PURPOSE: We have devised a new surgical method of video-assisted minilaparotomy surgery-live donor nephrectomy (VAMS-LDN), which is a hybridized form of laparoscopic and open surgery that combines the advantages of both. We present our series of 202 consecutive patients. METHODS: Since 1993 we have performed 202 successful VAMS-LND. All 202 healthy kidney donors' characteristics and their postoperative courses were retrospectively reviewed and all data were compared to 95 open donor nephrectomies performed during the same period. RESULTS: The mean age and weight of the patients were 37.1+/-9.5 years and 61.6+/-3.3 kg, respectively. The mean operating time was 139+/-39 minutes which was similar to open donor nephrectomy but shorter than laparoscopic donor nephrectomy. There were no major intraoperative complication except two tears to lumbar veins which required transfusion. The mean warm ischemic time was 2.2+/-0.7 minutes which was equal to open donor nephrectomy. Patients experienced less postoperative pain and recovered quicker compared to open donor nephrectomy. CONCLUSION: VAMS-LDN is a safe and minimally invasive technique for live donor nephrectomy, incorporating advantages of both conventional open and laparoscopic methods. VAMS-LDN is a viable option for living donor kidney transplantation.
Humans ; Intraoperative Complications ; Kidney ; Kidney Transplantation ; Laparoscopy ; Laparotomy* ; Living Donors ; Nephrectomy* ; Pain, Postoperative ; Retrospective Studies ; Tissue Donors* ; Veins ; Warm Ischemia

No abstract available.
Lutein* ; Plasma*

No abstract available.
Burns* ; Spinal Cord Injuries* ; Spinal Cord*

PURPOSE: Hematuria is a frequently encountered clinical problem in kidney graft recipients. The causes are variable, may be benign or malignant, but imperative to affect long- term graft function and survival. We have evaluated renal recipients who had hematuria using a newly defined algorithm. METHODS: We evaluated 1060 renal transplant recipients from March 1, 1992 to February 28, 2000. In 93 recipients, hematuria was transitory and spontaneously resolved within 3 months. We tried to identify the cause of persistent hematuria in 126 recipients. Patients were evaluated with plain x-ray, sonography, cystoscopic examination and/or graft biopsy. RESULTS: The mean duration of hematuria onset after transplantation was 17.81+/-14.6 months (4-70 months). The causes of gross hematuria were urolithiasis (n= 15), benign bladder mucosal bleeding (n=3), bladder cancer (n=2) and kidney cancer from an original kidney (n=1). Graft kidney biopsies were performed in 96 patients and the results were as follows: chronic rejection in 18, IgA nephropathy in 16, cyclosporine toxicity in 8, acute rejection in 5, focal segmental glomerulosclerosis in 3, the other glomerulonephritis in 2, and tubular atrophy and interstitial fibrosis in 19 patients. Combined pathologic findings were detected in 15 patients. In 8 patients, no pathological diagnoses were made. We were unable to evaluate 9 patients due to patient's refusal. CONCLUSION: The causes of hematuria after kidney transplantation are variable from benign to malignant disease. If the cause of hematuria is uncertain on ultrasonographic examination, cystoscopic examination and/or graft biopsy should be performed for making a definite diagnosis.
Atrophy ; Biopsy ; Cyclosporine ; Diagnosis ; Disulfiram ; Fibrosis ; Glomerulonephritis ; Glomerulonephritis, IGA ; Glomerulosclerosis, Focal Segmental ; Hematuria* ; Hemorrhage ; Humans ; Kidney ; Kidney Neoplasms ; Kidney Transplantation ; Transplantation ; Transplants ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urolithiasis

An anomalous origin of the left coronary artery (LCA )from the pulmonary artery (ALCAPA syndrome )or Bland-White-Garland syndrome is a rare congenital cardiac anomaly. We report a 65-year old female patient who presented with atypical chest discomfort. Coronary angiography and three-dimensional multidetector computed tomography coronary angiography demonstrated the ectatic right coronary artery (RCA )arising from the aorta, rich collaterals from the RCA to LCA and the ectatic tortuous LCA that originated from the pulmonary trunk.
Aged* ; Aorta ; Bland White Garland Syndrome ; Collateral Circulation ; Coronary Angiography* ; Coronary Vessel Anomalies ; Coronary Vessels* ; Female ; Humans ; Multidetector Computed Tomography ; Pulmonary Artery* ; Thorax

PURPOSE: To evaluate the imaging findings of desmoid tumors using various imaging modalities and to evaluate whether diffusion-weighted imaging (DWI) can help differentiate between desmoid and malignant tumors. MATERIALS AND METHODS: The study included 27 patients with pathologically confirmed desmoid tumors. Two radiologists reviewed 23 computed tomography (CT), 12 magnetic resonance imaging (MRI) and 8 positron emission tomography-computed tomography (PET-CT) scans of desmoid tumors and recorded data regarding the shape, multiplicity, size, location, degree of enhancement, and presence or absence of calcification or hemorrhage. The signal intensity of masses on T1- and T2-weighted imaging and the presence or absence of whirling or band-like low signal intensity on T2-weighted imaging were recorded. The apparent diffusion coefficient (ADC) values of the desmoid tumors in nine patients with DWIs were compared with the ADC values of 32 malignant tumors. The maximum standardized uptake value (SUV(max)) on PET-CT images was measured in 8 patients who underwent a PET-CT. RESULTS: The mean size of the 27 tumors was 6.77 cm (range, 2.5-26 cm) and four tumors exhibited multiplicity. The desmoid tumors were classified by shape as either mass forming (n = 18), infiltrative (n = 4), or combined (n = 5). The location of the tumors was either intra-abdominal (n = 15), within the abdominal wall (n = 8) or extra-abdominal (n = 4). Among the 27 tumors, 21 showed moderate to marked enhancement and 22 showed homogeneous enhancement. Two tumors showed calcifications and one displayed hemorrhage. Eleven of the 12 MR T2-weighted images showed whirling or band-like low signal intensity areas in the mass. The mean ADC value of the desmoid tumors (1493 × 10⁻⁶ mm²/s) was significantly higher than the mean of the malignant soft tissue tumors (873 × 10⁻⁶ mm²/s, P < 0.001). On the PET-CT images, all tumors exhibited an intermediate SUV(max) (mean, 3.7; range, 2.3–4.5). CONCLUSION: Desmoids tumors showed homogenous, moderate to marked enhancement on CT and MRI scans and a characteristic whirling or band-like pattern on T2-weighted images. DWI can be useful for the differentiation of desmoid tumors from malignant soft tissue tumors.
Abdominal Wall ; Diffusion* ; Electrons ; Fibroma ; Fibromatosis, Aggressive* ; Hemorrhage ; Humans ; Magnetic Resonance Imaging

BACKGROUND AND OBJECTIVES: Plasma adiponectin, which decreases the progression of atherosclerosis and insulin resistance, as well as suppressing lipid accumulation in macrophages, is decreased in patients with acute myocardial infarction and unstable angina pectoris; however, the correlation between plasma adiponectin and vasospastic angina pectoris (VAP) remains to be verified. We compared the plasma adiponectin concentration between patients with VAP and other coronary artery diseases; moreover, we investigated the association between the plasma adiponectin concentration and VAP. SUBJECTS AND METHODS: Following coronary angiography for the evaluation of chest pain, 395 subjects (180 women and 215 men) were divided into 4 groups: acute coronary syndrome (ACS)(n=117), VAP (n=94), stable angina pectoris (SAP)(n=108) and angiographically normal coronary artery (n=76). The acetylcholine provocation test was used to confirm VAP, and plasma adiponectin concentrations were measured in all participants. RESULTS: The plasma adiponectin concentrations in patients with VAP and ACS were significantly lower than that of the normal coronary artery group (6.6+/-5.4 vs. 5.2+/-4.0 vs. 9.0+/-6.2 microgram/mL, p<0.001, respectively). A multivariate analysis indicated that plasma adiponectin [odd ratio (OR) 0.744, 95% confidence interval (CI) 0.645 to 0.858, p=0.001], smoking (OR 2.054, 95% CI 1.027 to 4.106, p=0.042) and age (OR 0.966, 95% CI 0.935 to 0.997, p=0.031) were independently correlated in patients diagnosed with VAP. CONCLUSION: Our results suggest that a decreased plasma adiponectin concentration may be associated with VAP.
Acetylcholine ; Acute Coronary Syndrome ; Adiponectin* ; Angina Pectoris ; Angina, Stable ; Angina, Unstable ; Atherosclerosis ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vasospasm ; Coronary Vessels ; Female ; Humans ; Insulin Resistance ; Macrophages ; Multivariate Analysis ; Myocardial Infarction ; Plasma* ; Smoke ; Smoking

We have devised a new surgical method of video-assisted minilaparotomy surgery-live donor nephrectomy (VAMS- LDN), which is a hybridized form of laparoscopic and open surgeries that combines the advantages of both. We present the findings of our series of 239 consecutive patients. Since 1993 we have performed 239 successful VAMS-LND. All 239 healthy kidney donors' characteristics and their postoperative courses were retrospectively reviewed and the data were compared to 95 open donor nephrectomies performed during the same period. The mean age and weight of the patients were 37.9 +/- 11.0 years and 62.4 +/- 7.9 kg, respectively. The mean operating time was 154 +/- 41 minutes, which was similar to open donor nephrectomy but shorter than laparoscopic donor nephrectomy. There were no major intraoperative complications except two tears to lumbar veins which required transfusion. The mean warm ischemic time was 2.1 +/- 0.7 minutes, which was equal to open donor nephrectomy. The patients experienced less postoperative pain and recovered quicker than the open donor nephrectomy patients. VAMS-LDN is a safe and minimally invasive technique for live donor nephrectomy, incorporating advantages of both conventional open and laparoscopic methods. We suggest that VAMS-LDN is a viable option for living donor kidney transplantation.
Adult ; Female ; Humans ; Laparotomy/*methods ; *Living Donors ; Male ; Middle Aged ; Nephrectomy/*methods ; Retrospective Studies ; *Surgery, Computer-Assisted

Primary hepatic lymphoma is extremely rare, representing less than 1% of all extranodal lymphomas. We report MR imaging features and pathologic correlation of a case of primary hepatic lymphoma. MR images showed a large lobulated mass with gradual contrast enhancement, resembling intrahepatic cholangiocarcinoma. However, both hepatobiliary phase image obtained 20 minutes after injection of hepatocyte specific contrast agent and diffusion-weighted image demonstrated characteristic three layered pattern representing viable lymphoma in the outer layer, tumor necrosis in the middle layer and necrotic hepatic parenchyma in the center.
Cholangiocarcinoma ; Hepatocytes ; Liver ; Liver Neoplasms ; Lymphoma ; Necrosis

Coronary arteriovenous malformation (AVM) is a rare congenital coronary anomaly. We report a 60 year-old woman with variant angina and coronary AVM. She presented with recurrent chest pain at rest but there were no significant cardiovascular risk factors. Baseline coronary angiography showed the AVM which originated from first diagonal branch. Acetylcholine (Ach) provocation test was performed at left anterior descending artery (LAD) to induce coronary spasm. Ach 50 microgram injection induced severe diffuse spasm at LAD with typical chest pain. We confirmed that this patient has variant angina with AV malformation.
Acetylcholine ; Arteries ; Arteriovenous Malformations* ; Chest Pain ; Coronary Angiography ; Female ; Humans ; Middle Aged ; Risk Factors ; Spasm