Over the 1 year 3 month period from 7/11/1997 until 10/30/1998, we have attempted graft salvage with tacrolimus conversion in a total of 11 patients (mean age 41 years, range 31~64 years) with ongoing rejection on baseline CsA immunosuppression after failure of high dose corticosteroid to reverse rejection. The indications for conversion to tacrolimus were ongoing biosy confirmed rejection in all patients. Seven grafts showed vascular rejection and 4 had cellular rejection on biopsy. The median interval to tacrolimus conversion was 4 days (range 1 days to 840 days) after transplantation. Three patients (27.3%) were dialysis-dependent owing to the severity of rejection. All patients (100%) have been successfully rescued and graft function of the patients improved from an average serum creatinine level of 7.3 3.6 mg/dl to 1.4 0.5 mg/dl. During the mean follow-up of 8.1 months after conversion, there were 10 complications following tacrolimus conversion including cytomegalovirus (CMV) infection in 2 patient, herpes esophagitis in 1, aspergillosis pneumonia in 1, pneumocystis carinii pneumonia in 1, new-onset diabetes mellitus in 4, tremor in 1 and bleeding due to thrombocytopenic thrombocytopenic purpura (TTP) in 1. Two of these postconversion complications resulted in patient death. Treatment with tacrolimus may successfully suppress ongoing acute rejection, even if high dose corticosteoid treatment have failed to reverse rejection. Base on these data, we recommend that tacrolimus be used for refractory rejection therapy. An additional anti-infective prophylaxis seems to be necessary in preventing severe complications after rejection therapy.
Allografts* ; Aspergillosis ; Biopsy ; Creatinine ; Cytomegalovirus ; Diabetes Mellitus ; Esophagitis ; Follow-Up Studies ; Hemorrhage ; Humans ; Immunosuppression ; Pneumonia ; Pneumonia, Pneumocystis ; Purpura, Thrombocytopenic ; Tacrolimus* ; Transplants ; Tremor

The anterior middle fossa is the most common location of benign intracranial arachnoid cysts. In the adult, headache, temporal bulging, and mild proptosis are the usual presenting complaints, although seizures and contralateral weakness have been described. Bitemporal hemianopsia associated with this lesion has not been noted previously. Herein we describe the patient with bitemporal hemianopsia associated with sylvian fissure arachnoid cyst. Cystoperitoneal shunt was beneficial. The etiology, histology, and suggested therapy of other patient with arachnooid cyst are also discussed.
Adult ; Arachnoid Cysts ; Arachnoid* ; Exophthalmos ; Headache ; Hemianopsia* ; Humans ; Seizures

A weanling Thoroughbred foal was admitted to Equine Hospital, Korea Racing Association with signs of colic. On admission the foal was sweating profusely, appeared anxious and exhibiting signs suggestive of abdominal pain. Clinical examination revealed: tachycardia (90 beats/min), tachypnea (50 breaths/min) and congested and slightly cyanotic mucous membranes. No intestinal sounds were auscultated in all 4 abdominal quadrants. Rectal palpation identified concurrent cecum and large colon impactions. Treatment consisted of intravenous administration of a balanced electrolyte solution, nasogastric siphonage and administration of analgesics. Nasogastric reflux contained ascarids. This treatment failed to alleviate the signs of colic. The foal died 3 hours later following discharge because the owner didn't want laparatomy because of economic constraints. Prior to admission this foal had not received any prophylactic anthelmintic treatment. In necropsy, there were masses of ascarids accumulation in the stomach, small intestine and large intestine. The outcome of this report is to describe the first diagnosed case of gastrointestinal impaction by P. equorum in a Thoroughbred foal in South Korea and indicates the importance of regular anthelmintic treatment.
Animals ; Ascaridida Infections/diagnosis/parasitology/*veterinary ; Ascaridoidea/*isolation&purification ; Fatal Outcome ; Fecal Impaction/diagnosis/parasitology/*veterinary ; Horse Diseases/diagnosis/*parasitology ; Horses ; Intestinal Diseases, Parasitic/diagnosis/parasitology/*veterinary ; Korea

Serotonin [5-hydroxytryptamine (5-HT)] regulates synaptic plasticity in the visual cortex. Although the effects of 5-HT on plasticity showed huge diversity depending on the ages of animals and species, it has been unclear how 5-HT can show such diverse effects. In the rat visual cortex, 5-HT suppressed long-term potentiation (LTP) at 5 weeks but enhanced LTP at 8 weeks. We speculated that this difference may originate from differential regulation of neurotransmission by 5-HT between the age groups. Thus, we investigated the effects of 5-HT on apha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR)-, gamma-aminobutyric acid receptor type A (GABA(A)R)-, and N-methyl-D-aspartic acid receptor (NMDAR)-mediated neurotransmissions and their involvement in the differential regulation of plasticity between 5 and 8 weeks. AMPAR-mediated currents were not affected by 5-HT at both 5 and 8 weeks. GABA(A)R-mediated currents were enhanced by 5-HT at both age groups. However, 5-HT enhanced NMDAR-mediated currents only at 8 weeks. The enhancement of NMDAR-mediated currents appeared to be mediated by the enhanced function of GluN2B subunit-containing NMDAR. The enhanced GABA(A)R- and NMDAR-mediated neurotransmissions were responsible for the suppression of LTP at 5 weeks and the facilitation of LTP at 8 weeks, respectively. These results indicate that the effects of 5-HT on neurotransmission change with development, and the changes may underlie the differential regulation of synaptic plasticity between different age groups. Thus, the developmental changes in 5-HT function should be carefully considered while investigating the 5-HT-mediated metaplastic control of the cortical network.
Animals ; Critical Period (Psychology)* ; Humans ; Long-Term Potentiation* ; N-Methylaspartate* ; Plastics ; Rats* ; Receptors, AMPA ; Receptors, GABA ; Receptors, GABA-A ; Serotonin ; Synaptic Transmission ; Visual Cortex*

Recently xenotransplantation has been thought as a final solution for the controi of donor organ shortage in allograft. In order to be a ciinicai entity, xenotransplantation has many obstacles such as hyperacute rejection and delayed xenogratt rejection as a potent immunologic reaction, zoonosis and ethical problems. We already reported the eariy immunoiogic events occuring soon after xenograft in animal model, in which natural antibody and complement have a crucial roie in rejection response. As a further step for the prolongation of graft survival, we used anticomplement agent (cobra venom factor, CVF) in the same model. Graft survival in discordant (guinea pig-to-rat) xenogratt was extended from 30.6 minutes to 2 days following singie injection of CVF, which showed similar pattern of rejection with the concordant xenogratt in terms of time of rejection response after grafting. In this setting antibody response in the blood did not show any difference between that of pre CVF and post CVF, even though IgM response was more pronounced than IgG. The complement activity in the blood showed marked suppression following CVF injection. Intragraft complement gene (C3 mRNA) expression in CVF injected discordant showed delayed response in a similar pattern like that of concordant xenograft. Interestingly enough intragraft anticomplement gene expression showed the simiiar pattern of response with the complement. From these results we can conclude that anticomplement agent (CVF) extended the graft survival in discordant xenograft upto the level of concordant xenograft by shifting the complement activation response from that of discordant to concordant xenograft.
Rats ; Animals

Four cases of delayed post-traumatic epidural hematoma which had not been present on initial CT scan were found on repeated CT scan. The delayed epidural hematoma was developed after evacuation of a hematoma in all cases. And a skull fracture was present at the site of the delayed hematoma in two cases. The neurologic deterioration heralded the onset of delayed epidural hematoma after decompressive therapy by either surgical or medical means. Repeated CT scan is indicated if anticapated improvement from does not occur after decompression by either surgical or medical means, recovery from shock, or whenever there is evidence of even minimal bleeding under a skull fracture on the initial CT scan.
Decompression ; Hematoma* ; Hemorrhage ; Shock ; Skull Fractures ; Tomography, X-Ray Computed

A retrospective study was conducted to evaluate the clinical outcomes of midtrimester emergency cervical cerclage in patients with painless cervical dilatation with/without prolapsed amniotic sac, including cases of no previous history of cervical incompetence. 10 patients including 1 twin pregnancy were teviewed for study, All had received emergency cervical cerclage with Macdonald operation or Shirodka operation at 18 to 31 weeksgestation. The procedures were carried out without serious complication except for one patient who had received re-operation 3 days after Macdonald operation because of re-protrusion of amniotic sae. The mean procedure to delivery internal was 8.9+/-5.3 (range 1 to 17) weeks. The mean gestational age at delivery was 32.4+/-5.6 (range 22 to 39+6) weeks for the entire group, 36.1+/-2.6 (range 32+4 to 39+6) weeks for the 6 who achived viability, and 27.6+/-5.0 (range 22 to 29+4) weeks for the 3 who died during the neonatal period. 1 died during gestation and was delivered at 33+6 weeksgestation. The mean birthweight was 2181.6+/-971.6 (range 498 to 3500)g for the entire group, and 2712.9+/- 571.5 (range 1860 to 3500)g for the 7 infants who lived until after neonatal period. The total survival rate for 11 babies was 64%. This study demonstrates that midtrimester emergency cervical cerclage for the patients who have dilated cervix with/without prolapsed amniotic sac is valuable method to try in the cases predicted they would lost the baby with conservative treatment only.
Cerclage, Cervical* ; Cervix Uteri* ; Dilatation* ; Emergencies* ; Female ; Gestational Age ; Humans ; Infant ; Labor Stage, First ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy, Twin ; Retrospective Studies ; Survival Rate

PURPOSE: Islet cell tumors are a rare disease that can be cured by surgical management if they are early diagnosed. However, diagnosis and localization are difficult due to their small size and varied clinical manifestations. We analyzed the clinicopathologic features, the diagnosis and the surgical management of islet cell tumors. METHODS: We retrospectively analyzed the case histories of 30 patients had undergone pancreatic surgery for islet cell tumors between April 1990 and December 1999. RESULTS: The islet-cell tumors included 16 insulinomas, 4 gastrinomas, 1 glucagonoma, one insulin-gastrin secreting tumor, and 8 nonfunctioning tumors. The major clinical manifestations were neuroglycopenic (94%) and adrenergic (75%) symptoms in cases of an insulinoma, abdominal ulcer symptoms (100%) in the cases of a gastrinoma, diabetis mellitus (100%) in the cases of a glucagonoma, and abdominal pain (63%) and a mass (25%) in nonfunctioning tumor. The preoperative tumor localization tools were angiography, transhepatic portal vein sampling, endoscopic ultrasonography, computed tomography, and octreotide scans which had sensitivities of 56%, 71%, 55.5%, 43.3%, and, 25% respectively. The surgical treatments were enucleation (38%) or segmental resection (25%) for insulinomas, pancreaticoduodenectomy with total gastrectomy (25%) or total pancreatectomy (25%) for gastrinomas, and pylorus preserving pancre aticoduodenectomy (38%) or regional pancreatectomy (26%) for nonfunctioning tumors. Malignant islet cell tumors were presenting cases (30%). Two patients died with postoperative complications on post operative day 3 and 35; the others survived during the follow-up period (1 month-10 years). Islet cell tumors with multiple endocrine neoplasm type I occurred in five (17%) cases; in three cases, the tumors were malignant. CONCLUSION: The early diagnosis and vigorous attempt to resect the lesion in islet cell tumors of the pancreas should be carried out for the long-term survival.
Abdominal Pain ; Adenoma, Islet Cell* ; Angiography ; Diagnosis ; Early Diagnosis ; Endosonography ; Follow-Up Studies ; Gastrectomy ; Gastrinoma ; Glucagonoma ; Humans ; Insulinoma ; Islets of Langerhans* ; Octreotide ; Pancreas* ; Pancreatectomy ; Pancreaticoduodenectomy ; Portal Vein ; Postoperative Complications ; Pylorus ; Rare Diseases ; Retrospective Studies ; Ulcer

PURPOSE: It is known that in animal experiments, a very small transplanted kidney relative to the recipient's size caused renal failure by a hyperfiltration injury on the nephron. Currently, studies of post-transplant renal function related to the allograft size are in process at many centers, checking the weight and the volume of the transplanted kidney. The results, however, need to be analyzed because of the diverse outcomes from different analytic points. The proper discriminating point should provide sound predictable factors for obtaining better recipient and graft survival. METHODS: We analyzed the results of renal function according to the different comparative points of the ratios of the kidney weight to the recipient's body weight (KW/BW) and of the kidney volume to the recipient's body surface area (KV/BSA). Among 243 patients who underwent a renal transplant between December 1995 and July 1997, 71 cases were excluded because of early graft loss, acute rejection and incomplete data. The remaining 172 patients were grouped into two groups above and below the various comparative points of the KW/BW and KV/BSA. Thereafter, serum Cr and 24-hr urine protein at 1-yr and 2-yr post- transplantation were compared between the groups. Also we analyzed the correlation between the renal size index (KW/BW, KV/BSA) and the serum Cr, the 24-hr urine protein, and the creatinine clearance at one and two years. RESULTS: From 2.5 to 2.9 of KW/BW, there were relatively consistent results; the transplanted kidneys which had more larger sizes excreted less protein in the 24-hr urine at one year (p<0.05). However, there was no difference in serum Cr level at 1- and 2-yr post-transplantation or in the 24-hr urine protein at 2 yr. Also there were correlations between the KW/BW and the 24-hrurine protein at 1 yr and between the KV/BSA and serum Cr at 1 yr (p<0.05). CONCLUSION: We conclude that the KW/BW, rather than the KV/BSA, was more predictable for post-transplant renal function such as urinary protein excretion, especially at 1 yr. The comparative point, however, should be deliberately adopted by using different multiple point. Also a method of measuring the functional size of the kidney, other than the simple geometric size, needs to be found.
Allografts ; Animal Experimentation ; Body Surface Area* ; Body Weight* ; Creatinine ; Graft Survival ; Humans ; Kidney Transplantation* ; Kidney* ; Nephrons ; Renal Insufficiency ; Transplants

Pancreas transplantation has became an accepted form of therapy for insulin dependent DM (IDDM). However, rejection remains the major cause of graft loss in pancreas allografts. To overcome the immunologic graft loss following pancreas allograft, early reliable method for rejection is crucial. The purpose of this study was to evaluate the significance of urine amylase (UA) levels as a reliable and sensitive indicator of pancreas allograft rejection retrospectively. Over a 15-month study period from August '97 to Cotover '98, 9 pancreas transplants with bladder drainage were performed at our center. Among which 6 pancreas transplantation alone (PTA) and 3 simultaneous pancreas-kidney transplantation (SPK) were performed. The diagnosis of rejection was based on clinical criteria (fever, tenderness, leukocytosis) and serology such as, a reduction in UA level. Rejection was developed in 5 patients (56%), including 4 PTA and 1 SPK recipients. Mean UA level during normal allograft function was 89,365 U/L, whereas level heralding rejection was 14,760 U/L (P<0.05). After steroid pulse therapy, first rejection episode result in 100% reversal of rejection and the UA level returned toward normal (mean 95,437 U/L). However more than one rejection episode resulted in poor outcome (all the graft were lost). Overall, reversal of rejection occurred in 63% of cases, with 2 PTA and 1 SPK lost due to rejection. Monitoring pancreas-allograft function by UA allows for the timely diagnosis and successful treatment of pancreas-allograft rejection. For more than one rejection episodes, more potent immunosuppressants are through needed to be improve the graft survival.
Allografts* ; Amylases* ; Diagnosis ; Drainage ; Early Diagnosis* ; Graft Survival ; Humans ; Immunosuppressive Agents ; Insulin ; Pancreas Transplantation* ; Pancreas* ; Retrospective Studies ; Transplants ; Urinary Bladder