PURPOSE: To evaluate the efficacy of catheter-directed thrombolysis in treating symptomatic deep venous thrombosis (DVT) in lower limbs. METHODS: Between Jan. 1999 and Dec. 2002, 29 consecutive patients with DVT had received thrombolytic therapy. The male: female ratio was 6: 23 and the mean age was 50.3+/-13.5 years. The mean duration of symptom was 9.9+/-22.1 days. Catheter-directed infusions of urokinase were administrated via ipsilateral popliteal veins and the angioplasty and stent placement performed after the thrombolytic procedure. The mean dosage of urokinase and duration of thrombolysis were 2, 435, 000+/-887, 000 units and mean duration of thrombolysis was 36.8+/-17.9 hours. Oral medication of warfarin continued at least six months or more. To evaluate the venous patency, duplex ultrasonography or CT venography were performed. RESULTS: Lysis was complete in 17 patients (58.6%, all acute DVT), partial in 11 (37.9%), with only one patient failing. Iliac vein stenosis had shown in 16 patient after thrombdysis. Which were treated with balloon angioplasty and stent insertion. As a postprocedural complication, vaginal bleeding occurred in two patients; one was treated with transfusion but the other stopped without treatment. CONCLUSION: Catheter-directed thrombolysis with urokinase is effective for the treatment of DVT in lower limbs. However further study will be reguired to evaluate the relationship between the incidence of postthrombotic syndrome and thrombolytic therapy alone.
Angioplasty ; Angioplasty, Balloon ; Constriction, Pathologic ; Female ; Humans ; Iliac Vein ; Incidence ; Lower Extremity ; Male ; Phlebography ; Popliteal Vein ; Postthrombotic Syndrome ; Stents ; Thrombolytic Therapy ; Ultrasonography ; Urokinase-Type Plasminogen Activator* ; Uterine Hemorrhage ; Venous Thrombosis* ; Warfarin

PURPOSE: With recent technological advances, the indications for retrograde intrarenal surgery (RIRS) have gradually increased. We evaluated the efficacy and treatment outcomes of RIRS for the treatment of renal stones. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 23 patients with renal stones (7 in the renal pelvis, 9 in the renal calyx, and 7 in the renal diverticulum) treated with RIRS from January 2001 to July 2008. Mean stone burden was 110 mm2 (range, 9.42-428.6 mm2), and all operations were performed under general anesthesia using a semi-rigid ureteroscope in 9 cases, a flexible ureteroscope in 11 cases, and both types simultaneously in 3 cases. The holmium:yttrium-aluminum-garnet (Ho: YAG) laser and the nitinol basket were used for stone fragmentation and retrieval. The patients were followed up postoperatively with KUB (21 cases) or nonenhanced computed tomography (CT; 2 cases). Success was defined as no visible stones on KUB or nonenhanced CT. RESULTS: The mean operating time was 93 minutes (range, 30-205 minutes) and the mean hospital stay was 3.7 days (range, 1-9 days). Of 23 patients, 16 (70%) experienced complete elimination of the stone after only a single intervention. After ancillary extracorporeal shock wave lithotripsy (ESWL), the success rate was increased to 74% (17/23). In the remaining 6 patients, residual stone findings were less than 3 mm and were followed up with X-ray. CONCLUSIONS: RIRS is a feasible procedure for treating renal stone disease with minimal complications. The results of our study suggest that RIRS can be recommended as a primary modality in the management of renal stone disease in selected patients such as those with ESWL failure and renal diverticular stones.
Alloys ; Anesthesia, General ; Humans ; Kidney Pelvis ; Length of Stay ; Lithotripsy ; Medical Records ; Retrospective Studies ; Shock ; Ureteroscopes

The Barricor tube (Becton Dickinson [BD], Sunnyvale, CA, USA) was recently developed to mechanically separate plasma by increasing the centrifugation rate. We compared the Barricor tube with existing serum- and plasma-based tubes based on 35 biochemical analytes and preanalytical turnaround time (TAT). Blood samples were collected from 30 healthy volunteers in a Barricor tube, serum separating tube (SST, Vacutainer SST II Tube 8.5 mL, #368972; BD), or plasma separating tube (PST, Vacutainer PST Tube 8.0 mL, #367964; BD) in random order. Next, 27 chemistry analytes, six immunochemistry analytes, and two cardiac markers were compared using Passing-Bablok regression and the Bland-Altman method. Preanalytical TAT was measured for each tube.The Barricor tube exhibited bias exceeding the desirable limit for nine and four analytes compared with the SST and PST, respectively. The Barricor tube lactate dehydrogenase value showed a bias of -10.29% and -9.86% compared with that of the SST and PST, respectively. The preanalytical TAT of Barricor tube was 8.8 minutes, which was the shortest among the three tubes. The clinical performance of the Barricor tube was equivalent to that of the SST and PST for most analytes, with an apparent advantage in preanalytical TAT. When using the Barricor tube, the reference range needs to be changed for some analytes that exceed the desirable bias limit.

0.99, slope: 0.965 and 0.955). When Modular D and Cobas 8000c 702 were compared, the slope and y-intercept were 0.9928 (95% confidence interval [CI]: 0.9802 to 1.000) and -0.0156 (95% CI: −0.0200 to −0.0054), respectively. The slope and y-intercept were 0.9811 (95% CI: 0.9570 to 0.9951) and -0.0484 (95% CI: −0.0638 to −0.0297) when Modular D and Au5800 were compared. Serum Cr measured by Cobas 8000 c702 and AU5800 using the Jaffe method were 3.2% and 6.9% lower than the values measured by Modular D, respectively. Both Modular D and Cobas 8000 c702 showed acceptable accuracies.CONCLUSIONS: Serum Cr measurements using Cobas 8000 c702 and AU5800 were comparable to those measured by Modular D, and showed satisfactory precision and linearity; thus, these techniques could be useful for clinical laboratories.]]>
Creatinine ; Methods

BACKGROUND: Rheumatoid factor (RF) is used as one of the diagnostic criteria for rheumatoid arthritis. The purpose of this study was to evaluate qualitative RF reagents used in clinical laboratories in Korea, and to provide basic data that can be used as a reference to improve the quality of RF testing. METHODS: We reviewed the proficiency testing results for RF from the Korean Association of External Quality Assessment Service (KEQAS) and College of American Pathologists. Moreover, we evaluated five commercially available RF qualitative reagents, including LabSlide RF (IVD Lab Co., Korea), ASAN RA Latex Reagents (Asan Pharmaceuticals Co., Korea), RaPET RF (Stanbio Laboratory, USA), RF Latex Test (Pulse Scientific Inc., Canada), and RF-100 (Teco Diagnostics, USA). Commercially available quality control materials, calibrators, and pooled sera were used in this study. The consistency of qualitative reagents and Kappa statistics were calculated based on the quantitative values of the quality control materials and the mixed sera. RESULTS: Up to 51.5% of high concentration samples were reported as negative in KEQAS. RF qualitative reagent test results were not consistent among reagent types. The consistency of the qualitative and quantitative test results was between 51% and 100%, and the kappa statistics varied depending on the reagent manufacturer. CONCLUSIONS: Measurement of RF qualitative reagents used in domestic clinical laboratories was not consistent with the quantitative values, and hence it is necessary to improve the consistency and verify the adequacy of the cut-off value.
Arthritis, Rheumatoid ; Chungcheongnam-do ; Indicators and Reagents ; Korea ; Latex ; Quality Control ; Rheumatoid Factor

PURPOSE: Tumor necrosis factor (TNF)-alpha and transforming growth factor (TGF)-beta1 have been shown to play important roles in allograft rejection of various organs. This study was performed to evaluate the association of TNF-alpha and TGF-beta1 genes and renal allograft dysfunction. METHODS: Five TNF-alpha ( 1,031 T/C, 863 C/A, 857 C/T, 308 G/A, 238 G/A) and two TGF-beta1 (codon 10 T/C, codon 25 G/C) single nucleotide polymorphism (SNP) sites were studied using PCR-SSCP and PCR-RFLP methods in 100 controls and 165 patients underwent renal transplantation. For the TGF-beta1 gene, we also studied the polymorphism of donors. RESULTS: The allele frequencies of each SNP sites in controls were not different from those of patients. The phenotype frequency of TNF-alpha high producer type, 308 A was significantly higher in the patients with recurrent acute rejection episodes (REs) compared with patients with no or one RE (38.5% vs. 9.2%, P=0.007). The frequency of TGF-beta1 low producer genotype, codon 10 CC was also significantly higher in the patients with recurrent REs (53.8% vs. 22.4%, P=0.029). Analysis of chronic renal allograft dysfunction (CRAD) revealed that the TGF-beta1 high producer type, codon 10 T allele in donors was associated with CRAD (66.7% vs. 48.2%, P=0.043). This association was significant only among patients with recurrent REs. Occurrence of CRAD was not influenced by TGF-beta1 polymorphisms in the patients. CONCLUSION: These results would be useful for predicting high risk group for acute rejection or CRAD in renal transplantation and might be useful for implying individualized immunosuppressive therapy.
Alleles ; Allografts* ; Codon ; Gene Frequency ; Genotype ; Humans ; Kidney Transplantation ; Phenotype ; Polymorphism, Single Nucleotide ; Tissue Donors ; Transforming Growth Factor beta1* ; Transforming Growth Factors ; Tumor Necrosis Factor-alpha*

PURPOSE: The management of prenatally detected bilateral ureteropelvic junction obstruction (UPJO) remains controversial. We attempted to develop a treatment plan for patients with severe bilateral UPJO. MATERIALS AND METHODS: We evaluated the records of 13 patients with prenatally diagnosed grade 3 or more bilateral hydronephrosis that led to the postnatal diagnosis of severe bilateral UPJO. Ultrasonography and (99m)technetium mercaptoacetyltriglycine ((99m)Tc-MAG3) renal scans were performed within 1 month. Four renal units had grade 3 and 22 had grade 4 hydronephrosis. All 13 patients were managed by unilateral pyeloplasty, and the patients' mean age was 3 months. At 1 month postoperatively, we decided whether delayed surgery in the opposite renal unit was necessary according to the findings of ultrasonography and (99m)Tc-MAG3 scans. RESULTS: Of 13 patients, 11 underwent initial pyeloplasty on renal units with more severe hydronephrosis or lower relative renal function (RRF) on (99m)Tc-MAG3 scans. The remaining 2 patients simultaneously underwent percutaneous nephrostomy on renal units with a lower RRF and initial pyeloplasty on renal units with a higher RRF. In 5 patients, contralateral hydronephrosis had spontaneously improved at 1 month postoperatively, and 8 patients underwent delayed contralateral pyeloplasty at 2 months postoperatively. CONCLUSIONS: In children with severe bilateral UPJO, the non-operated renal units with grade 3 and some with grade 4 hydronephrosis improved spontaneously after unilateral pyeloplasty. Therefore, delayed pyeloplasty of the opposite side should be considered at 1 month following initial pyeloplasty.
Child ; Humans ; Hydronephrosis ; Infant, Newborn ; Nephrostomy, Percutaneous ; Ureteral Obstruction

PURPOSE: IL-10 and IFN-gamma are amongst important cytokines, which are thought to have influence on organ transplantation outcome. The aim of this study was to investigate the IL-10 and IFN-gamma gene polymorphisms in Koreans, and their association with renal transplantation outcome. METHODS: Three SNP sites (-1082 G/A, -819 C/T, -592 C/A) of IL-10 promoter region and CA repeats in intron 1 of IFN-gamma gene were analyzed using PCR-single strand conformation polymorphism (SSCP) and direct sequencing methods in 73 controls and 164 kidney allograft recipients. Association between polymorphisms of these genes and transplantation outcome was analyzed using chi square test or Fisher's exact test. RESULTS: The allele frequencies of the IL-10 and IFN-gamma genes showed no significant differences between the control and patient groups. The frequencies of IL-10 and IFN-gamma high producer alleles were markedly lower than those of Caucasians. The incidence of multiple acute rejection episodes was higher in IL-10low producer (-1082 AA) than intermediate producer (-1082 GA) group (8.6% vs 0%), and in IFN-gamma high producer ([CA]12 positive) than low producer ([CA]12 negative) group (11.9% vs 6.6%). The incidence of chronic renal allograft dysfunction was lower in IL-10 intermediate producer than low producer group (7.7% vs 18.0%), and also lower in the combination of IL-10 intermediate/IFN-gamma low producer type than in other combinations (0% vs 18.2%). However, all these differences were not statistically significant. CONCLUSION: IL-10 and IFN-gamma have little influence on renal transplantation outcome in Koreans, probably due to quite limited polymorphisms of these genes in this population. The results of this study would be useful as basic data for renal transplantation in Koreans.
Alleles ; Allografts* ; Cytokines ; Gene Frequency ; Humans ; Incidence ; Interleukin-10* ; Introns ; Kidney Transplantation* ; Kidney* ; Organ Transplantation ; Promoter Regions, Genetic ; Transplants

PURPOSE: The aims of this study were to analyze clinical characteristics of the patients with AAA (Abdominal aortic aneurysm) and to report the results of AAA repair. We also compared the results of open repair (OR) with those of endovascular repair (ER) to evaluate the short-term efficacy of ER, especially in high-risk patients. METHODS: We reviewed the medical records of 118 (28 ruptured, 90 unruptured) patients who underwent AAA repair in Seoul National University Hospital from September 1986 to September 2002. We also compared the treatment outcomes of ER (n=21) with those of conventional OR (n=37) for unruptured AAA during the period July 1995 to September 2002. RESULTS: The mean aneurysm size was larger in ruptured AAA patients (8.49 cm vs. 6.67 cm, P<0.01). The most frequent comorbidity was hypertension (51.7%, n=61). Abdominal discomfort or pain was the most frequent symptom. The hospital mortality in ruptured AAA was higher than in unruptured AAA (35.7% vs. 4.4%, P=0.01), especially in intraabdominal free rupture (80%). The complications of OR were rather systemic, but those of ER repair were all local or vascular complications such as endoleak and graft thromboembolism. The graft failure rate was significantly higher in ER than in OR (P=0.001), but ER resulted in shorter operation time and length of ICU stay, less blood loss and a lower necessity for general anesthesia than OR. No significant difference was found in hospital mortality or survival rate. CONCLUSION: Ruptured AAA still has high operative mortality, especially in free ruptured AAA. We suggest that elective operation be performed before rupture occurs. Because the short-term outcomes of ER are considered to be acceptable, ER may be helpful especially in the patients with high operative risk. But further study of the long-term results of ER for AAA should be followed.
Anesthesia, General ; Aneurysm ; Aortic Aneurysm, Abdominal* ; Comorbidity ; Endoleak ; Hospital Mortality ; Humans ; Hypertension ; Medical Records ; Mortality ; Rupture ; Seoul ; Survival Rate ; Thromboembolism ; Transplants

No abstract available.
Empathy ; Humans