PURPOSE: To assess the MR findings of chondromalacia patella and correlate the grade and associated lesionswith the arthroscopic findings. MATERIALS AND METHODS: Twenty-five patients with pain in the anterior part of theknee underwent fat-suppressed axial and coronal T2-weighted, dual echo sagittal proton density-weighted andT2-weighted, and in some cases, T1-weighted and T2*-weighted imaging, using a 10-cm field of view, and a 5-inchgeneral purpose coil. We retrospectively assessed these find dings, and the locations, grades and associatedlesions, and correlated these with the arthroscopic findings. RESULTS: Fourteen cases(56%) of chondromalaciapatellae were arthroscopic grade I / II, nine(36%) were grade III, and two(8%) were grade IV; associated lesionswere medial synovial plicae (16 cases, 64%), meniscus tear (10 ; 40%), cruciate ligament injury (two ; 8%),complete or incomplete discoid meniscus (four ; 16%), bipartite patella (one ; 4%) and Osgood-Schlatter disease(one ; 4%). In 24 cases, MR imaging indicated chondromalacia patella ; 17 cases were grade I / II, five were gradeIII, and two were grade IV. the location of chondromalacia patella was the medial facet (five cases ; 20%), lateralfacet (three ; 12%), junction of the medial and odd facet (13 ; 52%), and diffuse involvement (four ; 16%). Thesensivity and specificity of MR imaging were 72% and 96% respectively. CONCLUSION: We evaluated the exact locationand grade of chondromalacia patella and associated lesions, as seen on MR images. These and the arthroscopicfindings showed close correlation, and in cases involving this condition, MRI is thus a useful indicator of anappropriate surgical method and plan.
Cartilage Diseases* ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Patella* ; Protons ; Retrospective Studies ; Sensitivity and Specificity

PURPOSE: The purpose of this study was to evaluate enhancement patterns, as seen on two-phase spiral CT, of hepatic hemangiomas in which atypical features had been seen on sonography (US) MATERIALS AND METHODS: Two-phase spiral CT scanning was performed in 18 patients in whom 24 atypical hemangiomas had been seen on US. Two-phase images were obtained at 25-45 seconds (arterial dominant phase) and 2-5 minutes (equilibrium phase) after the initiation of a bolus injection of contrast material (150 ml, 5 ml/sec). Enhancement patterns of hemangiomas during each phase were classified as homogeneous high, peripheral high, or low attenuation, and were retrospectively analyzed. RESULTS: In the arterial dominant phase of spiral CT, low attenuation was seen in nine hemangiomas (38%), globular or spotty peripheral high attenuation in 14 (58%), and homogeneous high attenuation in one (4%). In the equilibrium phase, enhancement patterns were peripheral high attenuation (partial fill-in) in 18 lesions (75%), and homogeneous high attenuation (complete fill-in) in three (12.5%), In the other three (12.5%) enhancement showed no significant change; in one of these, density was slightly less than in the arterial phase, and two showed subtle peripheral high attenuation. Fourteen hemangiomas (58%) showed globular or spotty peripheral high attenuation in the arterial dominant phase and peripheral or homogeneous high attenuation with progressive centripetal enhancement in the equilibrium phase. CONCLUSION: Our results suggest that two-phase spiral CT during the arterial dominant and equilibrium phase is useful in differentiating hepatic hemangiomas with atypical features seen on US from malignant hepatic tumors.
Hemangioma* ; Humans ; Retrospective Studies ; Tomography, Spiral Computed* ; Ultrasonography*

PURPOSE: To assess the frequency, location, associated MR findings, and clinical symptoms of the high levellumbar disc herniation(HLDH). MATERIALS AND METHODS: A total of 1076 patients with lumbar disc herniation wereretrospectively reviewed. MR images of 41 of these with HLDH(T12-L1, L1-2, L2-3) were analysed in terms offrequency, location, and associated MR findings, and correlated with clinical symptoms of HLDH. RESULTS: Theprevalence of HLDH was 3.8%(41/1076). HLDH was located at T12-L1 level in four patients(10%), at L1-2 level in14(34%), at L2-3 level in 21(51%), and at both L1-2 and L2-3 levels in two. The age of patients ranged from 20 to72 years (mean, 44), and there were 26 men and 16 women. In 11(27%), whose mean age was 32 years, isolated discherniation was limited to these high lumbar segments. The remaining 30 patients had HLDH associated with variableinvolvement of the lower lumbar segments. Associated lesions were as follow : lower level disc herniation(14patients, 34%); apophyseal ring fracture(8 patients, 19%); Schmorl's node and spondylolisthesis (each 6patients, each 14%); spondylolysis(3 patients, 7%); and retrolisthesis(2 patients, 5%). In 20 patients(49%) withHLDH(n=41), there was a previous history. CONCLUSION: Patients with HLDH showed a relatively high incidence ofassociated coexisting abnormalities such as lower lumbar disc herniation, apophyseal ring fracture, Schmorl'snode, spondylolysis, and retrolisthesis. In about half of all patients with HLDH there was a previous history oftrauma. The mean age of patients with isolated HLDH was lower; clinical symptoms of the condition were relativelynonspecific and their incidence was low.
Female ; Humans ; Incidence ; Magnetic Resonance Imaging* ; Male ; Spondylolisthesis ; Spondylolysis

PURPOSE: To determine the accuracy of magnetic resonance (MR) arthrography in the detection and staging of lesions of the acetabular labrum. MATERIALS AND METHODS: Fifteen hips of 14 patients with chronic hip pain and clinical suspicion of labral lesions were examined with direct or indirect MR arthrography and underwent subsequent arthroscopic evaluation. The study population consisted of six women and eight men aged between 40 and 59 years. Nine arthrograms were obtained intra-articular administration of gadolinium solution, and six involved articular motion exercise after intravenous administration of gadolinium solution. In 14 cases a phased-array pelvic coil was used, and a shoulder coil in one. Fat-suppressed T1-weighted images were obtained in the coronal, oblique coronal and oblique axial planes, and T1-and T2-weighted images were obtained in the axial plane. Labral lesions were graded according to the Czerny classification and evaluated on the basis of presence or absence of a tear and location (anteroinferior, anterosuperior, superior, posterosuperior, posteroinferior). The findings were then correlated with the arthroscopic findings. RESULTS: After direct and indirect MR arthography, the findings-based on the Czerny classification -were as follows : stage IA:3; IB:1; IIA:8; IIB:1; IIIA:4; IIIB:0. MR arthrography also showed that seven cases were located in the anterosuperior portion of the labrum, seven in the superior portion, and three in the posteroinferior portion. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MR arthrography for diagnosis of the labral tear was 92%, 75%, 92%, 75 %, and 88 %, respectively. CONCLUSION: In this preliminary study, MR arthrography appears to be a promising imaging modality for accurate diagnosis and useful for screening patients with chronic hip pain.
Acetabulum* ; Administration, Intravenous ; Arthrography* ; Classification ; Diagnosis* ; Female ; Gadolinium ; Hip ; Humans ; Male ; Mass Screening ; Sensitivity and Specificity ; Shoulder

Glomerulonephritis(GN) is characterized by cognate immune responses against self or non-self antigen. It is suggested that the crescentic GN is a manifestation of cell-mediated immune response akin to delayed type hypersensitivity. Uteroglobin(UG) is a steroid-dependent, immunomodulatory, and cytokine-like protein. It was reported that UG prevented fibronectin(Fn) deposition in the glomeruli of normal mice to form Fn-UG heterodimers that competed with Fn self-aggregation. We hypothesized that UG would prevent the development of experimental GN induced by anti-glomerular basement membrane globulin(anti-GBM Ab) in mice through immunomodulatory properties. GN was induced by intravenous injection of 4.5 mg rabbit anti-GBM Ab to mice(C57BL/6). Renal injury was evaluated at 7, 14, and 21 days thereafter. UG-treated mice(n=10) were received for 3 days(0.5 mg/mouse/day) beginning 1 hour after anti-GBM Ab injection. Also, disease-control mice(n=10) were received PBS for 3 days after anti-GBM Ab. Proteinuria was significantly reduced in the mice treated with UG when compared with the disease-control mice after 7 and 14 days of anti-GBM Ab injection. The amount of proteinuria was similar between UG treated and normal control mice. The mesangial matrix expansion and cellular crescent were markedly attenuated by the injection of UG. The proliferative responses of mesangial cells(C57BL/6) to LPS were blunted with the addition of UG in dose-dependent manner. In this study, we revealed the preventive effects of UG in the experimental model of glomerulonephritis. This result in turn could provide the basis for the treatment of human disease such as chronic glomerulonephritis.
Animals ; Basement Membrane ; Glomerulonephritis* ; Humans ; Hypersensitivity ; Injections, Intravenous ; Mice ; Models, Theoretical ; Proteinuria ; Uteroglobin*

BACKGROUND: Systemic lupus erythematosus (SLE) is one of chronic autoimmune diseases of which the central pathophysiologic derangement has not been yet established. Recently, it has been suggested that immune-regulatory cells might affect the development of autoimmune diseases such as SLE and RA. NKT cells were reported to be strong candidate for regulatory cells to regulate immune responses in vivo. To elucidate the roles of immune regulatory cells in the pathogenesis of SLE, we investigated the fractional distribution and functional status of NK and NKT cells in peripheral blood mononuclear cells (PBMC) of SLE patients and healthy volunteers. METHODS: Twenty-two SLE patients and 18 age-matched healthy volunteers were included in this study. The analysis for NK and NKT cells fraction in PBMCs of patients and normal controls were performed by flow cytometric analysis. In addition, to explore the functional status of these cells in SLE patients, we stimulated PBMCs using phorbol ester and ionomycin and measured cytoplasmic IL-4 and IFN-gamma by flow cytometry. RESULTS: The number (percentage) of NK cells was lower in SLE patients (CD3-CD56+: 4.93+/-1.30%, CD3-CD94+: 4.03+/-1.00%) than in controls (11.28+/-1.77%, 8.15+/-1.40%; p< 0.01, respectively). Peripheral NK cell numbers negatively correlated with anti-dsDNA Ab levels (r=-0.431, p< 0.05) and ESR (r= -0.475, p< 0.05). However, the percentage of these cells was not correlated with renal activity or corticosteroid doses. SLE patients showed, compared with controls, significantly decreased numbers of NKT cells (CD3+CD56+: 1.79+/-0.42% vs 5.04+/-0.44%, CD3+CD94+: 1.21+/-0.27% vs 4.39+/-0.45%; p< 0.01, respectively). The cytoplasmic expression of IL-4 and IFN-gamma in NK and NKT cells of SLE patients stimulated using phorbol ester and ionomycin were almost similar to those of normal controls, suggesting the NKT cells from SLE patients are functionally intact. CONCLUSION: Our results suggested that the decreased numbers of immune regulatory cells were associated with the immune dysregulation of SLE patients. The cellular replacement of NKT cells may be one of useful therapeutic approaches for autoimmune diseases such as SLE.
Autoimmune Diseases ; Cytoplasm ; Flow Cytometry ; Healthy Volunteers ; Humans ; Interleukin-4 ; Ionomycin ; Killer Cells, Natural* ; Lupus Erythematosus, Systemic* ; Natural Killer T-Cells

PURPOSE: Fungal peritonitis is a fatal disease with a high mortality and morbidity to the peritoneal dialysis(PD) patients. This study was implemented to provide a guideline for the prevention and treatment of fungal peritonitis in PD patients by analyzing the clinical and microbiologic features of fungal peritonitis cases. METHODS: We analyzed retrospectively into the 15 cases(14 patients) of fungal peritonitis among 376 end stage renal disease(ESRD) patients who newly started PD in the Seoul National University Hospital from Jan. 1991 to Dec. 1999. RESULTS: The patients' age was 53.6+/-11.6 years (mean+/-standard deviation) and their male to female ratio was 12:3. They have been on PD for 29.2+/-27.7 months before the fungal peritonitis developed. Candida species was the most common etiologic agent, accounting for 10(62.5%) out of the 16 fungal organisms isolated from our patients. Among others were two Aspergillus, one Cryptococcus, one Penicillium, one Torulopsis, and one Trichosporon beigelii cases. Bacterial agents were isolated simultaneously in five fungal peritonitis cases. Peritoneal catheters were all removed no later than 72 hours after the diagnosis was made. Patients were given a single or combined therapy with amphotericin B, fluconazole, or flucytosine on the physician's choice. The outcomes of fungal peritonitis were as follows; 20% continued PD, 60% converted to HD and 20% died of fungal peritonitis. We made a comparative analysis between the fungal and bacterial peritonitis cases which developed in the same 5-year period, which showed significantly higher catheter removal and technique failure rates in the fungal cases. CONCLUSION: Fungal peritonitis is a rare but a fatal disease with a high mortality and a technique failure rate. Candida species was the most prevalent microorganism in our study.
Amphotericin B ; Aspergillus ; Candida ; Catheters ; Cryptococcus ; Diagnosis ; Female ; Fluconazole ; Flucytosine ; Fungi ; Humans ; Male ; Mortality ; Penicillium ; Peritoneal Dialysis* ; Peritonitis* ; Retrospective Studies ; Seoul ; Trichosporon

PURPOSE: Although cyclosporine (CsA) improves short-term renal graft outcomes, many paradigms reduce or withdraw this drug because of its nephrotoxicity. However, inadequate immunosuppression with azathioprine led to little success. We conducted a prospective study to define the prolonged effect of CsA reduction in stable renal transplant recipients with mycophenolate mofetil (MMF). METHODS: Thirty-nine primary renal transplant recipients were divided into two cohorts, the AZA (N=13) and the MMF cohort (N=26). Both cohorts were allowed to reduce the CsA dose up to 50% of baseline within 3 to 4 months of conversion to AZA or MMF. Graft function, clinical parameters, and adverse events were monitored for up to 3 years. RESULTS: Ccr gradually deteriorated in the AZA cohort, but was stable in the MMF cohort. There was no episode of acute rejection or graft loss observed in either cohort. CONCLUSION: The CsA dose can be reduced in combination with MMF treatment in stable renal transplant recipients after 2 years of transplantation, resulting in beneficial effects on Ccr, lipid profiles, and blood pressure.
Azathioprine ; Cohort Studies ; Cyclosporine ; Immunosuppression ; Kidney Transplantation ; Mycophenolic Acid ; Prospective Studies ; Rejection (Psychology) ; Transplants

PURPOSE: Uteroglobin (UG), steroid inducible cytokine-like protein, has potent anti-inflammatory and immunomodulatory action. It is secreted by the mucosal epithelia of virtually all mammals. The aims of this study were to investigate the efficacy of recombinant adenovirus carrying uteroglobin (AdCMV-UG) in prevention and treatment of glomerulonephritis (GN) in mice. METHODS: The AdCMV-UG was created by inserting the uteroglobin cDNA into the pAdTrack- CMV vector and was transfected into the 293 cells through liposome mediated vehicles. AdCMV-UG was injected direct to the both kidneys of 20 mice. In control groups (disease controls), 13 mice received adenoviral vector with GFP and another 11 mice received PBS only. After 5days of viral injection, GN was induced by repetitive intravenous injection of 3.0 mg rabbit anti-GBM Ab to the pretreated mice (C57/B6). Histological and biochemical changes were evaluated 7 and 14 days after injection of anti-GBM Ab. RESULTS: UG was expressed in the renal tissues and mesangial cells infected with the infection of AdCMV-UG. Pretreatment with AdCMV-UG attenuated the cellular crescent formation 7 days after induction of GN when compared to AdCMV-GFP, PBS only. We also observed reduced mesangial matrix expansion in mice treated with adenovirus carrying UG. Proteinuria was significantly reduced in the mice treated with adenovirus carrying UG when compared with disease control mice (AdCMV-UG 102.2+/-20.97, AdCMV-GFP 170.6+/-41.77, and PBS 169.8+/-55.67, respectively p<0.05 mg/mg). However, at 14 days after anti-GBM Ab injection (total 19 days), there was no significant difference in the amounts of prot einuria and morphologic findings between pretreated and disease control groups. CONCLUSION: Adenoviral mediated gene transfer is an effective way of gene delivery. Locally expressed uteroglobin attenuated the severity of glomerulonephritis induced by anti-GBM antibody, although it was transient. Gene therapy using uteroglobin may be constituted for the treatment of human diseases such as chronic GN.
Adenoviridae ; Animals ; DNA, Complementary ; Genetic Therapy* ; Glomerulonephritis* ; Humans ; Injections, Intravenous ; Kidney ; Liposomes ; Mammals ; Mesangial Cells ; Mice* ; Proteinuria ; Uteroglobin*

PURPOSE: It has been known that the incidence of post-transplant diabetes mellitus (PTDM) is variable according to the immunosuppressant used. The goals of this study are to uncover the factors associated with the development of PTDM and to clarify the fate of PTDM. METHODS: The medical records of 267 patients who underwent renal transplant between 1996 and December 2002 at Seoul National University Hospital were retrospectively reviewed. Patients were divided into three groups: cyclosporine group (CsA, n=179), high tacrolimus group (HFK, mean trough level during post-transplant 2 week>15 ng/m, n=33) and low tacrolimus group (LFK, mean trough level during post- transplant 2 week< or =15 ng/mL, n=55). The incidence, risk factors of PTDM and clinical fate were analyzed. RESULTS: PTDM developed in 46 (17.2%) patients. PTDM incidence of HFK group (60.6%) was significantly higher than CsA group (10.1%) and LFK group (14.5%) (P=0.000). Tacrolimus use, age at the time of transplantation (>40year), family history of diabetes and obesity (BMI>25) were the risk factors for PTDM development. Incidences of associated clinical events, such as acute rejection, cerebrovascular accident, myocardial infarction, or infection were not different between PTDM and non-PTDM group. PTDM was resolved in 13 out of 46 patients (28.3%). Only 7 out of 33 patients (21.2%) in whom PTDM persisted lost their graft. CONCLUSION: PTDM incidence was higher in HFK group. So, LFK protocol is considered to be safe and beneficial, at least in terms of PTDM. Tacrolimus as immunosuppressant, recipient, family history of DM and obesity were the risk factors of PTDM development. PTDM was reversible in 28.3% of patients. PTDM had little impact on clinical outcomes during mid-term period.
Cyclosporine ; Diabetes Mellitus* ; Humans ; Immunosuppression ; Incidence ; Medical Records ; Myocardial Infarction ; Obesity ; Retrospective Studies ; Risk Factors ; Seoul ; Stroke ; Tacrolimus ; Transplants