We studied the chronic renal allograft dysfunction in Korean renal transplants from 1 year after transplantation to 5 years. We evaluated renal function by simply using the reciprocal serum creatinine level and sought to find factors affecting the value of the reciprocal serum creatinine and graft survival, and changes of the slope of reciprocal serum creatinine. We also estimated the reciprocal serum creatinine from demographic parameters and routine laboratory results. This study included 114 patients, 87 male and 27 female who underwent renal transplantations and had functioning allografts for more than 18 month after transplantation. The results were as follows. 1) The reciprocal serum creatinine level decreased slowly and linearly. 2) There were many factors related to the reciprocal creatinine, including blood urea nitrogen, serum uric acid level, age of donors, sex of recipients, presence of acute rejecton, age of recipient, serum phosphorus, white cell count in blood, cyclosporine level in blood, hemoglobin level, posttransplantation period. We could derive the estimated reciprocal serum creatinine from data of the patients. 3) The age of the recipient and cyclosporine level at 1 year after transplantation affected the slope of the reciprocal serum creatinine during follow-up time. 4) There were 16 graft loss, including 3 functioning graft loss and 13 graft loss due to chronic allograft dysfunction. 5) Besides creatinine and BUN level at 1 year, higher blood pressure and proteinuria and lower hemoglobin levels at 1 year after transplantation were related to the graft loss from chronic allograft dysfunction. 6) There were more chronic allograft loss in patients who had lower actuarial reciprocal serum creatinine than estimated reciprocal serum creatinine. Because follow-up time was relatively short and there were only mild increases in serum creatinine level in our study, follow up of our patients for a longer-term period is required to find other factors affecting the renal allograft dysfunction.
Allografts* ; Blood Pressure ; Blood Urea Nitrogen ; Cell Count ; Creatinine ; Cyclosporine ; Female ; Follow-Up Studies ; Graft Survival ; Humans ; Kidney Transplantation ; Male ; Phosphorus ; Proteinuria ; Tissue Donors ; Transplants ; Uric Acid

Renal and perirenal abscesses are disease entities caused by infections in or around the kidneys. As imaging modalities have improved in quality and convenience, diagnosing these diseases has become easier. Some cases are refractory to conventional treatment and require surgical correction, although most patients can be cured by antibiotic treatment and percutaneous drainage. We here report the case of a patient with a perirenal abscess that recurred twice after appropriate antibiotic treatment and percutaneous drainage. Although Gram-negative bacilli are the most common pathogenic cause of these diseases, we isolated methicillin-resistant Staphylococcus aureus and Mycobacterium tuberculosis in our patient. Thus, poor responses to appropriate treatment in patients with a perirenal abscess can result not only from antimicrobial resistance or a co-infection but also from the 2 conditions existing concomitantly.
Abscess ; Coinfection ; Drainage ; Escherichia ; Escherichia coli ; Humans ; Kidney ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Mycobacterium ; Mycobacterium tuberculosis ; Perinephritis ; Tuberculosis

BACKGROUND: It is well known that harmonious interactions among adhesion molecules and stromal cell-derived factor-1 (SDF-1)-mediated chemoattraction signalling via CXCR4 are needed for bone marrow homing of hematopoietic stem cells and progenitor cells. The aim of this study was to define the role of interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha), and transforming growth factor-beta 1 (TFG-beta1), known as hematopoiesis-inhibitory cytokines, in the regulation of the molecules in relation to the homing. METHODS: We investigated the effects of these cytokines on the expression of CXCR4 and adhesion molecules and the production of SDF-1 in bone marrow cells including CD34+ cells, bone marrow endothelial cells (BMEC-1 cells), and bone marrow stromal cells (BMSCs). We also examined whether the cytokines influence in vitro transmigration of hematopoietic progenitors. RESULTS: None of the cytokines influenced CXCR4 expression on CD34+ cells or SDF-1- mediated chemotaxis of the cells. IFN-gamma and TNF-alpha, but not TGF-beta up-regulated the expression of L-selectin, ICAM-1, and VLA-4 on CD34+ cells. However, the up-regulation was not translated into the enhanced transendothelial migration. IFN-gamma and TNF-alpha up-regulated the expression of VCAM-1 and ICAM-1 on BMEC-1 cells, and rendered the endothelium more suitable for transendothelial migration of hematopoietic progenitors. IFN-gamma and TNF-alpha also up-regulated the expression of VCAM-1 and ICAM-1 on primary human BMSCs. All three cytokines significantly attenuated SDF-1 production from primary BMSCs, and TNF-alpha diminished SDF-1 production from BMEC-1 cells. CONCLUSION: These data indicate that IFN-gamma, TNF-alpha, and TGF-beta1 play a role in the regulation of bone marrow homing of hematopoietic cells via up-regulation of adhesion molecule expression and down-modulation of SDF-1 production in bone marrow cells.
Bone Marrow Cells* ; Bone Marrow* ; Chemotaxis ; Cytokines ; Endothelial Cells ; Endothelium ; Hematopoietic Stem Cells ; Humans* ; Integrin alpha4beta1 ; Intercellular Adhesion Molecule-1 ; Interferon-gamma* ; L-Selectin ; Mesenchymal Stromal Cells ; Stem Cells ; Transendothelial and Transepithelial Migration ; Transforming Growth Factor beta ; Transforming Growth Factor beta1 ; Tumor Necrosis Factor-alpha* ; Up-Regulation ; Vascular Cell Adhesion Molecule-1

PURPOSE: This study was aimed at evaluating the recurrence rate and recurrence patterns after surgically treating for patients with operable breast cancer. METHODS: From 1992 to 2002, 3700 patients with breast cancer (stages 0-3) who underwent mastectomy or breast conservation surgery at Asan Medical Center, Seoul, were selected for this retrospective study. We analyzed the recurrence rate, the annual hazard rate, the risk factors, the time to recurrence and the recurrence patterns according to the clinicopathologic factors. RESULTS: During the median follow-up period of 45 months, 523 patients (14.1%) of the total 3700 patients developed recurrences: locoregional recurrences occurred in 148 patients (4.0%), distant recurrences occurred in 319 patients (8.6%), and both types occurred in 56 patients (1.5%). The 5-year and 10-year recurrence rates were 17.7% and 23.4%, respectively. The recurrence rate increased in proportion to the cancer stage. The annual hazard rate for recurrence had a peak at 2-years of follow-up. On multivariate analysis, the stage, progesterone receptor status, and c-erbB2 expression were the independent risk factors for recurrence. The median time to recurrence among the patients with recurrence was 24.0 months. 50.5% of recurrences were found within 2 years and 92.0% of recurrences were found within 5 years after surgery. A short time to recurrence was significantly associated with an increased stage, a negative progesterone receptor status, and locoregional recurrences. The common recurrence sites included the chest wall, SCLN and the axillary lymph nodes in a locoregional order, and the bone, lung and liver in a systemic order. Of note is that distant recurrences commonly occurred at multiple sites in a simultaneous manner. CONCLUSION: Our findings revealed that the 5 year-recurrence rate was 17.7% and the risk of recurrence was maintained 5 years later after surgery, although the annual hazard rate had the highest peak at 2 years after breast cancer surgery. Because the stage, progesterone receptor status, and c-erbB2 expression are independent risk factors, early detection of breast cancer is required for reducing recurrence.
Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Follow-Up Studies ; Humans ; Liver ; Lung ; Lymph Nodes ; Mastectomy ; Multivariate Analysis ; Receptors, Progesterone ; Recurrence* ; Retrospective Studies ; Risk Factors* ; Seoul ; Thoracic Wall

PURPOSE: The aim of this study was to clarify the clinicopathologic features in colorectal cancer with liver metastases and to evaluate their clinical significance. METHODS: From August 1996 to April 2002, 545 patients, who underwent radical surgery for primary colorectal cancers, were analyzed retrospectively. RESULTS: Colorectal cancers with and without synchronous liver metastases at the time of the surgery were 36 and 509 cases, respectively. Of the 509 cases without metastases, 34 cases had metachronous liver metastases by April 2002, but the others did not. Serosal, vascular, perineural, and lymph node invasions, as well as increased preoperative CEA levels, were more frequently observed in those with synchronous liver metastases than it was in those without metastases (P<0.05). According to multivariate analyses, lymph node invasion was statistically significant as an independent variable in those with synchronous metastases (P=0.009). Serosal, vascular, and lymph node invasions, increased preoperative CEA levels, DNA ploidy, and positive lateral resection margins were more frequently observed in those with metachronous liver metastases than it was in those without metastases (P<0.05). According to multivariate analyses, vascular invasion was statistically significant in those with metachronous metastases (P=0.015). CONCLUSIONS: Lymph node and vascular invasions appear to be significant determinants for synchronous and metachronous liver metastases in colorectal cancers. Therefore, close observation and careful postoperative follow-up is needed for such patients.
Colorectal Neoplasms* ; DNA ; Follow-Up Studies ; Humans ; Liver* ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis* ; Ploidies ; Retrospective Studies