BACKGROUND: Appendicitis is a common surgical disease. There are many problems for the early diagnosis of acute appendicitis in kidney transplant patients; differential diagnosis for acute rejection, limitation in imaging study, problems of immunosuppressant and non-characteristic symptoms. METHODS: We reviewed medical records and transplant database of 2,947 renal transplant patients between April, 1979 and September, 2009 retrospectively. Patient's characteristics, diagnostic methods for appendicitis and operative/postoperative progresses were analyzed. RESULTS: Of the 2,947 renal transplant patients, there were 15 (0.51%, 13 males and 2 females) acute appendicitis patients. Mean age at the diagnosis of appendicitis was 37.2+/-10.1 years. Fourteen (93.3%) patients suffered from prodromal symptom, such as abdominal pain, direct or rebound tenderness, nausea and vomiting. There were 12 (80%) patients with leukocytosis (WBC count >10,000/microliter). Computed tomography scans were performed in 5 (33.4%) patients for diagnosis. Laparoscopic appendectomies were applied for 8 (53.4%) patients. In pathologic diagnosis, 2 cases were reported as 'non pathologic diagnosis' complications occurred in 2 patients as remnant appendicitis and pancreatitis. However, there was no patient with mortality and renal failure during the hospitalization. CONCLUSIONS: There were no significant differences between the transplant patients and the general population in the incidence, clinical features, diagnosis and postoperative progresses of acute appendicitis.
Abdomen, Acute ; Abdominal Pain ; Appendectomy ; Appendicitis ; Diagnosis, Differential ; Early Diagnosis ; Hospitalization ; Humans ; Incidence ; Kidney ; Kidney Transplantation ; Leukocytosis ; Male ; Medical Records ; Nausea ; Pancreatitis ; Prodromal Symptoms ; Rejection (Psychology) ; Renal Insufficiency ; Retrospective Studies ; Transplants ; Vomiting

PURPOSE: Mesangial cell extracellular matrix (ECM) synthesis plays an important role in various renal diseases. Mycophenolic acid (MPA), which is an inhibitor of inosine monophosphate dehydrogenase (IMPDH), inhibits mesangial cell proliferation and ECM synthesis. However, the exact mechanism of MPA has not been clearly elucidated in mesangial cells. To examine the relative importance of IMPDH on the inhibitory action of MPA, we compared the effects of MPA or IMPDH2 siRNA on platelet-derived growth factor (PDGF)-induced fibronectin secretion and cellular reactive oxygen species (ROS) in mouse mesangial cells (MMC). METHODS: MMC were stimulated with PDGF 10 ng/ml with or without MPA 0.1~10micrometer, IMPDH2 siRNA 10~50 nM, or N-acetylcystein (NAC). IMPDH2 siRNA was transiently transfected by lipofectamine for 24 hours. MPA 0.1~10micrometer, ribavirin 10~100micrometer, and NAC 5 mM were administered 1 hour before the stimulation. Cell viability was measured by methylthiazoletetrazolium (MTT) assay, fibronectin secretion by Western blot analysis, and dichlorofluorescein (DCF)-sensitive cellular ROS by flow cytometry. RESULTS: PDGF 10 ng/ml effectively increased fibronectin secretion and cellular ROS in MMC. MPA and NAC at concentration without affecting basal level of fibronectin and cellular ROS ameliorated PDGF-induced fibronectin secretion and cellular ROS. However, IMPDH2 siRNA only partially reduced PDGF- induced fibronectin secretion and cellular ROS in MMC. CONCLUSION: These results suggest that MPA may inhibit PDGF-induced fibronectin secretion partly through IMPDH2 or cellular ROS in MMC, and there may be other mechanisms on the inhibitory action of MPA in mesenchymal cells.
Animals ; Blotting, Western ; Cell Survival ; Extracellular Matrix ; Fibronectins* ; Flow Cytometry ; Inosine Monophosphate* ; Inosine* ; Mesangial Cells* ; Mice* ; Mycophenolic Acid ; Oxidoreductases* ; Platelet-Derived Growth Factor ; Reactive Oxygen Species* ; Ribavirin ; RNA, Small Interfering

BACKGROUND: The supply of deceased donors is limited in Korea and most of kidney transplantations are performed using living related or unrelated donors. In this study, we investigated the clinical characteristics and outcomes of spousal donor kidney transplantation at our center. METHODS: From January 2000 to August 2008, we performed 909 cases of kidney transplantations. In this study, 475 one-haplomatch living-related donor (LRD) and 50 spousal donor kidney transplantations were retrospectively analyzed. We compared the outcomes of spousal donor group with those of one-haplomatch LRD group. We also compared the outcomes of husband-to wife with those of wife-to-husband subgroup. RESULTS: The number of Human leukocyte antigen (HLA) mismatch was significantly larger in spousal group (3.3+/-1.2) than in LRD group (2.7+/-0.7). The proportion of tacrolimus use was higher in spousal group (72.0%) than in LRD group (26.6%). The incidence rate of delayed graft function was higher in spousal group (4.0%) than in LRD group (0.4%). There was no significant difference in the incidence of acute rejection between the two groups. Graft survival rates in spousal group (98.0% at 1 year and 91.5% at 5 year) were comparable to those in LRD group (99.6% at 1year and 98.7% at 5 year) (P=0.321). There were no significant differences in the incidence of acute rejection and graft survival rates between the subgroups (husband-to-wife vs. wife-to- husband). CONCLUSIONS: We achieved excellent outcomes by using spousal donor as an option to reduce the donor organ shortage.
Delayed Graft Function ; Graft Survival ; Humans ; Incidence ; Kidney ; Kidney Transplantation ; Korea ; Leukocytes ; Rejection (Psychology) ; Retrospective Studies ; Spouses ; Tacrolimus ; Tissue Donors ; Unrelated Donors

BACKGROUND: Posttranplant lymphoproliferative disorder (PTLD) is a fatal complication of organ transplantation and standard treatment is either ineffective or too toxic to tolerate. This study aims to evaluate the characteristics of PTLD patients retrospectively. METHODS: We enrolled 2,630 kidney recipients who underwent transplantation from April 1979 to June 2007. And we retrospectively reviewed clinical manifestations of PTLD. RESULTS: Among one hundred ninety post-transplant malignancies from 2,630 renal recipients, 11 PTLD were diagnosed during 195.3+/-11.5 months (0~388 months) of mean follow up duration. PTLD predominantly occurred in male (Male : Female=10 : 1) and mean age of PTLD patients at the time of PTLD diagnosis was 51+/-15 year (18~71 year). Mean time interval to PTLD diagnosis were 126.6+/-74.8 months (6~240 months). In aspect of WHO classification, there were no early lesion, 1 polymorphic PTLD (9.1%), 10 monomorphic PTLD (90.9%) and no other types. In aspect of involved organ, GI tract was involved in 1 case, lung in 2 cases, bone in 2 cases, spleen in 2 cases, neck node in 2 cases, liver in 1 case, and multiple organs in 1 case. CONCLUSIONS: Our findings showed that the prevalence of PTLD was 0.46%, which was less than reports from Western countries. We also found that the late onset PTLD was more than early onset one, which was another difference from previous reports.
Follow-Up Studies ; Gastrointestinal Tract ; Humans ; Kidney ; Liver ; Lung ; Lymphoma ; Lymphoproliferative Disorders ; Male ; Neck ; Organ Transplantation ; Prevalence ; Retrospective Studies ; Spleen ; Transplants

Purpose: The purposes of this study were to compare the relative efficacy of urine decoy cell (UDC) and polymerase chain reaction (PCR) for the polyomavirus infection (PVI), and to search the efficacy of preemptive immunologic control for PVI in earlier stage before irreversible graft injury. Methods: Between Mar. 2003 to Sep. 2005, 265 patients were monitored for the PVI after kidney transplantation. Of the 265 patients, the results of preemptive immunologic modifications were searched among 222 recipients who had the complete data. Results: Of the total 222 patients, 75 patients (33.8%) were positive for UDCs in at least one examination. Overall cumulative incidence of PVI was 32.9%. According to the episode of acute rejection, the one year incidences of PVI were 51.4% and 29.5% in recipients with and without the episode of acute rejection, respectively (P=0.0047). Using decoy cells as a marker of PV viruria, cytology has a sensitivity of 57.1% and negative predictive value of 74.1%. The specificity and positive predictive value for viruria (not viral nephropathy) are 67.2% and 48.8%. False-negative results occurred in samples with suboptimal cellularity, and a low viral load. Three cases of PV nephropathy (PVN) were documented. From January 2001 to December 2002, when we did not prospectively monitor UDCs, 7 cases of PVN were documented among the 116 recipients. Conclusion: The combination test of UDC and PV PCR should be considered as screening test for PVI due to low positive predictive value of UDC. The modulation of net immunosuppression based on UDC values and PV viral loads may reduce the development of PVN.
Humans ; Immunosuppression ; Incidence ; Kidney Transplantation* ; Kidney* ; Mass Screening ; Polymerase Chain Reaction ; Polyomavirus Infections* ; Polyomavirus* ; Prospective Studies ; Sensitivity and Specificity ; Transplants ; Viral Load

BACKGROUND: Using long-term (more than 30 years) data from a single center, this retrospective study evaluated changes of independent risk factors affecting renal allograft survival by transplant era. METHODS: Of 3,000 cases of kidney transplantation, 2,708 (90.3%), including their follow-up observations, were reviewed. Transplant era was classified according to immunosuppressive regimens as either early group (transplant serial No. 1~1,500) or recent group (transplant serial No. 1,501~3,000). RESULTS: There was a significant difference observed in pre-transplant clinical manifestations between the early and recent groups. The number of elderly recipients and donors, number of deceased donors, and cases related to pre-transplant diabetes, pre-emptive transplantation, and retransplantation were differed relative to transplant era. The short- and long-term graft survival rate of the recent group improved significantly, and the effect of human leukocyte antigen mismatching and living donor type disappeared in the recent group. Moreover, pre-emptive transplantation and retransplantation were effective only in the recent group. However, non-immunological factors such as elderly recipients and donors, and immunologic factors such as episodes of acute rejection and types of immunosuppressive regimen were persistent independent risk factors affecting graft survival rate. CONCLUSIONS: According to the retrospective survival analysis of a large number of recipients in a single center, risk factors for kidney transplant patients differed by transplant era. However, the independent risk factors associated with elderly recipients and donors (non-immunologic), and episodes of acute rejection, and types of immunosuppressive regimen (immunologic) persisted regardless of transplant era.
Aged ; Follow-Up Studies ; Graft Survival ; Humans ; Immunologic Factors ; Kidney ; Kidney Transplantation ; Leukocytes ; Living Donors ; Rejection (Psychology) ; Retrospective Studies ; Risk Factors ; Tissue Donors ; Transplantation, Homologous ; Transplants

BACKGROUND/AIMS: To determine the incidence and clinical characteristics of tuberculosis (TB) medication-associated Clostridium difficile infection. METHODS: This multicenter study included patients from eight tertiary hospitals enrolled from 2008 to 2013. A retrospective analysis was conducted to identify the clinical features of C. difficile infection in patients who received TB medication. RESULTS: C. difficile infection developed in 54 of the 19,080 patients prescribed TB medication, representing a total incidence of infection of 2.83 cases per 1,000 adults. Fifty-one of the 54 patients (94.4%) were treated with rifampin. The patients were usually treated with oral metronidazole, which produced improvement in 47 of the 54 patients (87%). Twenty-three patients clinically improved with continuous rifampin therapy for C. difficile infection. There were no significant differences in improvement between patients treated continuously (n=21) and patients in whom treatment was discontinued (n=26). CONCLUSIONS: The incidence of C. difficile infection after TB medication was not low considering the relatively low TB medication dosage compared to other antibiotics. It may not be always necessary to discontinue TB medication. Instead, decisions concerning discontinuation of TB medication should be based on TB status.
Adult ; Aged ; Aged, 80 and over ; Anti-Infective Agents/therapeutic use ; Antibiotics, Antitubercular/*adverse effects ; *Clostridium difficile ; Enterocolitis, Pseudomembranous/chemically induced/drug therapy/*epidemiology ; Female ; Humans ; Incidence ; Male ; Metronidazole/therapeutic use ; Middle Aged ; Retrospective Studies ; Rifampin/*adverse effects ; Treatment Outcome ; Tuberculosis/*drug therapy

Retroperitoneal neurilemmoma is relatively rare and benign tumor. We report a case of a benign retroperitoneal pelvic neurilemmoma that presented with constipation and an adnexal mass and brief review of literatures.
Constipation ; Neurilemmoma*

Although Fursarium oxysporum causes diseases in economically important plant hosts, identification of F. oxysporum formae speciales has been difficult due to confusing phenotypic classification systems. To resolve these complexity, we evaluated genetic relationship of nine formae speciales of F. oxysporum with random amplified polymorphic DNA (RAPD), amplified fragment length polymorphism (AFLP), and translation elongation factor-1 alpha (EF-1alpha) gene. In addition, the correlation between mycotoxin content of fusaric acid and isolates based on molecular marker data was evaluated using the modified Mantel's test. According to these result, these fusaric acid-producing strains could not identify clearly, and independent of geographic locations and host specificities. However, in the identification of F. oxysporum formae speciales, especially, AFLP analysis showed a higher discriminatory power than that of a the RAPD and EF-1alpha analyses, all three techniques were able to detect genetic variability among F. oxysporum formae speciales in this study.
Amplified Fragment Length Polymorphism Analysis ; Classification ; DNA ; Fusaric Acid ; Fusarium* ; Geographic Locations ; Host Specificity ; Korea* ; Peptide Elongation Factor 1* ; Plants

Background/Aims: Patients in the intensive care unit (ICU) are at high risk for developing pressure injuries, which can cause severe complications and even increase the mortality risk. Therefore, prevention of pressure injuries is most important. In this study, we investigated the risk factors of pressure injury development in patients admitted to the ICU. Methods: We retrospectively analyzed patients ages > 18 years admitted to the medical ICU in a tertiary hospital between January and December 2019. We collected patient baseline characteristics, medications received, mechanical ventilation or hemodialysis use, laboratory findings, and date of pressure injury onset and characteristics. Results: We analyzed 666 patients who did not have pressure injuries at ICU admission. Pressure injuries developed in 102 patients (15%). The risk of pressure injury development increased as the administration days for neuromuscular blocking agents (NMBAs; odds ratio [OR], 1.138; p = 0.019) and opioids (OR, 1.084; p = 0.028) increased, and if the patient had problem with friction and shear (OR, 2.203; p = 0.011). Conclusions The prolonged use of NMBAs and opioids can increase the risk of pressure injury development. Because these medications are associated with immobilization, using both should be minimized and patient early mobilization should be promoted. Among the Braden subscales, “friction and shear” was associated with the development of pressure injuries in ICU patients.