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

In cadaveric renal transplantation, the graft survival from multiorgan donor (MOD) and kidney donor alone (KDA) can be suspected to be different due to a different situation. In MOD, more complicated procurement procedure and least priority of kidney can be a negative impact on graft survival. While in KDA, poor donor status can be an negative factor for graft survival. We have evaluated the characteristics of MOD and KDA group, and analyzed to find out whether there is a disparity in graft survival between the two groups. Among the 137 cadaveric renal allografts from 1991 to 1997, 80 patients(58%) underwent renal allograft from MOD and 57(42%) from KDA. Because of the limited organ resources, we managed every donor carefully as a potential multiorgan donor and final decision to harvest multiorgans was made during the exploration. The average donor age of MOD was younger than that of KDA(26yr vs 32yr, p=0.02) and proportion of category A (donors who had spent less than 6 days in the ICU and had received dopamine less than 5 microgram/kg/min and had not experenced cardiac arrest) was higher in MOD(p=0.03). There were fewer recepients with the ABO minor mismatching in the MOD group (p=0.04). Mean cold ischemic time for both groups did not differ significantly (9.5 hr vs 8.1 hr, p=0.9). Postoperative ATN (33.8% vs 38.6%, p=0.6) and rejection (22.5% vs 24.6%, p=0.7) did not differ significantly in both groups. The one -and 5-year graft survival of MOD group were 88% and 85% compared with 89% and 84% in KDA group. From these results, we can conclude that graft survival did not show any difference between the two groups, regardless of multifactorial differences in renal allograft between MOD and KDA.
Allografts* ; Cadaver* ; Cold Ischemia ; Dopamine ; Graft Survival ; Humans ; Kidney Transplantation ; Kidney* ; Tissue Donors*

Fracture involving the sella turcica is a rare complication of head injury but draws attention of neurosurgeon because it can result in serious neurological, vascular and endocrine complications. Anatomically the sella being located central within the extensive basal dural attachments to the cranial vault, shearing force is transmitted directly to this structure and results in isolated complications. We recently experienced a case of fractured dorsum sellae complicated with cranial nerve palsy and report here with some references.
Cranial Nerve Diseases ; Craniocerebral Trauma ; Sella Turcica

Posttransplant lymphoproliferative disease(PTLD) represents a diverse lymphoproliferative disorder ranging from non-specific reactive hyperplasia to malignant immunoblastic sarcoma developed in a setting of immunosuppression following organ or cellular transplantation. It is often associated with Epstein-Barr virus infection and high dose immunosuppression. EBV detection and immunotyping including immunoglobulin clonality is crucial for prediction of prognosis and treatment modality. We report one case of PTLD developed 5 months after renal transplantation in 33 year-old man. Clinical manifestion was submandibular mass, and EBV was detected by in situ hybridization. Histology and immunotyping revealed immunoblastic lymphoma andl lambda chain monoclonality. He has been treated with reduction of immunosuppression, acyclovir and radiotherapy, and is in stable condition with normal renal function at postoperative 11months without evidence of disease reccurrence.
Acyclovir ; Adult ; Herpesvirus 4, Human ; Humans ; Hyperplasia ; Immunoglobulins ; Immunosuppression ; In Situ Hybridization ; Kidney Transplantation* ; Lymphoma ; Lymphoma, Large-Cell, Immunoblastic ; Lymphoproliferative Disorders ; Prognosis ; Radiotherapy

BACKGROUND: Currently, the incidence of chronic pancreatitis is increasing due to the change of diet and high alcohol consumption in our country. Regarding more effective treatment of chronic pancreatitis, surgical intervention is favored for the control of intractable pain, various complications from the pancreatitis, suspected malignancy, and amelioration of progressively deterioratory exocrine and endocrine pancreas functions. We attempted to evaluate the various indications for an operation, various surgical treatments, and their results. METHODS: We retrospectively reviewed the clinical records of 50 patients with chronic pancreatitis who were managed surgically between July 1989 and Feb. 1998. RESULTS: The indications for operation were intractable pain in 25 cases, suspected malignancy in 12 cases, biliary obstruction in 4 cases, pancreatic pseudocyst in 7 cases, and treatment of Diabetes Mellitus in 2 cases. We performed 11 drainage procedures, 8 Peustow-Gillesby operations and 3, DuVal operations 2 combined denervations, 28 pancreatic resections 12 pancreaticoduodenectomies, duodenum-preserving resection of the pancreas head 12, distal pancreatectomies, 3 total pancreatectomies and a combined denervation, 9 bypass procedures and 2 pancreas transplantations in 2 cases. The follow-up period were from 1 month to 9 years and 7 months with a mean of 2 years and 11 months. The results were good in 23 cases (51 .1%), fair in 16 cases (35.6%) and poor (no change or aggravation) in 6 cases (13.3%). Postoperative mortality developed in 1 case due to postoperative aspiration pneumonia and sepsis after the bypass procedures. Late mortality occurred in 2 cases, one due to sepsis from uncontrolled DM and the other is rupture of the pseudoaneurysm of the anastomotic vessel after transplantation. CONCLUSIONS: Surgical procedures are the mainstays of definite treatment modality in chronic pancreatitis. Operations should be selected properly for each case. Pancreas or islet transplantation is another treatment option for the control of irreversible exocrine and endocrine pancreatic dysfunction.
Alcohol Drinking ; Aneurysm, False ; Denervation ; Diabetes Mellitus ; Diet ; Drainage ; Follow-Up Studies ; Head ; Humans ; Incidence ; Islets of Langerhans ; Islets of Langerhans Transplantation ; Mortality ; Pain, Intractable ; Pancreas ; Pancreas Transplantation ; Pancreatectomy ; Pancreatic Pseudocyst ; Pancreaticoduodenectomy ; Pancreatitis ; Pancreatitis, Chronic* ; Pneumonia, Aspiration ; Retrospective Studies ; Rupture ; Sepsis

BACKGROUND: Women with end-stage renal disease have low fertility. Following renal transplantation, the reproductive function returns to normal, and pregnancy becomes possible. METHOD: At our medical center, between June 1990 and February 1998, 263 female patients underwent renal transplantations, and 14 of them later became pregnant. The outcomes from 23 pregnancies in these 14 kidney transplant recipients were analyzed. RESULT: Forty-three percent (43%) of the pregnancies ended in artificial (9 cases) or spontaneous abortion (1 case), and 11 of 13 deliveries were successful. A vaginal delivery was performed in 9 cases (69%) and a cesarian section was done in 4 cases (31%). All of the 11 pregnancies that continued over 30 weeks ended successfully. The mean age of the recipients at the first pregnancy was 29.4 +/- 4.6 years (23-37). The mean time to first pregnancy since renal transplantation was 22.6 +/- 12.3 months (1-50). Thirteen (13) recipients were maintained on cyclosporin-based immunosuppressive regimens before and during pregnancy. One recipient, who was considered to have developed immune tolerance later, stopped the immunosuppressive drug at 3 months prior to the first pregnancy. The renal function remained stable and unchanged in all the recipients, and no rejection episodes occurred during and after pregnancy in any of the recipients. Preeclamsia occurred in 8 cases (35%) and a previous rupture of membrane in 1 case (4%). Of the 11 live births, 4 (36%) were premature (<37 weeks), 1 (9%) had a lowbirth-weight (<2500 gm), 1 (9%) had transient apnea, and 3 (27%) had transient neutropenia. The mean Apgar score at 1 minute was 7.8 (7-9), with only 2 children having a score below 7. No congenital anomalies were documented. The later development and health of all of the children were good during a mean follow-up of 16.6 +/- 10 (1-38) months. Two (2) recipients who had a successful first pregnancy had a second baby. CONCLUSION: From these results, we can conclude that pregnancy does not adversely affect graft function and fetal development, provided that the graft function was stable at the time of conception and prudent fetal monitoring could be done.
Abortion, Spontaneous ; Apgar Score ; Apnea ; Child ; Female ; Fertility ; Fertilization ; Fetal Development ; Fetal Monitoring ; Follow-Up Studies ; Humans ; Immune Tolerance ; Kidney ; Kidney Failure, Chronic ; Kidney Transplantation ; Live Birth ; Membranes ; Neutropenia ; Pregnancy* ; Rupture ; Transplantation ; Transplants