No abstract available.
Retrospective Studies ; Surgery, Oral ; Tracheostomy

No abstract available.

No abstract available.
Leptospira interrogans* ; Leptospira*

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

STUDY DESIGN: Case study of two cases. OBJECTIVES: The aim of our study is to describe atypical patterns of tuberculous spondylitis. SUMMARY OF LITERATURE REVIEW: Few reports of tuberculous spondylitis have discussed atypical cases, which resulted in a poor prognosis due to the delay in early diagnosis and proper treatment. MATERIALS AND METHODS: A 74-year-old female underwent an incision and drainage, and posterior decompression and fusion (PDF) due to tuberculous epidural abscess after vertebroplasty of a compression fracture at T12. A 52-year-old female underwent interbody fusion and posterior lateral fusion (PLF) because of aggravation of an abscess and neurologic symptoms following non-invasive intervention to treat atypical tuberculous spondylitis. RESULTS: Clinical symptoms and serological tests of the patients were improved at postoperative 6 months. CONCLUSIONS: When a patient presents with focal bony or soft tissue abnormality on an image study, the possibility of non-typical tuberculous spondylitis has to be considered when infective spondylitis or a tumor is detected. Moreover, an invasive diagnosis tool such as biopsy will be needed for proper management.
Abscess ; Aged ; Biopsy ; Decompression ; Diagnosis ; Drainage ; Early Diagnosis ; Epidural Abscess ; Female ; Fractures, Compression ; Humans ; Middle Aged ; Neurologic Manifestations ; Prognosis ; Serologic Tests ; Spondylitis* ; Vertebroplasty

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*

Primary hyperparathyroicism is a state of hypersecretion of PTH by the parathyroid. The etiology has not been established. The three possible etiologies of piimary hyperparathyroidism and incidences are adencena(83%), hyperplasia(15%), and carcinoma(1~2%). Parathyroid carcinoma usually presents in the fourth decades. The hallmark preoperative signs are hypercalcemia(serum calcium 15mg/dl). Palpable neck mass and bane and renal disease. Patients may present with multiple signs and syrnptoms, including recurrent nephrolithiasis, peptic ulcers, mental change, less frequently, extensive bone resorption. However, with greater awareness of the disease and wider use of screening tests, including blood calcium determinations, the diagnosis is frequently made in patients who have no symptoms and minimal, if any, signs of the disease ather than hypercalcemia and elevated levels of parathyroid Hormone. An 38-years-old woman was admitted to the hospital due to pain on the left knee joint. We experienced full-brown symptom pertaining to hyperpara- thyroidism. Thus we report a case herein and also discuss clinical anifestation, histologic features and treatment.
Bone Resorption ; Calcium ; Diagnosis ; Female ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Incidence ; Knee Joint ; Mass Screening ; Neck ; Nephrolithiasis ; Parathyroid Hormone ; Parathyroid Neoplasms ; Peptic Ulcer ; Thyroid Gland

STUDY DESIGN: Case report. OBJECTIVES: To report a case of a giant intramuscular lipoma after a blunt trauma. SUMMARY OF LITERATURE REVIEW: Lipomas are the most frequent benign tumor of the mesenchymal tissue. Although the etiopathogenesis is not complete understood yet, it is known that lipoma develope with a 1% rate after traumas in the related localizations. Traumata induce hematoma and initiates inflammatory reactions in fatty tissue and can trigger the development of lipoma. MATERIALS AND METHODS: 2 years after a blunt trauma a 56years male patient developed a back mass. A massive lipoma was confirmed clinical and radiological. RESULTS: A total excision was performed and the result was histopathologic confirmed. CONCLUSIONS: Patients who develop hematoma after a trauma need a close lipoma progress observation which decrease the invasive treatment of post-trauma hematoma.
Adipose Tissue ; Hematoma ; Humans ; Lipoma* ; Male

This paper reports a rare case of the symptomatic third metatarsal (MT3) - lateral cuneiform (LC) in a 55-year-old male who presented with complaints of severe intermittent pain in his right foot. Plain radiographs and computed tomography scans revealed sclerosis and irregularity at this joint. The intraoperative findings demonstrated a fibrocartilaginous coalition. The pain had improved one year after removing the MT3-LC joint by en bloc and arthrodesis.
Arthrodesis ; Foot ; Humans ; Joints* ; Male ; Metatarsal Bones ; Middle Aged ; Sclerosis

Mycophenolate mofetil (MMF) is being widely used as a maintenance imunosuppressive therapy in renal transplant patients. Myelotoxicity and gastrointestinal symptoms are the well-known adverse effects of this immunosuppressant. However, there areexistonly two reports on oral ulceration associtated with MMF. Although oral ulcerations are not life-threatening, they may seriously affect the quality of life. We report ourthe experience of a case of a 57-year-old female patient with painful oral mucosal ulcerations that improved following MMF discontinuation.
Female ; Humans ; Kidney Transplantation ; Middle Aged ; Mycophenolic Acid ; Oral Ulcer ; Quality of Life ; Transplants ; Ulcer