No abstract available.
Aneurysm, Infected ; Aorta, Abdominal

No abstract available.
Child* ; Humans ; Kidney Transplantation*

Renal transplantation is now a well established mode of optimal therapy for children with end-stage renal disease. A total of 119 pediatric renal transplantations were performed during last 20 years but 6 cases (early 3 cases treated with azathioprine and most recent 3 cases) were excluded for this study. A total of 113 pediatric renal transplants out of total 1,906 kidney transplantation recipients receiving cyclosporine A and low dose prednisone as the main immunosuppressive agent were the subjects of this study to find out the risk factors which might influence the pediatric renal allograft survival in a single center. When the potential donor was living related, at least the HLA 1-haplotype matched relative was selected, but, when unrelated, at least DR-1/2 or A+B 2/4 matching was required for selection. Living related donation from parent, brothers, sisters (n=82), and unrelated donation (n=31) through the swap program or from fully motivated healthy volunteers were the major source of kidney for allograft. The mean age of the recipient was 14.1 years ranging from ages 2.1 to 19.9. During a mean follow-up of 68.1 months, there were 21 cases of graft loss, and 3 recipient deaths. The major causes of graft loss were acute and/or chronic rejection, poor compliance and patients death. The 1-, 3- and 5-year graft survival were 94.6%, 88.9% and 79.2% respectively. There was no significant difference between children and adult in graft survival rate. No significant graft survival difference between the related and unrelated donors (73.3 vs 77.2% at 5-year, p>0.05) was found. The significant risk factors for the outcome were the ABO compatibility (p=0.0001) and development of more than 1 episode of acute rejection within 6 month (p=0.01) and 1 year (p=0.0016). Graft survival decreased with increasing number of rejection episode within 6 month (p=0.009) and 1 year (p=0.002). Other factors such as recipients age, original kidney diseases, type and duration of dialysis before transplantation, combined native kidney removals did not influence the outcome of graft. And because of presence of only 2 cadaveric donor in this analysis, we could not demonstrate any benefit of living donor transplantation. In conclusion, pediatric renal transplantation in at least older children (>5 years) is encouraging. The outcome of pre- emptive renal transplantation is also promising. More aggressive ABO matching and effort for reducing the rejection episode within 6 months and 1 year might be important factors for the successful outcome of pediatric renal transplantation. So development and application of more effective immunosuppressive agents such as mycophenolate mofetil or rapamycin to reduce the rejection episodes is to be needed in near future.
Adult ; Allografts* ; Azathioprine ; Cadaver ; Child ; Compliance ; Cyclosporine* ; Dialysis ; Follow-Up Studies ; Graft Survival ; Healthy Volunteers ; Humans ; Immunosuppressive Agents ; Kidney ; Kidney Diseases ; Kidney Failure, Chronic ; Kidney Transplantation ; Living Donors ; Parents ; Prednisone ; Risk Factors* ; Siblings ; Sirolimus ; Tissue Donors ; Transplants ; Unrelated Donors

No abstract available.
Child* ; Humans ; Kidney Transplantation*

The blood sugar control has been a significant problem after transplantation. Cyclosporine is partly responsible for post-transplantation diabetes mellitus (PTDM), but steroid has been well known to have diabetogenic effect and mainly responsible for glucose intolerance after transplantation. Deflazacort, a new steroid, has been introduced as a substitute of conventional steroid to prevent glucose intolerance after transplantation. We performed prospective study of deflazacort conversion from conventional steroid in kidney transplant patients with pre-transplantation diabetes mellitus(pre-Tx DM) or PTDM. A total of 82 kidney transplant patients was included for this study. Forty two patients were converted to deflazacort as a conversion group and 40 patients were remained on conventional steroid as a control group. In conversion group, the patients were converted from steroid to deflazacort with ratio of 5:6 in dosage. Nine patients developed severe anorexia with nausea/vomiting and three patients among them went back on steroid within 3 months after conversion(conversion failure 7.1%). After minimal 6 months of follow-up, there was neither episodes of graft dysfunction nor rejection. There was a significant improvement of glucose control in conversion group. In 12 patients(30.8%), more than 50% dose reduction of insulin or oral hypoglycemics requirement was possible. In control group, however, only 2 patients showed greater than 50% of insulin or oral hypoglycemics dose reduction. We could find that deflazacort conversion had a significant impact on blood sugar control in PTDM patients(11/26) but not in pre-Tx DM patients(1/13). In conclusion, conversion to deflazacort in PTDM patients with stable graft function was safe and blood sugar control was readily possible without an increment of risks of rejection and infection. We propose to use deflazacort as a substitute for prednisone in PTDM patients with stable graft function.
Anorexia ; Blood Glucose ; Cyclosporine ; Diabetes Mellitus ; Follow-Up Studies ; Glucose ; Glucose Intolerance ; Humans ; Hypoglycemic Agents ; Insulin ; Kidney* ; Prednisone* ; Prospective Studies ; Transplants

No abstract available.
Allografts* ; Humans ; Living Donors* ; Risk Factors*

No abstract available.
Allografts* ; Humans ; Living Donors* ; Risk Factors*

The gastrointestinal rnanifestations associated with antiphospholipid antibodies include Budd-Chiari syndroame, hepatic infarction, portal hypertension, pancreatitis, intestinal infarction, perforation, bleeding and ulceration. A 40-year old man, without prior thrombotic event, presented with severe abdominal pain for 3 days and septic shock. Multiple mesenteric venous thrombosis and colonic congestion were suggested by abdominal CT and angiography. Gastroendoscopy revealed esophageal varix and congestive gastropathy. Laboratory tests disclosed postive antiphospholipid antibodies, anti-HCV antibodies, HCV-PCR, prolonged PT, aPTT, thrombocytopenia and had no evidences of SLE and other connective tissue diseases. He was diagnosed as mutiple mesenteric thrombosis and portal hypertension associated with antiphospholipid antibodies in hepatitis C virus infection. He was improved with the antibiotics and intravenous vasopressors. He have had no other thrombotic events until one year after discharge.
Abdominal Pain ; Adult ; Angiography ; Anti-Bacterial Agents ; Antibodies, Antiphospholipid ; Colon ; Connective Tissue Diseases ; Esophageal and Gastric Varices ; Estrogens, Conjugated (USP) ; Hemorrhage ; Hepacivirus ; Hepatitis C Antibodies ; Hepatitis C* ; Hepatitis* ; Humans ; Hypertension* ; Hypertension, Portal ; Infarction ; Pancreatitis ; Shock, Septic ; Thrombocytopenia ; Thrombosis* ; Tomography, X-Ray Computed ; Ulcer ; Venous Thrombosis

BACKGROUND/AIMS: Recently, increased body weight has been found to be associated with an increasing risk of several cancers, including gastric cancer. The true pathogenic role of hyperglycemia in the development of gastric cancer remains unclear as hyperglycemia and its associated conditions may work as carcinogenic factors. The goal of this study was to clarify the factors associated with early gastric cancer and evaluate a homeostasis model assessment of the insulin resistance (HOMA-IR) index, fasting glucose, and lipid profile as predictors of early gastric cancer. METHODS: A total of 63 patients with early gastric cancer between November 2012 and March 2013 were included. Preoperative serum lipid profile levels and serum fasting glucose were examined prospectively in patients with early gastric cancer. The same number of controls were evaluated and matched to the early gastric cancer group for age and gender. We performed multivariate logistic regression analysis to identify independent risk factors for early gastric cancer. RESULTS: Univariate analysis showed that risk for early gastric cancer was associated with diastolic blood pressure (BP), total cholesterol, fasting glucose, and HOMA-IR. In the multivariate-adjusted model, higher total cholesterol, fasting glucose, body mass index, and diastolic BP were strongly associated with an increased risk of early gastric cancer. CONCLUSIONS: Hyperglycemia, a lower high-density lipoprotein cholesterol level, and a low HOMA-IR level appear to be associated with early gastric cancer risk.
Adiponectin ; Blood Pressure ; Body Mass Index ; Body Weight ; Case-Control Studies ; Cholesterol ; Fasting ; Glucose ; Homeostasis ; Humans ; Hyperglycemia ; Insulin Resistance ; Insulin ; Lipoproteins ; Logistic Models ; Prospective Studies ; Risk Factors ; Stomach Neoplasms

Focal segmental glomerulosclerosis (FSGS) is a relatively common glomerular disease which is known to be the final pathway of glomerular injuries caused by variable etiologies. There are some renal diseases that are known to have a tendency of familial inheritance such as adult polycystic kidney disease, thin glomerular basement membrane disease, and Alport's syndrome, nephrotic syndrome with many other diseases. Fanconi et al. described the familial occurrence of the nephrotic syndrome first. Since then, a number of other reports have described the cases of nephrotic syndrome within families, though only a handful of families were confirmed as FSGS with histologic evidence. Recently, reports of familial occurrence of FSGS are increasing in number. These patients have been found to be steroid-resistant and unresponsive to immunosuppressive drugs, and most of them progressed to the end stage renal disease. The specific factors leading to glomerular change are not clearly known, but a genetic predisposition has been postulated. A number of reports pointed out the importance of HLA type as a genetic factor related to the pathogenesis of FSGS but the genetic and immunological linkages in FSGS have not been clearly defined yet. We report cases with 4 patients in two unrelated families with HLA-A24 recovered from FSGS after kidney transplantation.
Child* ; Genetic Predisposition to Disease ; Glomerular Basement Membrane ; Glomerulosclerosis, Focal Segmental* ; Hand ; HLA-A24 Antigen* ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Nephritis, Hereditary ; Nephrotic Syndrome ; Polycystic Kidney, Autosomal Dominant ; Wills