We have performed 190 renal transplantations from August 1990 to June 1996. No cadaveric donor was used and all except one were first grafts. We conducted a clinical analysis, especially concerning the factors affecting acute rejection and graft function at 1 year. The results were as follows : 1) The mean ages of donor and recipient were 35.3 years and 37.4 years respectively. The ratio of male to female was 1.4 : 1 and 1.5 : 1, respectively. 2) One hundred and six cases(55.8%) were living unrelated donors and eighty four cases(44.2%) were living related donors. 3) One hundred and sixty six potential recipients were given 3 donor specific transfusions(DST), started about 5 weeks prior to transplantation with cyclosporin coverage. Six of these patients(3.6%) developed sensitization by DST that precluded the subsequent transplantation and the remaining 160 patients received the kidney from the blood donors. Another 28 recipients were given DST 24 hours prior to operation. 4) Most of initial acute rejection episodes(71 episodes, 95%) appeared within the first month of post-transplantation. 5) We analyzed the possible factors affecting the incidence of acute rejection. Donor age and HLA incompatibility were significant statistically(p<0.05). 6) Multiple regression analysis showed that a number of acute rejection episodes(p<0.001) was the only independent risk factor for the graft function at 1 year. 7) Overall graft and patient survival rate were 97.2% and 98.6% at 1 year, 94.1% and 95.5% at 3 years.
Blood Donors ; Cadaver ; Cyclosporine ; Female ; Humans ; Incidence ; Kidney ; Kidney Transplantation* ; Male ; Risk Factors ; Survival Rate ; Tissue Donors ; Transplants ; Unrelated Donors

BACKGROUND: We evaluated the analytical performances of Diasys reagents manufactured by Diasys Diagnostic Systems (Holzheim, Germany) with Hitachi 747. METHODS: We evaluated AST, ALT, ALP, gamma-GT, calcium, and glucose. Only two tests were adapt-ed to different methods from the current ones: the photometric test using the arsenazo III for calci-um, the kinetic colorimetric test according to Szasz/Persijin using l-gamma-glutamyl-3-carboxy-4-nitranilide as a substrate for gamma-GT. Precision, interference, linearity, and method comparisons were evaluated by NCCLS guidelines. RESULTS: The coefficient of variation (CV) of total precision was less than 6.8% in all items. Preci-sions and linearities of all items were acceptable. Correlation coefficients were more than 0.9884 and all items showed excellent agreement compared to the current reagents in the reportable range. We could not find any significant interference for six test items up to 750 mg/dL triglyceride, 50 mg/dL hemoglobin, and 20 mg/dL bilirubin, except that the latter ALT showed a negative bias by more than 5 mg/dL of bilirubin. CONCLUSIONS: Diasys reagents showed high precision, linearity and correlation in comparison to the current reagents. So we conclude that these reagents are good for routine clinical use with Hitachi 747.
Arsenazo III ; Bias (Epidemiology) ; Bilirubin ; Calcium ; Glucose ; Indicators and Reagents* ; Triglycerides

A variety of solid tumors can metastasize to bone marrow. In rare cases actual circulating neoplastic cells can be identified, accounting for usually only a low proportion of total white blood cells. It is well known that hematologic malignancies are often associated with mediastinal germ cell tumors, but huge tumor cell burden resulting in leukemia-like presentation is a very rare manifestation. We report here a case of malignant germ cell tumor with leukemia-like infiltration of bone marrow. A 19-year-old man was admitted for dyspnea for several months. Computer tomographic scan revealed that he had a huge mass at anterior mediastinum with a large amount of pleural effusion. His pleural fluid had many numbers of large, pleomorphic atypical cells. Peripheral blood also contained atypical cells with similar morphology. On bone marrow biopsy, diffuse infiltration of tumor cells were noted suggesting acute leukemia, but immunophenotyping ruled out the possibility of hematologic malignancy. His serum alpha-fetoprotein and beta-human chorionic gonadotropin levels were markedly elevated, which was consistent with the diagnosis of primary germ cell tumor. Cytogenetically the tumor cells showed hyper-triploidy. After induction chemotherapy with cisplatin, etoposide and bleomycin, the size of the tumor was regressed and the patient's symptoms were improved.
alpha-Fetoproteins ; Biopsy ; Bleomycin ; Bone Marrow* ; Chorionic Gonadotropin ; Cisplatin ; Diagnosis ; Dyspnea ; Etoposide ; Germ Cells* ; Hematologic Neoplasms ; Humans ; Immunophenotyping ; Induction Chemotherapy ; Leukemia ; Leukocytes ; Mediastinum ; Neoplasms, Germ Cell and Embryonal* ; Neoplastic Cells, Circulating ; Pleural Effusion ; Young Adult

Sturge-Weber syndrome is a congenital neurocutaneous disorder of the vessels of the face, the leptomeninges and the brain. Clinically SWS consists of symptoms and signs including a facial nevus (port-wine stain), seizure, hemiparesis, mental retardation. But only a few reports related to atypical Sturge-Weber syndrome without facial nevus have been published. We report a patient with atypical Sturge-Weber syndrome without any clinical feature except hemiparesis. In neuroimaging studies using brain CT scan and MRI, leptomeningeal angiomatosis was demonstated that is the characteristic feature of Sturge- Weber syndrome. In atypical Sturge-Weber syndrome, there may be late- developed complications such as hemiparesis. In conclusion, neuroimaging study is recommended to confirm diagnosis in suspicious atypical SWS patient.
Angiomatosis ; Brain ; Brain Stem Infarctions ; Diagnosis ; Humans ; Intellectual Disability ; Magnetic Resonance Imaging ; Neurocutaneous Syndromes ; Neuroimaging ; Nevus ; Paresis ; Seizures ; Sturge-Weber Syndrome* ; Tomography, X-Ray Computed

OBJECTIVE: To investigate the safety of exercise program under medical supervision for cardiac patients in their early phase from cardiac events, and the types and the frequency of possible cardiovascular complications during or after exercise. METHOD: 197 cardiac patients who participated in phase 2 cardiac rehabilitation were selected and they performed aerobic exercise program by individualized exercise prescription under ECG monitoring 3 times a week for 6 weeks. Throughout total 2,429 sessions of exercise, abnormal symptoms, hemodynamic responses and ECG abnormalities were analyzed. RESULTS: Cardiovascular complications ocurred in 25 patients (12.7%). ECG abnormalities in 14 sessions (0.58%) of 13 patients, chest pain during exercise in 17 sessions (0.67%) of 13 patients, abnormal hemodynamic responses in 8 sessions (0.33%) of 8 patients were observed. Cardiac arrest and myocardial infarct didn't happened. 18 patients (72%) experienced these complications during warming-up period, 6 patients (24%) during cool-down period and one patient (4%) during resting period. CONCLUSION: During exercise, there was some possibility of abnormal ECG changes, chest pain, hemodynamic responses but these potentially dangerous situations could be prevented from advancing on real emergency by intense attention and monitoring. Even cardiac patients of acute stage can tolerate adequate amount of exercise load safely under careful clinical supervision.
Chest Pain ; Electrocardiography ; Emergencies ; Exercise ; Heart Arrest ; Hemodynamics ; Humans ; Myocardial Infarction ; Organization and Administration ; Prescriptions ; Rehabilitation

OBJECTIVES: The aim of this study was to investigate the clinico-radiologic features and microbiologic data of patients with SPE in a tertiary care hospital in Busan. METHODS: We retrospectively analyzed clinical and radiologic features of 6 cases with septic pulmonary embolism that occurred from March 2009 to March 2011 in Dong-A university medical center. RESULTS: The mean age of the study population was 58 years, and two men and four women were included. Clinical symptoms included general weakness (5 patients), febrile sensation (4 patients) and pleuritic chest pain (2 patients). Underlying conditions were chemoport infection (4 patients), dental abscess (1 patients), and cellulitis of hip (1 patient). Chest computed tomography revealed bilateral multiple nodular opacities in most patients, and cavitation, central necrosis, feeding vessels were identified. All patients received parenteral antimicrobial therapy with or without central catheter removal, drainage of the extrapulmonary infection. Causative organisms were Pseudomonas aeruginosa (2 patients), Candida albicans (1 patient), Bacillus species (1 patient), and Klebsiella pneumonia (1 patient). CONCLUSIONS: Clinical and radiologic features of septic pulmonary embolism were various and nonspecific. The diagnosis was usually suggested by the presence of a predisposing factor of septic pulmonary embolism and CT findings of bilateral multiple nodular opacities in patients with infectious signs and symptoms. Most important underlying condition was intravascular device infection.
Abscess ; Bacillus ; Candida albicans ; Catheters ; Cellulitis ; Chest Pain ; Drainage ; Female ; Hip ; Humans ; Klebsiella ; Male ; Necrosis ; Pneumonia ; Pseudomonas aeruginosa ; Pulmonary Embolism ; Retrospective Studies ; Sensation ; Sepsis ; Tertiary Healthcare ; Thorax

Noncardiac chest pain (NCCP) is one of the most common esophageal symptoms and lacks a clearly defined mechanism. The most common cause of NCCP is gastroesophageal reflux disease (GERD). One of the accepted mechanisms of NCCP in a patient without GERD has been altered visceral sensitivity. Mast cells may play a role in visceral hypersensitivity in irritable bowel syndrome. In this case, a patient with NCCP and dysphagia who was unresponsive to proton pump inhibitor treatment had an increased esophageal mast cell infiltration and responded to 14 days of antihistamine and antileukotriene treatment. We suggest that there may be a relationship between esophageal symptoms such as NCCP and esophageal mast cell infiltration.
Adult ; Chest Pain/*etiology ; Esophageal Diseases/*complications/drug therapy ; Esophagus/cytology/pathology ; Female ; Histamine Antagonists/therapeutic use ; Humans ; Leukotriene Antagonists/therapeutic use ; Mast Cells/metabolism ; Mastocytosis/*complications/drug therapy

BACKGROUND AND OBJECTIVE: There have been some reports on the expression of TGF beta-an anti-inflammatory and fibrosing cytokine in airway mucosa of asthmatics. However, the ex- pression of TGF beta1 in bronchial mucosa of TDI-induced asthma is not known. The aim of this study was to observe immunolocalization of TGF beta1 in airway mucosa of TDI-induced asthma. METHODS: TGF beta1 expressions were compared using immunohistochemistry in bronchial muco- sa from 22 subjects with TDI-induced asthma (group I: 10 newly diagnosed, group II: 12 subjects with persistent asthma symptoms for more than 4 years after diagnosis), and 8 non- asthmatics undergoing pneumonectomy from lung tumor. The distribution and intensity of expression were analyzed by two observers in four areas of bronchial tissue-epithelium(EP), vascular endothelium(VE), smooth muscle(SM), and mucous glands(MG). RESULTS: Positive rates of TGF beta1 expression for groups I and II in the four areas were as follows; EP (50% vs 100%, p<0.05), VE(40% vs 100%, p<0.05), SM(33.3% vs 100%, p<0.05), and MG(66.7% vs 80%, p>0.05). Grades of TGF beta1 expression of EP, VE, and SM were significantly higher in group II than in group I(p<0.05, respectively). There was no significant difference in distribution and intensity of TGF beta1 expression between TDI-induced asthma and controls(p>0.05, respectively). CONCLUSION: TGF beta1 expressions of EP, VE, SM and MG were noted in airway mucosa of TDI-induced asthma and expressions of EP, VE, and SM were more intense and frequent in patients with persistent asthma symptoms.
Asthma* ; Humans ; Immunohistochemistry ; Lung ; Mucous Membrane* ; Pneumonectomy ; Toluene* ; Transforming Growth Factor beta1* ; Transforming Growth Factors*

BACKGROUND: The underlying mechanism to explain the poor prognosis of TDI-induced asthma is unknown. We performed this study to evaluate the role of TGFbeta1 and its receptor, TFGbeta receptor II (RII) in TDI-induced asthma. METHODS: We applied immunohistochemistry with monoclonal antibodies to TGFbeta1 and RII in bronchial mucosa from 22 subjects with TDI-induced asthma (group I: 10 newly diagnosed, group II: 12 subjects with persistent asthma symptoms for more than 4 years after diagnosis) and 8 non-asthmatics undergoing pneumonectomy from lung tumor. The expression was analyzed in 4 areas of bronchial tissue-epithelium (EP), vascular endothelium (VE), smooth muscle (SM), mucous gland (MG). The grade of intensity was presented from 0 to 3. Subepithelial basement memberane (SBM) and submucosal extracellular matrix (SECM) thickness were measured using an image analyzer. Serum specific IgE and IgG antibody levels to TDI- human serum albumin (HSA) conjugate were detected by ELISA. RESULTS: Grade of TGFbeta1 expression was significantly higher in EP, VE and SM in group II than those of group I of TDI-induced asthma (p<0.05 respectively), with significant difference in SM only in RII expression. SBM and SECM thickness of TDI-induced asthma were significantly higher than those of non-asthmatics (p<0.05, respectively), while there was no significant difference between group I and II (p>0.05). Significant correlations were noted between asthma duration after diagonsis and intensity of TGFbeta1 expression in EP, VE and SM (p<0.05, respectively), with no significant correlations with RII expression (p>0.05). TGF 1 expression was significantly higher in EP, VE and SM in subjects with specific IgG antibody to TDI-HSA than those without it (p<0.05). CONCLUSION: These findings suggest that TGFbeta1 may contribute to develop persistent asthma symptoms in TDI-induced asthma.
Antibodies, Monoclonal ; Asthma* ; Endothelium, Vascular ; Enzyme-Linked Immunosorbent Assay ; Extracellular Matrix ; Humans ; Immunoglobulin E ; Immunoglobulin G ; Immunohistochemistry ; Lung ; Mucous Membrane* ; Muscle, Smooth ; Pneumonectomy ; Prognosis ; Serum Albumin ; Toluene 2,4-Diisocyanate* ; Toluene* ; Transforming Growth Factor beta* ; Transforming Growth Factor beta1

Japanese hop (Hop J) pollen has been considered as one of the major causative pollen allergens in the autumn season. We developed a new Hop J immunotherapy extract in collaboration with Allergopharma (Reinbeck, Germany) and investigated immunologic mechanisms during 3 yr immunotherapy. Twenty patients (13 asthma with rhinitis and 7 hay fever) were enrolled from Ajou University Hospital. Sera were collected before, 1 yr, and 3 yr after the immunotherapy. Changes of serum specific IgE, IgG1 , and IgG4 levels to Hop J pollen extracts and serum IL-10, IL-12, TGF-beta1 and soluble CD23 levels were monitored by ELISA. Skin reactivity and airway hyper-responsiveness to methacholine were improved during the study period. Specific IgG1 increased at 1 yr then decreased again at 3 yr, and specific IgG4 levels increased progressively (p<0.05, respectively), whereas total and specific IgE levels showed variable responses with no statistical significance. IL-10, TGF-beta1 and soluble CD23 level began to decrease during first year and then further decreased during next two years with statistical significances. (p<0.05, respectively). In con-clusion, these findings suggested the favorable effect of long term immunotherapy with Hop J pollen extracts can be explained by lowered IgE affinity and generation of specific IgG4 , which may be mediated by IL-10 and TGF-beta1.
Transforming Growth Factor beta/blood ; Receptors, IgE/blood ; Pollen/*immunology ; Poaceae/*immunology ; Interleukin-10/blood ; Immunoglobulin G/blood ; Immunoglobulin E/blood ; Humans ; *Desensitization, Immunologic ; Cytokines/*blood ; Bronchial Hyperreactivity/etiology