Endoscopic metal stent insertion has been widely performed to palliatively treat gastrointestinal (GI) tract obstruction in patients with cancer. The use of metal stents for benign strictures of the GI tract is increasing due to the low risk of major complications other than stent migration. The incidence of acute pancreatitis after placing a GI tract metal stent is rare. Herein, we report a case of acute pancreatitis caused by a covered metal stent that was initially inserted for a benign stricture of a gastroduodenal anastomosis that developed after the operation, then distally migrated, bent into a U-shape, and impacted into the second portion of the duodenum in a 56-year-old female who underwent a Billroth-I gastrectomy due to gastric cancer.
Constriction, Pathologic ; Duodenum ; Female ; Gastrectomy ; Gastric Outlet Obstruction ; Gastrointestinal Tract ; Humans ; Incidence ; Middle Aged ; Pancreatitis ; Stents ; Stomach Neoplasms

PURPOSE: To compare the accuracy with which electron beam tomography (EBT) and 99m Tc-MIBI scanning measure myocardial perfusion valve. MATERIALS AND METHODS: Twenty-two subjects [normal volunteers (n = 6), patients in whom ischemic heart disease was diagnosed (n = 5), and those in whom ischemic heart disease was suspected but who were found to be normal (n = 11)] were involved in this study. EBT was performed after bolus injection of contrast media (50 ml of Iopamiro 370 or Optiray 350, 3 ml/sec). The myocardium was divided into 16 segments according to the classification devised by the American Society of Echocardiography, and each myocardial perfusion value was calculated by post-image processing. A pharmacologic stress test was performed in all subjects except four patients with acute myocardial infarction, and myocardial perfusion reserve ratios were assessed. Single photon emission computed tomography (SPECT) was performed after the injection of 20 mCi of 99m Tc-MIBI. Any segments with moderate to severe photon defect on visual analysis of SPECT were identified and perfusion values determined by EBT in normal and ischemic segments were compared. RESULTS: No difference in myocardial perfusion was found between volunteers and the suspected group. Their perfusion values were 0.71 +/-0.14 ml/g/min in the resting state and 1.16 +/-0.24 ml/g/min on the stress test and the myocardial perfusion reserve ratio was, therefore, 1:1.68 +/-0.38. In ischemic patients, 99m Tc-MIBI scanning revealed a perfusion defect in 28 segments, and on EBT the measurement obtained was 0.54 +/-0.19 ml/g/min. The remaining 324 perfusion segments shown by SPECT to be normal showed a perfusion value of 0.79 +/-0.22 ml/g/min on EBT. CONCLUSION: Compared with 99mTc-MIBI scanning, the measurement of myocardial perfusion by EBT provides absolute quantification of perfusion value and more detailed anatomic information.
Classification ; Contrast Media ; Echocardiography ; Exercise Test ; Humans ; Iopamidol ; Myocardial Infarction ; Myocardial Ischemia ; Myocardium ; Perfusion* ; Tomography, Emission-Computed, Single-Photon ; Tomography, X-Ray Computed* ; Volunteers

A persistent left superior vena cava(SVC) is found in about 0.3% of healthy individuals and 4.3% of patients with congenital heart disease. This anomaly is most frequently found in conjunction with a right-sided SVC, but may also be solitary. Recently, we experienced a case of persistent left SVC in patient with chronic renal failure. He required subclavian catheterization for hemodialysis due to leakage of peritoneal dialysate into external genitalia and pleural cavity. Because he had had a history of right subclavian catheterization for hemodialysis 3 months ago, the hemodialysis catheter was inserted in the left subclavian vein without any complication. Chest X-ray after insertion of the catheter showed that the distal tip of the catheter seemed to be within the aorta. Venography showed that the catheter was located within the left SVC and MRI showed isolated two SVC. He is receiving hemodialysis through the left subclavian catheter which is positioned within the left SVC without any problem.
Aorta ; Catheterization ; Catheters* ; Genitalia ; Heart Defects, Congenital ; Humans ; Kidney Failure, Chronic* ; Magnetic Resonance Imaging ; Phlebography ; Pleural Cavity ; Renal Dialysis* ; Subclavian Vein ; Thorax ; Vena Cava, Superior*

A 33-year-old man was admitted with macroscopic hematuria and systemic edema appearing after an acute upper respiratory tract infection. On admission, hypertension, nephrotic syndrome were evident together with a decreased renal function. Renal biopsy showed markedly increased mesangial cells acompanied with increase of endocapillary cells including neutrophils. Immunofluorescence microscopy showed granular deposits of C3 and IgA. Electron Microscopy revealed so-called "hump" on the subepithelial area. These features were consistent with the coexistence of IgA nephropathy (IgAN) and post-infectious glomerulonephritis. It is not clear about the prognosis and the therapeutic regimen in the patient who develop above situation. Although the patient showed still persistent proteinuria, high dose steroid therapy was probably useful for improving the disease.
Adult ; Biopsy ; Edema ; Glomerulonephritis* ; Glomerulonephritis, IGA* ; Hematuria ; Humans ; Hypertension ; Immunoglobulin A* ; Mesangial Cells ; Microscopy, Electron ; Microscopy, Fluorescence ; Nephrotic Syndrome ; Neutrophils ; Prognosis ; Proteinuria ; Respiratory Tract Infections

BACKGROUND: Monocyte chemoattractant protein- 1 (MCP-1) is produced by renal cells and an important mediator for monocyte/macrophage infiltration in various inflammatory renal diseases. In the process of renal disease, endothelin-1 is known to play an active role in cell growth, inflammation and fibrosis. The aim of this study was to investigate whether endothelin-1 regulates MCP-1 expression in cultured human proximal tubular epithelial cells. METHODS: Primary cultured human proximal tubular epithelial cells (PTEC) were incubated with or without various dose of endothelin-1. MCP-1 concentration in PTEC conditioned medium was measured by sandwich ELISA. MCP-1 mRNA expression was analyzed by Northern blotting. The NF-kB or AP-1 activity in response to endothelin-1 was measured by electrophoretic mobility shift assay. RESULTS: Endothelin-1 (10(-7) M) stimulated MCP- 1 production in PTEC, which was significant at 48 hours and various doses of endothelin-1 (10(-8)-10(-6) M) increased MCP-1 production from PTEC in a dose-dependent manner. Northern blot analysis revealed that endothelin-1 stimulated MCP-1 mRNA expression. Endothelin-1 (10(-7) M) stimulated both AP-1 binding activity and NF-kB binding activity up to 8 hour. Supershift analysis showed that p65 and p50 are major NF-kB subunit bound to the DNA probe and that c-Fos and c-Jun are major AP-1 subunit bound to the DNA probe. CONCLUSION: Our results suggest that endothelin- 1 may stimulate MCP-1 expression in proximal tubular epithelial cells through the activation of NF- kB and AP-1 binding activity.
Blotting, Northern ; Chemokine CCL2* ; Culture Media, Conditioned ; DNA ; Electrophoretic Mobility Shift Assay ; Endothelin-1* ; Enzyme-Linked Immunosorbent Assay ; Epithelial Cells* ; Fibrosis ; Humans* ; Inflammation ; Monocytes* ; NF-kappa B ; RNA, Messenger ; Transcription Factor AP-1

Clinical heterotopic liver transplantation(HLT) has been carried out in the several institutions since 1962. Recently, Rotterdam group reported a successful clinical series of HLT in spite of several negative viewpoints against orthotopic liver transplantation. Among the successful HLT cases till now, several occurrences of hepatocellular carcinoma in the native liver had been reported. In the current study, a thirty percent liver was transplanted heterotopically in the dimethylnitrosoamine(DMN)-induced cirrhotic rats and the feasibility of host-hepatectomy after regeneration of the graft was tested, and we are going to introduce the concept of host liver resection(HR) to the clinical auxiliary liver transplantation. Of the thirty syngeneic partial HLT with portal blood input only, 16 rats died following transplantation and three rats dies after HR. The DMN-induced cirrhotic liver specimen showed a microscopic finding of nodular cirrhosis with thick intralobular fibrous septa. Grafts examined at three posttransplant weeks appeared architecturally normal and well regenerated and the atrophied host livers were small hard showing micronodularity on the surface. Of all the animals examined, no host liver tissues were regrowing after one month following near total HR. We conclude that HLT can be performed in the clinically relevant cirrhotic rats and HR is feasible after graft regeneration and expect that this experimental model can be used for the study of cirrhosis and HLT.
Animals ; Carcinoma, Hepatocellular ; Fibrosis ; Hepatectomy* ; Liver Transplantation* ; Liver* ; Models, Theoretical ; Rats* ; Regeneration ; Transplants

PURPOSE:Preconditioning due to activation of AMPK might reduce ischemia-reperfusion (I/R) injury in the kidney, based on the key role of AMPK in preserving ATP. To evaluate this possibility, the effect of preconditioning with 5-aminoimidazole-4-carboxamide ribonucleoside (AICAR), AMPK activator, before sustained ischemia was investigated. METHODS:Adult male Sprague-Dawley rats weighing approximately 220-250 g were used. To induce renal ischemia, a laparotomy was performed under ketamine and xylazine hydrochloride, and the blood supply to both kidneys was interrupted by placement of vessel clamps at the level of the renal pedicles. Reflow was initiated by removing the clamps. The following experimental groups were defined 1. Acute renal ischemia 0 sec, 10 min, 15 min, 2. AICAR treatment, 3. Sham group (S), 4. Ischemia/ Reperfusion group (I/R), 5. AICAR+I/R group (A+I/R), 6. AraA (Adenine-9-b-D-arabinofuranoside, an AMPK) inhibitor+AICAR+I/R group (AraA+A+I/R) RESULTS:There was only faint AMPK phosphorylation in the sham group. After 10 minutes of ischemia, or AICAR preconditioning however, Thr172 phosphorylation of AMPK was increased (p<0.05). The serum levels of BUN and creatinine were significantly decreased in AICAR preconditioning group (A+I/R). (128.0+/-7.33 mg/dL, 4.18+/-0.27 mg/dL vs. 90.2+/-11.13 mg/dL, 2.58+/-0.7 mg/dL, p<0.05), but these effects were attenuated by AMPK inhibitor, AraA (AraA+A+I/R group). In quantitative analysis of tubular injury, tubular injury score in AICAR preconditioning group significantly decreased (p<0.05). CONCLUSION:The AMPK activator AICAR has a protective effect against renal I/R injury.
Adenosine Triphosphate ; Aminoimidazole Carboxamide ; AMP-Activated Protein Kinases ; Creatinine ; Glycosaminoglycans ; Humans ; Ischemia ; Ketamine ; Kidney ; Laparotomy ; Male ; Phosphorylation ; Rats, Sprague-Dawley ; Reperfusion ; Reperfusion Injury ; Ribonucleotides ; Salicylamides ; Xylazine

BACKGROUND: The impact of hepatitis B or hepatitis C virus infection on renal transplantation outcome is controversial. The aim of this study is to assess the impact of hepatitis B and hepatitis C infection on kidney transplant over the long-term, 15 years and to compare infected patients with noninfected patients matched for factors possibly associated with graft and patient survival. METHODS: We analyzed 1,042 patients who underwent renal transplantation in period from March 1984 to Dec. 1998 including 107 with positive HBsAg (HBV(+) group), 81 with positive anti-HCV antibody (HCV(+) group) and 714 noninfected recipients (NBNC group). One hundred-forty patients who had not taken ani-HCV antibody screening test were excluded. The prevalence of chronic liver disease, the patient mortality, the patient survival rate and the graft survival rate were evaluated. RESULTS: The patient mortality during the period of follow-up was significantly higher in HBV(+) group(32.7%) than in HCV(+) group(9.9%) and NBNC group(8.4%). The cause of death related to liver desease was significantly higher in HBV(+) group(57.1%) than HCV(+) group(0%) and NBNC group(1.7%). Five year and 10 year graft survival rate were significantly lower in HBV(+) group(52.2 %, 39.2%) than in HCV(+) group(68.4%, 47.2%) and NBNC group(86.6%, 65.8%). Five year and 10 year patient survival rate of HBV(+) group(72.0%, 68.9%) was significantly lower than HCV(+) group(91.6%, 87.3%) and NBNC group(94.4%, 88.2%), but there was no significant difference in the patient survival rate between HCV(+) and NBNC group. CONCLUSION: Hepatitis B virus infection has a significant deleterious effect on the patient and graft survival of renal transplantation recipients. The poor survival rate was a result of the mortality from liver disorder. Hepatitis C virus infection also has a poor graft survival rate compared to NBNC group, but the patient survial rate is similar to NBNC group.
Cause of Death ; Follow-Up Studies ; Graft Survival ; Hepacivirus* ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis B* ; Hepatitis C* ; Hepatitis* ; Humans ; Kidney ; Kidney Transplantation ; Liver ; Liver Diseases ; Mass Screening ; Mortality ; Prevalence ; Retrospective Studies* ; Survival Rate ; Transplants

The hemolytic uremic syndrome (HUS) is clinically characterized by microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. The unique cause has not been determined but some bacteria such as E. coli was regarded as the causative agent of HUS in infant. A 30-year-old male patient was admitted due to acute abdomen. In operating field, the periappendiceal abscess was found, so the appendectomy with the drainage of abscess was performed. Initial hemoglobin level was 16.2g/dL but abruptly developed anemia (12.6g/dL) and thrombocytopenia (27000/mm3) was detected at hospital day 3. The urinary outflow was totally absent, the serum creatinine was 12.8mg/dL and the LDH was 3,650IU/L. The peripheral blood smear showed strong evidence of microangiopathic hemolysis. We performed total plasma exchange and hemodialysis under the diagnosis of HUS. The patient's renal function was markedly improved and the last creatinine was 1.9mg/dl. To our knowledge, this is the first report of HUS associated with periappendiceal abscess in Korea. We present a case and the review of literature.
Abdomen, Acute ; Abscess* ; Acute Kidney Injury ; Adult ; Anemia ; Anemia, Hemolytic ; Appendectomy ; Bacteria ; Creatinine ; Diagnosis ; Drainage ; Hemolysis ; Hemolytic-Uremic Syndrome* ; Humans ; Infant ; Korea ; Male ; Plasma Exchange ; Renal Dialysis ; Thrombocytopenia

Hemophagocytic syndrome is a rare syndrome characterized by fever, weight loss, profound pancytopenia, lymphadenopathy, hepatosplenomegaly and the pathologic finding of hemophagocytosis (phagocytosis by macrophages of erythrocytes, leukocytes, platelets, and their precursors) in bone marrow and other tissue. This syndrome can be associated with viral infections and lymphoid neoplasia, bacteria, fungus and drugs. Hyperproduction of cytokines, including interferon-gamma, tumor necrosis factor-alpha, may play a role in the pathogenesis of hemophagocytosis. Authors experienced a rare case of hemophagocytic syndrome associated with tuberculosis in a 40-year- old female who had undergone renal transplantation 12 years ago and received triple immunotherapy. After the beginning of antituberculosis therapy, the laboratory disturbances disappeared and clinical symptoms improved. Tuberculosis is a common infection in Korea. Therefore, we would like to recommend early bone marrow biopsy and antituberculosis therapy if fever of unknown origin, hepatosplenomegaly and pancytopenia in immunosupressive patients.
Bacteria ; Biopsy ; Bone Marrow ; Cytokines ; Erythrocytes ; Female ; Fever ; Fever of Unknown Origin ; Fungi ; Humans ; Immunotherapy ; Interferon-gamma ; Kidney Transplantation ; Korea ; Leukocytes ; Lymphatic Diseases ; Lymphohistiocytosis, Hemophagocytic* ; Macrophages ; Pancytopenia ; Transplantation* ; Tuberculosis ; Tumor Necrosis Factor-alpha ; Weight Loss