BACKGROUND/AIMS: To investigate the drug survival rate of tacrolimus (TAC) and analyze the potential predictors of this rate in patients with rheumatoid arthritis (RA) in routine care. METHODS: 2018-01-16: In this retrospective longitudinal study, we enrolled 102 RA patients treated with TAC from April 2009 to January 2014 at a tertiary center in South Korea. The causes of TAC discontinuation were classified as lack of efficacy (LOE), adverse events (AEs), and others. The drug survival rate was estimated using the Kaplan-Meier method and the predictors of this rate were identified by Cox-regression analyses. RESULTS: TAC was discontinued in 27 of 102 RA patients (26.5%). The overall 1-, 2-, 3-, and 4-year TAC continuation rates were 81.8%, 78.4%, 74.2%, and 69.1%, respectively and the median follow-up period from the start of TAC was 32.5 months. The number of TAC discontinuations due to LOE, AEs, and others were 15 (55.6%), 11 (40.7 %), and 1 (3.7%), respectively. The baseline high disease activity was a significant risk factor for TAC discontinuation after adjusting for confounding factors (hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.16 to 5.35; p = 0.019). In addition, underlying interstitial lung disease was significantly associated with TAC withdrawal due to AEs (HR, 3.49; 95% CI, 1.06 to 11.46; p = 0.039). CONCLUSIONS In our study, TAC showed a good overall survival rate in patients with RA in real clinical practice. This suggests that the long-term TAC therapy has a favorable efficacy and safety profile for treating RA.

PURPOSE: We propose a quantitative Tc-99m diethylenetriaminepentaacetic acid (DTPA) single-photon emission computed tomography/computed tomography (SPECT/CT) for glomerular filtration rate (GFR) measurement.METHODS: Quantitative SPECT/CT data obtained at 2–3 min post-Tc-99m DTPA injection (370 MBq) were used to determine % injected doses (%IDs) for individual kidneys. The reproducibility of %ID measurement was tested and compared with planar scintigraphy. Cr-51 ethylenediaminetetraacetic acid (EDTA) GFR was used as reference standard. Nine young volunteers, representing normal GFR, and ten older volunteers, reflecting impaired GFR, were enrolled. The established GFR equation derived from these volunteerswas applied to 19 renal tumor patients post-partial nephrectomy.RESULTS: At 2–3 min, %ID was most reproducible with the highest intraclass correlation (ICC) (0.9379) and lowest % coefficient of variation (CV) (6.5259%), which were more reliable than the ICC (0.9368) and %CV (6.7689%) of planar scintigraphy. Cr-51 EDTA GFR (93.16 ± 24.81 ml/min) correlated significantly with %ID (7.66 ± 2.15%, r = 0.7906, p = 0.0001), yielding an equation: Cr-51 EDTA GFR (ml/min) = (%ID × 9.1462) + 23.0653. This equation revealed significant decreases in total and nephrectomized kidney GFR (p = 0.0012 and p < 0.0001, respectively) from preoperative to 3-month postoperative measurements.CONCLUSIONS: Quantitative Tc-99m DTPA SPECT/CT produces reliable and clinically applicable %ID estimates that translate to the GFR of individual kidneys.
Edetic Acid ; Glomerular Filtration Rate ; Humans ; Kidney ; Nephrectomy ; Pentetic Acid ; Radionuclide Imaging ; Volunteers

PURPOSE: The purpose of the present study was to evaluate the potential association of the G1691A mutation of factor V (factor V Leiden), which is a main causative factor of activated protein C resistance leading to intravascular coagulation, with osteonecrosis (ON) of the femoral head. MATERIALS AND METHODS: Genomic DNA was extracted from peripheral blood leukocytes of 116 consecutively identified patients with nontraumatic ON of the femoral head and 59 healthy controls. The region in exon 10, that encodes an APC cleavage site in factor V gene, was amplified by polymerase chain reaction (PCR) with use of the 2 primers (Korea Biotech Inc., Daejeon): 5'-GGA ACA ACA CCA TGA TCA GAG CA-3' (forward primer) and 5'-TAG CCA GGA GAC CTA ACA TGT TC-3'(reverse primer). Amplified product was subjected to MnlI restriction enzyme digestion and resulting fragments were separated by electrophoresis on 3% agarose gel. The homozygous and heterozygous patterns of DNA fragments of 1691G-A mutation in the factor V gene was investigated. RESULTS: The prevalence of factor V Leiden was 0% in the patients group and in the control group. CONCLUSIONS: The data suggested that thrombophilia by the G1691A mutation of factor V (factor V Leiden) was less likely to be associated with the development of ON of the femoral head in Koreans.
Activated Protein C Resistance ; Digestion ; DNA ; Electrophoresis ; Exons ; Factor V* ; Head* ; Humans ; Leukocytes ; Osteonecrosis* ; Polymerase Chain Reaction ; Prevalence ; Sepharose ; Thrombophilia

Mucin-producing tumors of the pancreas were first reported by Ohhashi and Takagi in 1980. Since then, many cases of intraductal papillary mucinous tumor (IPMT) of the pancreas, which is almost homonymous to mucin-producing tumors of the pancreas, have been reported. IPMTs are generally regarded as tumors with a favorable prognosis. Some IPMTs have invasiveness and this is always associated with a poor prognosis. Most IPMTs arise from the main pancreatic duct and IPMTs arising from the accessory pancreatic duct are relatively rare. Only 6 cases have been reported in the literature so far. Our patient was a 43-year old man who was admitted to the hospital due to recurrent pancreatitis. An endoscopic retrograde pancreatography revealed a patulous minor papilla orifice extruding mucin and a cystic lesion in a branch of the accessory duct. A pancreaticoduodenectomy was performed and a pathologic examination of the resected specimen showed intraductal papaillary mucinous neoplasm, low grade malignancy, in the accessory pancreatic duct and its branch. We herein report this interesting case with a review of the literature.
Adult ; Humans ; Mucins* ; Pancreas ; Pancreatic Ducts* ; Pancreaticoduodenectomy ; Pancreatitis ; Prognosis

PURPOSE: The majority of carcinomas of the biliary tract are often diagnosed at an advanced stage, despite improved diagnostic capabilities. Aggressive surgery is generally recommended in an attempt to cure the advanced disease because only complete resection of the tumor can provide a chance to improve the survival rate. Thus, the purpose of this research was to assess the effectiveness of a hepatopancreato duodenectomy (HPD) in patients with both advanced gallbladder cancer directly invading adjacent organs and diffuse bile-duct cancer by analyzing the long term results of an HPD. METHODS: Forty patients underwent an HPD at Asan Medical Center from December 1993 to May 1999, and their cases were retrospectively reviewed. Gallbladder cancers was present in 14 of the patients and bile-duct cancers in 24 cases; the other 2 cases were benign. Cancers were classified by using the criteria of the American Joint Commission on Cancer (AJCC). Survival curves were calculated by using the Kaplan-Meier method. The median follow-up was 35 months. RESULTS: Hepatectomies varied from a right trisegmentectomy to an S4aS5 subsegmentectomy. There were 19 (47.5%) major postoperative complications, including intraabdominal bleeding, intestinal obstruction, liver abscess, and others. Of the 14 patients experiencing tumor recurrence, 7 (50%) cases involved the remnant liver. There were 4 (10%) perioperative mortalities. The 5 (22.7%) patients who with stage IVa and IVb cancer (22 cases) survived more than 3 years are all still alive and without tumor recurrence. The 1-and 3-year cumulative survival rates for gallbladder cancer were 83.3% and 48.5%, respectively, and those for bile-duct cancer were 83.3% and 49.7%. The differences in survival between the groups was not statistically significant, excluding perioperative deaths. The median survival was 13.7 months. CONCLUSION: An HPD is indicated for either advanced gallbladdercancer or diffuse bile-duct cancer because complete resection through this surgical procedure can provide a chance to improve survival. It is necessary to decrease perioperative mortality and morbidity by complete preoperative evaluation, meticulous operative manipulation, and intensive postoperative care.
Biliary Tract ; Chungcheongnam-do ; Follow-Up Studies ; Gallbladder Neoplasms ; Hemorrhage ; Hepatectomy ; Humans ; Intestinal Obstruction ; Joints ; Liver ; Liver Abscess ; Mortality ; Postoperative Care ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Survival Rate

The Pentaspan is a high molecular weight(250,000), hyperosmolar(320 mOsm/l) colloid solution and blood volume expander in clinical practice. Many researches revealed the decreasing of systemic vascular resistance and pulmonary vascular resistance after Pentaspan administration in vivo. Some colloid solution is contraindicated in acute renal failure. We tried to confirm the direct effects of the Pentaspan and its mechanism on the abdominal aorta and renal artery in vitro. The rat abdominal aorta and renal artery were precontracted with norepinephrine(10(-7) M/1) in 50 ml Krebs solution and 5 ml Pentaspan was infused. Ten mininutes after, changes of the vascular tones were obtained. The results were as follows. 1) The vascular tones were significantly decreased in both vessels. 2) Abdominal aorta group, renal artery group and with or without endothelium group were not significant different each other. 3) The vascular tones were not affected by with or without endothelium, indomethacin and methylene blue pretreatment. Smooth muscles were induced relaxation by the Pentaspan infusion and the relaxation were not dependent to endothelium derived relaxing factor, prostanoid and cyclic guanosinemonophosphate.
Acute Kidney Injury ; Animals ; Aorta, Abdominal* ; Arteries ; Blood Volume ; Colloids ; Endothelium ; Endothelium-Dependent Relaxing Factors ; Hydroxyethyl Starch Derivatives* ; Indomethacin ; Methylene Blue ; Muscle, Smooth ; Rats* ; Relaxation ; Renal Artery* ; Vascular Resistance

This study was designed to evaluate the potential applications of magnetic resonance imaging for the diagnosis of early and sequential changes of acute renal ischemia. Renal isehmia was induced in seventeen rabbits by surgical ligation of the left renal artery. Magnetic resonance imaging(MRI) was performed with a 2.0T super conductive MR system and s pin-echo technique was used with echo times(TE) of 30 and 80 msec and repetition times(TR) or 0.5 and 2.5 seconds. Kidneys were evaluated before and up to 48 hours after left renal artery ligation, and the spin echo images were analyzed for intensity difference and T1, T2 relaxation times between the cortex and the medulla of both kidneys. After one, and one and half hour following ligation of the left renal artery, the kidneys showed a 4-20% decrease in the left cortex compared to the right cortex contrast uptake(CCC) (P<01). There was a 14-29% decrease in left medulla to right medulla contrast uptake(MMC) (P<01). A 29-147% increase in contrast uptake was noted when the left cortex was compared to the left medulla(P<05). There was a 51-68% decrease in CMC of the right kidney (P<05) on three different spin echo images. In the cortex of the left kidney, T2 relaxation time decreased 14% (P<01). CCC and MMC showed more prominent changes than CMC, and sequential changes of CCC and MMC were most prominent on T2 weighted images with TR = 2.5sec and TE=80msec when compared with T1 weighted and proton density weighted images. Twelve hours after renal arterial ligation. T2 relaxation time, CMC, CCC, and MMC returned to normal values and these findings were believed to be due to congestion and collateral blood supply. In renal ischemia, the most useful MRI findings for diagnosis were fund to be changes of CCC and MMC on T2 weighted image, and T2 relaxation time of the cortex in the ischemic kidney.
Diagnosis ; Estrogens, Conjugated (USP) ; Financial Management ; Ischemia* ; Kidney ; Ligation* ; Magnetic Resonance Imaging* ; Protons ; Rabbits ; Reference Values ; Relaxation ; Renal Artery*

This study was designed to evaluate the potential applications of magnetic resonance imaging for the diagnosis of early and sequential changes of acute renal ischemia. Renal isehmia was induced in seventeen rabbits by surgical ligation of the left renal artery. Magnetic resonance imaging(MRI) was performed with a 2.0T super conductive MR system and s pin-echo technique was used with echo times(TE) of 30 and 80 msec and repetition times(TR) or 0.5 and 2.5 seconds. Kidneys were evaluated before and up to 48 hours after left renal artery ligation, and the spin echo images were analyzed for intensity difference and T1, T2 relaxation times between the cortex and the medulla of both kidneys. After one, and one and half hour following ligation of the left renal artery, the kidneys showed a 4-20% decrease in the left cortex compared to the right cortex contrast uptake(CCC) (P<01). There was a 14-29% decrease in left medulla to right medulla contrast uptake(MMC) (P<01). A 29-147% increase in contrast uptake was noted when the left cortex was compared to the left medulla(P<05). There was a 51-68% decrease in CMC of the right kidney (P<05) on three different spin echo images. In the cortex of the left kidney, T2 relaxation time decreased 14% (P<01). CCC and MMC showed more prominent changes than CMC, and sequential changes of CCC and MMC were most prominent on T2 weighted images with TR = 2.5sec and TE=80msec when compared with T1 weighted and proton density weighted images. Twelve hours after renal arterial ligation. T2 relaxation time, CMC, CCC, and MMC returned to normal values and these findings were believed to be due to congestion and collateral blood supply. In renal ischemia, the most useful MRI findings for diagnosis were fund to be changes of CCC and MMC on T2 weighted image, and T2 relaxation time of the cortex in the ischemic kidney.
Diagnosis ; Estrogens, Conjugated (USP) ; Financial Management ; Ischemia* ; Kidney ; Ligation* ; Magnetic Resonance Imaging* ; Protons ; Rabbits ; Reference Values ; Relaxation ; Renal Artery*

Positive end expiratory pressure (PEEP) has been used to prevent and treat venous air embolism in patients in the sitting position undergoing neurosurgical operations However, the safety of PEEP has recently been questioned, because of concern that PEEP might incresae right atrial pressure more than left atrial pressure, thereby predisposing patients with a probe-patent foramen ovale to paradoxical air embolism. But it is controversial and needs further evaluation. In a prior study in rabbits with various venous air volume, the authors found that suddenly decreased mean arterial pressure and arterial PO2 showed peaked P wave, arrhythmias, ST depression and premature ventricular contraction on the EKG. In the present study, the authors examined the effects of 0, 3 and 5 cmHO PEEP (PEEP0, PEEP3, and PEEP5,) in 30 rabbits positioned supine with intravenous 0.5 mg/kg of air injection. In a prior study, we found that 0.5 mg/kg of air injection has serious change but showed low mortality. The measurements were obtained by the precordial doppler ultrasound, end tidal PCO2, mean arterial pressure, arterial PCO2, arterial PO2, and EKG. The results were as follow; 1) Doppler ultrasound was the most sensitive device even with PEEP and end tidal PCO2 was higher with PEEP5 than with PEEP3 and PEEP0 after suddenly decreased by the air injection. In PEEP statistic singnificance was observed (p<0.05). 2) The mean arterial pressure was significantly decreased by the air injection in PEEP0 PEEP3 and PEEP5 but there were no significant differences in all groups. It seemed likely due to low PEEP. 3) In PaCO2, slightly higher PaCO2 was observed in PEEP5 than in PEEP3 and PEEP. No statistic significance was obaerved. In PaO2, significant decrease was observed in all group but in PEEP3 small decrease was observed. 4) The incidence of bradycardia and ST depression was less in PEEP3 and PEEP5 than in PEEP0. In PEEP5, PVC was appeared relatively short duration than other group due to the air lock phenomenon. It was suspeeted that air was more freely passed according to increased right ventricular pressure after air lock. Authors conclude that PEEP has a benefit effect for the prevention of venous air embolism but after the occurence there is little benefit in the treatment.
Arrhythmias, Cardiac ; Arterial Pressure ; Atrial Pressure ; Bradycardia ; Depression ; Electrocardiography* ; Embolism, Air* ; Foramen Ovale ; Humans ; Incidence ; Mortality ; Positive-Pressure Respiration ; Rabbits* ; Ultrasonography ; Ventricular Premature Complexes ; Ventricular Pressure

No abstract available.
Renal Dialysis* ; Urea*