The first case report of granular cell tumor was by Abrikossoff in 1926, the tumor has been named with more than 20 different synonyms. It is found usually in the tongue, oral cavity, and the skin. It occurs rarely in the esophagus. Esophageal granular cell tumor is a benign lesion which can be diagnosed by endoscopic biopsy. Large symptomatic lesion can be removed by polypectomy. A 29-year-old female visited our hospital for intermittent epigastric pain and anterior chest discomfort. Endoscopy showed a 0.6 *0.4 cm whitish yellow nodule in the mid-esophagus, 25 cm from the incisor teeth. Endoscopic polypectomy was performed with "O"-type rubber band for endoscopic variceal ligation(EVL). A case of esophageal granular cell tumor conformed by S-100 protein stain is reported with the review of literature.
Adult ; Biopsy ; Endoscopy ; Esophagus* ; Female ; Granular Cell Tumor* ; Humans ; Incisor ; Mouth ; Rubber ; S100 Proteins ; Skin ; Thorax ; Tongue ; Tooth

No abstract available.
Alcohol Withdrawal Delirium* ; Delirium*

BACKGROUND: The renin angiotensin syaimstem plays an important role in hypertension. Therefore, the purpose of this study was to investigate the comparison of responsiveness to angiotensin II (ANG II) in isolated renal proximal convoluted tubules of spontaneously hypertensive (SHR) and Wistar Kyoto (WKY) rats. METHODS: Intracellualr calcium concentration ([Ca2+i) was measured using Fura- 2/AM, inositol trisphosphate (IP3) accumulation was determined by radioimmuno assay and cellular ATP content measured using the microchemilunescene method in renal proximal tubule suspension or isolated renal proximal tubules. RESULTS: When measured the ANG II-induced [Ca2+i, the young rats showed a greater response to ANG II than adult rats in both strains. The ANG II (10-7 M)-induced [Ca2+i transient in the cortical tubule suspension from adult SHR was significantly lower than that in age-matched WKY. In isolated proximal tubule segments, ANG II-induced [Ca2+i increment was only observed in S1 segments. Comparing responsiveness to ANG II in SHR and WKY, similar phenomenon was observed as experiment using tubule suspension. IP3 accumulation by ANG II also attenuated in adult SHR. The 20-minutes incubation without any exogenous substrate in proximal convoluted tubule (S1) significantly decreased cellular ATP content and ANG II (10-7 M) inhibited decrement of cellular ATP level. The effect of ANG II on cellular ATP restoration was disappeared by the treatment with losartan. CONCLUSION: From these results, the responsiveness of ANG II to AT1A receptor is attenuated in the proximal convoluted tubules of adult SHR comparing the age- mached WKY.
Adenosine Triphosphate ; Adult* ; Angiotensin II ; Angiotensins ; Animals ; Calcium ; Humans ; Hypertension ; Inositol ; Losartan ; Rats ; Renin

OBJECTIVES: The stress response involves the activation of the hypothalamic-pituitary-adrenal(HPA) axis and the sympathetic nervous system. Corticosteroids have been clearly demonstrated to cause anti-inflammatory and/or immnosuppressive effects in man including granulocytosis in part by decreasing migration into tissue, especially damaged tissues(myocardium), and circulating relative lymphocytopenia. To test whether automated measurements of the the increased serum cortisol-induced hematologic changes in the leukocyte differential significance or not in the initial differential diagnosis of acute myocardial infarction in acute chest pain syndromes. METHODS: 101 consecutive patients with myocardial infarction or myocardial ischemia presenting to the emergency room of Seoul Adventist Hospital with acute chest pain from January 1993 to August 1995(Retrospective group) and from December 1995 to March patients compatible with exclusion criteria in myocardial infarction were excluded. We measured automated leukocyte differential and serial CK-MB level in both groups, and the intial serum cortisol levels in prospective infarction group. RESULTS: 1) Total leukocyte and granulocyte counts were increased in acute myocardial infarction(p<0.01). 2) In acute myocardial infarction group, lymphocyte counts were slightly increased(p<0.05), but relative lymphocytes percentage more significantly decreased(p<0.01). 3) Serum cortisol levels are significantly raised early in the course of the acute myocardial infarction and prior to the elevation of the specific cardiac enzymes on the basis of analytic results of prospective infarction group. 4) Cortisol-induced changes in leukocyte differential were noted with time passes into reverse approximately 4 days later in our study. 5) The leukocyte differential does not shows significant changes in the retrospective myocardial ischemia group, so we arrive in careful conclusion that serum cortisol level seems does not increase. 6) No sexual differences were noted in leukocyte differential. CONCLUSIONS: The serum cortisol level and cortisol-induced leukocyte differential are helpful for initial differential diagnosis of acute myocardial infarction in acute chest pain sysdrome.
Adrenal Cortex Hormones ; Axis, Cervical Vertebra ; Chest Pain* ; Diagnosis, Differential* ; Emergency Service, Hospital ; Granulocytes ; Humans ; Hydrocortisone* ; Infarction ; Leukocytes* ; Lymphocyte Count ; Lymphocytes ; Lymphopenia ; Myocardial Infarction ; Myocardial Ischemia ; Prospective Studies ; Retrospective Studies ; Seoul ; Sympathetic Nervous System ; Thorax*

The extracellular calcium sensing receptor (CaSR) belongs to the type III family of G-protein-coupled receptors, a family that comprises the metabotropic glutamate receptor and the putative vomeronasal organ receptors. The CaSR plays an important role for calcium homeostasis in parathyroid cells, kidney cells and other cells to directly 'sense' changes in the extracellular calcium ion concentration ((Ca2+)o). The mesangial cells are known to be involved in many pathologic sequences through the mediation of altered glomerular hemodynamics, cell proliferation, and matrix production. In this study, we examined the expression of the CaSR in the mouse mesangial cell lines (MMC, ATCC number CRL-1927). Reverse transcription- polymerase chain reaction (RT-PCR) was perform with CaSR-specific primers, and this was followed by nucleotide sequencing of the amplified product; this process identified the CaSR transcript in the MMCs. Moreover, CaSR protein was present in the MMCs as assessed by Western blot and immunocytochemical analysis using a polyclonal antibody specific for the CaSR. Functionally, (Ca2+)o induced the increment of the intracellular calcium concentration ((Ca2+)i) in a dose-dependent manner. This (Ca2+)i increment by (Ca2+)o was attenuated by the pretreatment with a phospholipase C inhibitor (U73122) and also by a pretreatment with a CaSR antagonist (NPS 2390). The similar results were also obtained in IP3 accumulation by (Ca2+)o. To investigate the physiological effect of the CaSR, the effect of the (Ca2+)o on cell proliferation was studied. The increased (Ca2+)o (up to 10 mM) produced a significant increase in the cell numbers. This mitogenic effect of (Ca2+)o was inhibited by the co-treatment with a CaSR antagonist. From these results, the (Ca2+)o-induced (Ca2+)i elevation in the MMC is coupled with the extracellular calcium sensing receptor. Furthermore, (Ca2+)o produces a mitogenic effect in MMCs.
Animals ; Calcium/metabolism ; Cell Line ; Cell Proliferation ; Inositol 1,4,5-Trisphosphate/metabolism ; Mesangial Cells/*cytology/*metabolism ; Mice ; RNA, Messenger/genetics/metabolism ; Receptors, Calcium-Sensing/genetics/*metabolism ; Research Support, Non-U.S. Gov't

BACKGROUND: A shortage of kidney donors has produced a progressively increasing gap between the supply of cadaveric kidneys and the demand for cadaveric transplants. Thus, efforts to expand the donor pool have included the use of the living related and unrelated kidney donors in Korea. In certain countries like ours, cadaveric kidney sources are very limited for various reasons, therefore, the living kidney donors have been a major source for uremic patients in our hospital. We propose a new program for donation, in which is an exchange-donor program. It is a program in which the donation is not commercial, but voluntary, thus overcoming the shortage of cadaveric donors, and giving the opportunity for transplant to as many uremic patients as possible. METHODS: Between Jan. 1991 and Dec. 1997, 411 living-donor renal transplants were performed in our hospital. Of those, 61 patients received grafts from exchange donors. We compared the graft survival rate of the exchange-donor transplantations with that of the living related donor transplantations based on the recipient's age and sex, the donor's age and sex, human leukocyte antigens (HLA) mismatching, and the frequency of acute rejection. RESULTS: Fifty-nine (59) of 61 patients were still alive in Dec. 1997, with a median follow-up of 31 months (6-76 months), and the mean serum creatinine level was 1.64 mg/dL. The graft survival rates of the exchange-donor renal transplantations at 1 and 5 years were 92.12% and 80.27%, respectively, and there were no significant differences compared with those of the living related renal transplantations (p=0.1424). The graft survival rates at 1 and 5 years were 93.75% and 81.25%, respectively, for those with more than one HLA-haploidentical pair, and 91.89% and 78.76% for those with less than a one-haplotype match, respectively. The frequency of acute rejection was 37.7% in the exchange-donor group. The renal function of the exchange donors after the donation was not altered, and the postoperative complication rate was 1.6%. CONCLUSIONS: The results show that the graft survival rates of the exchange-donor program were similar to those of the living related renal transplantations, and that the good graft survival rates for the exchange-donor group could not be attributed to better HLA matching. We propose an exchange-donor program that will be able to expand the donor pool and overcome the shortage of cadaveric organ donors.
Cadaver ; Creatinine ; Follow-Up Studies ; Graft Survival ; HLA Antigens ; Humans ; Kidney ; Kidney Transplantation* ; Korea ; Postoperative Complications ; Tissue Donors ; Transplants

Arterial dissection begins with spontaneous or traumatic rent of intima, which sometimes allows blood to penetrate the layers of the arterial wall. Dissections of the craniocervical arteries are separated according to whether they are extracranial or intracranial, spontaneous or traumatic. Dissection of intracranial portions of the carotid system is rare, but it may be one of the important causes of ischemic stroke in the young adults. Cerebral angiography, MRI, and Doppler sonography are important diagnostic methods in this case. Initial treatment with anticoagulants or antiplatelet agents are effective in many cases, but sometimes surgical method is recommended. We presented ischemic infarctions in young men secondary to traumatic and spontaneous intracranial arteries dissection
Anticoagulants ; Arteries* ; Cerebral Angiography ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Male ; Platelet Aggregation Inhibitors ; Stroke ; Young Adult

The lack of available cadaveric organs for transplantation has result in an increased number of kidney transplantation from living donors. In order to characterize correlation of variable factors which affect on the renal graft survival and to compare graft survival of living related donor with that of living unrelated donor, the 515 cases of renal transplantation between January 1979 and December 1997 were reviewed. Each effect of factors included recipient age, donor age, infection, acute rejection, tissue typing, type of donor on graft survival was analyzed as well as the interrelationship on graft survival between six risk factors. It was risk factors which effect on the graft survival that acute rejection, tissue typing and type of donor (P=0.00, P=0.001, P=0.00). The 1 and 5 year graft survival rates of cadaveric renal donor group and acute rejection positive group were 64.8-32.4%, 84.5-49.8% for younger recipient group (<30), 81.3-53.9%, 84.5-49.8% for ideal age group (30-49), 0-0%, 44-44% for older recipients group (>50) (0.017). The 1 and 5 year survival rate of cadaveric renal donor group was 42.8% and 28.6% during 1978-1983, 37.5% and 12.5% during 1984-1990 and 100% and 80% during 1991-1997. The grafts survival rate of unrelated living donor is significantly higher than that of cadaveric grafts during 1978-1990 and had a survival rate similar to that of living related donor grafts under all the circumstance given. The tissue typing, acute rejection and type of donor were significant factor which have influence on the graft survival. The cadaveric renal donor & acute rejection had significantly negative effect in older recipients (>50). Recently, the survival rate of cadaveric graft was remarkably increased, but in the future the more data collection for cadaveric graft is required. Living-unrelated renal transplantation provides comparable result to living-related renal transplantation and the unrelated living donor is excellent source of organs for renal transplant recipients.
Allografts* ; Cadaver ; Data Collection ; Graft Survival ; Histocompatibility Testing ; Humans ; Kidney Transplantation* ; Living Donors ; Risk Factors* ; Survival Rate ; Tissue Donors ; Transplantation ; Transplants ; Unrelated Donors

The lack of available cadaveric organs for transplantation has result in an increased number of kidney transplantation from living donors. In order to characterize correlation of variable factors which affect on the renal graft survival and to compare graft survival of living related donor with that of living unrelated donor, the 515 cases of renal transplantation between January 1979 and December 1997 were reviewed. Each effect of factors included recipient age, donor age, infection, acute rejection, tissue typing, type of donor on graft survival was analyzed as well as the interrelationship on graft survival between six risk factors. It was risk factors which effect on the graft survival that acute rejection, tissue typing and type of donor (P=0.00, P=0.001, P=0.00). The 1 and 5 year graft survival rates of cadaveric renal donor group and acute rejection positive group were 64.8-32.4%, 84.5-49.8% for younger recipient group (<30), 81.3-53.9%, 84.5-49.8% for ideal age group (30-49), 0-0%, 44-44% for older recipients group (>50) (0.017). The 1 and 5 year survival rate of cadaveric renal donor group was 42.8% and 28.6% during 1978-1983, 37.5% and 12.5% during 1984-1990 and 100% and 80% during 1991-1997. The grafts survival rate of unrelated living donor is significantly higher than that of cadaveric grafts during 1978-1990 and had a survival rate similar to that of living related donor grafts under all the circumstance given. The tissue typing, acute rejection and type of donor were significant factor which have influence on the graft survival. The cadaveric renal donor & acute rejection had significantly negative effect in older recipients (>50). Recently, the survival rate of cadaveric graft was remarkably increased, but in the future the more data collection for cadaveric graft is required. Living-unrelated renal transplantation provides comparable result to living-related renal transplantation and the unrelated living donor is excellent source of organs for renal transplant recipients.
Allografts* ; Cadaver ; Data Collection ; Graft Survival ; Histocompatibility Testing ; Humans ; Kidney Transplantation* ; Living Donors ; Risk Factors* ; Survival Rate ; Tissue Donors ; Transplantation ; Transplants ; Unrelated Donors

The purpose of this study was comparing the serial change of serum creatinine and Resistive Index (RI) after renal transplantation. From Jul. 1995 to Feb. 1997, we examined Doppler sonography for 32 out of 99 patients, who were undertaken renal transplantation, whose resistive index were taken at POD #1 and POD #5 and named initial resistive index. The late resistive index were examined when they discharged or when the acute rejection was suspicious. The RI rejection group, which was consist of 22 out of 32 patients, were selected whose late resistive index were increased more 0.05 than inital resistive index. The RI control group, which was consist of 10 out of 32 patients, was selected whose late resistive index were not more 0.05 than initial resistive index. The group which was consist of 21 patient, had over 1.8 mg/dL of serum creatinine. The rest, 11 patients, had not more than 1.8 mg/dL of serum creatinine. The Student's T-test was used for the statistical analysis. In the RI rejection group, late RI value (0.77+/-0.04) was significantly higher than initial RI (p<0.05) and the increase of RI in the acute rejection group were significantly greater than that in the control group (p<0.05). With the serial changes of late RI more 0.05 than initial RI, we obtained 85.0% of sensitivity and 58.3% of specificity for the prediction of the acute rejection. In the patients with the serum creatinine over 1.8 mg/dL, the sensitivity was 85.0% and the specificity was 66.7%. In the patients with the serum creatinine over 1.8 mg/dL and increased RI over 0.05, the sensitivity was 94.1% and specificity was 66.7%. The result shows that serial changes of duplex Doppler scan and the level of serum creatinine after renal transplantation were not enough to predict acute rejection. But the correlation of the result show more higher sensitivity. We suggest to be able to use the Doppler sonography and serial changes of serum creatinine level with the other clinical findings to predict the acute rejection after renal transplantation.
Creatinine* ; Humans ; Kidney Transplantation* ; Sensitivity and Specificity