Patients with medullary spongy kidney(MSK) who recurrently form and pass stones are in danger of developing obstructive nephropathy. Since extracorporeal shock wave lithotripsy (ESWL) was introduced to treat urinary tract stones, the shock wave application to MSK with stones has been performed. Between February, 1990 and August, 1992, 11 renal units in 7 patients were diagnosed as stones in MSK on intravenous urography. These patients were all symptomatic with hematuria and/or flank pain, and then treated by ESWL. The number of stone-burden minor calyces was 1 to3 in 2 cases( 18.2%), 4 to 6 in 8 cases ( 72.7% ) and 7 or more in 1 case(9.1%). The average numbers of treatment for these stones were 8.5, 13.4 and 4 sessions, respectively and the average storage was 386, 470 and 115, respectively. Reduction in the number and size of the stones on plain films was more than ?5% in 5 cases( 45.4%), 25 to 75% in 4 cases( 36.4%), and less than 25% in 2 cases( 13.2%). Serum creatinine, blood urea nitrogen, and creatinine clearance rate did not show any change after the treatments. The post-ESWL complication was only persistent gross hematuria for 4 days in 1 case( 14.3% ) In conclusion, although ESWL does not clear the stones completely, the ESWL is considered to be an effective procedure to prevent an obstructive nephropathy and to reduce the frequency of symptomatic stone passage in medullary spongy kidney with stones.
Blood Urea Nitrogen ; Creatinine ; Flank Pain ; Hematuria ; Humans ; Kidney* ; Lithotripsy* ; Nephrocalcinosis* ; Shock* ; Urinary Calculi ; Urography

Although rare, renal arteriovenous fistulas have been discovered with increasing frequency since they were first described by Varela in 1923. Arteriovenous fistulas are classified as either congenital or acquired. The diagnosis of this condition is usually made by use of renal angiograms. In case of hematuria and/or hypertension either intra-arterial embolization or surgical excision and clipping of the arterial branch can be done. Intra-arterial superselective embolization seems to cause less functional loss of the renal parenchyme, whereas excision often leads to heminephrectomy or even total nephrectomy. Herein, we describe a case treated successfully in recurred renal A-V fistula after transcatheter embolization by Gianturco steel coil and reviewed the literature of renal A-V fistulas.
Arteriovenous Fistula ; Diagnosis ; Fistula* ; Hematuria ; Hypertension ; Kidney ; Nephrectomy ; Retreatment* ; Steel*

PURPOSE: This study evaluated the accuracy of three-dimensional gadolinium-enhanced MR angiography (Gd-MRA) in the preoperative evaluation of living renal transplant donors (LRTDs) for visualizing the renal vascular anatomy, with an emphasis on identifying the number of renal arteries and veins and the presence of small branch anomalies. MATERIALS AND METHODS: Between April 1999 and October 2003, a total of 42 LRTDs were evaluated with conventional renal angiography (CRA) or three-dimensional Gd-MRA. The three-dimensional Gd-MRA was performed in 20 cases and CRA in 22. All candidates then underwent a donor nephrectomy. The intraoperative findings of the renal vessels were compared between the CRA and three-dimensional Gd-MRA, and the complications and side effects also examined. RESULTS: The overall accuracies for predicting the numbers and abnormalities of renal arteries and veins by comparing the intraoperative findings were 85 and 95% for the three-dimensional Gd-MRA, and 91 and 98% for the CRA. The three-dimensional Gd-MRA missed 3 accessory renal arteries, while the CRA missed 1, as well as 1 renal artery bifurcation. There were three complications; one contrast anaphylaxis and two hematomas at the puncture site, in the 22 CRA cases, but there were no significant complications in the three-dimensional Gd-MRA. CONCLUSIONS: Three-dimensional Gd-MRA appears to be as accurate as CRA for visualizing the renal vascular anatomy in the preoperative assessment of potential LRTDs. Three-dimensional Gd-MRA is a noninvasive and noncontrast technique, which would be a good alternative to CRA for assessing potential LRTDs.
Anaphylaxis ; Angiography* ; Hematoma ; Humans ; Kidney Transplantation* ; Magnetic Resonance Angiography ; Nephrectomy ; Punctures ; Renal Artery ; Tissue Donors ; Veins

OBJECTIVE: A large body of evidence suggests that cyclooxygenase-2 (COX-2) is important in tumorigenesis of gastrointestinal and other cancers. This was the study to determine whether COX-2 was also expressed in benign and malignant ovarian tumors. METHODS: We studied the expression of COX-2 in various ovarian tumors [ Benign epithelial tumors (n=10), borderline epithelial tumors (n=12), malignant epithelial tumor (n=12), nonepithelial tumors(n=10) ] by immunohistochemistry. Results of immunoreactivity was classified semiquantitatively based on the proportion and intensity of tumor cell immunostaining. RESULTS: In the epithelial ovarian tumors, the intensity of immunostaining was stronger in the malignant tumors than the benign and borderline tumors (p<0.001). Especially all serous and mucinous malignant tumors (n=9) showed weak and strong immunoreactivity, with 66.7% strong reactivity. None of the nonepithelial ovarian tumors expressed COX-2 immunoreactivity. CONCLUSION: These preliminary data indicate that COX-2 may have a role in carcinogenesis of epithelial ovarian tumors, especially in the serous and mucinous types. COX-2 maybe a target for future research in the tumorigenesis of the epithelial ovarian malignancies.
Carcinogenesis ; Carcinoma ; Cyclooxygenase 2* ; Immunohistochemistry ; Mucins

PURPOSE: Mouse liver nonparenchymal cells play an important role in the development of active apoptosis in graft- infiltrating cytotoxic T lymphocytes, and this apoptosis can be an explanation for liver graft acceptance. We intended to clarify whether immature mouse liver dendritic cells can induce apoptosis in allogeneic activated T cells and determine which mechanism is involved in this phenomenon. METHODS: A radiometric DNA fragmentation test ("JAM" assay) was used to determine whether mouse liver dendritic cells were able to induce activated T-cell apoptosis in vitro. In addition, immunohistochemical staining for Bax and Bcl-2 was examined to clarify whether Bax or Bcl-2 was involved in this apoptosis. RESULTS: Immature mouse liver dendritic cells were quite strong inducers of activated T cell apoptotic death in allogeneic mice in vitro (39.2+/-13.2% at E/T ratio=12.5/1) compared with spleen cells as effectors (4.7+/-13.4% at E/T ratio=12.5/1) (P<0.0001). By using immunohistochemical staining, we also showed that Bax might play some role in this phenonenon, but that Bcl-2 might not. CONCLUSION: Our data indicate that immature mouse liver dendritic cells might have a strong apoptotic activity toward activated T cells in allogeneic mice in vitro through a Bax-involved mechanism.
Animals ; Apoptosis* ; Dendritic Cells* ; DNA Fragmentation ; Liver* ; Mice* ; Spleen ; T-Lymphocytes* ; T-Lymphocytes, Cytotoxic ; Transplants

Background: and Purpose Data regarding the effects of cannabidiol (CBD) on the quality of life (QOL) are currently inadequate. We assessed the QOL of pediatric patients with epilepsy who were treated with CBD. Methods: This prospective, open-label study included pediatric and adolescent patients (aged 2–18 years) with Dravet syndrome or Lennox-Gastaut syndrome. Oral CBD was administered at 10 mg/kg/day. The Korean version of the Quality Of Life in Childhood Epilepsy (QOLCE) questionnaire was administered when CBD treatment began and again after 6 months. Adaptive behavior was measured using the Korean versions of the Child Behavior Checklist (K-CBCL) and the second edition of the Vineland Adaptive Behavior Scales (Vineland-II). Results: This study included 41 patients (11 with Dravet syndrome and 30 with LennoxGastaut syndrome), of which 25 were male. The median age was 4.1 years. After 6 months, 26.8% (11/41) of patients experienced a ≥50% reduction in the number of seizures. The total score for the QOLCE questionnaire did not change from baseline to after 6 months of CBD treatment (85.71±39.65 vs. 83.12±48.01, respectively; p=0.630). The score in the motor skills domain of Vineland-II reduced from 48.67±13.43 at baseline to 45.18±14.08 after 6 months of treatment (p=0.005). No other Vineland-II scores and no K-CBCL scores had changed after 6 months of CBD treatment. Conclusions CBD is an efficacious antiseizure drug used to treat Dravet syndrome and Lennox-Gastaut syndrome. However, it did not improve the patient QOL in our study, possibly because all of our patients had profound intellectual disabilities.

Intravenous immunoglobulin (IVIG) therapy has been introduced to idiopathic dilated cardiomyopathy due to their antiviral and anti-inflammatory effects. But each study reported conflicting result and treatment regimen has not been clearly established. We experienced a case of 28-year-old woman with idiopathic dilated cardiomyopathy with severely depressed cardiac function. Its onset time was obvious within 1 month. Despite of conservative treatment of heart failure, sudden cardiac arrest was developed. We tried IVIG therapy, and her symptoms and cardiac function were improved after IVIG treatment.
Adult ; Cardiomyopathy, Dilated* ; Death, Sudden, Cardiac ; Female ; Heart Failure ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous*

STUDY DESIGN: A noninterventional, multicenter, cross-sectional study. PURPOSE: We investigated the prevalence of neuropathic pain (NP) and patient-reported outcomes (PROs) of the quality of life (QoL) and functional disability in Korean adults with chronic low back pain (CLBP). OVERVIEW OF LITERATURE: Among patients with CLBP, 20%–55% had NP. METHODS: Patients older than 20 years with CLBP lasting for longer than three months, with a visual analog scale (VAS) pain score higher than four, and with pain medications being used for at least four weeks before enrollment were recruited from 27 general hospitals between December 2014 and May 2015. Medical chart reviews were performed to collect demographic/clinical features and diagnosis of NP (douleur neuropathique 4, DN4). The QoL (EuroQoL 5-dimension, EQ-5D; EQ-VAS) and functional disability (Quebec Back Pain Disability Scale, QBPDS) were determined through patient surveys. Multiple linear regression analyses were performed to compare PROs between the NP (DN4≥4) and non-NP (DN4 < 4) groups. RESULTS: A total of 1,200 patients (females: 65.7%; mean age: 63.4±13.0 years) were enrolled. The mean scores of EQ-5D, EQ-VAS, and QBPDS were 0.5±0.3, 55.7±19.4, and 40.4±21.1, respectively. Among all patients, 492 (41.0%; 95% confidence interval, 38.2%–43.8%) suffered from NP. The prevalence of NP was higher in male patients (46.8%; p < 0.01), in patients who had pain based on radiological and neurological findings (59.0%; p < 0.01), and in patients who had severe pain (49.0%; p < 0.01). There were significant mean differences in EQ-5D (NP group vs. non-NP group: 0.4±0.3 vs. 0.5±0.3; p < 0.01) and QBPDS (NP group vs. non-NP group: 45.8±21.2 vs. 36.3±20.2; p < 0.01) scores. In the multiple linear regression, patients with NP showed lower EQ-5D (β=−0.1; p < 0.01) and higher QBPDS (β=7.0; p < 0.01) scores than those without NP. CONCLUSIONS: NP was highly prevalent in Korean patients with CLBP. Patients with CLBP having NP had a lower QoL and more severe dysfunction than those without NP. To enhance the QoL and functional status of patients with CLBP, this study highlights the importance of appropriately diagnosing and treating NP.
Adult* ; Back Pain ; Cross-Sectional Studies ; Diagnosis ; Hospitals, General ; Humans ; Linear Models ; Low Back Pain* ; Male ; Neuralgia* ; Prevalence* ; Quality of Life ; Visual Analog Scale