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Effects of NG-monomethyl-L-arginine and L-arginine on cerebral hemodynamics and energy metabolism during reoxygenation-reperfusion after cerebral hypoxia-ischemia in newborn piglets (급성 저산소성 허혈성 뇌손상이 유발된 신생자돈에서 재산소-재관류기 동안 NG-monomethyl-L-arginine과 L-arginine이 뇌의 혈역학 및 에너지 대사에 미치는 영향)

  • Ko, Sun Young;Kang, Saem;Chang, Yun Sil;Park, Eun Ae;Park, Won Soon
    • Clinical and Experimental Pediatrics
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    • v.49 no.3
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    • pp.317-325
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    • 2006
  • Purpose : This study was carried out to elucidate the effects of nitric oxide synthase(NOS) inhibitor, NG-monomethyl-L-arginine(L-NMMA) and nitric oxide precursor, L-arginine(L-Arg) on cerebral hemodynamics and energy metabolism during reoxygenation-reperfusion(RR) after hypoxia-ischemia(HI) in newborn piglets. Methods : Twenty-eight newborn piglets were divided into 4 groups; Sham normal control(NC), experimental control(EC), L-NMMA(HI & RR with L-NMMA), and L-Arg(HI & RR with L-Arg) groups. HI was induced by occlusion of bilateral common carotid arteries and simultaneously breathing with 8 percent oxygen for 30 mins, and followed RR by release of carotid occlusion and normoxic ventilation for one hour. All groups were monitored with cerebral hemodynamics and cytochrome $aa_3$ (Cyt $aa_3$) using near infrared spectroscopy(NIRS). $Na^+$, $K^+$-ATPase activity, lipid peroxidation products, and tissue high energy phosphate levels were determined biochemically in the cerebral cortex. Results : In experimental groups, mean arterial blood pressure, $PaO_2$, and pH decreased, and base excess and blood lactate level increased after HI compared to NC group(P<0.05). These variables subsequently returned to baseline after RR except pH. There were no differences among the experimental groups. In NIRS, oxidized hemoglobin($HbO_2$) decreased and hemoglobin(Hb) increased during HI(P<0.05) but returned to base line immediately after RR; 40 min after RR, the $HbO_2$ had decreased significantly compared to NC group(P<0.05). Changes of Cyt $aa_3$ decreased significantly compared to NC after HI and recovered at the end of the experiment. Significantly reduced cerebral cortical cell membrane $Na^+$, $K^+$-ATPase activity and increased lipid peroxidation products(P<0.05) were not improved with L-NMMA or L-Arg. Conclusion : These findings suggest that NO is not involved in the mechanism of HI and RR brain damage during the early acute phase of RR.

Feed Intake and Digestibility in Korean Native Goats Fed Fermented Domestic Agricultural By-Products (국내산 농산부산물 발효사료를 급여한 재래산양의 사료섭취량 및 소화율)

  • 안종호;유황종;김현진;조익환;이주삼
    • Korean Journal of Organic Agriculture
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    • v.8 no.3
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    • pp.111-120
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    • 2000
  • In this study, by-products of rice bran, rice hull, bean curd dregs and food waste were fermented with different ratios of 26, 26, 34 and 14% respectively and the experimental diets were prepared mixing it with various ratios of commercial diets (fermented feed commercial feed : A 80 : 20, B 70 : 30, C 60 : 40, D 50:50). In Experiment I, feed intake, nutrients digestibilities and nitrogen retention were investigated and body weight gain in Experiment 1. For chemical composition of experimental diets, crude protein contents were 13.73, 13.78, 14.45 and 15.14% in A, B, C and D respectively and the contents of crude fat and crude fiber were highest in A as 8.66 and 27.82% respectively. 2. Dry hurler intakes were significantly higher (P<0.05) in A(362.06g/d) and C(358.49g/d) than B and D. Intakes of crude protein and crude fat were not significantly different (P>0.05) among treatments however those of crude fiber and crude ash were significantly higher (P>0.05) in A(101.47g/d). 3. Dry matter digestibilities in the range of 53.38∼68.81% in all treatments have shown the highest value in C of 60% fermented feed plus 40% commercial diet but the lowest in A of 80% of fermented feed plus 20% commercial diet (P<0.05). 59.85% of digestibility of crude protein in A was also lowest among all treatments (p<0.05), 4. 8.47g/d of nitrogen intake in C was recorded highest (P<0.05) however the highest nitrogen retention was marked in B of 50% fermented feed plus 50% of commercial diet due mainly to lower excretion of nitrogen through feces. 5. The data of live weight gain in Experiment II has not been shown as a result since the proper daily gain of body weight was achieved only in D as 88.89g/d and the goats in other treatments have shown frequent diarrhea. However, neglecting the animals with diarrhea, higher amounts of concentrates in the diets (C and D) showed the tendency of higher weight gain. 6. In this study, feeding 60% fermented feed manufactured with domestic agricultural by-products of rice bran, rice hull, bean curd dregs and food waste to Korean native goats have shown satisfactory results of intake and digestibility and it indicates that utilization of domestic agricultural by-products in goats could be improved by the process of fermentation. However it's effects on body weight gain and nitrogen retention were below than expected. Different sources of feedstuff for fermentation may result in different performances of animals. However, to draw overall conclusion from this study, 50∼60% of fermented feed can be recommended in the case of mixing with concentrates.

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Global Cosmetics Trends and Cosmceuticals for 21st Century Asia (화장품의 세계적인 개발동향과 21세기 아시아인을 위한 기능성 화장품)

  • T.Joseph Lin
    • Journal of the Society of Cosmetic Scientists of Korea
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    • v.23 no.1
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    • pp.5-20
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    • 1997
  • War and poverty depress the consumption of cosmetics, while peace and prosperity encourage their proliferation. With the end of World War II, the US, Europe and Japan witnessed rapid growth of their cosmetic industries. The ending of the Cold War has stimulated the growth of the industry in Eastern Europe. Improved economies, and mass communication are also responsible for the fast growth of the cosmetic industries in many Asian nations. The rapid development of the cosmetic industry in mainland China over the past decade proves that changing economies and political climates can deeply affect the health of our business. In addition to war, economy, political climate and mass communication, factors such as lifestyle, religion, morality and value concepts, can also affect the growth of our industry. Cosmetics are the product of the society. As society and the needs of its people change, cosmetics also evolve with respect to their contents, packaging, distribution, marketing concepts, and emphasis. In many ways, cosmetics mirror our society, reflecting social changes. Until the early 70's, cosmetics in the US were primarily developed for white women. The civil rights movement of the 60's gave birth to ethnic cosmetics, and products designed for African-Americans became popular in the 70's and 80's. The consumerism of the 70's led the FDA to tighten cosmetic regulations, forcing manufacturers to disclose ingredients on their labels. The result was the spread of safety-oriented, "hypoallergenic" cosmetics and more selective use of ingredients. The new ingredient labeling law in Europe is also likely to affect the manner in which development chemists choose ingredients for new products. Environmental pollution, too, can affect cosmetics trends. For example, the concern over ozone depletion in the stratosphere has promoted the consumption of suncare products. Similarly, the popularity of natural cosmetic ingredients, the search of non-animal testing methods, and ecology-conscious cosmetic packaging seen in recent years all reflect the profound influences of our changing world. In the 1980's, a class of efficacy-oriented skin-care products, which the New York Times dubbed "serious" cosmetics, emerged in the US. "Cosmeceuticals" refer to hybrids of cosmetics and pharmaceuticals which have gained importance in the US in the 90's and are quickly spreading world-wide. In spite of regulatory problems, consumer demand and new technologies continue to encourage their development. New classes of cosmeceuticals are emerging to meet the demands of increasingly affluent Asian consumers as we enter the 21st century. as we enter the 21st century.

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Relationships on Magnitude and Frequency of Freshwater Discharge and Rainfall in the Altered Yeongsan Estuary (영산강 하구의 방류와 강우의 규모 및 빈도 상관성 분석)

  • Rhew, Ho-Sang;Lee, Guan-Hong
    • The Sea:JOURNAL OF THE KOREAN SOCIETY OF OCEANOGRAPHY
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    • v.16 no.4
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    • pp.223-237
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    • 2011
  • The intermittent freshwater discharge has an critical influence upon the biophysical environments and the ecosystems of the Yeongsan Estuary where the estuary dam altered the continuous mixing of saltwater and freshwater. Though freshwater discharge is controlled by human, the extreme events are mainly driven by the heavy rainfall in the river basin, and provide various impacts, depending on its magnitude and frequency. This research aims to evaluate the magnitude and frequency of extreme freshwater discharges, and to establish the magnitude-frequency relationships between basin-wide rainfall and freshwater inflow. Daily discharge and daily basin-averaged rainfall from Jan 1, 1997 to Aug 31, 2010 were used to determine the relations between discharge and rainfall. Consecutive daily discharges were grouped into independent events using well-defined event-separation algorithm. Partial duration series were extracted to obtain the proper probability distribution function for extreme discharges and corresponding rainfall events. Extreme discharge events over the threshold 133,656,000 $m^3$ count up to 46 for 13.7y years, following the Weibull distribution with k=1.4. The 3-day accumulated rain-falls which occurred one day before peak discharges (1day-before-3day -sum rainfall), are determined as a control variable for discharge, because their magnitude is best correlated with that of the extreme discharge events. The minimum value of the corresponding 1day-before-3day-sum rainfall, 50.98mm is initially set to a threshold for the selection of discharge-inducing rainfall cases. The number of 1day-before-3day-sum rainfall groups after selection, however, exceeds that of the extreme discharge events. The canonical discriminant analysis indicates that water level over target level (-1.35 m EL.) can be useful to divide the 1day-before-3day-sum rainfall groups into discharge-induced and non-discharge ones. It also shows that the newly-set threshold, 104mm, can just separate these two cases without errors. The magnitude-frequency relationships between rainfall and discharge are established with the newly-selected lday-before-3day-sum rainfalls: $D=1.111{\times}10^8+1.677{\times}10^6{\overline{r_{3day}}$, (${\overline{r_{3day}}{\geqq}104$, $R^2=0.459$), $T_d=1.326T^{0.683}_{r3}$, $T_d=0.117{\exp}[0.0155{\overline{r_{3day}}]$, where D is the quantity of discharge, ${\overline{r_{3day}}$ the 1day-before-3day-sum rainfall, $T_{r3}$ and $T_d$, are respectively return periods of 1day-before-3day-sum rainfall and freshwater discharge. These relations provide the framework to evaluate the effect of freshwater discharge on estuarine flow structure, water quality, responses of ecosystems from the perspective of magnitude and frequency.

Clinical Findings of Mycoplasma pneumoniae pneumonia under 3 Year-Old Children (3세 이하 Mycoplasma pneumoniae 폐렴환자의 임상적 고찰)

  • Lee, Sung-Soo;Youn, Kyung-Lim;Kang, Hyeon-Ho;Cho, Byoung-Soo;Cha, Sung-Ho
    • Pediatric Infection and Vaccine
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    • v.6 no.1
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    • pp.78-85
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    • 1999
  • Purpose : Mycoplasma pneumoniae pneumonia has been to be developed frequently in school age children and adolescence and hard to see under 3 year-old children. But it seems to be increased in number of patients with Mycoplasma pneumoniae pneumonia under 3-year old in clinical practice in these days. We have aimed to examine the characteristics of clinical findings of Mycoplasma pneumonia under 3 year-old children. Methods : We had performed retrospective review of medical records of 30 patients with Mycoplasmal pneumonia under 3-year old children who admitted to Department of Pediatrics, Kyunghee University Hospital from Jan. 1994 to Dec. 1997. The diagnostic criteriae was Cold agglutinin titer>1:64 or Mycoplasma antibody titer>1:80. Results : Mycoplasmal pneumonia was 30 out of 235 cases(12.7%) of total pneumonia under 3 year old children. Male female ratio was 1.3 : 1 and age distributions were 0~1y : 0, 1~2y : 8, 2~3y : 22 cases. Clinical symptoms and signs were cough(100.0%), sputum(83.3%), fever(80.0%) rhinorrhea(33.3%), vomiting(33.3%), moist rale(86.7%), decreased breathing sound(26.7%), wheezing(20.0%), and pharyngeal injection(30.0%). Thirteen out of 30 cases(43.3%) had unilateral infiltration, 10 cases(33.4%) had bilateral infiltration, 1 case(3.3%) had pleural effusion, and 6 cases(20.0%) had negative findings on chest radiography and there was no cases of atelectasis. On laboratory findings, 6 out of 30 cases(20.0%) had leukocytosis, 1 case(3.3%) had neutrophilia, 10 cases(30.0%) had eosinophilia, 17 cases(56.7%) had increased ESR, and 18 cases(60.6%) had positive CRP. Positive cold agglutinin titers(>1 : 64) were 19 cases(63.3%), and positive mycoplasma antibody(M-ab) titers(>1 : 80) were 27 cases(93.3%). Mycoplasma antibody test was more valuable than cold agglutinin test for the diagnosis of Mycoplasmal pneumonia and there was no correlation between cold agglutinin titer and mycoplasma antibody titer. Mycoplasma-polymerase chain reaction(M-PCR) was done with 13 cases, 12 out of 13 cases(92.3%) were positive. M-PCR test was valuable to the diagnosis of Mycoplasmal pneumonia but it will be needed to further study for their clinical application. Among 30 cases, 5 cases(16.7%) had complications, 3 cases(10.0%) had skin rash, 1 case(3.3%) had pleural effusion, 1 case(3.3%) had arthralgia, but all complications were mild and recovered without residual sequelae. Conclusion : The occurrence of Mycoplasmal pneumonia under 3 year-old children was not rare from this study. Clinical characteristics of Mycoplasmal pneumonia under 3-year old were normal radiologic findings in many cases, low complication rate, mild clinical course, and tend to rapid recovery compared with general manifestations of Mycoplasmal infectionsin children and adolescence. There were likely to be missed patients with Mycoplasmal pneumonia which did not diagnose by conventional serologic tests that had low sensitivity and specificity. We have to pay attention to the Mycoplasmal infection of the young children with pneumonia during epidemic periods of Mycoplasmal infection.

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Randomized Trial of Early Versus Late Alternating Radiotherapy/ Chemotherapy in Limited-Disease Patients with Small Cell Lung Cancer (국한성병기 소세포폐암 환자에서 조기 혹은 지연 교대 방사선-항암제치료의 전향적 비교연구)

  • Lee Chang Geol;Kim Joo Hang;Kim Sung Kyu;Kim Sei Kyu;Kim Gwi Eon;Suh Chang Ok
    • Radiation Oncology Journal
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    • v.20 no.2
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    • pp.116-122
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    • 2002
  • Purpose : A randomized prospective study was conducted to compare the efficacy of early or late alternating schedules of radiotherapy, and carboplatin and ifosfamide chemotherapy in patients with limited-disease small cell lung cancer. Materials and Methods: From August 1993 to August 1996, a total of 44 patients with newly diagnosed, limited-disease small cell lung cancer, PS $H0\~2$, wt $loss<10\%$ were enrolled in a randomized trial which compared early alternating radiotherapy (RT)/chemotherapy (CT) and late alternating RT/CT. The CT regimen included ifosfamide $1.5\;g/m^2$ IV, d1-5 and carboplatin AUC 5/d IV, d2 peformed at 4 week intervals for a total of 6 cycles. RT (54 Gy/30 fr) was started after the first cycle of CT (early arm, N=22) or after the third cycle of CT (late arm, N=22) with a split course of treatment. Results : The pretreatment characteristics between the two arms were well balanced. The response rates in the early $(86\%)$ and late $(85\%)$ arm were similar. The median survival durations and 2-year survival rates were 15 months and $22.7\%$ in the early arm, and 17 months and $14.9\%$ in the late arm (p=0.47 by the log-rank test). The two-year progression free survival rates were $19.1\%$ in the early arm and $19.6\%$ in the late arm (p=0.52 by the log-rank test). Acute grade 3 or 4 hematologic and nonhematologic toxicities were similar between the two arms. Eighteen patients $(82\%)$ completed 6 cycles of CT in the early arm and 17 $(77\%)$ in the late arm. Four patients received less than 45 Gy of RT in the early arm and two in the late arm. There was no significant difference in the failure patterns. The local failure rate was $43\%$ in the early arm and $45\%$ in the late arm. The first site of failure was the brain in $24\%$ of the early arm patients compared to $35\%$ in the late arm (p=0.51). Conclusion : There were no statistical differences in the overall survival rate and the pattern of failure between the early and late alternating RT/CT in patients with limited-disease small cell lung cancer.

The Histologic Type of Lung Cancer in Idiopathic Pulmonary Fibrosis : the Difference According to the Presence of Fibrosis at Cancer Location (특발성 폐섬유화증에서 발생한 폐암의 조직형의 특성 : 폐암 위치의 섬유화 유무에 따른 조직형의 차이)

  • Kwon, Sung-Youn;Kim, Deog-Kyeom;Lee, Suk-Young;Yoo, Chul-Gyu;Lee, Choon-Taek;Kim, Young-Whan;Im, Jung-Gi;Shim, Young-Soo;Han, Sung-Koo
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.4
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    • pp.441-452
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    • 2000
  • Background : It is well known that the prevalence of lung cancer is higher in idiopathic pulmonary fibrosis (IPF) patients than in the general population. This high prevalence is explained by the concept of 'scar carcinoma'. There have been several reports on the prevalence of histologic typo of lung cancer in IPF with conflicting results. Despite of the high smoker rate in almost all previous reports, none considered the smoking history of patients. Therefore we performed a separate studies on fibrosis associated lung cancer and smoking associated lung cancer. The purpose of this study is to investigate the proportion of lung cancer in IPF that is fibrosis associated and to determine the most common histologic type in fibrosis associated lung cancer in IPF. Method : A retrospective review of medical records and radiologic studies was performed for cases of lung cancer with IPF. We investigated smoking history, sequence of diagnosis of lung cancer and IPF, histologic type of lung cancer and the cancer location, especially whether the location is associated with fibrosis. To evaluate the proportion of fibrous associated lung cancer, the lung cancer in IPF were categorized according to the presence of fibrosis at cancer location. Results : Fifty seven patients were subjects for this analysis. Six (11%) cases were diagnosed as lung cancer during follow-up for IPF, and both diseases were diagnosed simultaneously in the others. Ninety four percent of patients were smokers and the average smoking amount was 47.1$\pm$21.9 pack-year. Among the patients with IPF and lung cancer, 42(80.8%) cases were considered as "fibrosis associated". The remainder was "not fibrosis associated" and probably was due to smoking etc. Although the most frequent histologic type was squamous cell carcinoma as a whole, adenocarcinoma was the prominent histologic type in "fibrosis associated lung cancer." Conclusion : Considering the proportion of "fibrosis not associated lung cancer" in the patients with IPF and lung cancer, significant proportion of lung cancer in IPF may not be fibrosis induced. This may influence the distribution of histologic type of lung cancer in IPF.

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Granulocytic Sarcoma(Chloroma) in Leukemic Patients (백혈병 환자의 과립구 육종(녹색종양))

  • Rhee, Seung-Koo;Kang, Yong-Ku;Bahk, Won-Jong;Jung, Yang-Kuk;Lee, Sang-Wook;Jeong, Ji-Ho
    • The Journal of the Korean bone and joint tumor society
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    • v.11 no.1
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    • pp.54-61
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    • 2005
  • Purpose: The granulocytic sarcoma which developed in leukemic patients are quite rare and it will have bad prognosis, but it's tumor pathogenesis and also their treatment are not yet established. Through this study we have tried to know their clinical course, prognosis and their end result of recent treatment. Material and Methods: Total 20 patients of granulocytic sarcoma which were developed in total 2,197 leukemic patients from April, 1998 to September, 2004 were treated at the leukemic center and the orthopaedic department of St. Mary's hospital, Catholic University of Korea, and followed them for 1~78 months(average 18 months). Results: Total 20 cases of granulocytic sarcoma was found in 14 cases of total 1,331 acute myelocytic leukemic patients(AML), 4 cases of total 744 of chronic myelocytic leukemic patients(CML), and only one case in total 122 of acute biphenotype of leukemia. And so their occurrence rate in leukmic patients are actually 0.91%, total 20 cases of granulocytic sarcoma in total 2,197 leukemic patients at same period. Their ages are average 28.3 years(4~52 years), and male are predominant(13 cases) than female(7 cases). Single involvement was found in 11 cases but multiple lesions are in 9 cases, and spine, brain, extremities, chest, and pelvic bone are involved in frequency. The granulocytic sarcoma was developed in various stages of the leukemia, ie, 8 cases in complete remission of leukemia, and 12 cases in the treatment process of AML. The pathohistologic evaluation of granulocytic sarcoma was done in 6 cases which was developed in their extremities, and confirmed numerous immature myeloblasts and lymphocytes mixed. The treatment of these granulocytic sarcoma was mainly limited for the treatment of leukemia by Glivac and massive steroid therapy(19cases) and also combined with the bone marrow transplantation(13 cases), but radiation therapy with average 3,500 rads in 15 cases out of total 20 sarcomas was also done, and followed them for average 17.5 months after development of granulocytic sarcomas. Finally their prognosis was so bad that 12 patients(60%) out of total 20 granulocytic sarcoma were dead in 6.5 months after sarcoma developed and we found the granulocytic sarcoma was more fatal if they are developed during the process of CML(mortality: 100%(4/4cases). Conclusion: The prognosis of granulocytic sarcomas in leukemic patients are quite fatal, and much more studies for their pathogenesis and ways of treatment should be performed continuously.

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The Difference between Career Barrier Recognition and Career Preparation Behavior by Mandatory military service Planning Level among Male College Students (남자대학생의 군 의무복무계획 수준에 따른 진로장벽인식과 진로준비행동의 차이)

  • Hong, Hye-Young;Kang, Hye-Young
    • 대한공업교육학회지
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    • v.38 no.2
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    • pp.218-239
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    • 2013
  • This study aims to understand the status of mandatory military service planning and career barrier recognition as well as to analyze the difference between how students perceive mandatory military service as a potential barrier to their future careers(career barrier recognition) and career preparation behavior by the mandatory military service planning level among male college students. For the purpose, inquiries for the subject were set up as follows. 1. What are the levels of mandatory military service planning and career barrier recognition? 2. Is there a difference in career barrier recognition depending on the level of mandatory military service planning? 3. Is there a difference in career preparation behaviour depending on the level of mandatory military service planning? This study found out the level of mandatory military service, military barrier recognition and career preparation behavior of 284 male students from 4 universities in Daejeon and Chungnam area. Along with that, descriptive statistic, correlation analysis and t-test were conducted with SPSS 17.0 program The results of this study are as follows: First, 79.2% of male students have higher mandatory military service planning than the average value. Meanwhile, considering 3 sub-factors of mandatory military service planning, the ratio of those with high scores in practicality is lower than importance and concreteness. Based on this, it is assumable that they have a low perception for practical and concrete behaviors such as data collection in mandatory military service planning, which indicates their awareness has not developed into concrete behaviors even though they recognize the importance of planning. Also 73.9% of male students responded higher career barrier recognition than the average value shows that they recognize mandatory military service as a barrier relatively highly. Especially, those who answered "Very much" (7 scores) for every inquiry in career barrier recognition accounted for 16.9%, which forms the biggest group. and considering the response by each inquiry, it is ascertained that they consider the absence by mandatory military service time or military service as the biggest difficulty. Second, the difference in career barrier recognition between the top 30% and bottom 30% of mandatory military service planning is not statistically significant. However, in terms of importance and the sub-factor of mandatory military service planning, a significant inter-group difference in career barrier recognition is shown. In other words, to join the military is recognized as an obstacle in their career barrier recognition regardless of the mandatory military service planning level. Also, a group which considers the importance of the mandatory military service planning highly recognizes the military as the bigger obstacle compared to the other groups which are not considered in this way. Third, the difference in career barrier recognition between the top 30% and the bottom 30% of the mandatory military service planning is statistically significant. The need of mandatory military service planning is marked by the fact that those with a high level of mandatory military service planning show stronger career barrier recognition than those without plans. Through the study, the need of mandatory military service planning is suggested to both male students and career consultants considering the mandatory military service from a perspective of career based on Korean reality. Also, as precedent studies on pre-inducted men can be hardly found currently, this study is significant in accumulating empirical data about mandatory military service, a unique characteristic of the Korean career development process.

Clinical Picture of Adrenal Insufficiency-associated Hypotension in Preterm Infants (조산아에서 발생하는 부신기능부전과 연관된 저혈압의 임상상)

  • Choi, Eun-Jin;Sohn, Jin-A;Lee, Eun-Hee;Lee, Ju-Young;Lee, Hyun-Ju;Chung, Hye-Rim;Lee, Jin-A;Choi, Chang-Won;Kim, Ee-Kyung;Kim, Han-Suk;Kim, Beyong-Il;Choi, Jung-Hwan
    • Neonatal Medicine
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    • v.18 no.1
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    • pp.82-88
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    • 2011
  • Purpose: This study aims to describe the clinical characteristics of adrenal insufficiency-associated hypotension in preterm infants and the effects of hydrocortisone therapy on their cardiovascular system and serum electrolytes. Methods: Twelve preterm infants less than 32 gestational weeks admitted to neonatal intensive care unit (NICU) of the Seoul National University Bundang Hospital from January 2007 to August 2009 with clinical and laboratory findings suggestive of adrenal insufficiency were analyzed retrospectively. Results: Gestational age was 27.8${\pm}$2.5 weeks and birth weight was 1,110${\pm}$307 g. Postnatal age, postmenstrual age, weight at the onset of adrenal insufficiency-associated hypotension were 19${\pm}$7 day, 30.6${\pm}$2.4 weeks, 1,285${\pm}$365 g. In preterm infants who showed vasopressor resistance, intravenous hydrocortisone was started with a stress dose of 4 mg/kg/day, maintained for 2.2${\pm}$0.7 days, and then tapered. Serum cortisol concentration before hydrocortisone administration was 11.6${\pm}$4.1 mg/dL. Mean blood pressure increased from 25.0${\pm}$5.4 mmHg to 35.0${\pm}$5.3 mmHg, 38.3${\pm}$8.0 mmHg and 41.9${\pm}$6.5 mmHg at time of hydrocortisone administration and 2, 4 and 6 hours after hydrocortisone administration. Urine output increased from 0.9${\pm}$0.6 mL/kg/hr to 4.1${\pm}$3.4 mL/kg/hr. Twelve hours after the administration of hydrocortisone, dopamine requirement decreased from 11.0${\pm}$2.9 $\mu$g/kg/min to 8.0${\pm}$2.3 $\mu$g/kg/min, and to 5.5${\pm}$3.4 ${\mu}g$/kg/min after 24 hours. Serum sodium concentration was increased from 130${\pm}$4 mEq/L to 136${\pm}$4 mEq/L, serum potassium concentration was decreased from 6.1${\pm}$1.1 mEq/L to 4.6${\pm}$0.6 mEq/L before and 12 hours after hydrocortisone administration. Conclusion: In preterm infants with adrenal insufficiency-associated hypotension, hydrocortisone administration improved blood pressure and urine output, decreased vasopressor requirement, and normalized serum electrolyte abnormalities.