No abstract available.
Immunosuppression* ; Prognosis* ; Transplantation*

We report our experience of endoluminal expandable stent placement for the treatment of post- transplant renal artery stenosis. Fourty years old male patient, underwent living donor renal allograft 16 months ago, was admitted due to uncontrollable hypertension and gradual graft dysfunction. On the past history, he had had acute rejection at post-transplant day 4 and it had been treated successfully with steroid pulse therapy. After then, he have been relatively doing well and the graft function has shown normal with serum creatinine of 1.1 mg/dl. His blood pressure has been marked 140/90 mmHg, which has been well controlled with amlodipine (calcium channel blocker) and atenolol (beta blocker). On the physical examination, there was no briut on the iliac fossa and blood pressure was 190/110 mmHg. Serum creatinine was 2.0 mg/dl and blood renin level showed 15.61 ng/ml in supine postion, 11.51 ng/ml in erect postion, which were about 10 times above the normal range, respectively. With the impression of post-transplant renal artery stenosis, angiography was performed. The angiogram showed nearly complete transplant renal artery stenosis(about 90% of the lumen) at the anastomotic site. Expandable metal stent was indwelled successfully into the endolumen of transplant renal artery. After this precedure, the blood pressure of this patient was down to 130/80 mmHg and serum creatinine was stabilized to 1.1 mg/dl. Percutaneous endoluminal stent procedures for resistant transplant renal artery stenosis is promising. Longer follow-up periods are necessary for true evaluation of this procedure.
Allografts ; Amlodipine ; Angiography ; Atenolol ; Blood Pressure ; Creatinine ; Follow-Up Studies ; Humans ; Hypertension ; Living Donors ; Male ; Physical Examination ; Reference Values ; Renal Artery Obstruction* ; Renal Artery* ; Renin ; Stents* ; Transplants

We report our experience of endoluminal expandable stent placement for the treatment of post- transplant renal artery stenosis. Fourty years old male patient, underwent living donor renal allograft 16 months ago, was admitted due to uncontrollable hypertension and gradual graft dysfunction. On the past history, he had had acute rejection at post-transplant day 4 and it had been treated successfully with steroid pulse therapy. After then, he have been relatively doing well and the graft function has shown normal with serum creatinine of 1.1 mg/dl. His blood pressure has been marked 140/90 mmHg, which has been well controlled with amlodipine (calcium channel blocker) and atenolol (beta blocker). On the physical examination, there was no briut on the iliac fossa and blood pressure was 190/110 mmHg. Serum creatinine was 2.0 mg/dl and blood renin level showed 15.61 ng/ml in supine postion, 11.51 ng/ml in erect postion, which were about 10 times above the normal range, respectively. With the impression of post-transplant renal artery stenosis, angiography was performed. The angiogram showed nearly complete transplant renal artery stenosis(about 90% of the lumen) at the anastomotic site. Expandable metal stent was indwelled successfully into the endolumen of transplant renal artery. After this precedure, the blood pressure of this patient was down to 130/80 mmHg and serum creatinine was stabilized to 1.1 mg/dl. Percutaneous endoluminal stent procedures for resistant transplant renal artery stenosis is promising. Longer follow-up periods are necessary for true evaluation of this procedure.
Allografts ; Amlodipine ; Angiography ; Atenolol ; Blood Pressure ; Creatinine ; Follow-Up Studies ; Humans ; Hypertension ; Living Donors ; Male ; Physical Examination ; Reference Values ; Renal Artery Obstruction* ; Renal Artery* ; Renin ; Stents* ; Transplants

A microemulsion cyclosporine(Me-CsA) was developed and became available with more predictable whole blood CsA concentration and minimal inter- and intra-personal variability in daily dosage of CsA. We prospectively performed this study to assess 1) the ability of Me-CsA maintaining the adequate predefined therapeutic level and 2)long-term safety and tolerability of Me-CsA in kidney transplant recipients. A total of 123 renal transplant patients were enrolled on the Me-CsA group, who have been on Me-CsA as an initial main immunosuppressant since their transplantation. This group of patients were compared to 200 renal transplant patients on conventional cyclosporine(Con-CsA) as a historical control group(Con-CsA group). There were no differences in the methods of operation, induction immunosuppression, the strategies of maintenance immunosuppression and anti-rejection therapy between these two groups. The clinical status and laboratory values were monitored at 1,3,6,9, and 12 months after the kidney transplantation. There were no statistical differences in acute rejection episodes, serum creatinine level, and graft failure and survival rate between Con-CsA and Me-CsA groups. In this study, we could demonstrate the significant fluctuation of the mean values of daily dosage and whole blood trough level and their standard deviations of cyclosporine in Con-CsA group compare to those of Me-CsA group. We also could demonstrate early stabilization of CsA blood trough level in patients using Me-CsA. These results mean that Me-CsA has less interpersonal variations than Con-CsA. In conclusion, Me-CsA has more predictable pharmacodynamic characteristics than Con-CsA and comparable tolerability and safety to Con-CsA with no additional side effects.
Allografts* ; Creatinine ; Cyclosporine* ; Follow-Up Studies* ; Humans ; Immunosuppression ; Kidney ; Kidney Transplantation ; Prospective Studies ; Survival Rate ; Transplantation ; Transplants

In this study, we evaluated the safety and efficacy of mycophenolate mofetil(MMF) for the prevention of acute rejection episodes when given in combination with cyclosporine and corticosteroids during the first 6 postoperative months in living donor kidney transplantation. One hundred patients were enrolled; 50 patients received dual immunosuppression (cyclosporine+corticosteroids: control group) and another 50 patients received triple regimen including MMF 2 g/day(cyclosporine+corticosteroids+MMF: study group) through randomization. In the protocol, first-line treatment for acute rejection was a high-dose steroid pulse therapy. Steroid resistant acute rejection was to be treated with polyclonal antilymphocyte agents(ATG). There was no demographic difference between study and control groups. There were 7(14%) acute rejection episodes in the study group and 16(32%) in the control group with statistical significance. Two cases of premature withdrawal were developed in the study group(one severe abdominal pain and another profound leukopenia). The incidence of opportunistic infection was 7(14%) in the study group and 6(12%) in the control group within 6 months post transplantation. There was no statistical differences in serum creatinine level between study and control group at 6 months after transplantation(1.28+/-0.33 mg/dl vs. 1.24+/-0.51 mg/dl). The addition of MMF to a dual immunosuppressive regimen with cyclosporine and corticosteroids seems to lower the incidence and severity of acute rejection in living donor kidney transplantation during the early post-transplantation period. The graft function of the MMF group is comparable with that of the control group. The most common adverse effect of MMF was abdominal pain and diarrhea but almostly resolved with symptomatic treatment. If the frequency of acute rejection during the first 6 months is one of the main determinants of long-term graft survival, it might be expected that MMF could lead to an improved graft survival in combination with cyclosporine and corticosteroids.
Abdominal Pain ; Adrenal Cortex Hormones ; Allografts* ; Creatinine ; Cyclosporine ; Diarrhea ; Graft Survival ; Humans ; Immunosuppression ; Incidence ; Kidney Transplantation ; Living Donors* ; Opportunistic Infections ; Prospective Studies* ; Random Allocation ; Transplants

We report a case of dilated pare of Winer occuring in a 33-year-oid female patient. Dilated pore belongs to adenoma or organoid group of benign hair differentiation tumors. The patient has had a giant comedone on the right submandibular area for 1 month. Histopathologic features revealed rnarkedly dilated pilar infundibulum lined by epidermis that is atrophic near the ostium but hypertrophic deeper in the cystic cavity. Three months after excisional biopsy, there was no recurrence.
Adenoma ; Biopsy ; Epidermis ; Female ; Hair ; Humans ; Organoids ; Recurrence

Iliac vein compression syndrome is a rare clinical condition in which left common iliac vein is anatomically compressed between right common iliac artery and the fifth lumbar vertebrae or pelvic brim. Patients usually have marked edema of the left leg. Although the actual incidence is unknown, this syndrome most affects women in the second to fourth decade of life. We report 4 cases of iliac compression syndrome treated by surgical intervention during the last fifteen-year period. Among them, two women have suffered from chronic intermittent swelling and pain of left leg, and two men had acute or subacute symptoms. The fibrous web in the entrance of left iliac vein into vena cava existed in one case. Including this one, two were treated by transposition of iliac artery or vein with thrombectomy. One was decompressed the arterial compression by mobilization or adhesiolysis of the surrounding vessles with thrombectomy. To the last one in which the distal common iliac vein was compressed by tortous dilated left internal iliac artery, transsection and ligation of the internal iliac artery was performed. All patients have experienced improved left leg condition after operation. except the last one in which suffered from thrombosis of left popliteal vein after the iliac decompression.
Decompression ; Edema ; Female ; Humans ; Iliac Artery ; Iliac Vein ; Incidence ; Leg ; Ligation ; Lumbar Vertebrae ; Male ; May-Thurner Syndrome ; Popliteal Vein ; Thrombectomy ; Thrombosis ; Veins

One hundred gastric cancer patients who underwent total gastrectomy and Roux-en-Y, end-to-side esophagojejunostomy by using stapling devices were analyzed with regard to their operative results. The median time required for the anastomosis was 18 minutes (range of 15 to 45 minutes). A cartridge of 25 mm in diameter was preferred (85% of 25 mm vs. 15% of 28 mm). In 92 patients, procedures were uneventful. Intraoperative problems happened in 8 patients: Two misfirings of stapler due to mechanical problems, in 6 patients, doughnut tissues were incomplete. Mechanical problems were solved by a change of the stapler and for incomplete doughnut tissues, anastomosis was simply reinforced (2 cases) or reanastomosed with restaplings (4 cases). Anastomotic leakage occurred in 2 patients but it was seen only in radiological studies. During the follow up period, two cases of anastomotic stricture were found and they were treated with endoscopic dilatations. There was no operative mortality nor other complication. In addition, routine use of the Levin tube after total gastrectomy was appraised by comparing postoperative courses. Twenty patients were randomly divided into two groups; for 10 patients the Levin tube was removed at the recovery room and for another 10 patients the Levin tube was indwelled until peristalsis returned. Timing of the tube removal did not affect the duration of the hospital stay and starting day of oral intake. We think that the stapler, when properly used, can facilitate the esophagojejunostomy safely and routine use of the Levin tube after total gastrectomy may be unnecessary.
Adult ; Aged ; *Anastomosis, Roux-en-Y ; *Esophagostomy ; Female ; *Gastrectomy ; Human ; *Jejunostomy ; Male ; Middle Age ; *Surgical Staplers

Small bowel transplantation is the most rapidly evolving area of the solid organ transplantation. Pathophysiologic nature of the intestinal failure leads various surgical options performing intestinal transplantation, e.g. isolated intestine, liver and intestine, and multivisceral transplantation. Because of high dosing of immunogenic tissue from the allograft, prevention and treatment of the acute rejection is still one of the main hurdles to improve clinical outcome after transplantation. With the contribution of refining surgical skills, novel immunosuppressive therapy, and upgraded patient management before and after transplantation, clinical outcome has been improved significantly for last decade. The indication of the intestinal transplantation, however, still remained to use this novel treatment option as a life- saving procedure in intestinal failure patients and not to be justified for pre-emptive intestinal transplantation. Intestinal or multivisceral transplantation has so many unveiled areas, which warrants additional vigorous study.
Allografts ; Humans ; Intestines ; Liver ; Organ Transplantation ; Transplants

BACKGROUND: Several abnormalities of the autonomic regulation of the heart have been noted after acute myocardial infarction(AMI). Measurement of heart rate(HR) variability has been reported to provide indirect, noninvasive estimate of the cardiac efferent parasympathetic activity. The purposes of this study were to get the information on heart rate variability after AMI and to determine its relation to clinical and hemodynamic data. METHODS: We measured HR variability in 28 patients(23 men and 5 women : mean age, 56.6+/-10.4 years) 3-15days after AMI, in 25 patients with unstable angina and in 21 normal subjects by using triangular interpolation of the frequency distribution histogram om normalto-normal RR intervals from Holter tapes. RESULTS: HR variability was lower in AMI than unstable angina patients(357.9+/-118.6 versus 426.1+/-122.5 msec : p<0.05) and normal subjects(525.1+/-137.4 msec : p<0.025). There was no difference for infarct site, thrombolytic therapy, presence of Q-wave. HR variability was significantly related to mean 24-hour HR, left ventricular ejection fraction(all p<0.0001), left ventricular end diastolic diameter(p<0.05). HR varability was lower in patients belonging to Killip class 2-4 and who reqired the use of diuretics or digitalis(all p<0.05). CONCLUSION: After AMI, HR variabillity was reduced and significantly related to clinical and hemodynamic indexes of severity. Measurement of HR variability early after AMI may offer important clinical information for the early high stratification of patients.
Angina, Unstable ; Autonomic Nervous System ; Diuretics ; Female ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Male ; Myocardial Infarction* ; Thrombolytic Therapy