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

BACKGROUND: In the past, ABO incompatibility was an absolute contraindication for solid organ transplantation. However, multiple recent trials have suggested strategies for overcoming the reactions between graft antigens and recipient antibodies that cause graft rejection. In this study, we determined the usefulness of plasma exchange (PE) for removing anti-A/B antibodies that cause hyperacute/acute humoral graft rejection in patients undergoing ABO-incompatible kidney transplantation. METHODS: In our study, 12 patients underwent ABO-incompatible kidney transplantation. All recipients received pre-transplantation conditioning by PE or intravenous immunoglobulin (IVIG) administration. After pre-transplantation conditioning, anti-A/B antibody titers were evaluated, and transplantation was performed when the titer was below 1:8. To assess the transplantation outcome, anti-A/B antibody titers, creatinine level, estimated glomerular filtration rate (eGFR), and proteinuria levels were measured. RESULTS: Anti-A/B antibody titers were below 1:8 in all patients at the time of transplantation. eGFR measured on post-transplant day 14 showed that 10 patients had immediate recovery of graft function, while 2 patients had slow recovery of graft function. Short-term outcomes of ABO-incompatible kidney transplantation (measured as creatinine levels) after reducing anti-A/B antibody titers were similar to those of ABO-compatible kidney transplantation. After transplantation, the anti-A/B antibody titers were below 1:8 in 7 patients, but the remaining 5 patients required post-transplantation PE and IVIG treatment to prevent antigen-antibody reactions. CONCLUSIONS: With the increasing demand for kidney donations, interest in overcoming the ABO incompatibility barrier has increased. PE may be an important breakthrough in increasing the availability of kidneys for transplantation.
ABO Blood-Group System/*immunology ; Adult ; *Blood Group Incompatibility/immunology ; Creatinine/blood ; Female ; Glomerular Filtration Rate ; Graft Rejection/therapy ; Humans ; Immunoglobulins, Intravenous/therapeutic use ; Isoantibodies/immunology/physiology ; Kidney Transplantation/*immunology ; Male ; Middle Aged ; *Plasma Exchange ; Proteinuria ; Transplantation Conditioning ; Transplantation Immunology

PURPOSE: The purpose of this study was to compare once-daily tacrolimus with twice-daily tacrolimus in terms of safety, efficacy, and patient satisfaction. MATERIALS AND METHODS: This prospective, randomized, open-label, multicenter study was conducted at three institutes. Patients in the investigational group were converted from tacrolimus twice daily to the same dose of extended-release tacrolimus once daily at 1 month post-transplantation, while patients in the control group were maintained on tacrolimus twice daily. The efficacies, safeties, and patient satisfaction for the two drugs at 6 months post-transplantation were compared. RESULTS: Sixty patients were enrolled and randomized to the investigational group (28 of 29 patients completed the study) or the control group (26 of 31 patients completed the study). At 6 months post-transplantation, composite efficacy failure rates including the incidences of biopsy-confirmed acute rejection in the investigational and control groups were 0% and 10.7%, respectively; patient survival was 100% in each group. No difference in estimated glomerular filtration rate values were observed at 6 months post-transplantation (p=0.97). The safety and satisfaction profile (immunosuppressant therapy barrier scale) of once-daily tacrolimus was comparable with that of twice-daily tacrolimus (p=0.35). CONCLUSION: Conversion from twice-daily tacrolimus to once-daily tacrolimus one month after transplantation is safe and effective.
Adult ; Drug Administration Schedule ; Female ; Graft Rejection/drug therapy/prevention & control ; Humans ; Immunosuppressive Agents/*administration & dosage/adverse effects/therapeutic use ; *Kidney Transplantation ; Male ; Middle Aged ; Safety ; Tacrolimus/*administration & dosage/adverse effects/therapeutic use

BACKGROUND: Compliance from kidney transplant recipients might improve with less frequent doses of immunosuppressant drugs. We describe the development of an extended-release formulation of tacrolimus that enables taking the drug just once a day, instead of the current twice a day tacrolimus formulation. METHODS: We performed a prospective, open-label, 1:1 randomized, and multicenter study. Patients received Prograf(R) (Astellas Inc.) twice a day for 1 month post-transplantation. The patients of the investigational group converted to a dose of Advagraf(R) (Astellas Inc.) given once a day. We evaluated the efficacy, safety, and patient satisfaction of both groups. RESULTS: Within 5 months after conversion to Advagraf, the incidence of biopsy-confirmed acute rejection was 0%, while patient and graft survival was 100%. We could not find differences of the patients' estimated glomerular filtration rate (eGFR) between the Prograf and Advagraf treated groups 1~6 months post-transplantation. The safety profile and satisfaction profiles (immunosuppressant therapy barrier scale) were also equivalent between the treated groups. CONCLUSIONS: The preliminary results of this study support the safety, efficacy, and patient satisfaction from a single daily formulation of tacrolimus (Advagraf(R)).
Compliance ; Glomerular Filtration Rate ; Graft Survival ; Humans ; Immunosuppression ; Incidence ; Kidney ; Kidney Transplantation ; Patient Satisfaction ; Prospective Studies ; Rejection (Psychology) ; Tacrolimus