Renal allograft rupture is an uncommon but life-threatening complication. The most common cause of the spontaneous rupture of the renal graft is acute rejection but other causes including acute tubular necrosis, renal vein thrombosis and urinary tract obstruction have been reported. Here we report a case of spontaneous rupture of renal graft caused by arteriovenous fistula in the patient being managed by plasmapheresis due to hemolytic uremic syndrome developed in the renal graft 3 years late after transplantation.
Allografts* ; Arteriovenous Fistula* ; Hemolytic-Uremic Syndrome ; Humans ; Necrosis ; Plasmapheresis ; Renal Veins ; Rupture* ; Rupture, Spontaneous ; Thrombosis ; Transplants ; Urinary Tract

BACKGROUND: Measurements of coronary flow reserve(CFR) and phasic coronary flow profile are useful in assessment of the physiologic significance of coronary lesions. However, alterations in hemodynamic status are known to influence coronary flow reserve. The purpose of this study was to assess the effect of increase in heart rate on maximal pharmacologin coronry flow reserve and phasic flow pattern. METHODS: We investigated 12 patients(9 females and 3 males, mean age : 49+/-12 years) with normal coronary artery and atypical chest pain syndrome for the measurement of CFR and coronary flow profile. CFR and systolic and diastolic coronary flow velocity integral(CFVI) were measured at the proximal portion of left anterior descending artery with 0.018 inch(12MHz) Doppler guide wire before and during intracoronary injection of 12 mcg of adenosine. The heart rate at the baseline ranging from 62 beats/min to 79 beats/min(mean : 70+/-5 beats/min) was increased to 100 beats/min and again to 120 beats/min by right atrial pacing. RESULTS: CFR progressively decreased from 3.0+/-0.5 at baseline to 2.4+/-0.4 during pacing at 100 beats/min and to 2.0+/-0.3 during pacing at 120 beats.min(p<0.001). CFVI/min at baseline was progressively increased(130+/-15% of control value at 100 beats.min, 135+/-30% at 120 beats.min(p<0.01) whereas in adenosine hyperemia remained unchanged(286+/-81% at hyperemia baseline, 296+/-91% at 100 beats/min, 289+/-105% at 120 beats/min, p>0.05). Systolic CFVI/min was increased at baseline(185+/-35% at 120 beats/min, p<0.01) and in adenosine hyperemia(377+/-153% at hyperemia baseline, 457+/-178% at 120 beats/min, p=0.01). Diastolic CFVI/min was increased at baseline(134+/-178% at 120 beats/min, p<0.01), but in adenosine hyperemia, no significant change was observed(278+/-77% at hyperemia baseline and 251+/-77% at 120 beats/min, p>0.05). CONCLUSION: Increase in heart rate induces a substantial reduction in maximal CFR. Thus,heart rate appears to be one of important variable for the measurement of CFR and phasin coronary flow profile.
Adenosine ; Arteries ; Chest Pain ; Coronary Vessels ; Female ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Hyperemia ; Male

PURPOSE: At present renal transplantation, the most frequent surgical complications may be occurred on ureterovesical anastomosis site (i.e. leakage, stenosis and reflux). The results of ureteroureterostomy using recipient's own ureter in these complications, will be presented. METHODS: From 1983 to 2004, 410 renal transplantations were performed at our institution. In all cases, external ureteroneocystostomy technique was used. Complications involving the anastomosis site occurred in 23 cases (5.4%), with 15 stenosis (3.4%) and 8 cases of leakage (1.9%). All of them were living donor cases. The mean recipient's age was 47.2 years. Corrective surgery were performed as soon as complication confirmed radiologically (ultrasonography), 16.1+/-22.3 days after transplantaion for leakage and 86.8+/-87.6 days for stenosis. If the length of graft ureter was long enough, ureteroneocys tostomy was performed again and if not, end to side ureteroureterostomy was performed in 12 cases, end to end ureteroureterostomy in 1 case and end to end pyeloureterostomy in one case. A double J ureteral stent was used in every case. RESULTS: There were one graft loss due to stone formation nephropathy, one mortality due to herpetic infection with functioning graft and one failure of recovery of graft function because of too late patients visit. Others had good graft function until last follow up with 3.8+/-2.5years of mean follow-up without further ureteral complications. CONCLUSION: Ureteroureterostomy is a safe and permanent treatment for complications of ureterovesical anastomosis site and gives good results.
Constriction, Pathologic ; Follow-Up Studies ; Humans ; Kidney Transplantation* ; Living Donors ; Mortality ; Stents ; Transplants ; Ureter

Mediastinal parathyroid cyst is a very rare disease and is usually found incidentally. Surgical excision is the treatment of choice and recurrence is very rare when complete excision is done. A 71-year-old man was referred to our department because of 6x5cm sized right superior mediastinal mass found incidentally on chest X-ray. Surgical excision was performed and pathologic findings were confirmed as mediastinal parathyroid cyst. The patient has been followed up postoperatively without recurrence for 4 months up to now. We report a case of mediastinal parathyroid cyst.
Aged ; Humans ; Mediastinal Cyst ; Parathyroid Glands ; Parathyroid Neoplasms ; Rare Diseases ; Recurrence ; Thorax

Pseudoaneurysm is one of the undesirable complications of interventional cardiology procedures involving peripheral puncture site. Nowadays, it is not uncommon as a consequences of more complex interventional preocedures, larger catheters and prolonged anticoagulation treatment. Surgical repair has been mainstay of treatment for pesudoaneurysm. However, sucessful closures of pseudoaneurysms have been reported recently by using direct compression guided by color doppler ultrasound. We report a case of pseudoaneurysm in femoral artery, which was developed at the right inguinal puncture site in 38 year old male patient with unstabel angina who had received continuous intravenous infusion of heparin and had undergone coronary angiography treated successfully with direct compression guided by color doppler ultrasound.
Adult ; Aneurysm, False* ; Cardiology ; Catheters ; Coronary Angiography ; Femoral Artery* ; Heparin ; Humans ; Infusions, Intravenous ; Male ; Punctures ; Ultrasonography*

Thymic carcinoid or neuroendocrine tumor of thymus is a very rare disease and has poor prognosis due to frequent recurrence and distant metastasis. A 43-year-old man was refered to our hospital because of Rt. chest pain and tightness. Chest X-ray revealed 7 X 8cm sized mass on Rt. anterior mediastinum. Surgical excision was performed and light microscopic, immunohistochemical and electron microscopic findings were confirmed as atypical thymic carcinoid tumor with thymic cyst. The patient has been followed up without recurrence or distant metastasis postoperatively for 3 months to now. We report a case of atypical thymic carcinoid with thymic cysts.
Adult ; Carcinoid Tumor* ; Chest Pain ; Humans ; Mediastinal Cyst* ; Mediastinum ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Prognosis ; Rare Diseases ; Recurrence ; Thorax ; Thymus Gland

BACKGROUND: In the diagnosis of acute myocardial infarction, measurement of CK-MB is widely used as an enzyme test, but it needs special instruments, lacks specificity in the presence of concomitant skeletal muscle injuries, and has narrow diagnostic time window. Cardiac specific troponin T-a new marker for the diagnosis of myocardial injury-is now available. Besides the quantitative assay, rapid qualitative asay is also possible with the development of rapid assay Kit. We studied about the efficacy of the Troponin T rapid assay Kit in early doagnosis of actue myocardial infarction in the emergency room. METHODS: Total Ck, Ck-MB, LDH and serum troponin T activities were determined when the patients arrived at the emergency room and at the same time Troponin T rapid assay kit test was done. Final diagnosis was made through the serial measurement of CK, CK-MB and LDH. Diagnostic efficacy of each rest was evaluated. RESULTS: Overall diagnostic sensitivity and specificity of Troponin T rapid assay kit were 0.97 and 0.91. When evaluated only with the initial results, Troponin T rapid assay kit showed sensitivity 0.87, specificity 0.97, serum troponin T 0.75, 0.92, and Ck-Mb 0.81,0.95. In one patient who was finally diagnosed as a septic shock, Ck-MB was elevated but serum troponin T was not and Troponin T rapid assay kit test showed negative result. CONCLUSION: Troponin T rapid assay kit test seems to show nearly the same sensitivity and specificity in diagnosis of acute myocardial infarction compared to CK-MB. This test can be done simply and easily in a short time. Thus, with the use of this test, morbidity, mortality and economic loss due to misdiagnosis and delay of diagnosis of myocardial infarction might be reduced.
Diagnosis ; Diagnostic Errors ; Early Diagnosis* ; Emergency Service, Hospital ; Humans ; Mortality ; Muscle, Skeletal ; Myocardial Infarction* ; Sensitivity and Specificity ; Shock, Septic ; Troponin T* ; Troponin*

Hamartoma is rare but the most common benign neoplasm in the lung. However endobronchial lipomatous hamartoma has been rarely reported. A 73-year-old male patient was admitted to our hospital due to hemoptysis 1 month prior to admission. On bronchoscopic examination, a large pedunculated endobronchial mass right upper lobar bronchus. The endobronchial mass was enucleated by bronchotomy that is no evidence of malignancy in frozen specimens. We report a case of endobronchial lipomartous hamartoma which was resected by bronchotomy.
Aged ; Bronchi ; Bronchial Neoplasms ; Hamartoma* ; Hemoptysis ; Humans ; Lung ; Male

BACKGROUND: Elevated serum levels of growth differentiation factor-15 (GDF-15) are associated with type 2 diabetes. Therefore, the effects of atorvastatin on metabolic parameters and GDF-15 levels in patients with type 2 diabetes and dyslipidemia were evaluated. METHODS: In this prospective randomized trial from February 2013 to March 2014, 50 consecutive type 2 diabetic patients with a low density lipoprotein cholesterol (LDL-C) levels > or =100 mg/dL were enrolled. The patients were divided into two groups based on the amount of atorvastatin prescribed, 10 mg/day (n=23) or 40 mg/day (n=27). The effect of atorvastatin on metabolic parameters, including lipid profiles and GDF-15 levels, at baseline and after 8 weeks of treatment were compared. RESULTS: The baseline metabolic parameters and GDF-15 levels were not significantly different between the two groups. After 8 weeks of treatment, the total cholesterol (TC) and LDL-C levels were significantly decreased in both groups. The mean changes in TC and LDL-C levels were more significant in the 40 mg atorvastatin group. The GDF-15 level was decreased in the 10 mg atorvastatin group, from 1,460.6+/-874.8 to 1,451.0+/-770.8 pg/mL, and was increased in the 40 mg atorvastatin group, from 1,271.6+/-801.0 to 1,341.4+/-855.2 pg/mL. However, the change in the GDF-15 level was not statistically significant in the 10 or 40 mg atorvastatin group (P=0.665 and P=0.745, respectively). CONCLUSION: The GDF-15 levels were not significantly changed after an 8-week treatment with atorvastatin in type 2 diabetic patients.
Cholesterol ; Cholesterol, LDL ; Diabetes Mellitus, Type 2* ; Dyslipidemias* ; Growth Differentiation Factor 15 ; Humans ; Prospective Studies ; Atorvastatin Calcium

Transfusion free surgery is of increasing interest as more patients are refusing a blood transfusion because of religious belief, infection or fear of a blood-transmitted disease such as AIDS. Patients of the Jehovah's Witness faith generally do not accept transfusions of blood or blood products but some will accept cadaveric organs for transplantation. Recently, it is possible to perform 'bloodless' autologous or reduced-intensity allogeneic transplants in properly selected patients. The success of these procedures depends on the transplantation technique and on meticulous attention to blood conservation and supportive care. In our center, nine Jehovah's Witness received a kidney transplantations and transfusion free surgery. All the patients received erythropoietin injection and iron supplement before kidney transplantation. They were not serious bleeding in surgery and graft dysfunction after surgery. All the recipients are alive and have well functioning grafts. Elective living donor kidney transplantation allows implementation of a transfusion free strategy. We think that various methods replaced blood transfusion reduced risk of postoperative anemia and unnecessary transfusion.
Anemia ; Blood Transfusion ; Bloodless Medical and Surgical Procedures ; Cadaver ; Erythropoietin ; Hemorrhage ; Humans ; Iron ; Kidney ; Kidney Transplantation ; Living Donors ; Religion ; Transplants ; Wit and Humor as Topic