Xanthogranulomatous pyelonephritis is an uncommon entity of chronic renal infection and often misdiagnosed with renal tumor clinically. The characteristic examination are foamy histiocyte containing lipid material and foreign body giant cell forming granulomas, Macroscopically yellow nodules are present at the area of necrotic tissue. We have experienced a case of xanthogranulomatous pyelonephritis in 38 years old woman and reported with review of some literatures.
Adult ; Female ; Giant Cells, Foreign-Body ; Granuloma ; Histiocytes ; Humans ; Pyelonephritis, Xanthogranulomatous*

PURPOSE: Five hundreds of renal transplantation were performed in the our institute from November, 1982 to April, 2000. During this period, there were two big changes of immunosuppressive regimen. These are introduction of cyclosporin microemulsion formula (Neoral(R)) in April, 1994 and mycophenolate mofetil (MMF) in April, 1997. So, the result of our 500 consecutive renal transplantation was analysed and compared according to the regimen. METHODS: We analysed the result of our 500 renal transplantation by retrospective chart review. And we compared the result according to the regimen. RESULTS: Mean age of recipients were 33.6 years and male to female ratio was 2.14 : 1. There was 18 retransplantation and 18 pediatric transplantation. Overall 1 year, 3 year and 5 year graft survial was 95.38%, 81.65% and 70.56%. And the patient survival was 96.78%, 92.31% and 89.46%, respectively. Before the introduction of Neoral(R)(n=285), acute rejection during first 6 months (AR6mo) was 0.52+/-1.09 and serum creatinine level at 12 months posttranplant (Cr12mo) was 1.954+/-1.488 and 1 year (1YSR), 3 year (3YSR) and 5 year (5YSR) graft survival was 93.64%, 77.66% and 65.32%. After introduction of Neoraland before MMF (n=134), AR6mo and Cr12mo was 0.62+/-1.83 and 1.625+/-1.203 and 1YSR, 3YSR and 5YSR was 96.27%, 87.03% and 79.97%, respectively. After addition of MMF (n=74), AR6mo and Cr12mo was 0.19+/-0.39 and 1.434+/-0.773 and 1YSR and 3 YSR was 95.93% and 95.93%. Because of short term follow up for the last group, long term survival rate was indefinable. CONCLUSION: With advancement of immunosuppressive agents and accumulation of clinical experiences, short term result of the kidney transplantation was improved. Further evaluation of long term result is needed.
Creatinine ; Cyclosporine ; Female ; Follow-Up Studies ; Graft Survival ; Humans ; Immunosuppressive Agents ; Kidney Transplantation* ; Male ; Retrospective Studies ; Survival Rate ; Transplants

PURPOSE: To assess the tolerance, complete response rate, bladder preservation rate and survival rate in patients with muscle-invading bladder cancer treated with selective bladder preservation protocol. METHOD AND MATERIALS: From October 1990 to June 1998, twenty six patients with muscle-invading bladder cancer (clinical stage T2-4, N0-3, M0) were enrolled for the treatment protocol of bladder preservation. They were treated with maximal TURBT (transurethral resection of bladder tumor) and 2 cycles of MCV chemotherapy (methotrexate, crisplatin, and vinblastine) followed by 39.6~45 Gy pelvic irradiation with concomitant cisplatin. After complete urologic evaluation (biopsy or cytology), the patients who achieved complete response were planed for bladder preservation treatment and treated with consolidation cisplatin and radiotherapy (19.8 Gy). The patients who had incomplete response were planed to immediate radical cystectomy. If they refused radical cystectomy, they were treated either with TURBT followed by MCV or cisplatin chemotherapy and radiotherapy. The median follow-up duration is 49.5 months. RESULT: The patients with stage T2-3a and T3b-4a underwent complete removal of tumor or gross tumor removal by TURBT, respectively. Twenty one out of 26 patients (81%) successfully completed the protocol of the planned chemo-radiotherapy. Seven patients had documented complete response. Six of them were treated with additional consolidation cisplatin and radiotherapy. One patient was treated with 2 cycles of MCV chemotherapy due to refusal of chemo-radiotherapy. Five of 7 complete responders had functioning tumor-free bladder. Fourteen patients of incomplete responders were further treated with one of the followings : radical cystectomy (1 patient), or TURBT and 2 cycles of MCV chemotherapy (3 patients), or cisplatin and radiotherapy (10 patients). Thirteen patients of them were not treated with planned radical cystectomy due to patients' refusal (9 patients) or underlying medical problems (4 patients). Among twenty one patients, 12 patients (58%) were alive with their preserved bladder, 8 patients died with the disease, 1 patient died of intercurrent disease. The 5 years actuarial survival rates according to CR and PR after MCV chemotherapy and cisplatin chemoradiotherapy were 80% and 14%, respectively (p=0.001). CONCLUSION: In selected patients with muscle-invading bladder cancer, the bladder preservation could be achieved by MCV chemotherapy and cisplatin chemo-radiotherapy. All patients tolerated well this bladder preservation protoco. The availability of complete TURBT and the responsibility of neoadjuvant chemotherapy and chemoradiotherapy were important predictors for bladder preservation and survival. The patients who had not achieved complete response after neoadjuvant chemotherapy and chemoradiotherapy should be immediate radical cystectomy. A randomized prospective trial might be essential to determine more accurate indications between cystectomy or bladder preservation.
Chemoradiotherapy ; Cisplatin ; Clinical Protocols ; Combined Modality Therapy* ; Cystectomy ; Disulfiram ; Drug Therapy ; Follow-Up Studies ; Humans ; Radiotherapy ; Survival Rate ; Urinary Bladder Neoplasms* ; Urinary Bladder*

INTRODUCTION: Comparing with living donor renal transplantation, cadaveric renal transplantation is usually performed as an emergency procedure and has prolonged preservation time and increased incidence of delayed graft function. Korean Network for Organ Sharing (KONOS) was launched from February 2000 to manage the organ transplantation in Korea and expected to increase donor organs supply and an effective organ allocation. PURPOSE: In order to compare the result of cadaveric renal transplantation before and after KONOS system, 108 cadaveric renal transplants performed in Dongsan hospital until October 2003 were reviewed and analyzed. METHODS: Donors and recipients were divided into two groups (group 1; transplantation performed before KONOS, group 2; transplantation after KONOS) and their characteristics and results were analyzed retrospectively. RESULTS: Among donor factors, number of multi-organ procurement increased (23.1% vs 78.6%), and use of inotrophic agent decreased (63% vs 46%) significantly after KONOS, however cold preservation time was not changed even after KONOS system. Procured organs per one donor in our hospital was increased from 2.25 to 2.65. Increased recipient age (from 30.1 to 41.9 years old), more chance to diabetic patient and decreasing number of HLA mismatching (4.6 to 3.9) were considered as a result of KONOS allocation system. However, early results including incidence of acute rejection episode and delayed graft function, and serum creatinine level at the end of one year were no statistic differences. The number of early graft loss were decreased up to 2 years after transplantation. CONCLUSION: Renal transplantation from cadaveric donor after KONOS resulted in lower early graft loss but increased waiting time due to organ shortage is a serious problem to be solved in the future.
Cadaver* ; Creatinine ; Delayed Graft Function ; Emergencies ; Humans ; Incidence ; Kidney Transplantation* ; Korea ; Living Donors ; Organ Transplantation ; Retrospective Studies ; Tissue Donors ; Transplantation ; Transplants