PURPOSE: This study was designed to compare conventional renal and contrast enhanced magnetic resonance angiography (CRA & CE-MRA, respectively) for the preoperative evaluation of living renal transplant donors. MATERIALS AND METHODS: Between September 2002 and November 2004, forty-five consecutive live renal transplant donors underwent preoperative evaluations of the renal vessels, using both CRA and CE-MRA before the donor nephrectomy. The intraoperative findings of the number of renal vessels were compared with those of CRA and CE-MRA, respectively. RESULTS: Both angiographic modalities were able to detect multiple renal arteries and veins, with overall agreement between CRA and CE-MRA of 97.8 and 97.8%, respectively. The overall accuracies for predicting the number of renal arteries and veins, relative to the intraoperative findings, were 91.1 and 91.1% for CRA and 88.9 and 95.6% for CE-MRA, respectively. The CE-MRA missed 5 accessory renal arteries, whereas CRA missed 4 cases. Despite the undetected cases, there was no significant intraoperative morbidity. Additionally, renal cysts seen on CE-MRA were not detected by CRA. CONCLUSIONS: Our findings suggest that noninvasive CE-MRA is a promising substitute for CRA to evaluate the renal vessels of live renal transplant donors.
Angiography* ; Humans ; Magnetic Resonance Angiography* ; Nephrectomy ; Renal Artery ; Tissue Donors* ; Transplantation ; Veins

No abstract available.
Health Status Indicators* ; Surveys and Questionnaires

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

PURPOSE: Standard treatment of asymptomatic spinal cord hemangioblastoma in von Hippel-Lindau (VHL) disease has yet to be established. The purpose of this study was to propose guidelines for the treatment of asymptomatic spinal cord hemangioblastomas in VHL disease. MATERIALS AND METHODS: VHL disease patients treated for spinal cord hemangioblastomas between 1999 and 2009 were included. All spinal cord hemangioblastomas were divided into three groups: Group 1, asymptomatic tumors at initial diagnosis followed with serial imaging studies; Group 2, asymptomatic tumors at initial diagnosis that were subsequently resected; and Group 3, symptomatic tumors at initial diagnosis, all of which were resected. RESULTS: We identified 24 spinal cord hemangioblastomas in 12 patients. Groups 1, 2 and 3 comprised 13, 4 and 7 tumors, respectively. Group 1 exhibited a smaller tumor volume (257.1 mm3) and syrinx size (0.8 vertebral columns) than those of Group 2 (1304.5 mm3, 3.3 vertebral columns) and Group 3 (1787.4 mm3, 6.1 vertebral columns). No difference in tumor volume or syrinx size was observed between Groups 2 and 3. Five tumors in Group 1 were resected during follow-up because symptoms had developed or the tumor had significantly grown. Finally, among 17 asymptomatic tumors at the initial diagnosis, nine tumors were resected. Only one tumor of these nine tumors resulted in neurological deficits, while five of seven symptomatic tumors caused neurological deficits. CONCLUSION: Selective resection of asymptomatic tumors before they cause neurological deficits might bring about better outcomes.
Adult ; Aged ; Aged, 80 and over ; Female ; Hemangioblastoma/etiology/*pathology/*surgery ; Humans ; Male ; Middle Aged ; Treatment Outcome ; von Hippel-Lindau Disease/*complications

Purpose: The incidence of renal hemorrhage and the transfusion rates in patients undergoing balloon or Amplatz fascial dilation of the nephrostomy tract during percutaneous nephrolithotomy (PCNL) were compared. Materials and Methods: The medical records of 100 patients who underwent PCNL were reviewed. The nephrostomy tract was dilated with either a balloon (53 patients) or Amplatz sequential (47 patients) dilators. The time required for nephrostomy tract dilation, the stone burden, perioperative blood hemoglobin level and blood transfusion rates were compared between the two groups. Results: Of the 47 patients that underwent percutaneous renal Amplatz dilatation, 14 (29%) required a blood transfusion, compared to only 7 of the 53 (13%) that underwent balloon dilation. The difference in the transfusion rates between the 2 groups was statistically significant (p=0.04). The time required for nephrostomy tract dilation was also shorter with balloon than Amplatz dilation (6.5 versus 12.3 minutes, p=0.02). Conclusions: Balloon dilation led to less renal hemorrhage and lower transfusion rates compared to Amplatz dilation during PCNL. Additionally, the time required for nephrostomy tract dilation was shorter with balloon dilation.)
Blood Transfusion ; Dilatation ; Hemorrhage ; Humans ; Incidence ; Medical Records ; Nephrostomy, Percutaneous*

Epidermal cysts are benign cysts, which rarely localize in solid organs, but have an unclear pathogenesis. Herein, a case of an intrarenal epidermal cyst, in a 60-year-old woman with right flank pain, is reported. Multiple renal stones in the right kidney were identified by an intravenous pyelogram. A percutaneous nephrolithotomy (PCNL) was performed under the assumption of renal stones. Amorphorous cysts, containing calcification, were identified during the PCNL, which were histologically identical in appearance to an epidermal cyst within the skin. We suspected the pathogenetic mechanism of this lesion was a metaplasia of traumatic origin, due to the patient's history of renal stones, which had been previously treated with an open nephrolithotomy. According to the literature, an intrarenal epidermal cyst was usually treated by nephrectomy, under the assumption of a renal mass. Although the intrarenal epidermal cyst was incidentally found during the PCNL, an additional nephrectomy was not performed as it had almost been removed.
Epidermal Cyst* ; Female ; Flank Pain ; Humans ; Kidney ; Metaplasia ; Middle Aged ; Nephrectomy ; Nephrostomy, Percutaneous ; Skin

Epidermal cysts are benign cysts, which rarely localize in solid organs, but have an unclear pathogenesis. Herein, a case of an intrarenal epidermal cyst, in a 60-year-old woman with right flank pain, is reported. Multiple renal stones in the right kidney were identified by an intravenous pyelogram. A percutaneous nephrolithotomy (PCNL) was performed under the assumption of renal stones. Amorphorous cysts, containing calcification, were identified during the PCNL, which were histologically identical in appearance to an epidermal cyst within the skin. We suspected the pathogenetic mechanism of this lesion was a metaplasia of traumatic origin, due to the patient's history of renal stones, which had been previously treated with an open nephrolithotomy. According to the literature, an intrarenal epidermal cyst was usually treated by nephrectomy, under the assumption of a renal mass. Although the intrarenal epidermal cyst was incidentally found during the PCNL, an additional nephrectomy was not performed as it had almost been removed.
Epidermal Cyst* ; Female ; Flank Pain ; Humans ; Kidney ; Metaplasia ; Middle Aged ; Nephrectomy ; Nephrostomy, Percutaneous ; Skin

BACKGROUND: Immunosuppressive agents with higher potencies, such as tacrolimus and mycophenolate mofetil (MMF), have been introduced and widely accepted in clinical practice. This study evaluated the impact of these newer immunosuppressive drugs on the pattern and timing of post-kidney transplantation infections. METHODS: Data of kidney transplant recipients at the Seoul National University Hospital between January 1990 and November 2005 were analyzed. Recipients were divided into double immunosuppression (double group, n=198), triple immunosuppression including MMF (MMF group, n=253), and azathioprine (AZA, n=184) groups. RESULTS: The MMF group demonstrated higher graft survival and reduced rates of acute rejection within the fifth post-transplant year than both the AZA (P<0.001) and the double (P<0.001) groups. The overall incidence of infection in the first month was significantly higher in the MMF group (2.17/1,000 transplant-days) than in the AZA (0.73/1,000 transplant-days) and double (0.84/1,000 transplant-days) groups (P=0.01, ANOVA), and this was caused by viral infections that were significantly higher in the MMF (1.57/1,000 transplant-days) group than in the AZA (0.54/1,000 transplant-days) and double (0.67/1,000 transplant-days) groups. MMF was identified as a significant risk factor for viral infection (P=0.013; OR, 2.04; 95% CI, 1.16-3.60) in a multivariate logistic regression analysis. CONCLUSIONS: The results suggest that viral infection rates were higher in the MMF group and should be considered the primary source of perioperative infectious complications in MMF-receiving recipients.
Azathioprine ; Graft Rejection ; Graft Survival ; Immunosuppression ; Immunosuppressive Agents ; Incidence ; Kidney ; Logistic Models ; Mycophenolic Acid ; Rejection (Psychology) ; Risk Factors ; Tacrolimus ; Transplants ; Viruses

Anterior lumbar interbody fusion (ALIF) is a popular procedure that is used in spine surgery for treating disc herniation. Although this operation is usually safe, it can cause vascular injury, including arterial thrombosis. We report here on the case of 59-year-old woman who developed acute arterial thrombosis during ALIF. Toward the end of the operation, the somatosensory evoked potential signals decreased more than 50% in the left lower extremity, suggesting acute arterial occlusion. Therefore, a vascular surgeon was contacted and immediate thrombo-endarterectomy was performed. Thrombosis developed due to rupture of preexisting plaque during the arterial retraction. After the endarterectomy, the somatosensory evoked potentials signals and pulse were restored. To avoid vascular injury, preoperative evaluation of the vascular images and careful handling of the vessels during surgery are important. A vascular surgeon should be available not only in the event of complications, but such a surgeon should also be included from the planning of the operation.
Endarterectomy ; Evoked Potentials, Somatosensory ; Female ; Handling (Psychology) ; Humans ; Iliac Artery ; Lower Extremity ; Middle Aged ; Rupture ; Spine ; Thrombosis ; Vascular System Injuries

PURPOSE: Vascular endothelial growth factor (VEGF) is one of the factors regulating angiogenesis. For angiogenesis, the local concentration of VEGF has to be maintained. Because of its short half-life, VEGF has been conjugated with nanoparticles. Some nanoparticles, such as poly (lactic-co-glycolic acid (PLGA)) or polyethylenimine (PEI) are commonly used in this field, but have weak points such as faster release than expected and cell toxicity. We investigated the effect of core/shell nanoparticles including lecithin lipid cores in the ischemic hindlimb model. METHODS: Mice were anesthetized and a region of the common femoral artery and vein was ligated and excised. Hindlimb ischemic mice (n=28) were divided randomly into four groups: Control group (normal saline, n=7), mouse VEGF group (mVEGF, n=7), nanoparticle including mVEGF group (N-mVEGF, n=7), and nanoparticle/hydrogel mouse VEGF group (NH-mVEGF, n=7). The drug was injected postoperatively into the thigh muscle of the ischemic limb. Perfusion, capillary number and H&E stain were assessed 28 d after treatment. RESULTS: The capillary number increased in N-mVEGF and mVEGF group (P=0.026). Improvements of ischemic limb perfusion were inferior in N-mVEGF, NH-mVEGF groups (P=0.006) compared to other groups. Mice received N-mVEGF, NH-mVEGF treatment showed significant inflammation in the H&E staining. CONCLUSION: Sustained VEGF delivery via core/shell nanoparticle with lecithin core did not show improved perfusion rate despite an increase in capillary number. Furthermore, vacuolization and induction of inflammation requiring a different composition of nanoparticle should be tested.
Animals ; Capillaries ; Extremities ; Femoral Artery ; Half-Life ; Hindlimb ; Inflammation ; Lecithins ; Mice ; Muscles ; Nanoparticles ; Perfusion ; Polyethyleneimine ; Thigh ; Vascular Endothelial Growth Factor A ; Veins