Since the first description of arteriovenous fistula (AVF) secondary to lumbar disc surgery by Linton and White in 1945, many cases of the accidental injury to the great vessels anterior to the lumbar area have been reported. We experienced a unique case of AVF between the internal iliac artery and internal iliac vein following disc surgery. Diagnosis of traumatic AVF in a patient with multiple varicose dilatation of vein in the left thigh and inguinal area was heralded by the presence of unique, unusual arterial signals in the area of dilated veins during the leg Doppler scan. 3D-CT angiography clearly confirmed the presence of a fistular tract between the internal iliac artery and vein. Using the Seldinger technique, a PTFE stent graft was inserted into the internal iliac artery to cover the fistular site nonsurgically. After the procedure, venous dilatation decreased and the patient felt comfortable. Follow-up 3D-CT angiography one month after procedure showed complete obliteration of fistuar tract and patent blood flow through PTFE stent graft in the internal iliac artery.
Angiography ; Arteriovenous Fistula* ; Blood Vessel Prosthesis* ; Diagnosis ; Dilatation ; Follow-Up Studies ; Humans ; Iliac Artery ; Iliac Vein ; Leg ; Polytetrafluoroethylene* ; Stents* ; Thigh ; Veins

PURPOSE: In order to obtain better quantitation of kidney uptake, this study is to evaluate a conjugate view method (CVM) using a geometric mean attenuation correction for kidney uptake and to compare it to Gate's method. MATERIALS AND METHODS: We used a Monte Carlo code, SIMIND and a Zubal phantom, to simulate kidney uptake. SIMIND was both simulated with or without scatter for the Zubal phantom. Also, a real phantom test was carried out using a dual-head gamma camera. The activity of 0.5 mCi was infused into two small cylinder phantoms of 5 cm diameter, and then, they were inserted into a cylinder phantom of 20 cm diameter. The results by the CVM method were compared with ideal data without both of attenuation and scatter and with Gate's method. The CVM was performed with or without scatter correction. The Gate's method was performed without scatter correction and it was evaluated with regards to 0.12 cm (-1) and 0.15 cm (-1) attenuation coefficients. Data were analyzed with comparisons of mean counts in the regions of interest (ROI), profiles drawn over kidney images and linear regression. Correlation coefficients were calculated with ideal data, as well. RESULTS: In the case of the computer simulation, mean counts measured from ideal data, the CVM and the Gate's method were (right: 998 +/- 209, left: 896 +/- 249), (right: 911 +/- 207, left: 815 +/- 265), and (right: 1065 +/- 267, left: 1546 +/- 267), respectively. The ideal data showed good correlation with the CVM and the correlation coefficients of the CVM, Gate's method were (right: 0.91, left: 0.93) and (right: 0.85, left: 0.90), respectively. CONCLUSION: The conjugate view method using geometric mean attenuation correction resulted in better accuracy than the Gate's method. In conclusion, the conjugate view method independent of renal depths may provide more accurate kidney uptake.
Computer Simulation ; Gamma Cameras ; Kidney* ; Linear Models

Castleman's disease is uncommon lymphoproliferative disorder as giant lymph node hyperplasia and angiofollicular lymph node hyperplasia. Multicentric variant of Cagtleman's disease, plasma cell type has been, described that has mort generalized lymph node involvement as well as involvement of other organ systems than localized type. Multicentric plasma cell type is frequently accompanied by systemic manifestations, such as weight loss, lowgrade fever and weakness. But the reported cases of pulmonary parenchymal involvement are rare and have almost consisted of hyalinized ganuloma adjacent 13 a bronchus. We report a patient with Castleman's disease of the lung, pathologically proven interstitial pulmonary involvement.
Bronchi ; Fever ; Giant Lymph Node Hyperplasia* ; Humans ; Hyalin ; Lung* ; Lymph Nodes ; Lymphoproliferative Disorders ; Plasma Cells ; Weight Loss

BACKGROUND: The occurrence of malignancy following kidney transplantation has been estimated three to five times the incidence compared to that of the general population. It is estimated that particularly in renal cell carcinoma (RCC), the relative risk increases. The aim of this study was to analyze the characteristics, risk factors, and prognosis of RCC following kidney transplantation. METHODS: Total number of 3,272 kidney recipients who underwent transplantation from April 1979 to December 2012 and patients who had RCC following kidney transplantation were retrospectively reviewed and analyzed. RESULTS: We found that among 232 cases of posttransplant malignancies, 25 recipients were diagnosed with RCC. We have observed in our study that it took an average of 175.2+/-71.0 months to develop RCC after their first kidney transplantation. However, with longer follow up period, interval incidence of RCC increased. Fourteen patients (56%) were diagnosed with RCC 15 years after transplantation. We also found that with reference to the risk factor analysis for posttransplant RCC, the long-term follow-up period was the only independent risk factor. In our study, 21 patients with RCC were treated with radical nephrectomy. Of them, 16 patients survived, and four RCC-related deaths occurred. Furthermore, the patient survival rate of RCC recipients was lower than that of the nonmalignancy group despite the graft survival rate were not different. CONCLUSIONS: We conclude that the incidence of RCC increased in a time-dependent manner following kidney transplantation. Therefore, we strongly recommend the procedure of regular-interval screening for the patients who are on compulsive long-term immunosuppression.
Carcinoma, Renal Cell ; Follow-Up Studies ; Graft Survival ; Humans ; Immunosuppression ; Incidence ; Kidney ; Kidney Transplantation ; Mass Screening ; Nephrectomy ; Prognosis ; Retrospective Studies ; Risk Factors ; Survival Rate ; Transplants

BACKGROUND: To find out effectiveness of multimodality treatments based on induction chemotherapy(CTx) in patients with clinical stage IIIA NSCLC METHODS: From 1997 to 2002, 74 patients with clinical stage IIIA NSCLC underwent induction CTx at the hospital of Chungnam National University. Induction CTx included above two cycles of cisplatin-based regimens(ectoposide, gemcitabine, vinorelbine, or taxol) followed by tumor evaluation. In 30 complete resection group, additional 4500-5000cGy radiotherapy(RTx) was delivered in 15 patients with pathologic nodal metastasis. 29 out of 44 patients who were unresectable disease, refusal of operation, and incomplete resection were followed by 60-70Gy RTx in local treatment. Additional 1-3 cycle CTx were done in case of induction CTx responders in both local treatment groups. RESULTS: Induction CTx response rate were 44.6%(complete remission 1.4% & partial response 43.2%) and there was no difference of response rate by regimens(p=0.506). After induction chemotherapy, only 33 out of resectable 55 ones(including initial resectable 37 patients) were performed by surgical treatment because of 13 refusal of surgery by themselves and 9 poor predicted reserve lung function. There were 30(40.5%) patients with complete resection, 2(2.6%) persons with incomplete resection, and 1(1.3%) person with open & closure. Response rate in 27 ones with chest RTx out of non-operation group was 4.8% CR and 11.9% PR. In complete resection group, relapse free interval was 13.6 months and 2 year recur rate was 52%. In non-complete resection(incomplete resection or non-operation) group, disease progression free interval was 11.2 months and 2 year disease progression rate was 66.7%. Median survival time of induction CTx 74 patients with IIIA NSCLC was 25.1months. When compared complete resection group with non-complete resection group, the median survival time was 31.7 and 23.4months(p=0.024) and the 2-year overall survival rate was 80% and 41% . In the complete resection group, adjuvant postoperative RTx subgroup significantly improved the 2-year local control rate(0% vs. 40%, p= 0.007) but did not significantly improve overall survival(32.2months vs. 34.9months, p=0.48). CONCLUSION: Induction CTx is a possible method in the multimodality treatments, especially followed by complete resection, but overall survival by any local treatment(surgical resection or RTx) was low. Additional studies should be needed to analysis data for appropriate patient selection, new chemotherapy regimens and the time when should RTx be initiated.
Chungcheongnam-do ; Disease Progression ; Disulfiram ; Drug Therapy ; Humans ; Induction Chemotherapy ; Lung ; Neoplasm Metastasis ; Patient Selection ; Recurrence ; Survival Rate ; Thorax

PURPOSE: Due to their comorbidities, dialysis patients have many chances to undergo radiologic procedures using iodinated contrast media. We aimed to assess time-sequenced blood oxidative stress level after contrast exposure in hemodialysis (HD) patients compared to those in the non-dialysis population. MATERIALS AND METHODS: We included 21 anuric HD patients [HD-coronary angiography (CAG) group] and 23 persons with normal renal function (nonHD-CAG group) scheduled for CAG, and assessed 4 oxidative stress markers [advanced oxidation protein products (AOPP); catalase; 8-hydroxydeoxyguanosine; and malondialdehyde] before and after CAG, and subsequently up to 28 days. RESULTS: In the nonHD-CAG group, only AOPP increased immediately after CAG and returned to baseline within one day. However, in the HD-CAG group, all four oxidative stress markers were significantly increased starting one day after CAG, and remained elevated longer than those in the nonHD-CAG group. Especially, AOPP level remained elevated for a month after contrast exposure. CONCLUSION: Our study showed that iodinated contrast media induces severe and prolonged oxidative stress in HD patients.
Aged ; Contrast Media/*adverse effects ; Female ; Humans ; Male ; Middle Aged ; Oxidative Stress/*drug effects ; Renal Dialysis/*adverse effects

Although malignant melanoma involving the stomach is commonly mentioned in association with autopsies, endoscopic experience in this gastric malignancy is still limited, and few cases have been illustrated in the literature. This clinical condition is even rarer in Asians who are much less vulnerable to malignant melanoma than Caucasians. We experienced two cases of gastric metastases of malignant melanoma which presented as indigestion and epigastric pain. In the first case, a 75-year-old man visited because of indigestion persisting for 2 months. He had a history of multiple gastric ulcer and was treated at a local medical center, but symptoms did not improved. Endoscopic finding revealed multiple and elevated lesions with central black pigmented bases. In the second case, a 47-year-old man visited because of epigastric soreness and intermittent pain for 1 month. Metastatic melanoma in the stomach was noticed by endoscopic examination. Both patients had multiple metastatic lesions in the liver, thyroid, and brain. These two cases were diagnosed as having metastatic malignant melanoma in the stomach of unknown origin. Therefore, we report these cases with a brief review of the related literature.
Aged ; Asian Continental Ancestry Group ; Autopsy ; Brain ; Dyspepsia ; Humans ; Liver ; Melanoma* ; Middle Aged ; Neoplasm Metastasis ; Stomach ; Stomach Ulcer ; Thyroid Gland

The gastrointestinal rnanifestations associated with antiphospholipid antibodies include Budd-Chiari syndroame, hepatic infarction, portal hypertension, pancreatitis, intestinal infarction, perforation, bleeding and ulceration. A 40-year old man, without prior thrombotic event, presented with severe abdominal pain for 3 days and septic shock. Multiple mesenteric venous thrombosis and colonic congestion were suggested by abdominal CT and angiography. Gastroendoscopy revealed esophageal varix and congestive gastropathy. Laboratory tests disclosed postive antiphospholipid antibodies, anti-HCV antibodies, HCV-PCR, prolonged PT, aPTT, thrombocytopenia and had no evidences of SLE and other connective tissue diseases. He was diagnosed as mutiple mesenteric thrombosis and portal hypertension associated with antiphospholipid antibodies in hepatitis C virus infection. He was improved with the antibiotics and intravenous vasopressors. He have had no other thrombotic events until one year after discharge.
Abdominal Pain ; Adult ; Angiography ; Anti-Bacterial Agents ; Antibodies, Antiphospholipid ; Colon ; Connective Tissue Diseases ; Esophageal and Gastric Varices ; Estrogens, Conjugated (USP) ; Hemorrhage ; Hepacivirus ; Hepatitis C Antibodies ; Hepatitis C* ; Hepatitis* ; Humans ; Hypertension* ; Hypertension, Portal ; Infarction ; Pancreatitis ; Shock, Septic ; Thrombocytopenia ; Thrombosis* ; Tomography, X-Ray Computed ; Ulcer ; Venous Thrombosis

PURPOSE: Tertiary hyperparathyroidism (tHPT) means a persistent secondary hyperparathyroidism even after successful renal transplantation. Parathyroidectomy (PTX) is an efficient way to treat tHPT. In this study, we reviewed our single center Experience of PTX in regard to postoperative outcomes and analyzed any differences by the types of surgery. METHODS: Among 2,589 recipients who underwent renal allograft between April. 1979 and Dec. 2006, 11 patients (0.4%) were identified to have tHPT and underwent PTX. Levels of intact parathyroid hormone (iPTH) and serum calcium were measured before and after PTX to evaluate therapeutic effect, and serum-creatinine and GFR using the Modification of Diet in Renal Disease (MDRD) equation to investigate any effect to graft function. RESULTS: One patient showed persistent hyperparathyroidism and hypercalcemia after subtotal PTX. We experienced 10 successful PTXs in which 2 total PTX with autotransplantations, 4 subtotal PTXs and 4 limited PTXs. Level of iPTH and serum calcium were at normal range after PTX. Serum creatinine increased and estimated GFR decreased after PTX. Total PTX with autotransplantation showed a tendency of more decrease in the values of iPTH, and GFR after PTX than Subtotal PTX. CONCLUSION: PTX can cure tHPT-specific symptoms and sign by the recovery of hypercalcemia but may carry the risk of deterioration of kidney graft function. Subtotal PTX rather than total PTX might be recommended in the surgical treatment of tHPT to prevent any risk of kidney graft deterioration.
Allografts ; Autografts ; Calcium ; Creatinine ; Diet ; Humans ; Hypercalcemia ; Hyperparathyroidism* ; Hyperparathyroidism, Secondary ; Kidney ; Kidney Transplantation* ; Parathyroid Hormone ; Parathyroidectomy ; Reference Values ; Transplants

Background: and PurposeWe aimed to determine the effect of demographic factors on cortical thickness and brain glucose metabolism in healthy aging subjects. Methods: The following tests were performed on 71 subjects with normal cognition: neurological examination, 3-tesla magnetic resonance imaging, 18F-fluorodeoxyglucose positron-emission tomography, and neuropsychological tests. Cortical thickness and brain metabolism were measured using vertex- and voxelwise analyses, respectively. General linear models (GLMs) were used to determine the effects of age, sex, and education on cortical thickness and brain glucose metabolism. The effects of mean lobar cortical thickness and mean lobar metabolism on neuropsychological test scores were evaluated using GLMs after controlling for age, sex, and education. The intracranial volume (ICV) was further included as a predictor or covariate for the cortical thickness analyses. Results: Age was negatively correlated with the mean cortical thickness in all lobes (frontal and parietal lobes, p=0.001; temporal and occipital lobes, p<0.001) and with the mean temporal metabolism (p=0.005). Education was not associated with cortical thickness or brain metabolism in any lobe. Male subjects had a lower mean parietal metabolism than did female subjects (p<0.001), while their mean cortical thicknesses were comparable. ICV was positively correlated with mean cortical thickness in the frontal (p=0.016), temporal (p=0.009), and occipital (p=0.007) lobes. The mean lobar cortical thickness was not associated with cognition scores, while the mean temporal metabolism was positively correlated with verbal memory test scores. Conclusions Age and sex affect cortical thickness and brain glucose metabolism in different ways. Demographic factors must therefore be considered in analyses of cortical thickness and brain metabolism.