Transplant renal artery stenosis (TRAS) is an important cause of hypertension, allograft dysfunction, and graft loss. Patient and allograft survival rates are lower in patients with TRAS. Causes of TRAS include acute rejection, cytomegalovirus infection, calcineurin inhibitor toxicity, atherosclerosis of recipient, and/or donor. Technical problems due to surgery are a common cause of early TRAS. A 62-year-old male in end stage renal disease received kidney transplant surgery. There was 5/6 mismatch of human leukocyte antigen and the panel reactive antibody of patient was class I 0% and class II 0%. End to side anastomosis was done between the graft's renal artery and the patient's common iliac artery. His serum creatinine was measured at 6.4 mg/dL before transplantation but his serum creatinine level did not fall below 2.6 mg/dL at 5 days postoperative. His blood pressures was 160/90~180/100 mmHg. There was a significant TRAS (about 80% luminal narrowing) at the arterial anastomosis site on the renal magnetic resonance angiography. We performed percutaneous transluminal angioplasty (PTA) for the stenotic lesion. The balloon angioplasty was done with a 5 mm balloon and low pressure (8 mmHg, nominal pressure was 10 mmHg) at the stenotic lesion. The arterial pressure gradient was 8 mmHg (recipient's common iliac arterial pressure, 147/73 mmHg; poststenotic segmental renal arterial pressure, 139/70 mmHg) just before the balloon angioplasty. After PTA, the arterial pressure gradient became 3 mmHg (recipient's common iliac arterial pressure, 157/66 mmHg; poststenotic segmental renal arterial pressure, 154/65 mmHg). The arterial size and blood flow recovered to within normal range and serum creatinine level was normal after PTA. PTA using low pressure and a small balloon was safe and effective modality in treating early TRAS.
Allografts ; Angioplasty ; Angioplasty, Balloon* ; Arterial Pressure ; Atherosclerosis ; Calcineurin ; Creatinine ; Cytomegalovirus Infections ; Humans ; Hypertension ; Iliac Artery ; Kidney ; Kidney Failure, Chronic ; Kidney Transplantation ; Leukocytes ; Magnetic Resonance Angiography ; Male ; Middle Aged ; Phenobarbital ; Reference Values ; Renal Artery Obstruction* ; Renal Artery* ; Survival Rate ; Tissue Donors ; Transplants

Kidney transplantation (KTP) lowers the mortality and morbidity of patients with end-stage renal disease. Post-transplantation infection and antibody mediated rejection (AMR) are the most common complications. Hepatitis B surface antigen (HBsAg) positive carrier donors and high anti A/B antibody titer ABO incompatible KTP could lead to recipient hepatitis B virus (HBV) infection and AMR. Here, we report a case of successful KTP in a 41-year-old male with a high titer of ABO incompatible and HBsAg positive donor. He underwent seven rounds of plasmapheresis, low dose intravenous immunoglobulin and rituximab treatment to inhibit antibody production and remove antibodies from the serum, after which he was administered anti-viral agent for HBV prophylaxis. The recipient maintained successful allograft function for 6 months after transplantation; therefore, we report that desensitization and anti-viral treatment achieved successful outcome in a 1:512 anti A/B antibody titer ABO incompatible and hepatitis B carrier donor KTP.
Adult ; Allografts ; Antibodies ; Antibody Formation ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis B* ; Hepatitis* ; Humans ; Immunoglobulins ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Male ; Mortality ; Plasmapheresis ; Rituximab ; Tissue Donors

BACKGROUND: Although nutritional problems associated with dialysis are well described, nutritional problems after renal transplantation have received little attention. Nutrition interventions play an important role in prevention and management of common health problems associated with renal transplantation such as obesity, hypertension, diabetes, and cardiovascular disease. METHODS: Sixty-four kidney transplant recipients who received post-transplant management at our hospital replied to the questionnaire. The questionnaire included 102 questions on the amount and types of Korean foods that they consumed last week. Nutritional elements of diet in renal transplant patients who consume Korean food were analyzed on the basis of the survey. RESULTS: The mean energy and protein of daily intake were 2,088+/-1,016 kcal and 75.5+/-38.2 g. Patients' diets were generally sufficient, but characterized by deficiencies in vitamin B2, vitamin D, niacin, calcium, and magnesium intake. CONCLUSIONS: Dietary advice is required with regard to intake of some nutritional elements for kidney transplant recipients who consume Korean foods. Their main nutritional problem is obesity after transplantation. Attention should be paid to prevention of nutritional imbalance.
Calcium ; Cardiovascular Diseases ; Dialysis ; Diet ; Humans ; Hypertension ; Kidney Transplantation ; Kidney* ; Magnesium ; Niacin ; Obesity ; Surveys and Questionnaires ; Riboflavin ; Transplantation ; Vitamin D

Intrathoracic omental herniation through the esophageal hiatus is extremely rare. Here, we report a case of a 57-year-old male with continuous ambulatory peritoneal dialysis (CAPD) who was admitted to our hospital after experiencing nausea and abdominal discomfort for 3 days. Computed tomography (CT) revealed a fatty mass, extended continuously through the esophageal hiatus into the thoracic cavity. Laparoscopic surgery revealed an omental herniation through the esophageal hiatus. There was no herniation of the stomach or intestines. Peritoneal dialysis was resumed six weeks later. This is a report of omental herniation through the esophageal hiatus in a patient with CAPD.
Hernia ; Humans ; Intestines ; Laparoscopy ; Male ; Middle Aged ; Nausea ; Omentum ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Stomach ; Thoracic Cavity

BACKGROUND: Previously, the inhibition of coronary restenosis with Abciximab (ReoPro (R) ) -coated stent in a porcine model was reported. ReoPro (R) inhibits platelet aggregation, the proliferation of vascular smooth muscle cells and the inflammatory reaction. METHODS: A prospective randomized trial was performed to compare two types of stent for revascularization in the native coronary artery. The primary effective end points were major adverse coronary events (MACE) : cardiac death, acute myocardial infarction, target vessel revascularization (TVR) and restenosis at the 6-month clinical and angiographic follow-ups. RESULTS: One hundred and fifty-five patients were enrolled between August 2001 and June 2003. The mean ages (56.0 +/- 10.0 vs. 56.9 +/- 10.8 years), baseline diameter of stenosis and minimal luminal diameter were no different between the two groups. There was one myocardial infarction and revascularization during the hospital stay in control stent group. During the clinical follow-up there were two myocardial infarctions in control group. Follow-up coronary angiograms were performed in 62.3% (48/77) and 65.4% (51/78) of the coated and control groups, respectively. The diameter of stenosis and late loss were significantly less in the ReoPro (R) -coated stent group compared with the controls (16.4 +/- 5.8% vs. 34.3 +/- 6.1%, p=0.009; and 0.33 +/- 0.28 mm vs. 0.88 +/- 0.41 mm; p=0.002). The restenosis and TVR rates of the ReoPro (R) -coated stent were relatively lower compared with the control stent [14.6% (7/48) vs. 29.4% (15/51), p=0.062; and 9.2% (7/76) vs. 14.7% (11/75) ; p=0.327]. CONCLUSION: A ReoPro (R) -coated stent is safe, and may be effective in the prevention of coronary restenosis.
Antibodies, Monoclonal/pharmacokinetics/*therapeutic use ; Coated Materials, Biocompatible/pharmacokinetics/*therapeutic use ; Coronary Arteriosclerosis/*surgery ; Coronary Restenosis/epidemiology/prevention & control ; Female ; Humans ; Immunoglobulins, Fab/*therapeutic use ; Korea/epidemiology ; Male ; Middle Aged ; Platelet Aggregation Inhibitors/pharmacokinetics/*therapeutic use ; Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors ; Prospective Studies ; Research Support, Non-U.S. Gov't ; *Stents

Isolated noncompaction of the left ventricular myocardium is a rare cardiac disorder due to an arrest in myocardial morphogenesis. It is characterized by prominent and excessive trabeculation in a ventricular wall segment, with deep intertrabecular spaces perfused from the ventricular cavity. Echocardiographic findings are important clues for the diagnosis. Clinical symptoms include signs of left ventricular systolic dysfunction even to the point of heart failure, ventricular arrhythmias, and embolic events. We describe two cases of isolated noncompaction of the myocardium, with ventricular tachycardia in one, and chest pain due to microvascular dysfunction in the other.
Adult* ; Arrhythmias, Cardiac ; Chest Pain ; Diagnosis ; Echocardiography ; Heart Failure ; Humans ; Morphogenesis ; Myocardium* ; Tachycardia, Ventricular

BACKGROUND: Previously we reported the inhibition of coronary restenosis with Abciximab (ReoPro(R))-coated stent in a porcine model. ReoPro(R) inhibits platelet aggregation, the proliferation of vascular smooth muscle cells and inflammatory reaction. METHODS: We performed a prospective randomized trial to compare two types of stents for the revascularization in native coronary artery. The primary effective end points were major adverse coronary events (MACE): cardiac death, acute myocardial infarction, target vessel revascularization (TVR), restenosis at 6-month clinical and angiographic follow-up. RESULTS: One hundred fifty-five patients were enrolled between Aug, 2001 and Jun, 2003. Mean ages (56.0 +/- 10.0 vs. 56.9 +/- 10.8 years), baseline diameter stenosis and minimal luminal diameter were not different between the two groups. There was one myocardial infarction and revascularization during hospital stay in control stent group. During clinical follow-up, there were two myocardial infarctions in control group. Follow-up coronary angiogram was done 62.3% (48/77) in coated and 65.4% (51/78) in control groups. Diameter stenosis and late loss were significantly less in the ReoPro(R)-coated stent group compared with controls (16.4 +/- 5.8% vs. 34.3 +/- 6.1%, p=0.009; and 0.33 +/- 0.28 mm vs. 0.88 +/- 0.41 mm; p=0.002). The restenosis and TVR rates of ReoPro-coated stent were relatively lower compared with control stent [14.6% (7/48) vs. 29.4% (15/51), p=0.062; and 9.2% (7/76) vs. 14.7% (11/75); p=0.327]. CONCLUSION: A ReoPro(R)-coated stent is safe and may be effective in the prevention of coronary restenosis.
Blood Platelets* ; Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Restenosis ; Coronary Vessels* ; Death ; Follow-Up Studies ; Glycoproteins* ; Humans ; Length of Stay ; Muscle, Smooth, Vascular ; Myocardial Infarction ; Phenobarbital ; Platelet Aggregation ; Prospective Studies ; Stents*

BACKGROUND AND OBJECTIVES: The purpose of the study was to evaluate the usefulness of cardiac troponin as a marker for the detection of minor myocardial injury following percutaneous coronary interverntion (PCI). SUBJECTS AND METHODS: In 79 patients who underwent successful PCI under the diagnosis of stable angina, serum creatinine kinase MB isoenzyme (CK-MB), cardiac troponin T (cTnT), and cardiac troponin I (cTnI) were measured before and at 6, 12 and 24 hours after PCI, and the angiographic findings and procedural characteristics of PCI were compared between the elevated and the normal enzyme groups. RESULTS: Abnormal values of one or more markers following PCI were observed in 17 patients (22%) ; 11 after stenting and 6 after balloon angioplasty alone. The frequency of abnormal cTnI levels was 19% and was significantly higher than that of CK-MB (6%, p < 0.01). No significant differences in target vessel number, target artery, ACC/AHA type, TIMI flow, stenting, time and number of ballooning, maximal inflation pressure or balloon diameter and length were observed between the two groups. Small side branch occlusions developed in 23% of the elevated enzyme group and in 3% of the normal enzyme group. CONCLUSION: Minor myocardial injury can be detected by cTnI and is observed frequently in patients with stable angina following PCI. A small side branch occlusion is related with elevated cTnI.
Angina Pectoris ; Angina, Stable ; Angioplasty, Balloon ; Arteries ; Coronary Disease ; Creatinine ; Diagnosis ; Humans ; Inflation, Economic ; Percutaneous Coronary Intervention* ; Phosphotransferases ; Stents ; Troponin I ; Troponin T ; Troponin*

BACKGROUND AND OBJECTIVES: It has been reported that intracoronary radiation therapy (ICRT) using a Ho-166 coated balloon inhibits restenosis of porcine coronary arteries. However, the consequences of ICRT on coronary artery endothelial function are unknown. The aim of this study is to investigate the effects of ICRT using a Ho-166 balloon on coronary artery endothelial function and vasomotor reactivity. MATERIALS AND METHODS: Female pigs (25-35 kg) were orally premedicated daily with aspirin (100 mg) and ticlopidine (250 mg) for the duration of the study. Under sterile conditions with local anesthesia of the skin provided by 2% lidocaine, an arteriotomy of the left carotid artery was performed, an 8 Fr sheath was inserted, and intraarterial heparin sodium (10,000 IU) was injected. Under fluoroscopic guidance, the coronary artery main branch was selected through an 8 Fr guiding catheter for coronary artery overdilation injury (balloon to artery ratio, 1.3:1) and ICRT. A Ho-166 coated balloon prepared to deliver 20 Gy at a depth of 2 mm from the balloon surface was used for ICRT. The coronary artery main branch in each pig was randomly assigned to either balloon injury (Group I) or balloon injury plus ICRT (Group II). Coronary artery segments were taken from the animals at 0 week (n=8), 4 weeks (n=6) and 8 weeks (n=8) after the intervention. Data in each group denote the relative ratio compared to non-injured coronary artery and are expressed as mean +/- standard error of mean. RESULTS: The degree of KCl-induced contractile response (g) was not different between the two groups at 0 and 4 weeks, but was significantly decreased in group II compared to group I at 8 weeks (I:1.04+/-0.06, II:0.79+/-0.07, p=0.014). In rings precontracted with prostaglandin F 2alpha (PGF 2alpha), the degree of NO-dependent relaxation (%) induced with substance P was significantly decreased in group II compared to group I at 0 week (I:0.93+/-0.33, II:0.47+/-0.31, p=0.03), but the difference between the two groups was not significant at 4 and 8 weeks. In rings precontracted with PGF 2alpha and LAME in the presence of indomethacin, the degree of EDHF-induced relaxation (%) using substance P was not different between the two groups at 0, 4 and 8 weeks; nor was the degree of sodium nitroprusside-induced endothelium independent relaxation (%) in depolarized conditions with PGF 2alpha. CONCLUSION: Endothelial function of the porcine coronary artery is only transiently impaired after ICRT using a Ho-166 coated balloon. Therefore this therapy can be used as an effective method to prevent restenosis after percutaneous coronary intervention.
Anesthesia, Local ; Angioplasty ; Animals ; Arteries ; Aspirin ; Carotid Arteries ; Catheters ; Coronary Restenosis ; Coronary Vessels ; Endothelium ; Female ; Heparin ; Humans ; Indomethacin ; Lidocaine ; Percutaneous Coronary Intervention ; Prostaglandins F ; Relaxation ; Skin ; Sodium ; Substance P ; Swine ; Ticlopidine

BACKGROUND: Aortic valve stenosis induces left ventricular hypertrophy as an adaptive response to the chronic overload caused by the valve disease. Despite the fact that aortic valve replacement may lead to regression of the left ventricular hypertrophy, there is a controversy on the change of the left ventricular muscle after use of small prostheses. MATERIAL AND METHOD: We reviewed 20 patients who had undergone aortic valve replacement for aortic stenosis. There were 13 males and 7 females with a mean age of 61+/-13.8 years. A retrospective analysis of Doppler echocardiography was undertaken in preoperatively, early postoperatively(mean 10.4days), and late postoperatively(mean 29.9 months). They were divided into two groups according to the size of prosthesis used(group 1; 21 mm or smaller, group 2; 23 mm or larger). RESULT: Significant improvement of NYHA Functional class was detected in all groups. Ejection fraction was not significantly different in the group 1 between preoperative and postoperative period, however it increased significantly in the group 2 over time. But preoperative ejection fraction of the group 2 was significantly lower than that in the group 1(p=0.044). Left ventricular muscle mass index(g/m2) was not reduced significantly in the group 1 at the early postoperative period, but it was reduced significantly at the late postoperative period. In the group 2 it was reduced significantly over time. CONCLUSION: Both groups showed clinical improvement. However, the number of patients in whom 19 mm size prosthesis was used was only two. Thus, we suggest that more attention to age, BSA, and exercise should be paid in patients who will undergo aortic valve.
Aortic Valve Stenosis ; Aortic Valve* ; Echocardiography, Doppler ; Female ; Humans ; Hypertrophy, Left Ventricular* ; Male ; Postoperative Period ; Prostheses and Implants* ; Retrospective Studies