No abstract available.
Hypnotics and Sedatives*

A kidney containing more than 1,000ml fluid in its collecting system is generally defined as giant hydronephrosis. The clinical manifestations of giant hydronephrosis are indistinct. The patient seems to seek medical help late due to tolerable symptoms and particularly in the state of poor economic condition. We present a giant hydronephrosis of contents of 60 liters associated with ureteropelvic junction stricture on a 43-year-old woman. The final diagnosis was performed by exploration of abdomen and nephrectomy was done.
Abdomen ; Adult ; Constriction, Pathologic ; Diagnosis ; Female ; Humans ; Hydronephrosis* ; Kidney ; Nephrectomy

PURPOSE:BK virus associated nephropathy (BKVAN) affects 1-10% of kidney transplant (KT) patients and it produces a progressive destruction of allograft. Reducing immunosuppression is the only way to save the graft, while it needs tight monitoring of the graft rejection and graft survival is poorer in advanced case. Leflunomide has immunosuppressive effect and also antiviral activity. Addition of leflunomide may improve BK virus clearance and graft survival. METHODS:6 KT patients with biopsy proven BKVAN (Histological pattern B) were treated with leflunomide and reduced immunosuppression. All patients were monitored with serial determination of viral load in blood and graft function. RESULTS:BKVAN was diagnosed at 14 months (7-28) post transplant, at that time median serum creatinine concentration was 2.8 mg/dL (1.8-3.6). 12.5 months (6-16) later of leflunomide treatment, median serum creatinine was 2.3 mg/dL and no graft loss was found. CONCLUSION:Leflunomide therapy with reduced immunosuppression may be effective in the treatment for BKVAN.
Biopsy ; BK Virus ; Creatinine ; Graft Rejection ; Graft Survival ; Humans ; Immunosuppression ; Isoxazoles ; Kidney ; Kidney Transplantation ; Transplantation, Homologous ; Transplants ; Viral Load ; Viruses

A polyetherurethane (PU) film containing 0.1% zinc diethyldithiocarbamate (ZDEC) is the international standard reference material for testing the in vitro cytotoxicity of polymer based biomaterials. Nowadays, culturing L929 or BALB/3T3 cells in direct contact or in an extract dilution condition is the most frequently using method for evaluating the cytotoxicity from biomaterials and medical devices. However, the results often vary, because it is directly related to the cellular functions and the mechanism of the toxicity of the contacting cells. In this study, 13 cell lines originating from various tissues were used to detect the cytotoxic activities of a PU film containing 0.1% ZDEC (PU-ZDEC). The correlation between the reactivity zone size and the relative cytotoxicity by quantifying the released total protein from each cell in the direct contact testing method was investigated. Hepa-1c1c7 cells demonstrated the highest sensitivity in the reactivity zone size, while CHO/dhFr(-) cells were the most sensitive in terms of the relative cytotoxicity. A correlation between the two processes in each cell line was not found (r=-0.478). In the extract dilution method, which involved cultivating the cells in the medium with various ZDEC concentrations prepared by diluting the PU incubation, the cytotoxicity increased with increasing ZDEC concentration in all cell lines. The BALB/ 3T3 cells demonstrated the highest sensitivity in the extract dilution method. No correlation in a comparison of the relative cytotoxicity from the direct contact method with the extract dilution method in each cell line, was found (r=-0.445). In this experiment, Hepa-1c1c7, BALB/3T3, CHO/dhFr(-) and L-929 cells among the 13 types of cell lines were the sensitive cell lines according to the two methods. The preliminary results suggest that a comparison of at least one or more cytotoxicity testing methods and many cell lines is necessary for an in vitro cytotoxicity test of biomaterials.
Animal ; Cell Line ; Cell Survival/drug effects ; Ditiocarb/*toxicity ; Hamsters ; Human ; Mice ; Polyurethanes/*toxicity ; Support, Non-U.S. Gov't ; Toxicology/*methods

BACKGROUND: Initial symptoms for esophageal perforation have not been clarified, but when there is no early diagnosis and proper treatment to follow immediately after the diagnosis, it is fatal for the patients. Therefore, this study attempted to discover the factors that influence the prognosis of esophageal perforation to contribute to the improvement of the treatment result. MATERIAL AND METHOD: The subjects of this study are 32 patients who came to the hospital with esophageal perforation from October, 1984 to June, 2000. This study examined the items for clinical observation such as patients' sex, age, cause of the perforation, perforation site, the time spent until the beginning of the treatment, symptoms caused by the perforation and its complication, and treatment methods. This study tried to find out the relationship between the survival of patients and each item. RESULT: There were 24 male and 8 female patients and their mean age was 49.7 +/- 16.4. For the causes of perforation, there were 14 cases(43%) of iatrogenic perforation, which ranked first, caused by the medical instrument operation and surgical damage. As for the perforation sites, thoracic esophagus was the most common site(26 cases of 81.2%) and chest pain was the most frequent symptom. The complication caused by esophageal perforation showed the highest cases in the order of mediastinitis, empyema, sepsis and peritonitis. After the treatment, there were 23 cases of survival and 9 cases of mortality. The total mortality rate was 28.1% and the main causes of mortality were sepsis and acute respiratory distress syndrome(ARDS). As for the treatment, 8 cases(25.0%) treated the perforation successfully using conservative treatment only. As for the surgical treatment, there were 5 cases(15.6%) of cervical drainage, 7 cases (21.8%) of primary repair and 12 cases(37.5%) of esophageal reconstruction after performing an exclusion-diversion. There were 18 cases(56.2%) of complete treatment of esophageal perforation at its initial treatment and in 14 cases(43.8%) of treatment failure at its initial treatment, patients were completely cured in the next treatment stage or died during the treatment. The cases of perforation in thoracic esophagus, complication into severe mediastinitis or sepsis and the cases of failure at initial treatment showed a statistically significant mortality rate (p<0.05). CONCLUSION: Based on the above results, it is thought that a proper choice for initial treatment choice depending on the perforation site and the prevention of serious complication such as mediastinitis or sepsis can shorten the treatment period for the patients with esophageal perforation and improve the convalescence.
Chest Pain ; Convalescence ; Diagnosis ; Drainage ; Early Diagnosis ; Empyema ; Esophageal Perforation* ; Esophagus ; Female ; Humans ; Male ; Mediastinitis ; Mortality ; Peritonitis ; Prognosis ; Sepsis ; Treatment Failure

Bilateral fibroepithelial polyps of the ureter are scarcely seen benign mesodermal tumor that occurs most often at the proximal ureter. Most patients present with either hematuria due to necrosis at urethral polyp of flank pain secondary to partial ureteral obstruction. The Diagnosis may be established with intravenous pyelography, retrograde pyelography, ureteroscopy and CT. Local resection is the treatment of choice. We report a case of bilateral fibroepithelial polyps of the ureter with a brief review of literatures.
Diagnosis ; Flank Pain ; Hematuria ; Humans ; Mesoderm ; Necrosis ; Polyps* ; Ureter* ; Ureteral Obstruction ; Ureteroscopy ; Urography

Femoral hernias are very uncommon in children and very easily misdiagnosed. During a period of three years, three children of femoral hernia were treated by one pediatric surgeon at Severance Hospital. Only one case was diagnosed correctly before surgery; the other two were thought to be either an indirect inguinal hernia or groin mass. Only one patient had curative hernioplasty (McVay hernioplasty) at the first operation; the other two did not have curative hernioplasty at the first operation. Femoral hernia in childhood is a challenging clinical problem because of its rarity and similar clinical presentation as indirect inguinal hernia. The frequency with which an incidental indirect inguinal hernia sac or patent processus vaginalis can be found at surgery can perpetuate a misdiagnosis. The absence of an expected indirect inguinal hernia sac or an apparent recurrence of an indirect inguinal hernia should lead to consideration of possible femoral hernia.
Child* ; Diagnostic Errors ; Groin ; Hernia, Femoral* ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Recurrence

Ectopia cordis is defined as a congenital malposition of the heart partially or completely outside the thorax and often associated with sternal and congenital heart defects:surgical repair is generally unsuccessful because of the magnitude of the deformity and the associat-ed intracardiac anormalies. Four types of ectopia cordis are described : cervical, thoracic, abdominal and thoracoa- bdominal. Cervical and thoracic type are often fatal within days, because the heart is expo- sed and malformed. Abdominal type carries a better prognosis because cardiac abnormalities are less often found. The prognosis of thoraco-abdominal type mainly depends on the pre- sence of intracardiac abnormalities. We have experienced a case of thoracic ectopia cordis at 25 weeks' gestation by ultra- sonography, so present the case and the review with literature briefly.
Congenital Abnormalities ; Ectopia Cordis* ; Heart ; Pregnancy ; Prenatal Diagnosis* ; Prognosis ; Thorax

The development of endometrial stromal sarcomas (ESSs) in foci of endometriosis is extremely rare, and few cases have been reported in the literature to date, particularly with regard to multiple extrauterine ESS. Here we report a case of endometrial stromal sarcoma with multiple metastasis that arose from an ovarian endometriotic lesion. The literature is also briefly reviewed.
Endometriosis ; Female ; Neoplasm Metastasis ; Ovary ; Sarcoma, Endometrial Stromal

Congenital constriction band of the trunk is a rare congenital malformation. A 14-year-old girl with a congenital circumferential constriction band around the waist is described. Seven other cases of congenital constriction band on the trunk are reviewed in the literature. This malformation is probably related to the amniotic band syndrome such as constriction band on the limbs. The surgical treatment of this constriction band was W-plasty and produced good cosmetic results.
Adolescent ; Amniotic Band Syndrome ; Constriction* ; Extremities ; Female ; Humans ; Infant, Newborn