An association between drug treatment for viral infections and severe cutaneous adverse reactions has been noted. We investigated six patients diagnosed with Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) after being prescribed acetaminophen for suspected viral illnesses. Multiplex analysis was performed to measure cytokine levels in sera before and after treatment. IL-2Rα levels significantly decreased during the convalescence phase. Although acetaminophen is relatively safe, the drug can trigger SJS/TEN in patients with suspected viral infections. T-cells and monocytes may be key components of the link between viral infection and acetaminophen-induced SJS/TEN.
Acetaminophen* ; Convalescence ; Humans ; Monocytes ; Stevens-Johnson Syndrome* ; T-Lymphocytes

We report three patients with adrenal pheochromocytoma who were associated with type I neurofibromatosis. Two of them were asymptomatic, but one case involved hypertension. We reviewed medical records and adrenal imaging, and estimated the prevalence of adrenal pheochromocytoma among neurofibromatosis type I patients in one university hospital in Korea. A total of 658 patients were coded for neurofibromatosis type I (Q85.0 with International Classification of Diseases 10 version) with clinical impression, but only 371 were confirmed via 1997 National Institute of Health criteria. Adrenal images were generated in 203 patients, and 3 of them were diagnosed with pheochromocytoma. According to the results of this study, the estimated prevalence of adrenal pheochromocytoma in type I neurofibromatosis was 0.30-1.48%.
Humans ; Hypertension ; International Classification of Diseases ; Korea ; Medical Records ; Neurofibromatoses ; Neurofibromatosis 1 ; Pheochromocytoma ; Prevalence

Lymphangiomas are rare benign tumors of the lymphatic system. They usually occur in the neck or axillary region, whereas the retroperitoneum is one of the least frequent sites. The treatment of choice is complete surgical excision. We report a case of a 56-year-old man who had a retroperitoneal cystic lymphangioma in combination with bladder cancer. After complete surgical excision of the retroperitoneal lymphangioma with transurethral resection of the bladder tumor followed by intravesical BCG immunotherapy, the patient remained free of recurrence at 1 year after treatment.
Humans ; Immunotherapy ; Lymphangioma ; Lymphangioma, Cystic* ; Lymphatic System ; Middle Aged ; Mycobacterium bovis ; Neck ; Recurrence ; Urinary Bladder Neoplasms* ; Urinary Bladder*

BACKGROUND/AIMS: Transferrin and alpha-1 antitrypsin are reportedly associated with liver fibrosis. We evaluated the usefulness of serum transferrin and alpha-1 antitrypsin as new liver fibrosis markers in patients with chronic hepatitis B. METHODS: The study included 293 patients with chronic hepatitis B who underwent a liver biopsy between October 2005 and June 2009, and who had no history of hepatocellular carcinoma. Serum markers and liver fibrosis stages were compared. RESULTS: Univariate analysis revealed that age (P<0.001), serum platelet count (P<0.001), and serum alkaline phosphatase level (P=0.003) differed significantly between the patients with and without liver cirrhosis. Serum transferrin levels were significantly lower in advanced fibrosis than in mild fibrosis in both univariate analysis (P=0.002) and multivariate analysis (P=0.009). In addition, the serum transferrin level was significantly lower in cirrhotic patients than in noncirrhotic patients (P=0.020). However, the serum level of alpha-1 antitrypsin was not significantly associated with liver cirrhosis in patients with chronic hepatitis B. CONCLUSIONS: Serum transferrin could be promising serum marker for predicting advanced liver fibrosis in patients with chronic hepatitis B.
Adolescent ; Adult ; Aged ; Area Under Curve ; Biological Markers/blood ; Female ; Hepatitis B, Chronic/complications/*diagnosis/pathology ; Humans ; Liver Cirrhosis/complications/*diagnosis ; Male ; Middle Aged ; Multivariate Analysis ; ROC Curve ; Retrospective Studies ; Transferrins/*blood ; Young Adult ; alpha 1-Antitrypsin/blood

PURPOSE: To find the incidence and risk factors for polyomavirus (PV) infection, we monitored urine decoy cell (UDC) after renal transplantation. METHODS: From March 2003 to September 2004, 142 de novo renal recipients were prospectively monitored for UDC at post-transplant 1, 3, 6, 9, 12 months. According to the number of UDC in Cytospin, patients were divided into 3 groups: A (0), B (1~9) and C (> or =10). We decreased immunosuppression (IS) when group C status persisted for more than 1 month or more than 4 UDC was continuously detected for more than 3 months. Differences in demographics and clinical characteristics among the groups were compared. RESULTS: Forty four (31%) patients were found to have positive UDC at least at one examination (30 in group B and 14 in C). The number of patients with positive UDC at postoperative 1, 3, 6, 9, 12 months were 10 (22.7%), 14 (31.8%), 17 (38.6%), 27 (61.3%), 20 (45.4%) respectively with a highest at 9 months. One PV nephropathy was documented by renal biopsy. During the period from January 2001 to December 2002 when we did not prospectively monitor UDC, 7 PV nephropathy cases were documented among 116 recipients. Tacrolimus (Tac) and episode of acute rejection (AR) were significant risk factor for positive UDC (P=0.036, 0.010, respectively). Cumulative incidence of PV infection was significantly different by the use of Tac and episode of AR (P=0.03, 0.013, respectively). CONCLUSION: Use of Tac and episode of AR were risk factor for positive UDC and PV infection. Modulation of IS by the result of UDC monitoring could decrease the development of PV nephropathy after renal transplantation.
Biopsy ; Demography ; Humans ; Immunosuppression ; Incidence ; Kidney Transplantation* ; Kidney* ; Polyomavirus ; Polyomavirus Infections ; Prospective Studies* ; Risk Factors ; Tacrolimus

Purpose: Concept that modification of immunosuppression can delay the deterioration of graft function and graft failure is the one of strategies for chronic rejection. We analyzed the effect of modification of immunosuppression in 116 recipients with biopsy confirmed mild chronic rejection retrospectively. Methods: Mild chronic rejection was diagnosed by single renal pathologist under the uniformed criteria; mild tubular atrophy & interstitial fibrosis (less than 25%) combined with vascular change such as fibrous intimal thickening. General rules of modification after chronic rejection in our center were (1) strict adjustment of cyclosporine (CsA) dosage around 100~120microgram/L of trough blood level, (2) triple conversion in double therapy recipients (add anti-metabolites; azathioprine or MMF), (3) dose increment of anti-metabolites, (4) maintain of immunosuppression if ongoing immunosuppression is satisfactory to above criteria. Results: After 74.8+/-44.5 months of follow-up, we identified 72 graft failures (62.1%). Overall post-diagnosis graft survival rate were 93.1%, 79.7%, 63.6% and 35.8% in 1, 3, 5 and 10 years respectively. The status of graft function categorizedn by stage of chronic kidney disease (CKD) at diagnosis (CKD 4 or 5 stage), timing of diagnosis (more than post-transplant 3 years) and presence of severe proteinuria (more than 1 g/day of urinary excretion) were significant risk factors affecting the post-diagnosis graft survival rate. In multivariate survival analysis, these factors were confirmed as independent variables affecting post-diagnosis graft survival rate. But modification of immunosuppressive regimen after mild chronic rejection which was classified by modification (yes versus no), type of anti-metabolites (azathioprine versus MMF) and change of immunosuppressive strength (equal versus additional versus incremental) didn't cause the significant difference of post-diagnosis graft survival rate. Conclusion: Though pathologic change is mild, the modification of immunosuppression is not effective to delay graft failure in renal allograft recipient with pathologically established chronic rejection.
Allografts* ; Atrophy ; Azathioprine ; Biopsy ; Cyclosporine ; Diagnosis ; Fibrosis ; Follow-Up Studies ; Graft Survival ; Immunosuppression ; Proteinuria ; Renal Insufficiency, Chronic ; Retrospective Studies ; Risk Factors ; Survival Rate* ; Transplants

Purpose: Many patients who have an acceptable living- kidney donor do not undergo transplantation because of the presence of antibodies against the donor cells resulting in a positive lymphocyte-crossmatch (LCX). Recently, the combination therapy of plasmapheresis, intravenous gamma- globulin and potent immunosuppression to induce negative conversion of LCX in patients who had positive LCX to their living donors was reported. Our institute gave these patients the combination therapy and reported the results of follow-up done 1~3 years after kidney transplantation. Methods: Eleven patients, who showed positive LCX to their living donors, underwent the conversion trials between January 1, 2002 and March 31, 2004. Combination therapy consisting of plasmapheresis, intravenous gamma globulin injection, tacrolimus, mycophenolate mofetil (MMF) and steroids was used. Plasmapheresis had been done every other day up to 6 times. Kidney transplantations were performed immediately after negative conversion was achieved. Five to ten day-courses of ATG (or OKT3) were used as an induction immunosuppression and tacrolimus, MMF, and steroids as a maintenance immunosuppression. Results: Negative conversions in ten out of eleven patients were achieved. Kidney transplantations in these 10 patients were successfully performed. No hyperacute rejection transpired, although four patients developed acute rejection, whose grafts were all rescued with steroid pulse therapy. Serum creatinine level was 1.57+/-0.12 mg/dL (mean+/-SD) during follow-up periods except for one whose graft was lost to Polyoma virus nephropathy. Conclusion: Nine of the 10 grafts are functioning well for 15~41 months after transplantations. Our results suggest that selected crossmatch positive patients can be transplanted successfully with living donor kidney allograft.
Allografts* ; Antibodies ; Creatinine ; Follow-Up Studies ; gamma-Globulins* ; Humans ; Immunosuppression ; Kidney ; Kidney Transplantation ; Living Donors ; Lymphocytes* ; Plasmapheresis* ; Polyomavirus ; Steroids ; Tacrolimus ; Tissue Donors ; Transplants

Purpose: The purposes of this study were to compare the relative efficacy of urine decoy cell (UDC) and polymerase chain reaction (PCR) for the polyomavirus infection (PVI), and to search the efficacy of preemptive immunologic control for PVI in earlier stage before irreversible graft injury. Methods: Between Mar. 2003 to Sep. 2005, 265 patients were monitored for the PVI after kidney transplantation. Of the 265 patients, the results of preemptive immunologic modifications were searched among 222 recipients who had the complete data. Results: Of the total 222 patients, 75 patients (33.8%) were positive for UDCs in at least one examination. Overall cumulative incidence of PVI was 32.9%. According to the episode of acute rejection, the one year incidences of PVI were 51.4% and 29.5% in recipients with and without the episode of acute rejection, respectively (P=0.0047). Using decoy cells as a marker of PV viruria, cytology has a sensitivity of 57.1% and negative predictive value of 74.1%. The specificity and positive predictive value for viruria (not viral nephropathy) are 67.2% and 48.8%. False-negative results occurred in samples with suboptimal cellularity, and a low viral load. Three cases of PV nephropathy (PVN) were documented. From January 2001 to December 2002, when we did not prospectively monitor UDCs, 7 cases of PVN were documented among the 116 recipients. Conclusion: The combination test of UDC and PV PCR should be considered as screening test for PVI due to low positive predictive value of UDC. The modulation of net immunosuppression based on UDC values and PV viral loads may reduce the development of PVN.
Humans ; Immunosuppression ; Incidence ; Kidney Transplantation* ; Kidney* ; Mass Screening ; Polymerase Chain Reaction ; Polyomavirus Infections* ; Polyomavirus* ; Prospective Studies ; Sensitivity and Specificity ; Transplants ; Viral Load

Gastrocolic and gastrojejunocolic fistula are well-recongnized but rare complications of a variety of diseases, and surgical or endoscopic procedures We had a case of gastrojejunocolic fistulae associated with marginal ulcer following gastrectomy with Billroth II gastrojejunostomy for recurrent peptic ulcer disease. He had chronic watery diarrhea, weight loss and fecal eructation and gastrojejunocolic fistula was dignosed by gastroscopy, barium enema, upper gastrointestinal series and abdominal CT scan. He underwent subtotal gastrectomy with Roux-en-Y gastrojejunal anastomosis and en-bloc resection including the fistula and surrounding colon, jejunum and gastric segments. Hereafter, he showed disappearance of diarrhea, along with slow rate of weight gain.
Barium ; Colon ; Diarrhea ; Enema ; Eructation ; Fistula* ; Gastrectomy ; Gastric Bypass* ; Gastroenterostomy ; Gastroscopy ; Jejunum ; Peptic Ulcer ; Tomography, X-Ray Computed ; Weight Gain ; Weight Loss

BACKGROUND/AIMS: Apolipoprotein E (ApoE) plays an important role in regulating lipid and lipoprotein metabolism, and ApoE genotypes are known to affect plasma lipoprotein concentrations. We investigated whether ApoE genotype determines the disease outcome in hepatitis B virus (HBV)-infected individuals, and verified the association between ApoE genotype and the occurrence of hepatocellular carcinoma (HCC) in patients with chronic liver diseases of various etiologies. METHODS: This hospital-based, case-controlled study enrolled 156 subjects (47 healthy controls, 50 HBV-related liver cirrhosis patients, and 59 HCC patients). ApoE genotypes were determined using PCR-based ApoE genotyping kits. The biological significance of ApoE genotype was verified by measuring serum ApoE levels using an ELISA kits. RESULTS: The epsilon3 allele was the most common allele, with allele frequencies among the entire cohort of 5.8%, 84.3%, and 9.9% for the epsilon2, epsilon3, and epsilon4 alleles, respectively. Significantly more of those patients carrying the epsilon3/3 genotype had developed liver cirrhosis compared to the control subjects. Being an ApoE4 carrier was associated with a lower probability of developing liver cirrhosis. The allele frequencies and genotype distribution of ApoE did not differ significantly between the liver cirrhosis and HCC patients. The serum level of ApoE was significantly higher in patients with liver cirrhosis than in the healthy controls, but did not differ significantly with the ApoE genotype. CONCLUSIONS: The ApoE epsilon3/3 genotype frequency was higher in patients with HBV-associated liver cirrhosis than in the controls.
Adult ; Aged ; Aged, 80 and over ; Alleles ; Apolipoproteins E/*genetics/metabolism ; Carcinoma, Hepatocellular/*metabolism/pathology ; Case-Control Studies ; Child ; Chronic Disease ; Cohort Studies ; Female ; Gene Frequency ; Genotype ; Hepatitis B/complications/metabolism/virology ; Hepatitis B virus/*physiology ; Humans ; Liver Cirrhosis/etiology/*metabolism ; Liver Neoplasms/*metabolism/pathology ; Male ; Middle Aged ; Young Adult