BACKGROUND: Immunosuppressive regimens with the fewest possible toxic effects are desirable for transplant recipients. This study evaluated the efficacy and relative toxic effects of four immunosuppressive regimens. METHODS: We assigned 299 renal-transplant recipients to receive group A (standard-dose cyclosporine, mycophenolate mofetil, and corticosteroids), group B (low-dose cyclosporine, basiliximab induction, mycophenolate mofetil, and corticosteroids), group C (standard-dose tacrolimus, mycophenolate mofetil, and corticosteroids), or group D (low-dose tacrolimus, basiliximab induction, mycophenolate mofetil, and corticosteroids) regimens. We compared the groups according to graft function through estimated glomerular filtration rate (GFR), acute rejection, and allograft survival. RESULTS: The mean calculated GFR in patients receiving low-dose tacrolimus (76.4 mL per minute) was higher than in the other three groups (range, 66.3 to 73.8 mL per minute). The rate of biopsy-proven acute rejection was lower in patients receiving low-dose tacrolimus (14.3%) than in those receiving standard-dose cyclosporine (29.6%), low-dose cyclosporine (19.8%), or standard-dose tacrolimus (23.8%). Allograft survival rates differed significantly among the four groups (P=0.006) and were highest in the low-dose tacrolimus group (99.9%). Serious adverse events were more common in the standard-dose tacrolimus group than in the other groups (51.2% vs a range of 41.4 to 42.3%), although a similar proportion of patients in each group had at least one adverse event during treatment (81.1 to 90.5%). CONCLUSIONS: A regimen of basiliximab, mycophenolate mofetil, and corticosteroids in combination with low-dose tacrolimus may be advantageous for renal function, allograft survival, and acute rejection rates, compared with regimens containing basiliximab induction plus either low-dose cyclosporine or standard-dose tacrolimus or with standard-dose cyclosporine without induction.
Adrenal Cortex Hormones ; Antibodies, Monoclonal ; Cyclosporine ; Glomerular Filtration Rate ; Graft Survival ; Humans ; Kidney Transplantation ; Mycophenolic Acid ; Recombinant Fusion Proteins ; Rejection (Psychology) ; Survival Rate ; Tacrolimus ; Transplantation, Homologous ; Transplants

PURPOSE: Accurate clinical diagnosis of acute appendicitis is more difficult in children since they may not be able to communicate their complaints adequately, and findings on physical examination may be nonspecific.The uncertainty in diagnosis may lead to a delay of surgery or to unnecessary laparotomy. Prompt diagnosis is important due to their complications such as perforation, abscess formation, and peritonitis. The authors conducted this study in order to find out usefulness of ultrasonography in diagnosis of acute appendicitis in children. METHODS: The authors was performed ultrasonographical examination to 290 children with abdominal pain under the age of 15 during a recent 16-months period from January 1994 to April 1995. High-resolution ultrasonography was used according to the graded compression method. The ultrasonographic findings were correlated with pathologic outcome in 87 cases. RESULTS: 1) Among 290 patients with abdominal pain, acute appendicitis was 81 cases (27.9%), and there were mesenteric lymphadenitis, terminal ileitis, intussusception, acute gastroenteritis, and nonspecific findings. 2) Sex ratio of acute appendicitis was 1.53:1. The acute appendicitis was occurred 13.6% in under the age of 5 and 86.4% in over the age of 6. Mean age was 10.6 3) The most frequent symptom was abdominal pain followed by vomiting, fever, nausea, and diarrhea. 4) Leukocytosis (>10,000/cu.mm) was occurred in 71 of 81 (87.7%) cases of acute appendicitis and 24 of 28 (85.7%) cases of acute appendicitis with perforation. 5) The perforation rate was higher in delayed diagnosis and in younger children. 6) Ultrasonography had a sensitivity of 97.5%, specificity of 96.2%, positive predictive value of 90.8%, and negative predictive value of 99.0% on diagnosis in acute appendicitis. CONCLUSIONS: Upon the above results, the authors were able to conclude that graded compression ultrasonography had high sensitivity and specificity and was useful for the diagnosis of acute appendicitis in children. And the ultrasonography can be applied as rapid, noninvasive, and well-tolerated investigation. So, it has diagnostic value as screening test in children whose chief complaint is abdominal pain.
Abdominal Pain ; Abscess ; Appendicitis* ; Child* ; Crohn Disease ; Delayed Diagnosis ; Diagnosis* ; Diarrhea ; Fever ; Gastroenteritis ; Humans ; Intussusception ; Laparotomy ; Leukocytosis ; Mass Screening ; Mesenteric Lymphadenitis ; Nausea ; Peritonitis ; Physical Examination ; Sensitivity and Specificity ; Sex Ratio ; Ultrasonography* ; Uncertainty ; Vomiting

PURPOSE: Prolonged recovery time of pulmonary function after an asthma exacerbation is a significant burden on asthmatics, and management of these patients needs to be improved. The aim of this study was to evaluate factors associated with a longer recovery time of pulmonary function among asthmatic patients hospitalized due to a severe asthma exacerbation. METHODS: We retrospectively reviewed the medical records of 89 patients who were admitted for the management of acute asthma exacerbations. The recovery time of pulmonary function was defined as the time from the date each patient initially received treatment for asthma exacerbations to the date the patient reached his or her previous best FEV1% value. We investigated the influence of various clinical and laboratory factors on the recovery time. RESULTS: The median recovery time of the patients was 1.7 weeks. Multiple linear regression analysis revealed that using regular inhaled corticosteroids (ICS) before an acute exacerbation of asthma and concurrent with viral infection at admission were associated with the prolonged recovery time of pulmonary function. CONCLUSIONS: The prolonged recovery time of pulmonary function after a severe asthma exacerbation was not shown to be directly associated with poor adherence to ICS. Therefore the results indicate that an unknown subtype of asthma may be associated with the prolonged recovery of pulmonary function time after an acute exacerbation of asthma despite regular ICS use. Further prospective studies to investigate factors affecting the recovery time of pulmonary function after an asthma exacerbation are warranted.
Adrenal Cortex Hormones ; Asthma* ; Humans ; Linear Models ; Medical Records ; Phenotype ; Prospective Studies ; Respiratory Function Tests ; Retrospective Studies

Segmental neurofibromatosis(neurofibromatosis type V) is rare disorder characterized by limitation of cafe-au-lait spots and neurofibroma or only neurofibroma on a given unilateral segment of the body. We report a case of segmental neurofibromatosis that developed in a 58-year-old male. The skin lesion was situated on the right antecubital area and wrist in the distribution of dermatomes C5 and C6. Histopathologic examination showed well-demarcated, non-encapsulated tumor of the dermis was composed of thin wavy collagenous fibers and loosely spaced spindle cells with elongated wavy nuclei. The patient was treated with surgical excision and carbon dioxide laser.
Cafe-au-Lait Spots ; Collagen ; Dermis ; Humans ; Lasers, Gas ; Male ; Middle Aged ; Neurofibroma ; Neurofibromatoses* ; Skin ; Wrist

Eosinophilic granulomatosis with polyangiitis (EGPA), also known as Churg-Strauss syndrome, is a rare systemic necrotizing vasculitis affecting small- to medium-sized vessels. EGPA is associated with severe asthma and eosinophilia. The most frequently involved organs are skin and peripheral nerves; however, EGPA may involve other organs, such as the gastrointestinal tract, kidney, and heart. Antineutrophil cytoplasm antibodies (ANCAs)-related abnormal immune reactions are known to be associated with EGPA, but only 30%-40% of patients have a positive marker of ANCA. ANCA-negative patients are at higher risk of cardiac involvement than ANCA-positive patients. Cardiac involvement is one of the leading causes of mortality and could be resistant to conventional treatment. Early treatment with steroid plus cyclophosphamide is important because it could give chances of restoration of cardiac function. For patients undergoing heart transplantation, we should consider the severity of cardiac disease and the presence of systemic diseases, including vasculitis. Here, we report a case of a 25-year-old EGPA patient with cardiac involvement who eventually received heart transplantation for progressive heart failure, although treated with systemic corticosteroid with cyclophosphamide. EGPA patients undergoing heart transplantion are rarely reported worldwide, and this is the first case report in Korea.
Adult ; Antibodies ; Antibodies, Antineutrophil Cytoplasmic ; Asthma ; Churg-Strauss Syndrome* ; Cyclophosphamide ; Cytoplasm ; Eosinophilia ; Eosinophils* ; Gastrointestinal Tract ; Heart ; Heart Diseases ; Heart Failure ; Heart Transplantation* ; Humans ; Kidney ; Korea ; Mortality ; Peripheral Nerves ; Skin ; Vasculitis

The association of neoplastic disease and thromboembolic disorder was first recognized by Trousseau in 1865. Since then, thromboembolic events have often been reported in a variety of malignant conditions. Recently, we experienced an unusual case of a 67-year-old ovarian cancer patient with extensive thromboembolic events involving lung, brain, extremity and abdominal cavity. In this report, we describe a systemic coagulopathy fluctuating in accordance with anticoagulant therapy, and have special regard for a role of anticoagulants for the treatment of this syndrome.
Abdominal Cavity ; Aged ; Anticoagulants ; Brain ; Extremities ; Humans ; Lung ; Ovarian Neoplasms ; Thromboembolism

Angioleiomyoma is a benign solitary tumor that arises from muscle layer of the vein walls and mainly develops on the lower extremities of middle-aged women. But it is rarely found on the lip. We report an unusual case of angioleiomyoma in a 27-year-old male who showed an asymptomatic, 0.3 X 0.5 cm sized mass on the upper lip for 3 years. Histopathologically, various sized, numerous vessels and bundles of smooth muscle fibers were observed in the dermis.
Adult ; Angiomyoma* ; Dermis ; Female ; Humans ; Lip* ; Lower Extremity ; Male ; Muscle, Smooth ; Veins

Psoriasis vulgaris, a disorder of partially genetic origin, affects 1-3% of the general population. Vitiligo, generally considered an autoimmune disease, affects 0.5% of the general population. Despite the relatively common occurrence of each disease, the concurrence of each disease in a patient has been considered unusual. It is difficult to discern any particular relationship between vitiligo and psoriasis. Assuming that vitiligo and psoriasis are pathogenetically distinct and are grouped independently of each other. We report a case of psoriasis vulgaris associated with vitiligo in a 19-year-old man. Diagnosis was confirmed by clinical and histopathological findings. He is being treated with narrow band UVB phototherapy.
Autoimmune Diseases ; Diagnosis ; Humans ; Phototherapy ; Psoriasis* ; Vitiligo* ; Young Adult