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

Psoas abscess is rarely encountered with various etiologies and nonspecific clinical presentation, frequently resulting in delayed diagnosis, with increased morbidity and mortality. Two types of psoas abscess are recognized. The primary psoas abscess is generally following hematogenous dissemination of an infectious agent and the source is usually occult. The most frequently isolated pathogen is Staphylococcuss aureus. On the other hand, the secondary abscess is the result of local extension of an infectious process near the psoas muscle, especially in diabetes, malnutrition, alcoholism, and steroid abuse. A 83-year-old woman presented with high fever and progressive back pain. Abdominal CT scan showed bilateral psoas abscesses combined with lobulated kidney. Both cultures of blood and urine showed Klebsiella pneumoniae. By prolonged antibiotic treatment and abscess drainage, she showed clinical, and radiological improvement. Here, we report an unusual case of bilateral pyogenic psoas abscess complicated by acute pyelonephritis due to Klebsiella pneumonia.
Abscess ; Aged, 80 and over ; Alcoholism ; Back Pain ; Delayed Diagnosis ; Drainage ; Female ; Fever ; Hand ; Humans ; Kidney ; Klebsiella pneumoniae* ; Klebsiella* ; Malnutrition ; Mortality ; Pneumonia ; Psoas Abscess* ; Psoas Muscles ; Pyelonephritis* ; Tomography, X-Ray Computed

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

BACKGROUND: Monocyte chemoattractant protein- 1 (MCP-1) is an important mediator for monocyte/ macrophage infiltration in various inflammatory renal diseases and is produced by renal cells. In the process of renal diseases, endothelin-1 (ET-1) is known to play an active role in cell growth, inflammation and fibrosis. The aim of this study was to investigate whether three isoforms of endothelin regulate MCP-1 expression in cultured mesangial cells. METHODS: Mesangial cells were incubated with or without various doses of ET-1, ET-2 or ET-3. To determine the monocyte chemotactic activity, chemotaxis assay was performed in modified Boyden chambers using freshly isolated human monocytes. MCP-1 mRNA expression in mesangial cells was measured by Northern blot analysis. RESULTS: ET-1, ET-2 and ET-3 stimulated monocyte chemotactic activity released from mesangial cells in a dose-dependent manner. ET-1, ET-2 and ET-3 also stimulated MCP-1 mRNA expression in a time-dependent manner, which was seen as early as 4 hours and was maintained up to 24 hours. CONCLUSION: These data suggest that ET-1, ET- 2 and ET-3 stimulate MCP-1 expression in mesangial cells and may contribute to the monocyte/ macrophage infiltration in inflammatory renal diseases.
Animals ; Blotting, Northern ; Chemokine CCL2* ; Chemotaxis ; Endothelin-1* ; Endothelin-2* ; Endothelin-3* ; Endothelins ; Fibrosis ; Humans ; Inflammation ; Macrophages ; Mesangial Cells* ; Monocytes* ; Protein Isoforms ; Rats* ; RNA, Messenger

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

We present a case of liposarcoma related with minimal change nephrotic syndrome. A 49-year-old woman was admitted due to generalized edema and a palpable mass at epigastric area. Her laboratory data were as follows : serum creatinine 0.6mg/dl, BUN 7mg/dl, serum total protein 3.6g/dl(albumin 0.6 g/dl) serum total cholesterol 299mg/dl, 24 hour-urine protein 5.1g. A CT scan of the abdomen revealed huge adult head sized mass(15X10X15cm) consisted with mixed pattern of well enhancing solid, cystic and fat portion which is located between the liver and the stomach. A kidney biopsy showed minimal change nephropathy. At explo-laparostomy the tumor was well differentiated liposarcoma. After operation and steroid therapy, her proteinuria and hypoalbuminemia were a little improved. And then radiation therapy(daily 180 cGy, 5 fx/wk, upto 5040cGy/28 fx/42 day) was done. Complete remission of liposarcoma was followed by regression of the nephrotic syndrome. After radiation therapy, her laboratory data were serum total protein 6.7g/dl (albumin 4.3g/dl), total cholesterol 170mg/dl, 24 hour-urine protein 0.3g. She has been maintained complete remission of the nephrotic syndrome by steroid maintenance dose.
Abdomen ; Adult ; Biopsy ; Cholesterol ; Creatinine ; Edema ; Female ; Head ; Humans ; Hypoalbuminemia ; Kidney ; Liposarcoma* ; Liver ; Middle Aged ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Proteinuria ; Stomach ; Tomography, X-Ray Computed

We report a case of somatostatinoma, which manifested as insulinoma after liver metastasis. A 74-year-old man suffered from diabetes mellitus and jaundice. The abdominal CT scan of this patient showed a mass in the pancreas head, which obstructed biliary duct. He underwent Whipples procedure. Immunohistochemical staining of postoperative specimen disclosed that this tumor was strongly positive for somatostatin. After 4 months, follow up CT scan showed multiple metastatic lesions in the liver. We performed transarterial chemoinfusion two times, but the response was disappointing. After 2 months, he suffered from altered mentality, which was relieved by intake of sugar. Biochemical laboratory findings and immunohistochemical staining of liver biopsy disclosed that the metastatic lesion in this patient was insulinoma. We performed embolization of hepatic artery with gelform. The biochemical response was dramatic, but he died of septic shock, which was caused by gas forming liver abscess. In summary, we report a case of somatostatinoma which manifested as insulinoma after metastasis to the liver.
Aged ; Biopsy ; Diabetes Mellitus ; Follow-Up Studies ; Head ; Hepatic Artery ; Humans ; Insulinoma* ; Jaundice ; Liver Abscess ; Liver* ; Neoplasm Metastasis ; Pancreas ; Shock, Septic ; Somatostatin ; Somatostatinoma* ; Tomography, X-Ray Computed

Goodpasture's syndrome is an autoimmune disease characterized by rapid progressive glomerulonephritis, alveolar hemorrhage and autoantibody to the NC1 domain of the alpha 3 chain of type IV collagen (anti-glomerular basement membrane antibody). It was common in Europe with peak incidence at third decades. However, Goodpasture's syndrome was reported only three cases in Korea. We reported a case of Goodpasture's syndrome in a 34 year old male. He admitted our hospital due to dyspnea and hemoptysis. We made diagnosis by detection of Anti-GBM Ab and biopsy of kidney. He was treated with hemodialysis, plasma exchanges and immunosuppressive agents. However, his renal function was not recovered. Currently, he is receiving regular hemodialysis.
Acute Kidney Injury ; Adult ; Anti-Glomerular Basement Membrane Disease* ; Autoimmune Diseases ; Basement Membrane ; Biopsy ; Collagen Type IV ; Diagnosis ; Dyspnea ; Europe ; Glomerulonephritis ; Hemoptysis ; Hemorrhage ; Humans ; Immunosuppressive Agents ; Incidence ; Kidney ; Korea ; Male ; Plasma Exchange ; Renal Dialysis