Chronic Aorto-Iliac Occlusive Disease (CAIOD) commonly occurs in conjunction with obstruction in the femoral and popliteal arteries, resulting in ischemia of the lower extremities. To analyze the characteristics of CAIOD among Koreans, we relied on 110 cases of aorto-iliac occlusive disease in-patients who underwent operative treatment at Yeungnam university hospital during the last 15 years. Among the 110 total cases, the mean age was 61, with the highest incidence among people in their 60s, followed by those in their 50 s and then in their 70 s. 88.2% of the cases occurred in males with the remaining 11.8% occurring among females. Co-existing diseases included hypertension 46 cases (41.8% of the cases), coronary arterial diseases 17 cases (15.4%), diabetes mellitus 22 cases (20%), chronic pulmonary diseases 14 cases (12.7%) and cerebrovascular diseases 10 cases (9.1%). 80% of the cases involved patients with a history of smoking. The level of serum total cholesterol was higher than normal in 32.7% of cases. Advanced arteriosclerotic manifestation was found in over two-thirds of the cases, with the anatomical distribution as follows: Type I 5 cases (4.5%), Type II 30 cases (27.3%) and Type III 75 cases (68.2%). According to the Fontaine classification of clinical symptoms, the distribution was as follows: Grade I (0 case), Grade II 52 cases (47.3%), Grade III 36 cases (32.7%) and Grade IV 22 cases (20.0%). Among the 110 cases, 75 received only inflow procedures, 19 received both inflow and outflow procedures at the same time, and 16 received only outflow procedures. Among the 94 cases of inflow procedures, PTA accounted for 11 cases, PTA with stent accounted for 5, endarterectomy for 3, and bypass operations for 75. The breakdown for the 75 cases of bypass operations was as follows: aortofemoral or aortoiliac (21 cases): iliofemoral (12 cases): extraanatomic bypass including axillobifemoral bypass (15 cases): and fem-fem bypass (27 cases). Thirty-five outflow procedures included femoropopliteal and femorotibial bypass (22 cases), thromboembolectomy (6 cases), endarterectomy (5 cases) and profundoplasty (2 cases). 19 out of these 35 outflow procedures were performed in conjunction with inflow procedures at the time of the initial operation, but 16 were used without inflow procedure, mainly for Type III cases with relatively mild aortoiliac pathology. In over 90% of the 110 operative cases, the early outcome was good with 3 to 2 rating according to Rutherford criteria. The early outcome seemed to be related to the extent of disease and preoperative clinical symptoms but not with the surgical procedures used. Among the 110 total cases, 26 (23.6%) required second procedures. Among the 94 cases of inflow procedures, 24 (25.5%) required the second procedures, while among the 16 cases of outflow procedures, 2 (12.5%) required the second procedures. Among the 94 cases of inflow procedures, the need for second operations was higher in cases undergoing both inflow and outflow procedure at the same time (36.8%, 7 out of 19 cases) compared to the cases that underwent inflow procedure only (22.6%, 17 out of 75 cases). Among the inflow procedures, axillofemoral (46.7%) and iliofemoral (41.7%) bypass required the 2nd procedures much more frequently than aorto-fem (23.8%), fem-fem (14.8%) bypass and PTA (18.8%). An overall 5-year cumulative patency rate demonstrated significant statistical differences between procedures (p=0.001 Log Rank test): aortofemoral or aortoiliac: 0.81, fem-fem: 0.77, PTA: 0.74, iliofemoral: 0.56, and axillofemoral: 0.50. A 5-year cumulative patency rate also showed a significant correlation with the extent of disease (p=0.01), preoperative ischemic symptoms (p=0.05) and Ankle Brachial pressure Index (ABI.). Operative mortality for the 110 cases was 3.6% (4 cases), including 3 resulting from associated cardiac conditions and 1 resulting from aortoduodenal fistula.
Ankle ; Cholesterol ; Classification ; Diabetes Mellitus ; Endarterectomy ; Female ; Fistula ; Humans ; Hypertension ; Incidence ; Ischemia ; Lower Extremity ; Lung Diseases ; Male ; Mortality ; Pathology ; Popliteal Artery ; Smoke ; Smoking ; Stents

The relationship between hypercalcemic crisis and pancreatitis, first described in patients with hyperparathyroidism, still remains controversial. Acute pancreatitis may complicate the clinical course of hyperparathyroidism, particularly when the degree of hypercalcemia is severe. The incidence of hyperparathyroidism presenting as acute pancreatitis appears to be steadily decreasing, possibly reflecting the earlier diagnosis of asymptomatic hyperparaparathyroidism due to widespread application of screening methods. Here, we report two patients with primary hyperparathyroidism manifesting clinically as acute pancreatitis. One patient died of progessive pancreatitis and uncontrolled sepsis. The other patient was fullly recovered by emergent parathyroidectomy followed by medical management of hypercalcemia.
Diagnosis ; Humans ; Hypercalcemia ; Hyperparathyroidism* ; Hyperparathyroidism, Primary ; Incidence ; Mass Screening ; Pancreatitis* ; Parathyroidectomy ; Sepsis

BACKGROUND: AEB071, an orally available PKC inhibitor, prevents organ rejection after transplantation in rodents and man. Furthermore, pro-inflammatory cytokines and inflammatory processes are important mediators of transplanted organ rejection. We therefore examined whether single or combination therapies of AEB071 and/or tacrolimus affect cytokine profiles in a rat cardiac allograft model. METHODS: AEB071 (60 mg/kg twice a day) and tacrolimus (0.6 or 1.2 mg/kg once a day) were orally administered daily after cardiac transplantation. Interferon (IFN)-gamma, interleukin (IL)-1beta, IL-2, IL-4, IL-6, IL-10, and tumor necrosis factor (TNF)-alpha levels in serum were subsequently measured 5 days after cardiac transplantation using a multiplex protein assay system. RESULTS: All cytokine levels were significantly depressed in cardiac transplanted rats treated with AEB071, whereas tacrolimus only reduced IFN-gamma, IL-2, IL-4, IL-6, and IL-10 levels. When administered in combination, AEB071 and low- or high-dose tacrolimus had additive effects on IFN-gamma, IL-4, IL-6, and TNF-alpha. CONCLUSIONS: These results suggest that AEB071 inhibits T cell activation by blocking the production of proinflammatory cytokines, and that tacrolimus combined with AEB071 can effectively regulate inflammatory cytokines in the transplantation setting.
Animals ; Cytokines ; Heart Transplantation ; Immunosuppression ; Interferons ; Interleukin-10 ; Interleukin-2 ; Interleukin-4 ; Interleukin-6 ; Interleukins ; Pyrroles ; Quinazolines ; Rats ; Rejection (Psychology) ; Rodentia ; Tacrolimus ; Transplantation, Homologous ; Transplants ; Tumor Necrosis Factor-alpha

Transfusion-related acute lung injury (TRALI) is a noncardiogenic pulmonary edema that occurs during or within 6 hours after transfusion. Risk factors for TRALI, which is relatively common in critically ill patients, include recent surgery, hematologic malignancy, and sepsis. Here, we report a case of TRALI induced by anti-human leukocyte antigen (anti-HLA) class II antibodies (HLA-DR) occurring after transfusion of platelet concentrates in a patient with acute leukemia. Although most patients with TRALI show improvement within 48-96 hours, our patient's condition rapidly worsened, and he did not respond to supportive treatment. TRALI is a relatively common and serious adverse transfusion reaction that requires prompt diagnosis and management.
Acute Lung Injury ; Antibodies ; Blood Group Incompatibility ; Blood Platelets ; Critical Illness ; Hematologic Neoplasms ; Humans ; Leukemia ; Leukocytes ; Pulmonary Edema ; Risk Factors ; Sepsis

BACKGROUND AND OBJECTIVES: Canalith repositioning procedure (CRP) is an effective treatment for benign paroxysmal positional vertigo (BPPV). However, there is a significant number of patients who require multiple treatment visits for reliefs of symptoms. The purpose of this study is to identify factors that may be associated with these difficult to treat cases. MATERIALS AND METHODS: A retrospective review was made of 179 patients who were diagnosed as BPPV. 20 patients who required more than three treatment visits for CRP were included in this study. Statistical analysis included age and sex of patients, the kind of involved semicircular canal (SCC), direction of nystagmus, latency of nystagmus on electronystagmography (ENG) and duration of symptoms. RESULTS: There was no significant statistical association between the number of treatment visit and patient's age, sex. Although significant statistical association was not found, the therapeutic efficacy of lateral SCC BPPV was lower than that of posterior SCC BPPV. In the cases where the direction of nystagmus was ageotrophic, the efficacy of CRT was decreased and statistical significant association was found. Also when short latency of nustagmus on ENG and long duration of symptoms appeared, more trial of CRP was needed and statistical significant association was found. CONCLUSION: In the treatment of BPPV by CRP, we can consider latency of nystagmus on ENG, duration of symptoms, direction of nystagmus and type of involved semicircular canal as prognostic factors.
Electronystagmography ; Humans ; Rehabilitation* ; Retrospective Studies ; Semicircular Canals ; Vertigo*

We describe two cases of post-radiation sarcoma after breast cancer treatment. The first patient was a 61-year-old woman who underwent partial mastectomy of the right breast and adjuvant whole breast irradiation 7 years previously. Subsequently, a rapidly growing mass from the anterior arc of the right fifth rib was incidentally detected on an abdomino-pelvic computed tomography scan. The second patient was a 70-year-old woman who received neoadjuvant chemotherapy and a partial mastectomy of the left breast 9 years ago. Adjuvant irradiation was delivered to the whole breast and supraclavicular region. Subsequently, an approximate 8 cm mass developed in the left axillary area. Both patients received wide excision of the tumor with negative resection margins. The pathological diagnoses were osteosarcoma and undifferentiated pleomorphic sarcoma, respectively. Although post-radiation sarcomas are rare complications with a poor prognosis, enhanced awareness and early detection by clinicians are essential to improve outcomes via curative surgical resection.
Aged ; Breast ; Breast Neoplasms ; Female ; Humans ; Mastectomy, Segmental ; Middle Aged ; Neoplasms, Radiation-Induced ; Osteosarcoma ; Prognosis ; Ribs ; Sarcoma

PURPOSE: Highly sensitized patients with a high level of panel reactive antibody (PRA) experience more episodes of antibody-mediated rejection (AMR) and poorer graft survival than non-sensitized patients. Rituximab is a well-known monoclonal anti-CD20 antibody that causes the depletion of B lymphocytes. The aim of this study was to compare a rituximab-administered and a non-administered group of highly sensitized recipients. METHODS: Forty-three kidney recipients with a PRA level of > or =50% were included. Sixteen (group R) received one dose of rituximab at 2 days prior to transplantation and 27 patients (group NR) did not. RESULTS: Patients' demographics, such as age, sex, dialysis duration, and type of immunosuppressive agent were not different in the two groups. No side effects due to rituximab administration were observed in group R. Class I PRA of group R (75.6 +/- 37.7%) was higher than that of group NR (45.7 +/- 35.8%, P = 0.013). More acute rejection episodes occurred within 1 year after transplantation in group NR but the difference between the groups was not significant (18.8% in group R vs. 29.6% in group NR, P = 0.631). However, two AMR episodes occurred only in group NR. Renal functions were not different in the two groups. In group R, CD19 and CD20 rapidly decreased 2 days after rituximab infusion. Furthermore, the administration of rituximab was not linked to acute rejection. CONCLUSION: To confirm the long-term anti-rejection and beneficial effects of rituximab, further studies should be performed with a larger cohort. In conclusion, rituximab administration 2 days prior to transplantation is both effective and safe.
Antibodies, Monoclonal, Murine-Derived ; B-Lymphocytes ; Cohort Studies ; Demography ; Dialysis ; Graft Survival ; Humans ; Immunization ; Kidney ; Kidney Transplantation ; Rejection (Psychology) ; Rituximab ; Transplants

PURPOSE: To compare the treatment outcomes and to analyze prognostic factors between the use of a breast-conserving treatment (BCT) and a mastectomy for early stage breast cancer. MATERIALS AND METHODS: We retrospectively reviewed 1,200 patients with pathological stage T1-2N0 breast cancer who received surgery between September 1994 and December 2002 at Samsung Medical Center. We compared the patient characteristics and treatment outcomes between the two treatment groups. RESULTS: Among the 1,174 eligible patients, 601 (51.2%) patients received a BCT and the remaining 573 (48.8%) patients received a mastectomy. The mastectomy group of patients had significantly more cases with a larger tumor size, multicentricity, extensive intraductal component, and estrogen- and progesterone-receptor negativity. The ten-year overall survival rates (OS) of the BCT and mastectomy groups were 91.96% and 91.01%, respectively (p=0.1274). The ten-year disease-free survival rates (DFS) were 80.48% for the BCT group of patients and 84.95% for the mastectomy group of patients, respectively (p=0.8795). CONCLUSION: Our study shows some differences in patient characteristics between the two treatment groups. However, these differences did not result in significant survival differences.
Breast Neoplasms

BACKGROUND: Appendicitis is a common surgical disease. There are many problems for the early diagnosis of acute appendicitis in kidney transplant patients; differential diagnosis for acute rejection, limitation in imaging study, problems of immunosuppressant and non-characteristic symptoms. METHODS: We reviewed medical records and transplant database of 2,947 renal transplant patients between April, 1979 and September, 2009 retrospectively. Patient's characteristics, diagnostic methods for appendicitis and operative/postoperative progresses were analyzed. RESULTS: Of the 2,947 renal transplant patients, there were 15 (0.51%, 13 males and 2 females) acute appendicitis patients. Mean age at the diagnosis of appendicitis was 37.2+/-10.1 years. Fourteen (93.3%) patients suffered from prodromal symptom, such as abdominal pain, direct or rebound tenderness, nausea and vomiting. There were 12 (80%) patients with leukocytosis (WBC count >10,000/microliter). Computed tomography scans were performed in 5 (33.4%) patients for diagnosis. Laparoscopic appendectomies were applied for 8 (53.4%) patients. In pathologic diagnosis, 2 cases were reported as 'non pathologic diagnosis' complications occurred in 2 patients as remnant appendicitis and pancreatitis. However, there was no patient with mortality and renal failure during the hospitalization. CONCLUSIONS: There were no significant differences between the transplant patients and the general population in the incidence, clinical features, diagnosis and postoperative progresses of acute appendicitis.
Abdomen, Acute ; Abdominal Pain ; Appendectomy ; Appendicitis ; Diagnosis, Differential ; Early Diagnosis ; Hospitalization ; Humans ; Incidence ; Kidney ; Kidney Transplantation ; Leukocytosis ; Male ; Medical Records ; Nausea ; Pancreatitis ; Prodromal Symptoms ; Rejection (Psychology) ; Renal Insufficiency ; Retrospective Studies ; Transplants ; Vomiting

BACKGROUND: Infection is a major cause of morbidity and mortality following liver transplants. We evaluated the risk factors of mortality within 1 month of liver transplantation caused by post-transplant infections. METHODS: We retrospectively reviewed the medical records of 199 patients who underwent liver transplants from September 2005 to August 2010. We divided the enrolled patients into 3 groups. The first group, the Culture(-) group, was defined as those who had no significant culture results. The second group, the Culture(+)/survival group, was defined as those who tested positive for culture but survived longer than 1 month after transplantation. The third group, the Culture(+)/mortality group, was defined as those who died within 1 month of the transplant with positive culture test results. RESULTS: The culture(+)/mortality group consisted of more deceased donor liver transplants than other groups. Also, the Culture(+)/mortality group showed more evidence of pre-transplant infections, intensive care unit (ICU) admission, continuous post-transplant renal replacement therapy (CRRT), and a higher MELD score than other groups. The risk factors of early mortality combined with infection 1 month after liver transplantation are hospitalization in ICU before transplantation (HR=16.3, CI=2.6~102.3, P=0.003) and the positive results of culture within 7 days of the operation (HR=38.7, CI=4.1~368.8, P=0.001). CONCLUSIONS: Hospitalization in ICU before transplantation and an early positive culture result can be an early clinical indicator of a good prognosis after liver transplantation.
Hospitalization ; Humans ; Intensive Care Units ; Liver ; Liver Transplantation ; Medical Records ; Prognosis ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors ; Tissue Donors ; Transplants