In brachytherapy of uterine cervical cancer using a high dose rate remote afterloading system, it is of prime importance to deliver a accurate dose in each fractionated treatment by minimizing the difference between the pre-treatment planned and post-treatment calculated doses. The post-treatment calculated point A dose was not much different from the pretreatment planned dose (500 cGy). The average+/-standard deviation was 500+/-18 cGy and 84 percent of 82 intracavitary radiotherapy was within the range of 500+/-25 cGy.
Brachytherapy ; Cervix Uteri* ; Female ; Radiotherapy* ; Uterine Cervical Neoplasms

This review will focus on the current issues in the government-driven regulation of transplantation practice in Korea, Korean renal transplant statistics, unrelated renal transplantation, renal transplantation in cross-match positive patients, preemptive renal transplantation, non-invasive renal imaging, novel minimally-invasive living donor nephrectomy, and tailored immunosuppression.
Humans ; Immunosuppression ; Kidney Transplantation* ; Korea ; Living Donors ; Nephrectomy

The shortage of donor organs is one of the major barriers of transplantation worldwide. After the success of the direct exchange donor (swap) program in Korea since 1991, a swaparound program has been developed. Recently, a web-based (computerized) algorithm to facilitate donor kidney exchange was devised and tested in multi-center settings. An excellent longterm outcome was achieved by using the donor exchange program as an option to reduce the donor organ shortage. Herein, we discussed on the current status of the exchange donor renal transplantation in Korea, a couple of problems we have had, and future directions we have to head and make better to improve organ donation activities.
Head ; Humans ; Kidney ; Kidney Transplantation ; Korea ; Tissue and Organ Procurement ; Tissue Donors ; Transplants

PURPOSE: Proliferation, migration, and the accumulation of extracellular matrix (ECM) protein of vascular smooth muscle cells (VSMC) play roles for transplant arteriosclerosis. We have previously reported that carvedilol (CA) inhibits the proliferation and the migration of VSMCs. The present study examined the effects of CA on platelet-derived growth factor (PDGF)-induced collagen synthesis in VSMC and the roles of reactive oxygen species (ROS), extracellular signal- regulated protein kinase (ERK), and p38 mitogen-activated protein kinase (p38 MAPK). METHODS: Primary cultured rat VSMCs were obtained from aorta of Sprague-Dawley rats. Growth arrested and synchronized cells were pretreated with CA (10 nM~10micrometer) at 1 hour before the addition of PDGF 10 ng/ml. Collagen synthesis was measured by 3[H]-proline incorporation, ROS by flow cytometry using ROS-sensitivedichlorofluorescein (DCF) dye, and the activation of ERK andp38 MAPK by Western blot analysis. RESULTS: PDGF significantly increased collagen synthesis by 2.0-fold, intracellular ROS by 1.6-fold, the activation of ERK 1/2 and p38 MAPK by 4.2-fold and 3.9-fold compared to control, respectively. CA above 1micrometer inhibited PDGF-induced collagen synthesis. CA also inhibited DCF-sensitive ROS and the activation of ERK and p38 MAPK. All pharmacological inhibitors of ROS, ERK, and p38 MAPK effectively inhibited PDGF-induced collagen synthesis. CONCLUSION: These data suggest that CA inhibit PDGF-induced collagen synthesis possibly through inhibiting intracellular ROS and ERK 1/2 and p38 MAPK activation.
Animals ; Aorta ; Arteriosclerosis ; Blotting, Western ; Collagen* ; Extracellular Matrix ; Flow Cytometry ; Muscle, Smooth, Vascular* ; p38 Mitogen-Activated Protein Kinases ; Platelet-Derived Growth Factor ; Protein Kinases ; Rats* ; Rats, Sprague-Dawley ; Reactive Oxygen Species ; Signal Transduction*

BACKGROUND: Vascular smooth muscle cell (VSMC) proliferation plays an important role in the development and progression of chronic allograft vasculopathy as in atherosclerosis. We already reported that mycophenolic acid (MPA) inhibited VSMC proliferation, cellular reactive oxygen species (ROS) and mitogen-activated protein kinases (MAPK) in human VSMCs. In this study, we examined further molecular mechanisms involved in the anti-proliferative effect of MPA in rat VSMCs. METHODS: Primary rat VSMCs were stimulated with PDGF-BB 10 ng/mL in the presence or absence of MPA and various kinds of cell signaling inhibitors. Cell proliferation was assessed by [H3]- thymidine incorporation, NAD(P)H oxidase subunits mRNA expression by RT-PCR, dichlorofluorescein- sensitive cellular ROS by FACS, and the activation of PDGF receptor-beta (Tyr 751), rac1, and MAPK by Western blot analysis. RESULTS: PDGF increased cell proliferation and cellular ROS, activation of PDGF receptor-beta (Tyr 751), rac1, expression of p22phox and MOX1 mRNA, ERK 1/2, and p38 MAPK, compared to control. MPA inhibited up-regulation of rac1 phosphorylation, p22phox and MOX1 mRNA expression, cellular ROS, and phosphorylation of ERK 1/2 and p38 MAPK. However, MPA did not affect PDGF receptor-beta (Tyr 751) activation. Wortmannin, diphenyleniodonium (DPI), trolox, and NAC, each inhibited PDGF- induced ERK 1/2 and p38 MAPK activation. PD98059 and p38 MAPK inhibitor also inhibited PDGF-induced cell proliferation. CONCLUSION: These results suggest that MPA inhibits PDGF-induced VSMC proliferation through inhibiting NAD(P)H oxidase-dependent cellular ROS leading to ERK 1/2 and p38 MAPK activation.
Allografts ; Animals ; Atherosclerosis ; Blotting, Western ; Cell Proliferation ; Humans ; Mitogen-Activated Protein Kinases ; Muscle, Smooth, Vascular* ; Mycophenolic Acid* ; NADPH Oxidase ; p38 Mitogen-Activated Protein Kinases ; Phosphorylation ; Rats ; Reactive Oxygen Species ; RNA, Messenger ; Thymidine ; Up-Regulation

Kidney transplantation is a treatment of choice which improves survival and quality of life for patients with end-stage renal disease. Due to the growing waiting list for kidney transplantation, expansion of the donor pool to use of deceased pediatric kidneys is of critical importance. However, the use of pediatric kidneys has been limited due to concerns about early graft failure, hyperfiltration injury, and technical difficulties. Performing ureteroneocystostomy using small pediatric en bloc kidneys is sometimes difficult due to the small diameter and short length of the ureter in the adult kidney recipient. We hereby report on a partial bladder wall transplantation using pediatric en bloc kidneys. Pediatric en bloc kidneys and partial bladder wall from a 12-month-old female donor who weighed 9.13 kg was transplanted into a 49-year-old male recipient. The urinary tract was reconstructed with a partial bladder wall of the donor. At 12 months post-transplantation, Doppler ultrasonograpy and renogram showed stable graft renal function without urological complications. Pediatric en bloc kidney transplantation with a partial bladder wall can be a safe and feasible surgical technique to reduce urological complications.
Adult* ; Female ; Humans ; Infant ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Male ; Middle Aged ; Quality of Life ; Tissue Donors ; Transplants ; Ureter ; Urinary Bladder* ; Urinary Tract ; Waiting Lists

PURPOSE: This retrospective study was performed to evaluate clinicopathologic findings, outcomes according to the treatment modality, and prognostic factors in anal cancer. METHODS: Among the 64 patients who were diagnosed as anal cancer at our department from September 1986 to December 1999, 55 patients were analysed retrospectively. Nine patients who refused the treatment or whose medical record could not be retrieved were excluded. Concurrent chemoradiotherapy was performed for twenty-seven patients with squamous cell carcinoma. The chemotherapy with 5-FU and cisplatin and the radiotherapy were started at the same time. 750 mg/m2/day of 5-FU was infused intravenously for 5 days and 100 mg/m2 of cisplatin was started on the second day of therapy. The second cycle chemotherapy was given for 5 days before the radiotherapy was completed. A dose of 5,400cGy was given to the primary lesion and whole pelvis including inguinal area. Eight patients with squamous cell carcinoma were treated by surgery including abdominoperineal resection, local excision, or wide excision. Abdominoperineal resection was the primary treatment modality for melanoma of anus. RESULTS: Among 55 patients with anal cancer, the dominant histologic type was squamous carcinoma (n=35), followed by cloacogenic carcinoma (n=6) and melanoma (n=6). The clinical stages by AJCC were classified as stage I: 4 cases, stage II: 15 cases, stage III: 29 cases, stage IV: 7 cases. The overall 5-year survival rate of anal cancer was 60%. The 5-year survival rate in squamous carcinoma was 79.9% for the concurrent chemoradiotherapy group (n=27) and 54.7% for the surgical resection group (n=8), which was statistically insignificant. Variables affecting the survival rate with statistical significance were age, the initial tumor size, and the state of lymph node and distant metastasis. CONCLUSIONS: The concurrent chemoradiotherapy for patients with squamous cell carcinoma of the anus offered the same outcomes equivalent to surgical modality and preserved anal sphincter function. Melanoma of the anus exhibited poor prognosis and more systemic recurrence regardless of treatment modality. On univariate analysis for risk factors, age, tumor size, and lymph node and distant metastasis had statistical significance.
Anal Canal* ; Anus Neoplasms ; Carcinoma, Squamous Cell ; Chemoradiotherapy ; Cisplatin ; Drug Therapy ; Fluorouracil ; Humans ; Lymph Nodes ; Medical Records ; Melanoma ; Neoplasm Metastasis ; Pelvis ; Prognosis ; Radiotherapy ; Recurrence ; Retrospective Studies ; Risk Factors ; Survival Rate

Solid organ transplantations give end stage organ failure patients new, healthy and normal lives and have them return to their families, friends and communities. But, there has been a donor organ shortage and it has been considered a major obstacle. A national report in 2009 showed a severe disparity between the annual numbers of organ donors (1,787) and the number of patients (12,235) on the deceased donor waiting list. In terms of donor action, and to meet the demands of organs for transplantation, we need to educate the public on the need for organs, eye and tissue donations, and we need to motivate the public to make an actionable donor designation. The unification of non-governmental organization (NGO) is necessary to educate the public about organ, eye and tissue donations and to avoid duplication of effort.
Eye ; Friends ; Humans ; Organ Transplantation ; Tissue and Organ Procurement ; Tissue Donors ; Transplants ; Waiting Lists

PURPOSE: The prevalence and significance of vesicoureteral reflux (VUR) after kidney transplantation has been varies among authors. While these results suggested that VUR can be a source of repeated infections, which might be a prognostic factor impairing long-term graft function. We evaluated the prevalence, clinical manifestations and diagnostic methods of VUR after living donor kidney transplantation and their proper management with the results of each treatment. METHODS: We reviewed thirty-four patients among five hundreds and thirteen living donor kidney transplant recipients, who developed VUR after the transplantations at our center from June 1998 to June 2003. Twenty-three patients underwent a corrective surgical procedure, ureteroneocystostomy, and we excluded 3 patients who underwent the procedure less than 1 year. The patients were divided into three groups: those with severe VUR underwent a corrective surgical procedure with more than 1 year follow-up (group I, n=20), those with mild VUR underwent a conservative management (group II, n=8) and control group of patients without VUR (group III, n=20). The incidence of urinary tract infection (UTI) and graft function were assessed for 1~7 years. Voiding cystoureterography (VCUG) was performed in patients with recurrent urinary tract infections and reflux was classified from Grade I to Grade IV. RESULTS: We examined immunological and non-immunological risk factors such as age, sex, primary diseases, duration on dialysis, diuresis prior to the treatment, donor selection, the degree of HLA mismatches, cold ischemia time, the incidence of acute rejection. There was no significant demographic difference among study groups except sex (female). Analysis of patients and grafts survival rates revealed no statistical differences among three groups. CONCLUSION: VUR dose not seem to negatively affect graft function if surgical correction were performed in proper period after the diagnosis. The indication of surgical correction of VUR is clinically significant UTIs, UTI sepsis, Grade III or IV VUR. Close attention, proper diagnosis and prompt surgical correction are necessary to minimize the adverse influence of VUR after kidney transplantation.
Cold Ischemia ; Diagnosis ; Dialysis ; Diuresis ; Donor Selection ; Follow-Up Studies ; Humans ; Incidence ; Kidney Transplantation* ; Kidney* ; Living Donors ; Prevalence ; Risk Factors ; Sepsis ; Survival Rate ; Transplantation ; Transplants ; Urinary Tract Infections ; Vesico-Ureteral Reflux*

BACKGROUND: The optimal immunosuppressive strategy for renal transplant recipients at high immunological risk requires clarification. We compared the 3 year outcomes of a sirolimus group (tacrolimus plus sirolimus) to those of a control group (tacrolimus plus mycophenolate mofetil). METHODS: This observational study was an extension of a prospective pilot study. We assessed acute rejection, glomerular filtration rate, adverse events, graft, and patient survival. RESULTS: Overall, 43% of the sirolimus group versus 78% of the control group were still on the initial immunosuppressive regimen at 3 years (P=0.005), and most discontinuations in each group were due to adverse events. No differences were observed between two groups with respect to acute rejection. The mean glomerular filtration rate at 36 months was greater in the sirolimus group than in the control group, but this was not statistically significant (64.0±6.8 mL/min/1.73 m² vs. 61.8±17.1 mL/min/1.73 m², P=0.576). Graft and patient survival were similar in both groups. Importantly, mean tacrolimus through levels were significantly lower in the sirolimus group than in the control group at each time point. No neoplasm was reported in the sirolimus group. In the control group, three cases of neoplasms developed during the study period. CONCLUSIONS: The sirolimus group had a greater number of discontinuations, particularly related to adverse events. Nevertheless, optimal concentration of sirolimus allowed reduced calcineurin inhibitor exposure in high immunologic risk patients, without increasing the risk of acute rejection and graft failure.
Calcineurin ; Glomerular Filtration Rate ; Humans ; Immunosuppression ; Kidney Transplantation ; Kidney* ; Observational Study ; Pilot Projects ; Prospective Studies ; Sirolimus* ; Tacrolimus* ; Transplant Recipients* ; Transplants