Various reconstructive surgery have been performed for repair of the patellar tendon defect due to direct trauma or infected open wound. But most surgical procedure need wide skin incision and soft tissue dissection, that result in joint stiffness or muscle weakness. We carried out two-stage reconstructive surgery used bone-patellar tendon-bone allograft and bioabsorbable interference screw for skin and patellar tendon defect due to repetitive debridment for infected wound management. The result was satisfactroy and the patient achieved nearly full return of knee motion and quadriceps strength.
Allografts* ; Humans ; Joints ; Knee ; Muscle Weakness ; Patellar Ligament* ; Skin* ; Wounds and Injuries

BACKGROUND/AIMS: Kidney transplantations at our center rely mainly on living donors. The purpose of this study was to suggest future donor supply directions by reviewing changing trends in donor type. METHODS: During the past 40 years, 1,690 kidney transplantations were performed at our center. We divided the follow-up period into four decades and the donor population into three groups: living related, living unrelated, and deceased. We analyzed changing trends in donors from each group for each decade. Patients receiving overseas transplantation were also included. RESULTS: The proportion of living related donors decreased from 84% (54/64) in the 1970s to 61% (281/458) in the 2000s. Living unrelated donors showed a sustained proportion of around 20% after 1990. However, among living unrelated donors, the proportion of spouse donors increased from 4.6% (17/369) in the 1980s to 8.5% (39/458) in the 2000s. Transplants from deceased donors were only 3.3% (12/369) in the 1980s. However the proportion of deceased donors increased gradually, reaching 13.2% (105/799) in the 1990s and 19.9% (91/458) after 2000. Overseas transplantations increased after 2000 and reached 20% of all cases treated in our center during the 2000s. Such transplantations peaked in 2006 and decreased markedly thereafter. CONCLUSIONS: The proportion of each donor type has continuously changed, and the changes were associated with changes in the social structure and system. We expect that this study could be an important reference for other countries to estimate future changes of donor type.
Adult ; Female ; History, 20th Century ; History, 21st Century ; Humans ; Kidney Transplantation/*history/statistics & numerical data/trends ; Korea ; Living Donors/history/statistics & numerical data ; Male ; Middle Aged ; Tissue Donors/*history/statistics & numerical data ; Tissue and Organ Procurement/history/statistics & numerical data/trends

Most of the previous studies on immune dysregulation in end-stage renal disease (ESRD) have focused on T cell immunity. We investigated B cell subpopulations in ESRD patients and the effect of hemodialysis (HD) on B cell-associated immune profiles in these patients. Forty-four ESRD [maintenance HD patients (n = 27) and pre-dialysis patients (n = 17)] and 27 healthy volunteers were included in this study. We determined the percentage of B cell subtypes, such as mature and immature B cells, memory B cells, and interleukin (IL)-10+ cells, as well as B cell-producing cytokines (IL-10, IL-4 and IL-21) by florescent activated cell sorting (FACS). B cell-associated gene expression was examined using real-time PCR and B cell producing cytokines (IL-10, IL-4 and IL-21) were determined using an enzyme-linked immunosorbent assay (ELISA). The percentage of total B cells and mature B cells did not differ significantly among the three groups. The percentages of memory B cells were significantly higher in the pre-dialysis group than in the HD group (P < 0.01), but the percentage of immature B cells was significantly lower in the pre-dialysis group than in the other groups. The percentages of IL-10-expressing cells that were CD19+ or immature B cells did not differ significantly (P > 0.05) between the two subgroups within the ESRD group, but the serum IL-10 concentration was significantly lower in the pre-dialysis group (P < 0.01). The results of this study demonstrate significantly altered B cell-associated immunity. Specifically, an imbalance of immature and memory B cells in ESRD patients was observed, with this finding predominating in pre-dialysis patients.
Adaptor Proteins, Signal Transducing/genetics ; Adult ; Antigens, CD19/metabolism ; B-Lymphocyte Subsets/immunology/metabolism ; B-Lymphocytes/*immunology/metabolism ; Cytokines/biosynthesis ; Female ; Humans ; Immunophenotyping ; Interleukin-10/metabolism ; Kidney Failure, Chronic/*immunology/metabolism ; Leukocytes, Mononuclear/metabolism ; Male ; Middle Aged ; Proto-Oncogene Proteins/genetics ; T-Lymphocytes, Regulatory/immunology/metabolism

This study aimed to investigate the effect of bortezomib in the desensitization and treatment of acute antibody mediated rejection (AAMR) in kidney transplantation. Nine patients who received bortezomib therapy for desensitization (DSZ group, n = 3) or treatment of AAMR (AAMR group, n = 6) were included in this study. In the DSZ group, 2 patients required DSZ owing to positive cross match and 1 owing to ABO mismatch with high baseline anti-ABO antibody titer (1:1,024). Bortezomib was used at 1, 3, 8, and 11 days from the start of the treatment. In the AAMR group, 3 patients showed full recovery of allograft function after bortezomib use and decrease in donor specific anti-HLA antibody (HLA-DSA). However, 3 patients did not respond to bortezomib and experienced allograft failure. In the DSZ group, negative conversion of T-CDC (complement-dependent cytotoxicity) was achieved, and HLA-DSA was decreased to lower than a weak level (median fluorescence intensity [MFI] < 5,000) in 2 patients. In the case of ABO mismatch kidney transplantation, the anti-A/B antibody titer decreased to below the target (< or = 1:16) after bortezomib therapy. Therefore, bortezomib could be an alternative therapeutic option for desensitization and treatment of AAMR that is unresponsive to conventional therapies.
Adult ; Boronic Acids/*therapeutic use ; Desensitization, Immunologic/*methods ; Female ; Graft Rejection/*drug therapy/*prevention & control ; HLA Antigens/immunology ; Humans ; Kidney/surgery ; Kidney Transplantation/*methods ; Male ; Middle Aged ; Pyrazines/*therapeutic use ; Treatment Outcome

PURPOSE: Specimen adequacy and safety of percutaneous ultrasound-guided native kidney biopsies performed by short-term trained nephrology fellows were evaluated. METHODS: The differences in specimen adequacy and safety between nephrology fellow-performed (NP, n=67) and radiologist-performed (RP, n=82) percutaneous ultrasound-guided native kidney biopsies were retrospectively evaluated. RESULTS: The mean age of the patients was 35+/-15 years old, and the M:F ratio was 1.2:1. There were no differences in age, sex, anemia, platelet count and glomerular filtration rate between NP and RP patients. The mean glomerular count was 15.9+/-8.4 in light microscopy and 9.9+/-7.2 in immunofluorescent microscopy. Ninety five percent of biopsy specimens were adequate for pathological diagnosis. Between NP and RP kidney biopsies, there were no differences in the glomerular count in light and immunofluorescent microscopy, percentage of presence of glomeruli in electron microscopy, and the specimen adequacy for the pathological diagnosis. The rates of major and minor complications were 1.5% and 6%, respectively, in NP kidney biopsies. On the other hand, the rate of major complications was 9.8% in RP kidney biopsies, which was significantly higher than that in NP kidney biopsies. The rate of decrease in hemoglobin and hematocrit levels after biopsies was significantly higher in RP biopsies than in NP biopsies. CONCLUSION: Short-term trained nephrology fellows perform percutaneous ultrasound-guided kidney biopsy at a level equal to or superior to radiologists.
Anemia ; Biopsy ; Glomerular Filtration Rate ; Hand ; Hematocrit ; Hemoglobins ; Humans ; Kidney ; Light ; Microscopy ; Microscopy, Electron ; Nephrology ; Platelet Count ; Retrospective Studies