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

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

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

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

BACKGROUND: Although chronic rejection remains the leading cause of late graft failure, the pathophysiology of the phenomena is not completely understood and no specific treatment is available. The new immunosuppressive agent, mycopheonolate mofetil (MMF), has been effective for treatment of acute rejection and acute refractory rejection after renal transplantation. MMF has been thought to have potential effects on chronic rejection because it can inhibit arterial smooth muscle cell proliferation and antibody synthesis and also inhibit lymphocytes recruitment to the inflammatory site by diminishing activity of adhesion molecule. But there have been only a few reports about its effect on chronic rejection. METHODS: Thirty-three renal transplant patients with chronic rejection which was clinically suspected or biopsy proven were enrolled in this study. Patients who have taken azathioprine as one of their immunosuppressive regimen discontinued azathioprine and all patients added MMF to their immunosuppresants. We reduced cyclosporine doses on some patients according to their cyclosporine blood level. Before the change of immunosuppresive regimen, the mean serum creatinine was 1.94+/- 0.37 mg/dl. The mean follow up period after the change of immunosuppresants was 6.57+/- 2.1 months. RESULTS: After this MMF trial, mean serum creatinine was significantly decreased during the follow up period as compared with the pretreatment value (at months 1, 1.82 +/-0.33 mg/dl, at months 3, 1.76 +/-0.38 mg/dl, at months 6, 1.73+/- 0.33 mg/dl; Vs baseline of 1.94+/- 0.37 mg/dl, P<0.05, at respectively). The dosage of cyclosporine, as intended, was significantly reduced from 232 54 mg/dl to 210 51 mg/dl after 6 months observation period (p<0.01). There was no episode of acute rejection after starting MMF with a reduction in cyclosporine. CONCLUSION: With this clinical trial, we propose that MMF may be effective for prevention of progression of chronic rejection. By addition of MMF, we could reduce the cyclosporine doses without risk of acute rejection and we suggest that it may have an important role for prevention of chronic cyclosporine nephrotoxicity.
Azathioprine ; Biopsy ; Creatinine ; Cyclosporine ; Follow-Up Studies ; Humans ; Kidney Transplantation* ; Lymphocytes ; Myocytes, Smooth Muscle ; 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

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

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

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

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