Intussusception in adult is a rare disease and laparotomy is usually considered because of the probability of malignancy. Especially with obstruction symptom or sign, it might be needed emergency operation. This case was a simultaneous development of small bowel intussusception and acute hepatitis A. The patient had abdominal pain and vomiting. Intitial laboratory examination with elevated aminotransferase revealed that the diagnosis was acute hepatitis. As managing acute hepatitis, the abdominal pain was not improved and the patient had tenderness on periumbilical area on physical examination. A jejunal intussusception with a lead point was proved on the abdominal computed tomography scan. Fortunately, symptom of intussusception was relieved while nulli per os (NPO) and intravenous hydration. After recovery of acute hepatitis, laparotomy was done. The lead point was 2.5x3.0 cm sized hamartoma. This was the case that the symptom of intussusception was confused with that of acute hepatitis.
Abdominal Pain ; Adult ; Emergencies ; Hamartoma ; Hepatitis ; Hepatitis A ; Humans ; Intussusception ; Laparotomy ; Physical Examination ; Rare Diseases ; Vomiting

A 60-year-old man undergoing maintenance hemodialysis presented with periodic fever, which resembled Pel-Ebstein fever of Hodgkin's lymphoma. Despite scores of diagnostic evaluations, origin of the fever remained obscure. On positron emission tomography/computed tomography scan, focal hot uptakes were seen in the mediastinum and mediastinoscopic biopsy showed many acid-fast bacilli with chronic granulomatous inflammation and necrosis. After a week of anti-tuberculosis medication, the patient remained afebrile without recourse to antipyretics.
Antipyretics ; Biopsy ; Electrons ; Fever ; Fever of Unknown Origin ; Hodgkin Disease ; Humans ; Inflammation ; Mediastinum ; Middle Aged ; Necrosis ; Renal Dialysis ; Tuberculosis, Lymph Node

A 60-year-old man undergoing maintenance hemodialysis presented with periodic fever, which resembled Pel-Ebstein fever of Hodgkin's lymphoma. Despite scores of diagnostic evaluations, origin of the fever remained obscure. On positron emission tomography/computed tomography scan, focal hot uptakes were seen in the mediastinum and mediastinoscopic biopsy showed many acid-fast bacilli with chronic granulomatous inflammation and necrosis. After a week of anti-tuberculosis medication, the patient remained afebrile without recourse to antipyretics.
Antipyretics ; Biopsy ; Electrons ; Fever ; Fever of Unknown Origin ; Hodgkin Disease ; Humans ; Inflammation ; Mediastinum ; Middle Aged ; Necrosis ; Renal Dialysis ; Tuberculosis, Lymph Node

BACKGROUND: There has been a lack of study on the structural changes of serum albumin in patients with minimal change disease (MCD). To determine whether glycation and/or conformational transitions of albumin are involved in the pathogenesis of albuminuria, nine patients with MCD were enrolled in a prospective follow-up study for comparison of these parameters in serum albumin during the remission and relapse of nephrotic syndrome. METHODS: Circular dichroism measurements were made with purified albumin. Ellipticities at each wavelength were transformed to mean residue ellipticity. Monosaccharide composition was analyzed by high-pH anion-exchange chromatography with pulsed amperometric detection. RESULTS: There was no difference in the proportions of alpha-helix, beta-conformation, and beta-turn of albumin between the sera of control patients and those with nephrotic syndrome. However, the proportion of the random configuration was slightly higher in the plasma albumin of patients in relapse than in those in remission. The proportion of the random configuration was lower in the albumin of the serum than in the urine of patients with nephrotic syndrome, but there was no difference in the proportions of alpha-helix, beta-conformation, and beta-turn of albumin between their plasma and urine. CONCLUSION: Our results suggest that conformational changes in albumin are involved in albuminuria in patients with MCD.
Adult ; Albuminuria/urine ; Case-Control Studies ; Female ; Follow-Up Studies ; Glycosylation ; Humans ; Male ; Middle Aged ; Nephrosis, Lipoid/*blood/urine ; Nephrotic Syndrome/blood/urine ; Prospective Studies ; Research Support, Non-U.S. Gov't ; Serum Albumin/*chemistry

Here we report two cases of isolated diffuse mesangial sclerosis (IDMS) with early onset end-stage renal failure. These female patients did not show abnormalities of the gonads or external genitalia. Direct sequencing of WT1 PCR products from genomic DNA identified WT1 mutations in exons 8 (366 Arg>His) and 9 (396 Asp>Tyr). These mutations have been reported previously in association with Denys-Drash syndrome (DDS) with early onset renal failure. Therefore we suggest that, at least in part, IDMS is a variant of DDS and that investigations for the WT1 mutations should be performed in IDMS patients. In cases with identified WT1 mutations, the same attention to tumor development should be required as in DDS patients, and karyotyping and serial abdominal ultrasonograms to evaluate the gonads and kidney are warranted.
Base Sequence ; DNA/chemistry/genetics ; DNA Mutational Analysis ; Fatal Outcome ; Female ; Glomerular Mesangium/*pathology ; Humans ; Infant ; Infant, Newborn ; *Mutation ; Nephrosclerosis/*genetics ; WT1 Proteins/*genetics

PURPOSE: This study was performed to report the diagnosis and treatment of nephrotic syndrome manifesting in the first year of life. METHODS: We retrospectively reviewed the clinical data with chart review in 7 patients who were diagnosed as nephrotic syndrome manifesting in the first year of life from 1996 to 2007. RESULTS: Three patients had congenital nephrotic syndrome, the other 4 patients had infantile nephrotic syndrome. Their ages ranged from birth to 11 months and male to female ratio was 1 to 6. Renal biopsies were done in 6 patients. One patient had Finnish type congenital nephrotic syndrome, 2 patients had diffuse mesangial sclerosis, 2 patients had focal segmental glomerulosclerosis and 1 patient had minimal change disease. Genetic analyses of NPHS2, PLCE1, and WT1 were done in 4 patients and 2 of them had WT1 mutation. Among 3 patients with congenital nephrotic syndrome, 1 patient was diagnosed as congenital nephrotic syndrome of Finnish type and the other 2 patients were diagnosed as Denys-Drash syndrome. All of the patients with congenital nephrotic syndrome died due to sepsis. Among 4 patients with infantile nephrotic syndrome, 2 patients died and 1 had remission, another patient progressed to end stage renal disease. CONCLUSION: Most of nephrotic syndrome manifesting in the first year was hereditary renal disease. Patients with nephrotic syndrome manifesting in the 3 month of life had poorer prognosis and needed more aggressive management including early dialysis and renal transplantation might be considered compared with infantile nephrotic syndrome. Further genotype-phenotype correlation studies are needed.
Biopsy ; Denys-Drash Syndrome ; Dialysis ; Female ; Genetic Association Studies ; Glomerulosclerosis, Focal Segmental ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation ; Male ; Nephrosis, Lipoid ; Nephrotic Syndrome ; Parturition ; Prognosis ; Retrospective Studies ; Sclerosis ; Sepsis

BACKGROUND: Present limitations to monopolar RF include the small lesion size, difficulties in targeting, and questions about the reliability.In contrast with monopolar RF, bipolar RF create larger, more predictable, and more extensive ablative lesion. This study documents the optimal spacing of two needles, temperature, and time required to produce bipolar RF lesions. METHODS: Two 20-gauge 5 mm active tip needles and 10 mm active tip needles were secured in a parallel position 6, 8, and 10 mm apart and submerged in egg white that would allow visualization of the size and shape of the lesion.RF lesions were produced at 70, 80, and 90degrees C.At each temperature, photographs were taken at 30, 60, 90, and 120 seconds. RESULTS: When the 5 mm active tips with 6 mm distance were above 60 s and with 8, 10 mm distance above 120 s, continuous strip lesions were produced.10 mm active tips with 120 s were produced too.The others had discrete unipolar lesions around each cannula.The lesion size increased with a higher temperature and time.But time was the more important factor in determining lesion size. CONCLUSIONS: A continuous strip lesion was produced even though the electrode spaced 10 mm apart.And spacing the electrode 6 mm apart with 5 mm active tip and 8 mm apart with 10 mm active tip at 90degrees C for 90 s maximize the surface area of the lesions.
Egg White ; Electrocoagulation ; Electrodes ; Needles

The purpose of the study was to examine the current status of nutritional management at elderly nursing homes. A survey was performed of 83 nursing homes from January 5, 2011 to January 21, 2011 via mail. A total of 34 nursing homes responded to the survey and 149 elderly subjects were analyzed according to the presence of a dietitian. Among the 34 nursing homes, 70.6% had a dietitian on duty. All of the facilities with a dietitian had the dietitian making the meal plan, whereas 70% of the facilities without dietitian served meals planned by a non-professional person. Overall, however, a low proportion of nursing homes implemented dietetic treatments for residents with diseases. For the nutritional assessment of these residents, a mini nutritional assessment (MNA) was performed. MNA scores were significantly associated with body mass index (BMI), mid-arm circumference (MAC), calf circumference (CC), ingestion problems, and weight loss during the last 3 months (P<0.001). Among the elderly studied, 5.4% were malnourished, and 36.9% were at risk for malnutrition by MNA score. The results of this survey show that the current management of nutrition at nursing homes is insufficient because the elderly who needed dietetic treatment did not receive proper care. Dietetic management is the most important service in all nursing homes. Therefore, to improve the nutritional status of elderly residents in nursing homes, systematic nutrition management by nutrition experts should be implemented.
Aged* ; Body Mass Index ; Eating ; Humans ; Insurance, Long-Term Care ; Malnutrition ; Meals ; Nursing Homes* ; Nursing* ; Nutrition Assessment ; Nutritional Status ; Postal Service ; Weight Loss

BACKGROUND: The changes in acid-base balance and serum electrolytes after infusion of 0.9% normal saline during renal transplantation are poorly characterized. In this study, the relationships between the infusion of fluids and the changes in arterial blood gas analysis, serum electrolytes and central venous pressure during renal transplantation were determined. METHODS: Sixty-seven patients undergoing elective renal transplantation were divided into two groups: group I (n = 33) was made up of patients who received a living related renal transplantation, while group II (n = 34) was made up of those who received a living unrelated renal transplantation. Blood gas analysis, central venous pressure and serum electrolytes were evaluated just after the beginning of the operation, just before reperfusion (unclamping of the renal artery and vein), just after reperfusion and 20 minutes after arriving in the recovery room. RESULTS: pH, base excess, HCO3 and Na+ concentration were decreased, but PaCO2 was not changed during the operation. Central venous pressure and K+ concentrations were elevated during the operation. CONCLUSIONS: The results of this study suggest that 0.9% normal saline and mannitol leads to dilutional acidosis. If a lot of fluids are required during transplantation, we need to consider that 0.9% normal saline can aggravate acidosis in a renal transplantation patient.
Acid-Base Equilibrium ; Acidosis ; Blood Gas Analysis* ; Central Venous Pressure* ; Electrolytes* ; Humans ; Hydrogen-Ion Concentration ; Kidney Transplantation* ; Mannitol ; Recovery Room ; Renal Artery ; Reperfusion

BACKGROUND: Dendritic cells (DCs) are the most potent stimulators of immune response including antitumor response. DCs are currently being pursued clinically in the development of cancer vaccines; therefore there are demands for large-scale and clinical-grade generation of DCs. In the present study, to find out the most efficient separation method of DC precursors, we compared two separation methods, namely, based on magnetic based selection and plastic adherence selection. METHODS: MNCs were collected by leukapheresis from healthful donors and separated by CD14 + immunomagnetic adsorption or plastic adherence. DC precursors separated using the two methods were differenciated in the same condition. Matured DCs were compared in terms of yield, viability, the expression of surface markers and ability to induce immune reaction. RESULTS: This study demonstrated that mature DCs from CD14 + monocytes separated using CD14 + immunomagnetic adsorption had higher expression of surface markers of DCs, yield (1.9 +/-0.5% vs. 0.5 +/-0.2%), viability (94.7 +/-2.5% vs. 72.8 +/-7.5%) and better functionality in inducing immune reaction than those from plastic adherent cells. CONCLUSION: These results demonstrated that CD14 + immunomagnetic adsorption was found to be more effective than the adherent selection for the generation of DCs. This study will allow researcher to facilitate choosing the appropriate protocol to obtain DCs.
Adsorption* ; Cancer Vaccines ; Dendritic Cells* ; Humans ; Leukapheresis ; Monocytes* ; Plastics ; Tissue Donors