BACKGROUND: Identification of the genes expressed differentially in renal cell carcinoma (RCC)but not in the non-cancerous kidney is important for understanding the molecular basis ofrenal cell carcinoma and for defining possible prognostic value and therapeutic intervention.We investigated the changes in gene expression accompanying the development and progression of kidney cancer by cDNA microarrays. METHODS: To identify molecular alterations in renal cell carcinoma, we measured expression profiles for paired neoplastic and noncancerouskidney samples from an individual by means of a cDNA microarry representing 7, 500genes. Of the differentially expressed genes, we assessed the decorin gene at the proteinlevel using immunohistochemistry. RESULTS: The 60 genes were noted to have more than a fivefold change in expression (either increased or decreased) in RCC compared to the noncancerouskidney. The changed genes are those associated with signal transduction, metabolizingenzymes, the cytoskeleton, cell adhesion, cell cycle control, modulation of transcription, the tumor suppressor gene and tumor antigens. Under immunohistochemistry, the expressionof decorin was significantly decreased in the tumor than in the non-cancerous kidney.The expression rate of decorin was not associated with the patient's sex, age, histologic type, Fuhrmann nuclear grade and T stage. CONCLUSION: The author predicted that these geneexpression profiling experiments will lead to improvements in the basic understanding of renaltumor pathogenesis and will promote the discovery of novel molecular markers for renal tumordiagnosis and therapy.
Antigens, Neoplasm ; Carcinoma, Renal Cell* ; Cell Adhesion ; Cell Cycle Checkpoints ; Cytoskeleton ; Decorin* ; DNA, Complementary* ; Gene Expression* ; Genes, Tumor Suppressor ; Immunohistochemistry ; Kidney ; Kidney Neoplasms ; Oligonucleotide Array Sequence Analysis* ; Signal Transduction

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

Iodinated contrast-induced acute renal failure is estimated to occur in 0.15 to 2% of all patients undergoing contrast imaging studies. Incidence is higher in patients with renal insufficiency, diabetes mellitus, dehydration, multiple myeloma, congestive heart failure, advanced age. We here report successful vascular interventional procedure by using gadopentetate dimeglumine(Gd-DTPA) as a contrast agent in a patient with chronic renal insufficiency and right superficial femoral artery stenosis. The patient had a history of iodinated contrast-induced acute renal failure. Gd-DTPA(0.17mmoVkg) diluted 1: 1 with 0.9% norrnal saline was used as contrast agent for the interventional procedure. Percutaneous transluminal angioplasty was successfully performed and there was no evidence of contrast material- induced acute renal failure after the procedure. Gd- DTPA is an alternative contrast agent for patients with chronic renal insufficiency.
Acute Kidney Injury ; Angioplasty* ; Constriction, Pathologic ; Dehydration ; Diabetes Mellitus ; Femoral Artery ; Gadolinium DTPA* ; Heart Failure ; Humans ; Incidence ; Multiple Myeloma ; Pentetic Acid ; Renal Insufficiency ; Renal Insufficiency, Chronic*

Adult ; Case Report ; Goodpasture Syndrome/physiopathology ; Goodpasture Syndrome/complications* ; Hemoptysis/etiology* ; Human ; Kidney/physiopathology ; Male

Polyurethane foam dressings are becoming widely used in partial and full thickness skin wounds since they are safe and convenient for both patients and physicians. However, the influence of polyurethane foam dressings on epithelialization has not been fully determined yet. This study was designed to compare 2 internationally available polyurethane foams and 3 locally made polyurethane foams as to their effects on the epithelialization in vivo. Twenty white rats were used. A 5 mm punch was employed to excise skin and subcutaneous tissue in a round fashion at six sites in the back area of 10 rats. After creating 6 open wounds, above mentioned 5 polyurethane foams and gauze dressings were applied. On the 5th day the lengths of the nonepithelialized area were measured under light microscope. In addition, partial thickness wounds were created using carbon dioxide laser at six sites on the back of the another 10 rats. Six dressings were applied on the wounds as same as above. On the 4th day the degree of the epithelialization was measured and compared. In full thickness wound study the best wound closing was also seen in chitin mixed Medifoam-N group. In partial thickness wound study the best epithelialization was seen in chitin mixed Medifoam-N and chitosan mixed Medifoam-N groups. These results demonstrated that polyurethane foam dressings influenced the epithelialization, and chitin mixed Medifoam-N showed the best result.
Animals ; Bandages* ; Chitin ; Chitosan ; Humans ; Lasers, Gas ; Polyurethanes* ; Rats* ; Skin ; Subcutaneous Tissue ; Wounds and Injuries

Although infectious diseases are frequent in systemic lupus erythematosus, salmonella osteomyelitis is rarely reported. We here report an unusual case of salmonella osteomyelitis with osteonecrosis in a patient with systemic lupus erythematosus. A 29-year old woman with systemic lupus erythematosus was admitted to our hospital because of a painful swelling of right knee joint. She had been taking steroid and cyclophosphamide for 4 months because of diffuse membranous proliferative lupus nephritis. MRI showed both osteonecrosis of the right distal femur and osteomyelitis of the right proximal tibia. The abscess culture demonstrated almonella species (non typhoidal). The infection was treated successfully by a combination of surgical drainage and intravenous ceftriaxone.
Abscess ; Adult ; Ceftriaxone ; Communicable Diseases ; Cyclophosphamide ; Drainage ; Female ; Femur ; Humans ; Knee Joint ; Lupus Erythematosus, Systemic* ; Lupus Nephritis ; Magnetic Resonance Imaging ; Osteomyelitis* ; Osteonecrosis* ; Salmonella Infections ; Salmonella* ; Tibia

Gastrointestinal stromal tumors (GISTs) were recently defined as spindle cell, epithelioid, or occasionally, pleomorphic mesenchymal tumors of the gastrointestinal tract that express the CD117 (proto-oncogene c-kit protein, stem cell factor receptor), as detected using immunohistochemistry. And they show a new tendency to include the CD117-positive mesenchymal spindle cell or epithelioid neoplasms primary in the omentum and mesentery, and is so termed extragastrointestinal stromal tumors (EGISTs). Omental EGISTs are very rare and similar to their gastrointestinal counterpart. We present a case of primary EGIST of the greater omentum in a 58-year-old man. The resected tumor mass measured 20X15X5 cm and weighed 1,150 g. The cut surface displayed a central cystic change and partial mural nodules. Microscopically, most parts of the tumor were composed of round or polygonal cells, with many of them containing perinuclear vacuoles. The mitotic count was less than one per 50 high-power-fields. Immunohistochemically, the tumor cells were diffusely positive for CD117 and vimentin, and focally for smooth muscle actin and CD34. Ultrastructurally, partially smooth muscle differentiation was confirmed in this case.
Actins ; Epithelioid Cells ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans ; Immunohistochemistry ; Mesentery ; Middle Aged ; Muscle, Smooth ; Omentum* ; Proto-Oncogene Proteins c-kit ; Stem Cell Factor ; Vacuoles ; Vimentin

We report an uncommon case of pyogenic hepatic abscess with hepatobronchial fistula. A 59 year-old male was admitted because of purulent sputum and cough. Ultrasonography and abdominal computed tomography showed an abscess on the superior segment of right hepatic lobe. Diagnostic and therapeutic percutaneous trans-hepatic abscessography disclosed hepatobronchial fistula. Liver abscess with hepatobronchial fistula was managed with percutaneous abscess drainage and antibiotics. The abscess was resolved and he is being on the follow-up with symptom free status.
Abscess ; Anti-Bacterial Agents ; Cough ; Drainage ; Fistula* ; Follow-Up Studies ; Humans ; Liver Abscess* ; Liver Abscess, Pyogenic ; Liver* ; Male ; Middle Aged ; Sputum ; Ultrasonography

We report an uncommon case of pyogenic hepatic abscess with hepatobronchial fistula. A 59 year-old male was admitted because of purulent sputum and cough. Ultrasonography and abdominal computed tomography showed an abscess on the superior segment of right hepatic lobe. Diagnostic and therapeutic percutaneous trans-hepatic abscessography disclosed hepatobronchial fistula. Liver abscess with hepatobronchial fistula was managed with percutaneous abscess drainage and antibiotics. The abscess was resolved and he is being on the follow-up with symptom free status.
Abscess ; Anti-Bacterial Agents ; Cough ; Drainage ; Fistula* ; Follow-Up Studies ; Humans ; Liver Abscess* ; Liver Abscess, Pyogenic ; Liver* ; Male ; Middle Aged ; Sputum ; Ultrasonography

PURPOSE: To analyze the controversies surrounding therapeutic decision-making and the withholding of life- sustaining treatments, values held concerning therapeutic interventions of terminal cancer patients are compared between physicians and family members. MATERIALS AND METHODS: 42 advanced or terminal stage cancer patients were enrolled for the study. The questionnaires were administered to the duty doctor and the family of the patients. Questions included whether to use new agents with a 15% partial efficacy and whether to use opioid analgesics, intravenous nutrition, a feeding tube, antibiotics, and hemodialysis. Additionally, we asked about the administration of CPR, ventilator application, and euthanasia. If the family permitted, the same questionnaires were given to the patients. RESULTS: Of the 42 cases, 5 families refused to answer the questionnaire. Of the available 37 families, only 5 families permitted access to the patients. Of the 5 patients, 2 patients refused the questionnaire. Only 67.6% and 8.1% of families and the patients clearly understood the stage of cancer. The use of a new agent was accepted by 45.2% of the physicians and 45.9% of the families. The rankings of the acceptance of treatment in the physicians and in the families were similar. The concordance rate between the physicians and the families was lowest on ventilator application and CPR. 31% of the physicians and 43.2% of the families agreed on the issue of euthanasia. CONCLUSION: Values held on issues like therapeutic decision-making and the withholding of life-sustaining treatments in terminal cancer patients are discordant between physicians and family members. In order to resolve controversies on the role of physicians in end-of-life decisions, the values of physicians as well as patients and their family members should be considered in the final decision-making process.
Analgesics, Opioid ; Anti-Bacterial Agents ; Cardiopulmonary Resuscitation ; Euthanasia ; Humans ; Medical Futility ; Renal Dialysis ; Ventilators, Mechanical ; Withholding Treatment ; Surveys and Questionnaires