No abstract available.

BACKGROUND: A shortage of kidney donors has produced a progressively increasing gap between the supply of cadaveric kidneys and the demand for cadaveric transplants. Thus, efforts to expand the donor pool have included the use of the living related and unrelated kidney donors in Korea. In certain countries like ours, cadaveric kidney sources are very limited for various reasons, therefore, the living kidney donors have been a major source for uremic patients in our hospital. We propose a new program for donation, in which is an exchange-donor program. It is a program in which the donation is not commercial, but voluntary, thus overcoming the shortage of cadaveric donors, and giving the opportunity for transplant to as many uremic patients as possible. METHODS: Between Jan. 1991 and Dec. 1997, 411 living-donor renal transplants were performed in our hospital. Of those, 61 patients received grafts from exchange donors. We compared the graft survival rate of the exchange-donor transplantations with that of the living related donor transplantations based on the recipient's age and sex, the donor's age and sex, human leukocyte antigens (HLA) mismatching, and the frequency of acute rejection. RESULTS: Fifty-nine (59) of 61 patients were still alive in Dec. 1997, with a median follow-up of 31 months (6-76 months), and the mean serum creatinine level was 1.64 mg/dL. The graft survival rates of the exchange-donor renal transplantations at 1 and 5 years were 92.12% and 80.27%, respectively, and there were no significant differences compared with those of the living related renal transplantations (p=0.1424). The graft survival rates at 1 and 5 years were 93.75% and 81.25%, respectively, for those with more than one HLA-haploidentical pair, and 91.89% and 78.76% for those with less than a one-haplotype match, respectively. The frequency of acute rejection was 37.7% in the exchange-donor group. The renal function of the exchange donors after the donation was not altered, and the postoperative complication rate was 1.6%. CONCLUSIONS: The results show that the graft survival rates of the exchange-donor program were similar to those of the living related renal transplantations, and that the good graft survival rates for the exchange-donor group could not be attributed to better HLA matching. We propose an exchange-donor program that will be able to expand the donor pool and overcome the shortage of cadaveric organ donors.
Cadaver ; Creatinine ; Follow-Up Studies ; Graft Survival ; HLA Antigens ; Humans ; Kidney ; Kidney Transplantation* ; Korea ; Postoperative Complications ; Tissue Donors ; Transplants

From 1985 to 1991, we analyzed experiences in the treatment of 37 children with neurogenic bladder who were closely followed up for averaging 25 months. Initial urodynamic study revealed hyperreflexic bladder in 17 patients: 12 with detrusor sphincter dyssynergia. Areflexic bladder was round in 20 patients: 11 with high leak pressure. Among the 17 patients with hyperreflexic bladder. intermittent catheterization had been well performed in 13 patients and in 11 cages of which oral or topical anticholinergics were added Renal function was well preserved and urinary incontinence was improved in 10 of 13 patients and urinary diversion was done in 1 case. In 4 patients that were not treated by intermittent catheterization owing to poor compliances augmentation cystoplasty was performed or to be considered. Four cases of areflexic bladder with high leak pressure had good results with treatment, whereas 4 cases had deterioration of renal function because of poor complianes to treatment. Among 9 cases of areflexic bladder with low leak pressure, 6 cases were treated by intermittent catheterization. In all of which voidine symptoms were improved. The other 3 cases are under observation without any problems except urinary incontinence. As above, we can conclude that preservation of renal function and improvement of urinary incontinence can be achieved with intermittent catheterization and oral or topical anticholinergics in pediatric neurogenic bladder patients and that noninvasive treatment including Crede maneuver may be used in the treatment of patients with areflexic bladder with low leak pressure.
Ataxia ; Catheterization* ; Catheters* ; Child* ; Cholinergic Antagonists ; Humans ; Urinary Bladder ; Urinary Bladder, Neurogenic* ; Urinary Diversion ; Urinary Incontinence ; Urodynamics

In vitro PVR(Proliferative vitreoretinopathy) models allow identification of factor which may inhibit porliferation and contraction. In this study we evaluated the contraction of collagen matrix by choroidal fibroblast and the inhibition of contraction by antipoliferative drug. Each antiproliferative drug showed inhibition of collagen matrix contraction : Colchicine (0.1microgram/ml), Cytochalacin (0.05microgram/ml), Puromycin(10microgram/ml). Transmission electron microgram of collagen matrices containing colchicine, cytochalacin or puromycin showed no collagen fiber surrounding choroid fibroblast and showed cell destruction. Scanning electron microgram of collagen matrices containing colchicine, cytochalacin and puromycin showed that collagen fibers were well preserved without distortion. Colchicine, cytochalacin and puromycin are effective inhibitor of cell mediated contraction in additon to it`s potent antiproliferative effect wherease Interfereon has no anticontractile effect. The current study present a model to investigate the effect of antiproliferative drug on fibroblast mediated collagen matrix contraction.
Choroid ; Colchicine ; Collagen* ; Fibroblasts ; Interferons ; Puromycin ; Vitreoretinopathy, Proliferative

Anti-Inflammatory Agents, Non-Steroidal ; Follow-Up Studies ; Humans ; Inflammation ; Molar, Third ; Mouth

We report a unique case of synchronous double primary gastric cancer consisting of adenocarcinoma components with micropapillary features and composite glandular-endocrine cell carcinoma components. The patient was a 53-year-old man presenting with a 6-month history of epigastric pain and diarrhea. A subtotal gastrectomy was performed. Histologically, one tumor was composed of micropapillary carcinoma components (50%) with tight clusters of micropapillary aggregates lying in the empty spaces, admixed with moderately differentiated adenocarcinoma components. MUC-1 was expressed at the stromal edge of the micropapillary component. The other tumor was composed of atypical carcinoid-like neuroendocrine carcinoma (50%), adenocarcinoid (30%), and adenocarcinoma components (20%). The neuroendocrine components were positive for CD56, synaptophysin, chromogranin, and creatine kinase. The adenocarcinoid components were positive for both carcinoembryonic antigen and neuroendocrine markers (amphicrine differentiation). This case is unique, due to the peculiar histologic micropapillary pattern and the histologic spectrum of adenocarcinoma adenocarcinoid-neuroendocrine carcinoma of the synchronous composite tumor.
Adenocarcinoma* ; Carcinoembryonic Antigen ; Carcinoma, Neuroendocrine ; Creatine Kinase ; Deception ; Diarrhea ; Gastrectomy ; Humans ; Middle Aged ; Stomach Neoplasms ; Stomach* ; Synaptophysin

No abstract available.
Cadaver* ; Kidney Transplantation* ; Kidney*

It has been well known that successful anesthesia is provided by rendering patients free from apprehension and fear prior to operation. This report is concerned with a new sedative compound which appears to reduce anxiety-tension and relax skeletal muscles. Preanesthetic usefulness of diazepam, which is a derivative of benzodia-zepine and has a high safety index as a preanesthetic medication agent, has been clinically assessed by a standard double blind study on 288 patients in this hospital. They received diazepam(0.3mg/ kg), meperidine hydrochloride (1.0~1.5mg/kg) or saline (1.0ml) via intramuscular route. The following are the results: 1) Diazepam was effective in producing a sound sleep during the preoperative night. 2) Diazepam was effective in reducing apprehension and fear immediately prior to induction of anesthesia. 3) Less nausea and vomiting as well as better sedation were produced by diazepam than by meperidine hydrochloride.
Anesthesia ; Diazepam* ; Double-Blind Method ; Humans ; Meperidine ; Muscle, Skeletal ; Nausea ; Preanesthetic Medication* ; Vomiting

No abstract available.
Humans ; Intracranial Aneurysm* ; Tomography, Emission-Computed, Single-Photon*

In this study, We evaluated the safety and efficacy of mycophenolate mofetil (MMF) for the prevention of acute rejection episodes when given in combination with cyclosporine and corticosteroids during the postoperative period in living donor kidney transplantation. 212 patients were enrolled; 106 patients received triple therapy with azathioprine (control group) and another 106 patients received triple regimen with MMF 2 g/day (study group). There was two subgroup in the study group. Of the study group, one subgroup was 90 patients treated MMF after acute rejection episode or an increase in serum creatinine level above 2.0 mg/dl (MMF conversion) and another group was 16 patients with primary MMF therapy. We made no demographic difference between study and control groups with patient selection for reducing bias. There was no statistical differences in serum creatinine level between two groups at 2 years after transplantation. There were 12 (13.3%), 3 (18.8%) acute rejection episodes in the MMF conversion and primary MMF therapy groups and 36 (33.7%) in the control group with statistic difference (p=0.01). 5 patients (5.6%) in the MMF-treated group lost their graft versus 16 patiens (15%) in the AZA-treated group. The 2-year graft survival rate was 97.4% in the study group and 83.9% in the control group. There was signficant difference in 2-year graft survival (p=0.003). The adverse effects of MMF were opportunistic infection, leukopenia, abdominal pain and diarrhea. MMF in combination with cyclosporine and prednisone was superior to a standard immunosuppressive regimen including azathioprine. Taken together, the data indicated that MMF will be a valuable addition to the list of immunosuppressants available for the prevention and treatment of acute renal rejection after renal transplantation. Its final place in clinical transplantation will be determined by further analysis of future, randomized-prospective studies, and by broadening experience with this important addition to the immunosuppressive regimen.
Abdominal Pain ; Adrenal Cortex Hormones ; Azathioprine ; Bias (Epidemiology) ; Creatinine ; Cyclosporine ; Diarrhea ; Graft Survival ; Humans ; Immunosuppressive Agents ; Kidney Transplantation* ; Leukopenia ; Living Donors ; Opportunistic Infections ; Patient Selection ; Postoperative Period ; Prednisone ; Transplants*