No abstract available.
Calcinosis ; Calcium ; Calcium Gluconate ; Gluconates ; Humans ; Infant, Newborn

Linear atrophoderma of Moulin is a rare acquired atrophic skin condition following the lines of Blaschko. It is characterized by asymptomatic, band-like, hypopigmented atrophoderma, without obvious induration or sclerosis. Usually, the lesions begin in childhood or adolescence and are localized on the trunk or extremities with a unilateral distribution. Extensive lesions with bilateral involvement are extremely rare, and only three cases affecting patients bilaterally have been previously described. We herein present the case of a 17-year-old boy with multiple hyperpigmented atrophic patches, arranged in a linear pattern on both sides of the trunk, right buttock and leg, and left arm.
Adolescent ; Arm ; Buttocks ; Extremities ; Humans ; Leg ; Sclerosis ; Skin

To improve the graft survival in cadaveric donor renal transplantation, various factors that affect the results of allograft function has been analysed and reported. From January 1994 through December 1998, 39 cases of renal transplantation were performed using 20 cadaver donor. Thirty five of them were from brain dead donor and four from cardiac arrest donor. The most frequent cause of brain death was head injury by traffic accident, mostly autobicycle accident. Male donor ratio was 85.0% and their mean age were 29.3 years old. Mean cold ischemic time was 347.5 minutes and warm ischemic time of 4 cardiac arrest cases were 55-60 minutes. The number of HLA mismatch more than 4 were 64.1%. There were 8 cases of multiple renal arteries and 4 cases of double ureter. Donor hypotension during and before kidney procurement and warm ischemic time were factors that cause the delayed graft function in our cases. The number of HLA mismatch and use of Cellcept as immunosuppressant were two factors that affected the development of acute rejection during 6 months after renal allograft. Among the 39 kidneys of 20 donors, 12 paired kidneys showed different graft result in each recipient. Recipient age, number of HLA mismatch, cold ischemic time, duration of hemodialysis before transplantation, and level of hemoglobin were factors that cause the diffrerent result in paired kidney. One and two year graft survival rate were 89.6% and 76.5% respectively. In summary, the early results of our cadaver donor renal transplantation was comparable to living donor transplantation. Adequate donor management and HLA matching between donor and recipient are factors that can improve the graft result.
Accidents, Traffic ; Allografts ; Brain Death ; Cadaver* ; Cold Ischemia ; Craniocerebral Trauma ; Delayed Graft Function ; Graft Survival ; Heart Arrest ; Humans ; Hypotension ; Kidney ; Kidney Transplantation* ; Living Donors ; Male ; Renal Artery ; Renal Dialysis ; Tissue Donors* ; Transplants ; Ureter ; Warm Ischemia

To improve the graft survival in cadaveric donor renal transplantation, various factors that affect the results of allograft function has been analysed and reported. From January 1994 through December 1998, 39 cases of renal transplantation were performed using 20 cadaver donor. Thirty five of them were from brain dead donor and four from cardiac arrest donor. The most frequent cause of brain death was head injury by traffic accident, mostly autobicycle accident. Male donor ratio was 85.0% and their mean age were 29.3 years old. Mean cold ischemic time was 347.5 minutes and warm ischemic time of 4 cardiac arrest cases were 55-60 minutes. The number of HLA mismatch more than 4 were 64.1%. There were 8 cases of multiple renal arteries and 4 cases of double ureter. Donor hypotension during and before kidney procurement and warm ischemic time were factors that cause the delayed graft function in our cases. The number of HLA mismatch and use of Cellcept as immunosuppressant were two factors that affected the development of acute rejection during 6 months after renal allograft. Among the 39 kidneys of 20 donors, 12 paired kidneys showed different graft result in each recipient. Recipient age, number of HLA mismatch, cold ischemic time, duration of hemodialysis before transplantation, and level of hemoglobin were factors that cause the diffrerent result in paired kidney. One and two year graft survival rate were 89.6% and 76.5% respectively. In summary, the early results of our cadaver donor renal transplantation was comparable to living donor transplantation. Adequate donor management and HLA matching between donor and recipient are factors that can improve the graft result.
Accidents, Traffic ; Allografts ; Brain Death ; Cadaver* ; Cold Ischemia ; Craniocerebral Trauma ; Delayed Graft Function ; Graft Survival ; Heart Arrest ; Humans ; Hypotension ; Kidney ; Kidney Transplantation* ; Living Donors ; Male ; Renal Artery ; Renal Dialysis ; Tissue Donors* ; Transplants ; Ureter ; Warm Ischemia

No abstract available.
Carney Complex* ; Hyperplasia* ; Myxoma* ; Nevus, Blue* ; Testis*

PURPOSE: Early arteriovenous fistula (AVF) failure especially during the first several months after fistula creation makes the patient, physician and surgeon frustrated. To evaluate the patency rate of arteriovenous fistulas which were made for hemodialysis, we analyzed three different protocols pre- and peri-operatively in our hospital. METHOD: From January 1983 through December 1998, total 2,078 cases of AVF were done in 1,711 patients. During the first period (from 1983 to 1988, n=280), all of the AVFs were performed with naked eyes but during the second period (from 1989 to 1993, n=770), we used surgical loupe and microvascular anastomosing technique. During the third period (from 1994 to 1998, n=1,028), besides using surgical loupe, patients were treated peri-operatively with certain volumes of fluid to maintain the systolic blood pressure above 100 mmHg, venogram and duplex sonogram to identify an available vein before AVF creation, aggressive salvage procedures and use of aspirin after fistula creation. RESULT: There were no differences between each periods in their age distribution, sex ratio, serum creatinine level, associated diabetes mellitus and hemoglobin level except significantly low incidence of hypotension at the time of operation in period 3. The early fistula failure rate at 3 months decreased in period 2, 3 than period 1 (6.9%, 6.7% vs 12.7%) and showed statistical significance (p<0.05). The rate of fistulas that is patent more than 3 months and continued at the end of 12 months were no difference between the periods. Frequency of re-AVF within 3 months in period 1 was significantly higher than period 2, 3 which suggested improved early patency in later periods. The center ability to manage the created AVF checked by rate of re-AVF showed significant difference between our hospital and other local dialysis centers. The patency of primary AVF in each period was 69.7%, 75.2%, 77.5% at one year but that of re-AVF were 77.7%, 86.3% and 80.2%. CONCLLUSION: Microsurgical technic under surgical loupe improved primary AVF patency and decreased early failure rate. Also a protocoled perioperative management, improved management skill and experiences of dialysis center might decrease the re-AVF rate.
Age Distribution ; Arteriovenous Fistula* ; Aspirin ; Blood Pressure ; Creatinine ; Diabetes Mellitus ; Dialysis ; Fistula ; Humans ; Hypotension ; Incidence ; Renal Dialysis ; Sex Ratio ; Veins

Invasive opportunistic infection by Aspergillus fungus is life-threatening for kidney transplant recipients. The occurrence of aspergillosis by hematogenous dissemination can affect multiple organs. Despite having a lower incidence rate relative to bacterial or viral infections in kidney transplant recipients, fungal infections produce the highest number of mortalities. We report a simultaneous case of invasive aspergillosis in the lung and liver of a 52-year-old female patient who underwent living donor kidney transplant. She suffered massive blood loss and high-volume transfusions due to postoperative bleeding. One month after transplantation, she reported intermittent coughing without febrile sensation. Computed tomography revealed nodules on the right and left upper lobes of the lung and multiple cystic liver lesions. Based on pathologic findings and culture from aspirate, she was diagnosed with invasive aspergillosis involving the liver and lung. After a 4 month voriconazole treatment the nodules in the lung and liver disappeared.
Aspergillosis ; Aspergillus ; Cough ; Female ; Fungi ; Hemorrhage ; Humans ; Incidence ; Kidney ; Kidney Transplantation ; Liver ; Living Donors ; Lung ; Middle Aged ; Opportunistic Infections ; Pyrimidines ; Sensation ; Transplants ; Triazoles

BACKGROUND: The incidence of acute rejection has decreased with the introduction of new immunosuppressive agents. However, several studies have shown that allograft survival has not clearly improved over the past few decades. METHODS: We reviewed patients who underwent kidney transplantation between 1982 and 2007. We compared the causes of graft loss for three decades: 1982~1990 (period I),1991~2000 (period II), and 2001~2007 (period III), with the clinical characteristics of patients with functioning grafts and patients who lost their allografts. RESULTS: There were 785 recipients with a mean age of 36.1 years, and 65.2% were male. Graft loss occurred in 329 patients (41.9%), and the most common cause of graft loss was chronic allograft nephropathy (CAN, 52.0%), followed by patient death (17.6%), post-transplant glomerulonephritis (12.8%), and non compliance (7.9%). During the three time periods, 129, 172, and 28 patients lost their grafts, respectively. Five-year graft survival was 61.5%, 78.4%, and 90.8%, respectively, and increased significantly (P<0.000). CAN, as a cause of graft loss, fell from 65.1% (period I) to 32.1% (period III, P<0.000), but patient death increased from 12.4% to 32.1% (P=0.034). A multivariate analysis revealed that significant risk factors for graft loss included an older donor, transplantation at period I, and dual immunosuppression. Use of tacrolimus and mycophenolate mofetil was associated with a significantly reduced risk of graft loss. CONCLUSIONS: Graft survival has increased over the last three decades whereas the proportion of CAN, the most common cause of graft loss, has decreased. Attention to the main causes of graft loss, CAN, and patient death will offer potential improvement in graft survival.
Compliance ; Glomerulonephritis ; Graft Rejection ; Graft Survival ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Incidence ; Kidney ; Kidney Transplantation ; Male ; Multivariate Analysis ; Mycophenolic Acid ; Rejection (Psychology) ; Risk Factors ; Tacrolimus ; Time Factors ; Tissue Donors ; Transplantation, Homologous ; Transplants ; Treatment Outcome

A spontaneous subcapsular hematoma in an allograft kidney is a rare condition with only a few cases reported in the literature. Common causes of subcapsular hematoma of an allograft include trauma, post-biopsy status, occult malignancy, vascular diseases, and infection. Chronic allograft dysfunction related to spontaneous subcapsular hematoma is extremely rare. We report a case of spontaneous subcapsular hematoma in a patient who underwent a renal transplant 14 years ago in which we could not find an associated condition.
Hematoma ; Humans ; Kidney ; Transplantation, Homologous ; Transplants ; Vascular Diseases

PURPOSE: This study was planned to determine the efficacy and safety of mycophenolate mofetil (MMF) as a rescue treatment in patients with membranous nephropathy (MN) and focal segmental glomerulosclerosis (FSGS) who were not responsive to standard therapy with steroid and immunosuppressive regimen. METHODS: We planned a prospective, non-randomized study from Oct. 2002 to Aug. 2009, including biopsy-proven MN or FSGS patients in Keimyung university Dongsan hospital. MMF was initiated at 0.5-0.75 g twice daily, and advanced as appropriate or as tolerated to 0.75-1 g twice daily. RESULTS: 14 cases with MN and 5 cases with FSGS was enrolled. The mean age of patients was 51.7+/-12.3 years, and mean treatment duration was 14.4+/-6.5 months. Five patients (26.4%) went into complete remission and the seven (36.8%) into partial remission. The mean value of 24hr total urine protein over the follow-up 6 months' period declined significantly from 7.6+/-6.2 g in pre-treatment, to 4.1+/-3.2 g in 3 months, and 3.1+/-2.1 g in 6 months (p=0.011). The mean 24hr total urine protein decreased from 7.5+/-6.3 g in pre-MMF to 1.9+/-1.8 g in post-MMF (p=0.001). The mean serum albumin rose from 3.2+/-0.8 g/dL in pre-MMF to 3.9+/-0.5 g/dL in post-MMF (p=0.001). There were no significant changes in mean value for WBC, hemoglobin, serum creatinine, and total cholesterol. Side effects of MMF were infrequent and generally mild. CONCLUSION: MMF appears effective in 63% of patients with MN and FSGS who are resistant to other forms of treatment. Studies with more cases and multicenter controlled trials are required to establish the role and standards of MMF in these disorders.
Cholesterol ; Creatinine ; Follow-Up Studies ; Glomerulonephritis, Membranous ; Glomerulosclerosis, Focal Segmental ; Hemoglobins ; Humans ; Mycophenolic Acid ; Prospective Studies ; Serum Albumin