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

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

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: 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

Continuous efforts have been made by the organ donation and transplantation community in Korea to increase organ donation by the deceased. The authors detailed trends of organ donation and utilization over the past 10 yr using data provided by the KONOS. The yearly number of deceased donors has grown gradually since 2003. The number and percentage of old donors (> or =50 yr) and donors dying from intracranial hemorrhage has increased continuously. Therefore, the percentage of standard criteria donors (SCD) has been declining significantly, from 94% in 2000 to 79.2% in 2009. The number of organs transplanted per donor (OTPD) has also declined slightly since 2007, from 3.28 in 2007 to 2.95 in 2009. This decline may be attributable to increases in the number and percentage of extended criteria donors (ECD) and donors after cardiac death (DCD), since the OTPD was 2.25 for DCD, 2.5 for ECD, and 3.09 for SCD in 2009. In summary, the makeup of donors has changed significantly. There is an urgent need for establishment of an institutional framework including an independent organ procurement organization and for improvement for the National Transplant Act to increase deceased donor pool and to optimize management of ECD and DCD.
Adult ; Death ; Demography ; Female ; Humans ; Male ; Republic of Korea ; Tissue Donors ; Tissue and Organ Procurement/*trends

Hyperfunctioning fistulas are rare complications of hemodialysis access. They give rise to devastating complications, including a steal syndrome with reduced perfusion to the dependent limb and cardiac insufficiency caused by the high shunt volume. Numerous techniques such as fistula ligation, banding, plication, T-banding and distal revascularization with interval ligation have been developed. However, each technique bears the potential for its own complications, such as failure to resolve symptoms, recurrence and technical difficulty. Herein, we report a new technique that remedies the shortcomings of the other procedures. All the patients first underwent partial aneurysmal resection and lateral aneurysmorrhaphy of the enlarged vein from just distal to the anastomosis using a 6-0 prolene running sutures and then external wrapping with an 8 mm expanded polytetrafluoroethylene graft was done for a length of approximately 5 cm. Two patients with hyperfunctioning brachiocephalic arteriovenous fistula were treated this way. Doppler measurement of the fistula flow showed a mean flow reduction of about 60%. The procedure was effective and safe, with a mean follow up of 2 months.
Aneurysm ; Arteriovenous Fistula ; Extremities ; Fistula ; Follow-Up Studies ; Humans ; Ligation ; Perfusion ; Polypropylenes ; Polytetrafluoroethylene ; Recurrence ; Renal Dialysis ; Running ; Sutures ; Transplants ; Ursidae ; Veins

BACKGROUND: At the initiation of immunologic response, platelets rapidly release chemical mediators which may induce rejection of transplanted organ. The purpose of this study was to investigate the effect of antiplatelet agents in murine cardiac and skin transplantation models. METHODS: In the minor major histocompatibility (MHC) mismatch model, BALB/c (H2d) mice underwent heart transplantation from B10.D2 (H2d) mice. In the major MHC mismatch model, CBA (H2k) mice were used as the recipients and C57BL/10 (H2b) mice as donors. The recipients were divided into four groups and each group was treated with distilled water (DW), sarpogrelate, cilostazol, or clopidogrel respectively. For skin transplantation, the recipients in the minor MHC mismatch model were divided into four groups similar to those in cardiac transplantation. The recipients in the major MHC mismatch model were divided into DW-treated and sarpogrelate-treated groups. All treatments were done by the per oral route of administration. RESULTS: For graft survival in the minor MHC mismatch model of cardiac transplantation, sarpogrelate-treated group showed increased median survival time (MST) compared to the other groups (DW-treated group 17.5 days, sarpogrelate-treated group 88 days, cilostazol-treated group 13 days, clopidogrel-treated group 23 days). Similar results were observed in the major MHC mismatch model. In the major MHC mismatch model, the expression of adhesion molecules (L-selectin, intercellular adhesion molecule-1 [ICAM-1], Mac-1, lymphocyte function associated antigen-1 [LFA-1]) was significantly higher in DW-treated group compared to sarpogrelate-treated group (P<0.05) In the minor MHC mismatch model, MST in the antiplatelet-treated skin graft group was not remarkably prolonged compared to DW-treated group. In the major MHC mismatch model, sarpogrelate-treated group showed prolonged survival compared to DW-treated group (MST 25 vs. 19 days, P<0.05). There was no statistically significant difference in the proportion of activated T cells and regulatory T cells. CONCLUSIONS: The tendency for a better survival of grafts was observed in the sarpogrelate-treated skin and heart transplant group compared to DW-treated group. However, further mechanistic study is necessary to these results.
Animals ; Blood Platelets ; Graft Survival ; Heart ; Heart Transplantation ; Histocompatibility ; Humans ; Intercellular Adhesion Molecule-1 ; Lymphocytes ; Mice ; Platelet Aggregation Inhibitors ; Rejection (Psychology) ; Skin ; Skin Transplantation ; Succinates ; T-Lymphocytes ; Tetrazoles ; Ticlopidine ; Tissue Donors ; Transplants ; Water