A 6-day-old female infant had generalized superficial pustules which evolved into pigmented maucles, many of which had a peripheral collarvtte of scale. Histopsthologic stadies showed intracormeal aggregates of neutrophils. The appearance of the lesions and histopathologic finding fitted transient neonal pustular melanosis.
Female ; Humans ; Infant ; Melanosis* ; Neutrophils

Acute rejection in renal transplantation is a major risk factor threatening the longterm graft survival. Acute rejections refractory to conventional anti-rejection therapy using steroid pulse or antilymphocyte preparations occur in minority, preceding to progressive deterioration of renal function and graft loss. Recent reports showed that tacrolimus rescue therapy in this refractory rejections has converted rejection process. In order to evaluate the clinical outcome of tacrolimus rescue therapy in refractory rejections, we performed a retrospective study. Since April 1997, we performed tacrolimus rescue therapy intent-to-treat for steroid- or OKT3- resistant rejections in 5 patients. All rejections were histologically confirmed according to Banff criteria. As conventional antirejection therapy, steroid pulse therapy (solumedrol 500~1000 mg iv for 3 days) or OKT3 therapy (5 mg/day for 14 days) was performed. The outcome of the rescue therapy is classified into three categories by the change of serum creatinine level or the histologic findings; Improvement-return of serum creatinine level (sCr) to or below the prerejection baseline (nadir) level, Stabilization-arrested sCr increase, Failure-progressive deterioration of renal function, or graft loss. All were men and the mean age was 38 years. Living related- & unrelated-donor transplantation were 2 and 3 cases respectively. Immunosuppression were done with CsA Pd+ (3) or CsA+ Pd+ AZA (2). Acute rejection grades according to Banff criteria were mild (2) or moderate (3). The mean interval between transplantation and tacrolimus conversion was 54.4 days. The outcome was as follows; improvement 2 cases, stabilization 1 case and failure 2 cases. During 3~10 months followup PTLD occured in 1 case, treated with graft nephrectomy and no other complications in other 4 cases. In conclusion, we can convert ongoing refractory rejections to steroid and OKT3 therapy by tacrolimus rescue therapy in 60% (3/5) successfully. Although longterm followup result is necessary to confirm the efficacy and safety of the tacrolimus rescue therapy, the result of this early trial is so good that we may try tacrolimus in refractory rejections for rejection reversal.
Creatinine ; Follow-Up Studies ; Graft Survival ; Humans ; Immunosuppression ; Kidney Transplantation* ; Male ; Muromonab-CD3 ; Nephrectomy ; Retrospective Studies ; Risk Factors ; Tacrolimus* ; Transplants

The purpose of this study was to evaluate the effect of stroke on hypothalamic-pituitary axis using dexamethasone suppression test. The effects were evaluated according to age, sex, type, size, and lesion site of stroke. There tests were performed in 62 patients with stroke(cerebral infarction, 42 cases : intracerebral hemorrage, 20 cases) and 21 disabled controlled patients without intracranial diseases at Yeungnam University Hospital from June 1992 to June 1993. The results summarized as follows. 1. Cerebral infarction showed significantly higher frequency of DST non-suppression in stroke patients than control (p<0.05). 2. Patients with left hemisphere stroke showed more frequent abnormal neuroendocrine test results (p<0.01). 3. Patients with large infarction revealed strongly non-suppressed DST results(p<0.01). 4. Significantly higher basal cortisol level in patients with cerebral infarction was noted(p<0.01). 5. There are no statistical significance between DST results and sex, age, motor impairment, type of cerebral infarction.
Cerebral Infarction ; Dexamethasone* ; Humans ; Hydrocortisone ; Infarction ; Stroke*

Kisspeptin/G-protein couple receptor-54 (GPR54) system plays a key role in the activation of the gonadotropic axis at puberty. Central precocious puberty (CPP) is caused by the premature activation of hypothalamic gonadotropin-releasing hormone secretion. This study was aimed to identify KISS1 gene variations and to investigate the associations between KISS1 gene variations and CPP in Korean girls. All coding exons of KISS1 gene were sequenced in Korean girls with CPP (n = 143) and their healthy controls (n = 101). Nine polymorphisms were identified in KISS1 gene. A novel single-nucleotide polymorphism (SNP), 55648176 T/G, was identified for the first time. SNP 55648184 C/G and 55648186 -/T were detected more frequently in CPP group than in control group. SNP 55648176 T/G was detected less frequently in CPP group than in control group. Haplotype GGGC-ACCC was detected less frequently in CPP group. The genetic variations of KISS1 gene can be contributing factors of development of CPP. The association between the gene variations and CPP should be validated by further evidence obtained from large-scaled and functional studies.
Base Sequence ; Child ; Female ; Genetic Markers/genetics ; Genetic Predisposition to Disease/*epidemiology/*genetics ; Humans ; Kisspeptins/*genetics ; Molecular Sequence Data ; Point Mutation/genetics ; Polymorphism, Single Nucleotide/*genetics ; Prevalence ; Puberty, Precocious/*epidemiology/*genetics ; Reproducibility of Results ; Republic of Korea/epidemiology ; Risk Assessment ; Sensitivity and Specificity

Kisspeptin/G-protein couple receptor-54 (GPR54) system plays a key role in the activation of the gonadotropic axis at puberty. Central precocious puberty (CPP) is caused by the premature activation of hypothalamic gonadotropin-releasing hormone secretion. This study was aimed to identify KISS1 gene variations and to investigate the associations between KISS1 gene variations and CPP in Korean girls. All coding exons of KISS1 gene were sequenced in Korean girls with CPP (n = 143) and their healthy controls (n = 101). Nine polymorphisms were identified in KISS1 gene. A novel single-nucleotide polymorphism (SNP), 55648176 T/G, was identified for the first time. SNP 55648184 C/G and 55648186 -/T were detected more frequently in CPP group than in control group. SNP 55648176 T/G was detected less frequently in CPP group than in control group. Haplotype GGGC-ACCC was detected less frequently in CPP group. The genetic variations of KISS1 gene can be contributing factors of development of CPP. The association between the gene variations and CPP should be validated by further evidence obtained from large-scaled and functional studies.
Base Sequence ; Child ; Female ; Genetic Markers/genetics ; Genetic Predisposition to Disease/*epidemiology/*genetics ; Humans ; Kisspeptins/*genetics ; Molecular Sequence Data ; Point Mutation/genetics ; Polymorphism, Single Nucleotide/*genetics ; Prevalence ; Puberty, Precocious/*epidemiology/*genetics ; Reproducibility of Results ; Republic of Korea/epidemiology ; Risk Assessment ; Sensitivity and Specificity

No abstract available.
Child* ; Cytomegalovirus Infections* ; Cytomegalovirus* ; Hepatitis ; Humans ; Immunoglobulin M* ; Pneumonia

Endovascular aneurysm repair (EVAR) is used with increasing frequency in the management of high-risk abdominal aortic aneurysm (AAA) patients. We report a delayed open repair for a persistent type I endoleak after EVAR in a patient with co-morbidities. An infrarenal AAA with a transverse diameter of 9.86 cm was detected on CT angiography; it extended from 8 mm below the renal artery to both common iliac arteries. The infrarenal angle was 90 degrees. After insertion of a Zenith stent graft (COOK, USA), a type I endoleak was detected on aortography, and several balloon dilatations were performed. The procedure was finished with a sustained type I endoleak. The endoleak persisted after 5 days on Doppler ultrasound, so open repair was performed. Total operative time was 240 minutes, and the duration of supra-celiac aorta clamping was approximately 35 minutes. The patient suffered an acute myocardial infarction on postoperative day 7 and recovered with conservative management. The patient was discharged on postoperative day 29.
Aneurysm ; Aorta ; Aortic Aneurysm, Abdominal ; Aortography ; Constriction ; Dilatation ; Endoleak ; Humans ; Iliac Artery ; Myocardial Infarction ; Operative Time ; Renal Artery ; Stents ; Transplants

The development of de novo malignancy in renal transplant recipient is one of the most troublesome problems during long-term follow-up. We reviewed our experience of malignancies in renal transplant recipients in SNUH. Among the 625 cases of renal transplantation performed in SNUH from July 1969 to July 1998, 18 cases of de novo malignancies developed in 17 patients: Kaposi sarcoma (6 cases), mucocutaneous cancer (5), post-transplant lymphoproliferative disease (2), bladder cancer (2), hepatoma (2), and stomach cancer (1). The cumulative incidences of cancer in 1, 5, and 10 years were 1.04%, 1.75%, and 2.63% respectively. Four cancers (3.7%) developed among the 109 patients who received azathioprine -based immunosuppression, and 14 cancers (2.7%) in cyclosporine-based immunosuppression. Malignancy was diagnosed at the age of 44.1 (range 25-59) years and 69.9 (range 2-177) months after kidney transplantation. Nine patients received surgical treatment including curative local excision in 5 and graft nephrectomy in one with PTLD in the allograft. Chemotherapy and radiotherapy was done in 7 and 2 patients respectively. Transarterial embolization was done in 1 patient with multiple hepatoma. Reduction or withdrawal of immunosuppression was performed in all patients except five, treated with curative local excision. Total 9 patients died and 3 graft loss occured in 3 survivors due to chronic rejections and allograft nephrectomy. The 5- and 10- year survival rate in the patients with malignancy was 79.3% and 50.5%, which is poorer than those without malignancy (88.6%, 83.0%; p<0.001). Careful surveillance of malignancy in renal allograft recipients is highly recommended.
Allografts ; Azathioprine ; Carcinoma, Hepatocellular ; Drug Therapy ; Follow-Up Studies ; Humans ; Immunosuppression ; Incidence ; Kidney Transplantation ; Nephrectomy ; Radiotherapy ; Sarcoma, Kaposi ; Stomach Neoplasms ; Survival Rate ; Survivors ; Transplantation* ; Transplants ; Urinary Bladder Neoplasms

The operative treatment of abdominal aortic aneurysm (AAA) is generally recommended in ruptured AAA, symptomatic or rapidly expanding AAA, complicated AAA and atypical aneurysms, but there is a controversy in treatment of asymptomatic small-sized AAA. To determine the proper management plan, it is important to know the natural history of AAA, expansion rate and frequency or pattern of complications. There are several reports about the natural history of AAA in western population, but little has been reported in Koreans. Authors performed this study in order to analyze the natural history of small AAA, and to establish a guideline in the proper management of small AAA. PATIENTS & METHODS: Since January 1991, among the patients diagnosed as AAA at Seoul National University Hospital, we followed 15 patients whose aneurysm size was less than 6 cm without operation. In this study, we analysed the natural history of 11 cases with more than 6 months follow up; occurrence of symptoms, physical examinations, and aneurysm size measurement by ultrasound or CT every 6 months. RESULTS: All 11 patients were men, and the mean age was 63.9 years, ranging 54 to 75 years. According to the measurement of largest transverse diameter, mean expansion rate for 6 months was 0.17 0.138 cm. Follow-up period ranged 6~84 months and the median duration was 30 months. Expansion rate according to the initial size was 0, 0.246, 0.178, 0.1 cm/6 months respectively in group A (<2.9 cm; 1 case), B (3.0~3.4 cm; 3 cases), C (3.5~3.9 cm; 6 cases), D (>4.0 cm; 1 case). There was no rupture, aneurysm-related complication, nor death during the follow-up period. We performed elective operations in 2 cases, first case due to aneurysmal expansion over 6 cm, and the other due to severe anxiety of the patient for rupture. CONCLUSIONS: It may be a safe treatment discipline to follow up small AAA patients with sono-guided size measurement and elective operation in selected cases.
Aneurysm ; Anxiety ; Aortic Aneurysm, Abdominal* ; Follow-Up Studies ; Humans ; Male ; Natural History* ; Physical Examination ; Rupture ; Seoul ; Ultrasonography

Endovascular technologies have intrinsic appeal to patients and physicians, they may, if proved safe and effective, replace a substantial proportion of current vascular surgical procedures. Because the developement and the use of these technologies require the skills and the talents of the vascular surgeons and interventional radiologists, a collaborative, multispecialty approach to the use of endovascular technologies is recommended as the most reasonable and optimal treatment for patient care. The purpose of this article is to review our experiences with cooperative endovascular treatments in vascular disease and to stress the key role of vascular surgeon on these technologies. From July, 1995 to March, 1998, 7 cooperative endovascular treatments were done in six patients. Male to female ratio was 4:2 and median age was 58.0 yrs (40~71 yrs). All procedures were done in angiography suite under the local anesthesia. Indications for treatments were 3 pseudoaneurysms in Behcet's disease, 2 abdominal aortic aneurysms (AAAs), 2 acute arterial occlusions with ASO. Six stent graftings were done for aneurysmal diseases. Recurred pseudoaneurysm was occurred in one patient with Behcet's disease, and stent graft was reinserted. Postoperative leak was seen in one patient with AAA, but sealed up spontaneously on following angiography. Simultaneous endovascular balloon angioplasty with open thrombectomy were done in 2 acute arterial occlusions with ASO. Vascular surgeons and interventional radiologists executed cooperative, team approaches in all procedures with success. Although this approach may not be applicable for every vascular disease, vascular surgeons must represent the leadership of the this cooperative treatment. For this, sufficient knowledge and training program with active participation in these technologies are necessary.
Anesthesia, Local ; Aneurysm ; Aneurysm, False ; Angiography ; Angioplasty, Balloon ; Aortic Aneurysm, Abdominal ; Aptitude ; Blood Vessel Prosthesis ; Education ; Female ; Humans ; Leadership ; Male ; Patient Care ; Thrombectomy ; Vascular Diseases ; Vascular Surgical Procedures