxation. Anesthesia was maintained with continuous infusion of remifentanil 0.15-0.4 ug/kg/min with oxygen (in 2 cases) or continuous infusion of remifentanil 0.05-0.1 ug/kg/min and 0.4-1.0 vol% sevoflurane with oxygen (in 3 cases). It was safe and effective to perform bedside PDA ligation in the NICU. We describe the successful use of remifentanil with sevoflurane or remifentanil alone in 5 extremely low birth weight infants undergoing PDA ligation.

Antitumor immunity induced by tumor cells engineered to express a membrane-bound form of IL-2

Transduction of cytokine gene into tumor cells is a promising method of tumor therapy, but the value is limited by accompanying side effects. To focus antitumor immune response to tumor antigen-specific CTL, we developed an antitumor vaccine by transfecting modified IL-2 gene in a membrane-bound form (mbIL-2) into B16F10 melanoma cells. The mbIL-2 clone showed reduced tumorigenicity and metastatic ability, and inhibited metastasis and prolonged the survival of mice against B16F10 cells. The inhibition of B16F10 metastasis by mbIL-2 was accompanied by the increment of CD8+ T cells. The metastasis of mbIL-2 clone was significantly increased in the CD8+ T cell-depleted mice, but not in CD4+ T cell depleted mice. Spleen cells immunized with the mbIL-2 clone showed higher CTL activity towards B16F10 cells than those immunized with control cells. The size of CD8+ T cell population in the lung of mice injected with the mbIL-2 clone was markedly greater than that of mice injected with B16F10 cells, but there was no detectible change in CD4+ and CD8+ T cell populations of lymph nodes and spleen. These results suggest that when the mbIL-2 clone is introduced into the blood stream, it migrates mainly to lung and activates CD8+ T cells in situ, possibly by direct priming. Such a tumor vaccine may ameliorate the toxic side effects encountered with conventional cytokine gene therapy.

Fate of Vascularized Interposed Joint Capsule at Femorotibial Space in Rabbits / 대한정형외과연구학회지

The present study was designed to investigate the interposed joint capsule at the femorotibial space following meniscectomy which could contribute to the regeneration of meniscus. Thirty two rabbits were used for this study. The anterior half of the medial meniscus was resected and the joint capsule was cut transversely 4mm above the joint line. It was reflected and interposed at the meniscectomized site. Gross findings at 2, 6, 8, and 12 weeks were recorded, respectively. Hematoxylin-Eosin(H-E) and safranin-O staining were done for histological and histochemical study, respectively. The results were as follows : 1 . With tile passage of time, interposed joint capsules looked like normal meniscus in shape, and the surface was glistening. 2. At 12 weeks, the width and thickness of interposed tissue were gradually decreased until it became normal size (P>0.05). 3. Histologically(H-E stain), the interposed tissue consisted of dense connective tissue with fibrocyte at 2 weeks. The interposed tissue changed to wedge shape and consisted of dense connective tissue with fibrocyte and prolifelated synovial cells at 6 weeks. Immature chondrocytes appeared at the lower portion and fat cells appeared at the upper portion of the tissue at 8 weeks. The fat cells disappeared and more mature chondrocyte were found in the central portion of interposed tissue at 12 weeks after operation. 4. Histochemical study(safranin-O stain) showed the interstitial tissue was not stained at 2 and 6 weeks, but glycosaminoglycan synthetic activity increased in the newly formed chondrocytes at postoperative 8 weeks and 12 weeks. From these results, the interposed capsule at the femorotibial space could be a substitute material for postmeniscectomy patients.

Dissolution of uric acid calculi with alkaline fluid irrlgation through percutaneous nephrostomy tube / 대한비뇨기과학회지

We treated 4 patients with uric acid calculi in the renal pelvis or ureter with alkaline fluid irrigation through percutaneous nephrostomy (PCN) tube. Initial presentations were anuria or severe flank discomfort, we performed PCN to relieve such obstructive symptoms caused by uric acid calculi. We tried to dissolve uric acid calculi with normal saline mixed to sodium bicarbonate through a PCN tube. The success of therapy is believed to be related to the direct and constant urinary alkalinization effect obtained with irrigation compared to be the intermittent alkalization that occurs when oral agent are used.