A case of papillary adenoma of the gallbladder in a sixty seven-year-old female with varietise of epithelial components in metaplastic nature is presented. This adenoma was bordered by hyperplastic epithelium with intervening Paneth cells and enterochromaffin cells, but goblet cells were rarely participated, as with focal epithelial change resembling gastric foveolar epithelium and aggregation of antral type mucous glands. Based on its morphologically distinct type of gallbladder adenoma and histogenetic point of view, we propose this neoplasm to be designated as a metaplastic adenoma or polyp, and the relationship of various metaplastic changes to adenoma or carcinoma is discussed.
Female ; Humans ; Adenoma

No abstract available.
Embryo Transfer* ; Embryonic Structures* ; Fertilization in Vitro* ; Humans ; Pregnancy, Twin*

We report our experience of endoluminal expandable stent placement for the treatment of post- transplant renal artery stenosis. Fourty years old male patient, underwent living donor renal allograft 16 months ago, was admitted due to uncontrollable hypertension and gradual graft dysfunction. On the past history, he had had acute rejection at post-transplant day 4 and it had been treated successfully with steroid pulse therapy. After then, he have been relatively doing well and the graft function has shown normal with serum creatinine of 1.1 mg/dl. His blood pressure has been marked 140/90 mmHg, which has been well controlled with amlodipine (calcium channel blocker) and atenolol (beta blocker). On the physical examination, there was no briut on the iliac fossa and blood pressure was 190/110 mmHg. Serum creatinine was 2.0 mg/dl and blood renin level showed 15.61 ng/ml in supine postion, 11.51 ng/ml in erect postion, which were about 10 times above the normal range, respectively. With the impression of post-transplant renal artery stenosis, angiography was performed. The angiogram showed nearly complete transplant renal artery stenosis(about 90% of the lumen) at the anastomotic site. Expandable metal stent was indwelled successfully into the endolumen of transplant renal artery. After this precedure, the blood pressure of this patient was down to 130/80 mmHg and serum creatinine was stabilized to 1.1 mg/dl. Percutaneous endoluminal stent procedures for resistant transplant renal artery stenosis is promising. Longer follow-up periods are necessary for true evaluation of this procedure.
Allografts ; Amlodipine ; Angiography ; Atenolol ; Blood Pressure ; Creatinine ; Follow-Up Studies ; Humans ; Hypertension ; Living Donors ; Male ; Physical Examination ; Reference Values ; Renal Artery Obstruction* ; Renal Artery* ; Renin ; Stents* ; Transplants

We report our experience of endoluminal expandable stent placement for the treatment of post- transplant renal artery stenosis. Fourty years old male patient, underwent living donor renal allograft 16 months ago, was admitted due to uncontrollable hypertension and gradual graft dysfunction. On the past history, he had had acute rejection at post-transplant day 4 and it had been treated successfully with steroid pulse therapy. After then, he have been relatively doing well and the graft function has shown normal with serum creatinine of 1.1 mg/dl. His blood pressure has been marked 140/90 mmHg, which has been well controlled with amlodipine (calcium channel blocker) and atenolol (beta blocker). On the physical examination, there was no briut on the iliac fossa and blood pressure was 190/110 mmHg. Serum creatinine was 2.0 mg/dl and blood renin level showed 15.61 ng/ml in supine postion, 11.51 ng/ml in erect postion, which were about 10 times above the normal range, respectively. With the impression of post-transplant renal artery stenosis, angiography was performed. The angiogram showed nearly complete transplant renal artery stenosis(about 90% of the lumen) at the anastomotic site. Expandable metal stent was indwelled successfully into the endolumen of transplant renal artery. After this precedure, the blood pressure of this patient was down to 130/80 mmHg and serum creatinine was stabilized to 1.1 mg/dl. Percutaneous endoluminal stent procedures for resistant transplant renal artery stenosis is promising. Longer follow-up periods are necessary for true evaluation of this procedure.
Allografts ; Amlodipine ; Angiography ; Atenolol ; Blood Pressure ; Creatinine ; Follow-Up Studies ; Humans ; Hypertension ; Living Donors ; Male ; Physical Examination ; Reference Values ; Renal Artery Obstruction* ; Renal Artery* ; Renin ; Stents* ; Transplants

In this study, we evaluated the safety and efficacy of mycophenolate mofetil(MMF) for the prevention of acute rejection episodes when given in combination with cyclosporine and corticosteroids during the first 6 postoperative months in living donor kidney transplantation. One hundred patients were enrolled; 50 patients received dual immunosuppression (cyclosporine+corticosteroids: control group) and another 50 patients received triple regimen including MMF 2 g/day(cyclosporine+corticosteroids+MMF: study group) through randomization. In the protocol, first-line treatment for acute rejection was a high-dose steroid pulse therapy. Steroid resistant acute rejection was to be treated with polyclonal antilymphocyte agents(ATG). There was no demographic difference between study and control groups. There were 7(14%) acute rejection episodes in the study group and 16(32%) in the control group with statistical significance. Two cases of premature withdrawal were developed in the study group(one severe abdominal pain and another profound leukopenia). The incidence of opportunistic infection was 7(14%) in the study group and 6(12%) in the control group within 6 months post transplantation. There was no statistical differences in serum creatinine level between study and control group at 6 months after transplantation(1.28+/-0.33 mg/dl vs. 1.24+/-0.51 mg/dl). The addition of MMF to a dual immunosuppressive regimen with cyclosporine and corticosteroids seems to lower the incidence and severity of acute rejection in living donor kidney transplantation during the early post-transplantation period. The graft function of the MMF group is comparable with that of the control group. The most common adverse effect of MMF was abdominal pain and diarrhea but almostly resolved with symptomatic treatment. If the frequency of acute rejection during the first 6 months is one of the main determinants of long-term graft survival, it might be expected that MMF could lead to an improved graft survival in combination with cyclosporine and corticosteroids.
Abdominal Pain ; Adrenal Cortex Hormones ; Allografts* ; Creatinine ; Cyclosporine ; Diarrhea ; Graft Survival ; Humans ; Immunosuppression ; Incidence ; Kidney Transplantation ; Living Donors* ; Opportunistic Infections ; Prospective Studies* ; Random Allocation ; Transplants

A microemulsion cyclosporine(Me-CsA) was developed and became available with more predictable whole blood CsA concentration and minimal inter- and intra-personal variability in daily dosage of CsA. We prospectively performed this study to assess 1) the ability of Me-CsA maintaining the adequate predefined therapeutic level and 2)long-term safety and tolerability of Me-CsA in kidney transplant recipients. A total of 123 renal transplant patients were enrolled on the Me-CsA group, who have been on Me-CsA as an initial main immunosuppressant since their transplantation. This group of patients were compared to 200 renal transplant patients on conventional cyclosporine(Con-CsA) as a historical control group(Con-CsA group). There were no differences in the methods of operation, induction immunosuppression, the strategies of maintenance immunosuppression and anti-rejection therapy between these two groups. The clinical status and laboratory values were monitored at 1,3,6,9, and 12 months after the kidney transplantation. There were no statistical differences in acute rejection episodes, serum creatinine level, and graft failure and survival rate between Con-CsA and Me-CsA groups. In this study, we could demonstrate the significant fluctuation of the mean values of daily dosage and whole blood trough level and their standard deviations of cyclosporine in Con-CsA group compare to those of Me-CsA group. We also could demonstrate early stabilization of CsA blood trough level in patients using Me-CsA. These results mean that Me-CsA has less interpersonal variations than Con-CsA. In conclusion, Me-CsA has more predictable pharmacodynamic characteristics than Con-CsA and comparable tolerability and safety to Con-CsA with no additional side effects.
Allografts* ; Creatinine ; Cyclosporine* ; Follow-Up Studies* ; Humans ; Immunosuppression ; Kidney ; Kidney Transplantation ; Prospective Studies ; Survival Rate ; Transplantation ; Transplants

Various clinical and pathologic parameters in order to determine the prognosis of gastric carcinoma have been proposed. Among them "carcinoma with lymphoid stroma" has been proven to show good prognosis. But the criteria of lymphoid stroma in this condition remain vague and not clear. A total of 7 cases of gastric carcinoma with heavy lymphoid stromal response out of 947 surgically resected gastric carcinomas was reviwed with histotopographic analysis. They were all advanced carcinoma, Borrmann type I and II. Histologically, the lymphoid stromal response could be divided into three patterns; nodular (3 cases), diffuse (3 cases) and mixed (1 case). The nodular pattern was characterized by massive lymphoid cell infiltration with many follicle formation and little desmoplastic reaction, while the diffuse pattern showed diffuse permeative type of inflammatory cell infiltration with scarce lymphoid follicle formation and mild desmoplasia. Regional lymph node metastasis was found in 2 cases; one in diffused and another one in mixed pattern. The stromal reaction was not directly related with the depth of tumor invasion. We propoose that the term GCLS should be used in the cases of nodular pattern with complete follicle formation of lymphoid stroma.
Neoplasm Metastasis

OBJECTIVE: To estimate the predictive value of initial serum B-hCG and progesterone measurement for pregnancy outcome in IVF-ET. METHODS: Serum B-hCG at 11-12th day after embryo transfer and progesterone at 7th day after oocyte aspiration were measured in 48 successful pregnant IVF-ET cases from July 1993 to June 1997. RESULTS: Of 48 cases, 26 cases (54.2%) successfully carried to sustaining gestation and 22 cases (45.8%) failed to sustain gestation. The estimated initial serum B-hCG levels in the normal sustaining pregnancy group (132.28+ 22.42 mlU/ml) were statistical significantly higher than 29.43+8.08 mIU/ml in the failed sustaining pregnancy group (p<0.001), while the estimated initial serum progesterone levels showed no significant differences (p=0.159). In order to determine the predictive values using the Receiver Operator Curve (ROC), an appropriate cutoff value of 38 mIU/ml for initial serum B-hCG was obtained. In IVF-ET pregnancies, the estimated serum B-hCG levels in cases of chemical abortion in failed sustaining pregnancy were significantly lower compared to the normal sustaining pregnancy group (p<0.001). CONCLUSION: The initial serum B-hCG levels at 11 days after embryo transfer could be used to predict the pregnancy outcome in an IVF program. An initial progesterone level acquired on the 7th day after oocyte retrieval is not a useful indicator to predict pregnancy outcome.
Chorionic Gonadotropin* ; Embryo Transfer* ; Embryonic Structures* ; Female ; Humans* ; Oocyte Retrieval ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Progesterone*

Fifty three surgically resected gallbladders(49 cases of chronic cholecystitis with or without cholelithiasis, 4 cases of incidentally resected gallbladders) and 14 autopsy cases were subjected to the histotopographic analysis to identify the nature and distribution of metaplastic mucosal changes, and to determine the possible histogenesis of these mucosal lesions and diagnostic implication as a parameter of chronic cholecystitis. 1) Antral type glands were demonstrated in 47(88.7%), goblet cells in 19(35.8%) and surface epithelial changes in 27(50.9%) of total surgical specimens, indicating the benign metaplastic changes of the gallbladder mucosa toward the gastric or intestinal type. 2) Topographic distribution illustrated the extension of antral type gland to the middle and upper one third portions of the gallbladder mucosa in 37 cases, each. Goblet cells in the middle and upper one third of the mucosa were demonstrable in 13 cases(68%) an 8 cases(42%), respectively. 3) Average age by degree of extension was 50.0 years in Grade O-I, 50.1 years in Grade II and 56.4 years in Grade III. 4) Among 53 surgically resected gallbladders, gallstone was found in 31 cases, in which was a significant correlation between the distribution of metaplastic changes by degree of extent and cholelithiasis. 5) There was no statistical significance between incidence of metaplastic changes of the gallbladder and degree of inflammatory reaction by means of chronic and/or acute inflammatory cell infiltration and Rokitansky-Aschoff sinus formation. 6) Only two out of fourteen autopsy cases demonstrated focal and spotty presence of goblect cells. It is of authors assumption that the lining epithelium of the gallbladder undergos various types of metaplastic changes in the diseased conditions, in which cholelithiasis is included as one of preceding factor. And also, the diagnostic implication of epithelial metaplasia as an expression of chronic cholecystitis is discussed.
Incidence

The ovarian hyperstimulation syndrome is a rare but serious complication of ovulation induction therapy with gonadotropin. The clinical manifestations are generalized edema, ascites with pleural effusion and may become life-threatening in severe cases. The pathophysiology is still unknown therefore, the treatment should be symptomatic and conservative. We report a case of severe OHSS with massive right pleural effusion in excess of ten liters after human menopausal gonadotropin therapy because of secondary infertility. Fluid and electrolyte imbalances were corrected and albumin was administered. A right chest tube was placed for a total of sixteen days, draining eleven liters of pleural effusion totally, resulting a dramatic decrease of pleural effusion and improvement of symptoms.
Ascites ; Chest Tubes ; Edema ; Female ; Gonadotropins ; Humans ; Infertility ; Ovarian Hyperstimulation Syndrome* ; Ovulation Induction ; Pleural Effusion*