Heeyoung Kim

Effect of Furosemide on Ductal Closure and Renal Function in Indomethacin-Treated Preterm Infants during the Early Neonatal Period

Background: Furosemide is known to increase renal prostaglandin synthesis. However, its influence on ductal closure and renal toxicities of indomethacin in preterm infants has not been conclusive, especially during the early neonatal period. Objectives: To identify the effects of furosemide after indomethacin administration on the rate of patent ductus arteriosus (PDA) closure and renal function in preterm infants. Methods: 68 infants (gestational age <34 weeks and birth weight <2,000 g) receiving indomethacin therapy (one course: 0.2–0.1–0.1 mg/kg q 12 h, mostly started <48 h after birth) were randomly assigned to the furosemide (n = 35) or control (n = 33) group. Each indomethacin dose was followed by furosemide (1.0 mg/kg) or placebo. The primary (PDA closure) and secondary (acute renal failure (ARF) and others) outcomes were assessed. Renal parameters before and 0–12 and 24–36 h after the first course of indomethacin were also investigated. Results: In an intention-to-treat analysis, there were no differences in the PDA closure rate between the furosemide (29/34) and the control (27/29) group (p = 0.437). The incidence of ARF (serum creatinine >1.6 mg/dl) was greater in the furosemide group (20/34) than in the control group (3/29) (p < 0.001). Compared with the control group, serum creatinine and cystatin C levels and fractional excretion of sodium were significantly increased in the furosemide group for 24–36 h after indomethacin therapy (p < 0.01). There were no between-group differences in mortality and other neonatal morbidity rates. Conclusions: Use of furosemide in combination with indomethacin increased the incidence of ARF but did not affect the PDA closure rate in preterm infants.

Anti-Ri-Antibody-Associated Paraneoplastic Syndrome in a Man with Breast Cancer Showing a Reversible Pontine Lesion on MRI

Background Paraneoplastic neurological disorders associated with anti-Ri-antibodies, which are typically present with opsoclonus-myoclonus-ataxia. Most cases with anti-Ri-antibodyassociated paraneoplastic syndrome due to breast cancer occur in women - its occurrence in men is extremely rare. Case Report We present herein the case of a male patient with breast cancer who had atypical anti-Ri-antibody-associated paraneoplastic syndrome presenting as complete horizontal ophthalmoplegia, left trigeminal sensory symptoms, and truncal ataxia. Following the diagnosis of paraneoplastic syndrome, chemotherapy and immunomodulating treatment including intravenous immunoglobulin and oral prednisolone were administered. Although the patient was negative for serum anti-Ri-antibodies 14 weeks later, his symptoms persisted. Conclusions To our knowledge, this is the first case report of ophthalmoplegia without opsoclonus-myoclonus in a male anti-Ri-antibody-positive patient with breast cancer.

Recurrent Cerebral Venous Thrombosis Associated with Elevated Factor VIII

Cerebral venous thrombosis (CVT) rarely recurs, and the factors associated with a recurrence remain unclear. Recently, however, elevated plasma coagulation factor VIII has been considered a factor related to recurrent venous thromboembolism. Here we report a patient who had recurrent CVT associated with significantly elevated levels of factor VIII despite the chronic use of an antiplatelet agent. Factor IX was also elevated in this patient. These findings suggest that elevated factor VIII is a factor underlying the recurrence of CVT, and that prolonged anticoagulation therapy may have to be considered in patients with elevated coagulation factor levels.

The Effect of Macrolide Therapy on Bronchopulmonary Dysplasia in Ureaplasma-Positive Very Low Birth Weight Infants

*These authors contributed equally to this work. Objective: Ureaplasma has been demonstrated the cause of short and long-term morbidities of preterm infants, especially such as bronchopulmonary dysplasia (BPD). This study aims to evaluate the influence of Ureaplasma on neonatal morbidities and the effect of macrolide treatment in very low birth weight (VLBW) infants. Methods: We performed a retrospective review of clinical records of VLBW infants born between 2015 and 2016. Their endotracheal aspirate and gastric juice were obtained immediately after birth and tested for Ureaplasma. Therapeutic macrolides were administered according to the clinical judgment, not routinely, in Ureaplasma-positive infants. Neonatal morbidities were compared using individual matching analysis between Ureaplasma-positive and negative groups, and with macrolides administration. Results: A total of 144 infants with the mean (±standard deviation) gestational age of 28 (±3) weeks and birth weight of 1,051.9 (±290.0) g were included, and 30 (20.8%) were Ureaplasma-positive. Ureaplasma-positive group was associated with higher incidence of respiratory distress syn drome (RDS, P=0.039) and severe neurologic injury (SNI; intraventricular hemorrhage ≥grade 3 or periventricular leukomalacia, P=0.013). However, Ureaplasma-positive group was not associated with the risk of BPD (P=0.706). In the subgroup analysis for Ureaplasma-positive infants, there was no difference in the incidence of morbidities according to the macrolides administration. Conclusion: Although Ureaplasma has no independent role in the development of BPD, Ureaplasmapositive VLBW infants were more likely to have RDS and SNI. The macrolides administered in Ureaplasma-positive was not effective to reduce neonatal morbidities.

Can we further divide amnestic mild cognitive impairment based on the pattern of memory deficit

Background: Mild cognitive impairment (MCI) is considered as a transitional state between normal aging and dementia and can be subdivided into amnestic vs. nonamnestic and single vs. multiple domains types. It is suggested that these clinical subtypes may have different underlying etiologies and outcomes. The amnestic MCI differs in the performance profile on memory testing: retention vs. retrieval deficit. Generally, the retention deficit is attributed to the medial temporal dysfunction and the retrieval deficit to the frontal dysfunction. We tried to determine whether there could be distinctive subtypes available even in the amnestic MCI. Methods: Sixty-two patients with amnestic MCI-single domain were included in this retrospective study. They were divided into the retentionvs. the retrieval-deficit groups according to the results of Seoul Verbal Learning Test (SVLT). We compared baseline characteristics including vascular risk factors and neuropsychological profiles. We also measured the medial temporal atrophy (MTA) using a visual rating scale and assessed lacunar infarcts and white matter hyperintensities (WMH). Results: Of 62 patients, 41 had retention deficit and 21 had retrieval deficit on SVLT. Among baseline clinical and demographic variables, only the frequency of hypertension was higher in the retrieval-deficit group (P 1⁄40.005). There were no differences in neuropsychological profiles between the two groups other than a lower immediate recall score in the retention-deficit group (P1⁄40.012) and a higher recognition score in the retrieval-deficit group (P1⁄40.001). Severities ofWMHandMTA were not different between the two groups, nor were the number of lacunar infarcts and microbleeds. Conclusions: We could not find any significant difference except for the frequency of hypertension between the two subgroups of amnesticMCI, suggesting that there may be no further gain in subdividing a single domain amnestic MCI. Table Factor loadings for each ROI from analyses performed on group 1 (cognitively normal subjects) and group 2 (intermediate PIB subjects). Loadings above 0.5 are bolded for emphasis

A comparison of F-18 FDG-PET imaging in differential diagnosis of Alzheimer's disease and dementia with Lewy body disease

Background: Dementia with Lewy bodies (DLB) is the second most common cause of degenerative dementia after Alzheimer’s disease (AD). Clinically it is characterized by attentional fluctuation, recurrent visual hallucinations and motor features of Parkinsonism, while histopathologically by cortical and sub-cortical Lewy bodies. However, due to overlapping clinical features and low sensitivity of clinical diagnostic criteria, the differential diagnosis of AD and DLB remains a major problem in clinical practice. The aim of this study was to investigate the diagnostic value of metabolism in the diagnosis of DLB and AD in comparison with [F-18] fluoro-2-deoxy-D-glucose (FDG)-PET imaging. Investigations which could help improve the accuracy of discrimination between DLB and AD would be a major advance. Methods: All subjects underwent F-FDG-PET and MRI.We compared regional cerebral metabolic images by a voxel-by-voxel analysis with statistical parametric mapping among DLBD, AD and NC subjects, and evaluated differences of hypometabolic regions. All PET scans be visually rated from equivalent slices, each image volume was registered to match a F-FDG-PET template in standard MNI (Montreal Neurological Institute) space using statistical parametric mapping. Accurate normalization is essential for quantitative pattern analysis to neurodegenerative disease; the cerebellum or pons was often used as a reference region in the MR image, which assumed no significant regional influence of physiological fluctuations for quantitative. Results: F-FDG-PET revealed evidence of diffuse hypometabolism in both DLBD and AD with Parkinsonism marked declines in association cortices with relative sparing of subcortical structures and primary somatomotor cortex, a pattern reported previously in AD. Unlike AD, DLBD subjects also had hypometabolism in the occipital association cortex and primary visual cortex. Significant changes in hypometabolism in the volume of interest were assessed in the posterior cingulate gyrus, precuneus and parietal cortices. The severity of the decrease in metabolism in AD patients was significantly greater than in vascular dementia and frontotemporal dementia patients and controls. Conclusions: These findings indicate the presence of diffuse cortical abnormalities in DLBD and suggest that FDG-PET may be useful in discriminating DLBD from AD.