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

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

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 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*

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

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

BACKGROUND: We have allocated liver according to the Korean Network Organ Sharing (KONOS) status. However, it was necessary to change the system to a more adequate and objective system. We analyzed the correlation between KONOS status and MELD score under the current status of organ allocation. METHODS: We reviewed medical records of 70 liver recipients as KONOS status 2A and 2B between September 2005 and December 2010. We analyzed their KONOS status, MELD score, clinical characteristics, waiting time, Child-Turcotte-Pugh (CTP) score and clinical symptoms accorded to KONOS status 2A. RESULTS: Mean MELD and CTP score of the 2A group was significantly higher than the 2B group (P<0.001). In the 2B group, the blood types of all recipients were identical to those of the donors. However, 2A group included 7 cases (23.3%) of non-identical blood types. The MELD score of all recipients were correlated with CTP score (R=0.798, P<0.001). However, there was an overlapping area between the 2B group and the 2A group that was registered by the condition of intractable ascites. Those who had hepatorenal syndrome and hepatic encephalopathy showed high MELD score over 20. However, 36.4% of the patients who had only intractable ascites showed a MELD score of less than 20. CONCLUSIONS: CTP score was highly correlated with MELD score. However, KONOS status showed some overlapping area of the MELD score between 2A and 2B groups. We should make an effort to improve KONOS allocation system to meet the Korean situation.
Ascites ; Cytidine Triphosphate ; Hepatic Encephalopathy ; Hepatorenal Syndrome ; Humans ; Liver ; Liver Diseases ; Liver Transplantation ; Medical Records ; Resource Allocation ; Severity of Illness Index ; Tissue and Organ Procurement ; Tissue Donors ; Transplants

BACKGROUND: Recurrence of focal segmental glomerulosclerosis (FSGS) after kidney transplantation is a frequent and still unpredictable complication. Moreover, risk factors for recurrence have not yet been clearly identified. METHODS: We enrolled into our study 2,882 adult kidney recipients who underwent transplantation between April 1979 and April 2009. We retrospectively reviewed clinical manifestations of recurrence of FSGS. RESULTS: Among the 2,784 adult renal recipients, forty four had undergone renal transplantation for primary FSGS. Of the 44, 12 (27.3%) showed recurrent FSGS. Mean duration between transplantation and FSGS recurrence was 22.8+/-37.4 months. There were no significant differences in patient characteristics in the recurrence and non-recurrence groups. The cumulative incidence of FSGS recurrence was 13.8% within 1 year after kidney transplantation and 23.2% within 3 years. The overall graft survival rate in the recurrence group was significantly lower than that of the non-recurrence group (P=0.0018) and non-FSGS group (P=0.0001). Graft failure happened more in the recurrence group (75%) than in the non-recurrence group (37.5%, P=0.042). CONCLUSIONS: We failed to find any significant risk factors for FSGS recurrence after renal transplantation.
Adult ; Glomerulosclerosis, Focal Segmental ; Graft Survival ; Humans ; Incidence ; Kidney ; Kidney Transplantation ; Recurrence ; Retrospective Studies ; Risk Factors ; Transplants

BACKGROUND: Luminex panel reactive antibody (PRA) is a method that is well known for its high sensitivity and specificity. By using a single antigen assay, the presence or absence of donor specific antibody (DSA) can be determined and its strength can be quantified in terms of the mean fluorescence intensity (MFI). In this study, we analyzed the correlation between the pre-transplant PRA and DSA measured by the Luminex method and the post-transplant clinical features after kidney transplantation. METHODS: A total of 123 pre-transplant sera samples from kidney transplanted patients were tested. Luminex-PRA identification tests were performed using a Luminex fluoroanalyzer and a LifeCodes class I, II ID Kits. Single antigen assay by the Luminex method was used for detecting DSA and its MFI. RESULTS: The positive Luminex-PRA group included more highly-sensitized patients such as women, patients with a previously positive lymphocyte cross match test and patients who were undergoing retransplantation. There was no correlation between the acute rejection rate and positive PRA on the Luminex-PRA. However, pretransplant DSA detected by the single antigen assay was significantly associated with episodes of antibody mediated rejection (P=0.047, OR=10.2), and DSA with higher MFI values (MFI> or =3,000) was associated with antibody mediated rejection (P=0.023). CONCLUSIONS: Although pre-transplant positive PRA was not correlated with acute rejection episodes, the DSA measured by the Luminex single antigen assay seems to have a predictive value for post-transplant antibody mediated rejection.
Female ; Fluorescence ; Histocompatibility Antigens ; Humans ; Kidney ; Kidney Transplantation ; Lymphocytes ; Rejection (Psychology) ; Sensitivity and Specificity ; Tissue Donors ; Transplants

PURPOSE: Excess proliferation of mesenchymal cells such as vascular smooth muscle cells and glomerular mesangial cells, cause transplant vascular sclerosis and glomerulosclerosis, which are typical pathological lesions of chronic allograft dysfunction. Mycophenoic acid (MPA) and rapamycin (RPM) were recently reported to have strong anti-proliferative potentials toward vascular smooth muscle cells. However, the potential effects of these drugs, either alone or in combination, on glomerular mesangial cells, remain to be reported. METHODS: Primary cultured mesangial cells, from Sprague-Dawley rats, were isolated, and stimulated with 10ng/ml of PDGF. The test drugs MPA and RPM were administered at various concentrations, either alone or in combination, 15 minutes before the addition of the PDGF. The cell proliferation was assessed by [3H]-thymidine incorporation. RESULTS: The PDGF effectively stimulated the proliferation of the mesangial cells. The MPA inhibited the proliferation in a dose-dependent manner. In comparison to the stimulated control, the MPA (above 500 nM) showed a significant inhibitory effect. The IC50 of the MPA, against PDGF-stimulated mesangial cell proliferation, was between 500 nM and 1microM. The RPM, at 10 nM, showed a significant inhibitory effect. In a linear regression analysis, the RPM was supposed to suppress the mesangial proliferation in a dose-dependent manner (P<0.05). The pattern of inhibition for the MPA and RPM combination was very similar to that of either the MPA or the RPM alone. Both the MPA and RPM were shown to independently suppress the mesangial proliferation from a multiple regression analysis (R2=0.415, P<0.001). CONCLUSION: We demonstrated that MPA and RPM significantly inhibited the proliferation of glomerular mesangial cells, and that these effects were well maintained when used in combination. Our data indicate that both MPA and RPM have unique potentials in preventing the development of transplant mesangial proliferation in renal transplant recipients.
Allografts ; Animals ; Cell Proliferation ; Inhibitory Concentration 50 ; Linear Models ; Mesangial Cells* ; Muscle, Smooth, Vascular ; Mycophenolic Acid* ; Rats* ; Rats, Sprague-Dawley ; Sclerosis ; Sirolimus* ; Transplantation