No abstract available.
Hernia, Inguinal* ; Humans ; Peritoneal Dialysis, Continuous Ambulatory* ; Radionuclide Imaging*

Although spontaneous bacterial peritonitis is a frequent complication in the childhood nephrotic syndrome, it is very rare in adults with nephrotic syndrome. It frequently develops when the patients are either in relapse or receiving steroid therapy at the time peritonitis is diagnosed. We report an unusual case of a spontaneous bacterial peritonitis as the presenting feature in a 15-year-old male patient with nephrotic syndrome. He presented with diffuse abdominal pain and distension for 15 days. Abdominal paracentesis revealed the diagnostic laboratory findings of peritonitis, and the bacterial culture of the ascites showed a mixed growth of Escherichia coli and Pseudomonas aeruzinosa. His serum albu- min level was 1.6gldL and the amount of 24 hours proteinuria was 21.0g/day. Although he was treated with adequate antibiotics for 3 weeks, the peritonitis was more aggravated. We decided to insert a catheter into the peritoneal cavity for continuous drainage of the intractable ascites. Two weeks after drainage, the peritonitis improved as the peritonitis subsided, the proteinuria disappeared completely without a steroid therapy. Six months after spontaneous remission, the proteinuria have recurred, and the kidney biopsy then showed focal segmental glomerulorsclerosis.
Abdominal Pain ; Adolescent ; Adult ; Anti-Bacterial Agents ; Ascites ; Biopsy ; Catheters ; Drainage ; Escherichia coli ; Humans ; Kidney ; Male ; Nephrotic Syndrome* ; Paracentesis ; Peritoneal Cavity ; Peritonitis* ; Proteinuria ; Pseudomonas ; Recurrence ; Remission, Spontaneous

No abstract available.
Glomerulonephritis, Membranous* ; Small Cell Lung Carcinoma*

PURPOSE: Kidney size (KS) is used to diagnose the patients with renal disease. When the length of a kidney is measured under 9 cm, it is considered to indicate an irreversible disease. Because glomerular filtration rate (GFR) decreases with age, the normal range of KS in the elderly is indefinite. Therefore, we measured KS in adults older than 80 years old and investigated correlated factors. METHODS: One hundreds six adults (51 men, 55 women: mean age 83+/-0.3) without renal disease were included. Their serum creatinine (Scr) levels did not exceed 1.3 mg/dL, and the calculated GFR were over 60 mL/min/1.73m2. Abdominal ultrasonography were performed to all of them and their body indexes (BI) were measured. RESULTS: 1) The mean length of kidney was 9.9+/-0.07 cm. 2) KS in the early eighties was larger than that of adults over ninety. 3) KS showed negative correlations with age and Scr, but a positive correlation with body surface area . 4) The calculated GFR showed correlations with the surface areas of both kidney (BK) by C-G equation and with the size of BK by MDRD equation. 4) The GFR calculated by MDRD and C-G equation presented inverse correlations with Scr, but only MDRD equation showed a statistic significance. CONCLUSION:In the elderly, KS may be smaller than that of younger adults. Other factors such as either surface area or volume of BK and BI should be considered to estimate the individual KS to decide whether the size is within normal range.
Adult ; Aged ; Body Size ; Body Surface Area ; Creatinine ; Glomerular Filtration Rate ; Humans ; Kidney ; Male ; Organ Size ; Reference Values

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

Laparoscopic vascular surgery has not been widely embraced by vascular surgeons because of the specific technical skills needed in performing vascular anastomosis. Robot assisted vascular surgery has shown the possibility to overcome several limitations of laparoscopic vascular surgery in previous studies. We report two cases of robot assisted aortofemoral bypass grafting for aortoiliac occlusive disease. Two male patients, 65 and 62 years old were admitted complaining of disabling claudication. CT angiography revealed total occlusion of left iliac artery and bilateral superficial femoral arteries in one case and concentric stenosis of lower abdominal aorta, severe occlusion of left common iliac artery in the other case. Laparoscopic aortofemoral bypass grafting was performed with a proximal end-to-side anastomosis constructed with robotic arms using Dacron graft. Femoral anastomosis was performed in the conventional method. The aortic clamping times were 80 and 198 minutes and operating times were 435 and 605 minutes, respectively. The patients were discharged uneventfully on postoperative days 20 and 13. Robot assisted vascular surgery is a technically feasible and safe procedure.
Angiography ; Aorta, Abdominal ; Arm ; Constriction ; Constriction, Pathologic ; Femoral Artery ; Humans ; Iliac Artery ; Male ; Polyethylene Terephthalates ; Transplants

We developed nomograms to predict disease recurrence in patients with Ta, T1 transitional cell carcinoma of the bladder. Thirty-eight training hospitals participated in this retrospective multicenter study. Between 1998 and 2002, a total of 1,587 patients with newly diagnosed non-muscle invasive bladder cancer were enrolled in this study. Patients with prior histories of bladder cancer, non-transitional cell carcinoma, or a follow-up duration of less than 12 months were excluded. With univariate and multivariate logistic regression analyses, we constructed nomograms to predict disease recurrence, and internal validation was performed using statistical techniques. Three-year and five-year recurrence-free rates were 64.3% and 55.3%, respectively. Multivariate analysis revealed that age (hazard ratio [HR]=1.437, p<0.001), tumor size (HR=1.328, p=0.001), multiplicity (HR=1.505, p<0.001), tumor grade (HR=1.347, p=0.007), concomitant carcinoma in situ (HR=1.611, p=0.007), and intravesical therapy (HR=0.681, p<0.001) were independent predictors for disease recurrence. Based on these prognostic factors, nomograms for the prediction of disease recurrence were developed. These nomograms can be used to predict the probability of disease recurrence in patients with newly diagnosed Ta, T1 transitional cell carcinoma of the bladder. They may be useful for patient counseling, clinical trial design, and patient follow-up planning.
Aged ; Carcinoma in Situ/diagnosis/epidemiology ; Carcinoma, Transitional Cell/*diagnosis/*epidemiology ; Disease-Free Survival ; Female ; Humans ; Male ; Multivariate Analysis ; *Nomograms ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Recurrence ; Regression Analysis ; Reproducibility of Results ; Urinary Bladder Neoplasms/*diagnosis/*epidemiology

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

Acute infection increases disease activity in patients with systemic lupus erythematosus(SLE) and causes life threatening complication such as acute renal failure or ischemic bowel disease. We here report a case of acute renal failure and ischemic bowel disease complicated by acute pyelonephritis in a patient with SLE. A 19-year-old woman was admitted for high fever and right flank pain. Urine examination revealed acute pyelonephritis. Thrombocytopenia, proteinuria, positive antinuclear antibody and anti-dsDNA, false positive VDRL confirmed SLE. The pyelonephritis improved with antibiotic treatment, but oliguria and abdominal pain and ascites newly developed. Kidney biopsy and abdominal computed tomography revealed lupus nephritis type IV and ischemic bowel disease, respectively. After methylprednisolone and cyclophosphamide treatment, the patient improved.
Abdominal Pain ; Acute Kidney Injury* ; Antibodies, Antinuclear ; Ascites ; Biopsy ; Cyclophosphamide ; Female ; Fever ; Flank Pain ; Humans ; Kidney ; Lupus Erythematosus, Systemic* ; Lupus Nephritis ; Methylprednisolone ; Oliguria ; Proteinuria ; Pyelonephritis* ; Thrombocytopenia ; Young Adult

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