Eosinophilic cholecystitis is a rare disease characterized by transmural leukocyte infiltration composed of more than 90% eosinophils. Eosinophilic cholecystitis is clinically indistinguishable from ordinary cholecystitis, and as a rule it leads to cholecystectomy. We report a case of idiopathic eosinophilic cholecystitis treated with steroids. A 75-year-old woman presented with a classic history of acute cholecystitis and a peripheral eosinophilia of 41.8%. There was no evidence of allergy or parasitic infestation. An abdominal ultrasonography and computed tomography (CT) scan showed an edematous, thickened gallbladder wall, but no gallstones. There was no evidence of eosinophilic infiltration in other organs. Cholecystectomy was not performed because the patient refused surgical management. However, fever, abdominal pain, and peripheral eosinophilia persisted despite antibiotic and conservative therapy. Therefore, we attempted treatment with prednisolone. A week later, the symptoms disappeared and the peripheral eosinophilia normalized.
Abdominal Pain ; Aged ; Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute ; Eosinophilia ; Eosinophils ; Female ; Fever ; Gallbladder ; Gallstones ; Humans ; Hypersensitivity ; Leukocytes ; Prednisolone ; Rare Diseases ; Steroids

Clostridium difficile is the most common nosocomial pathogen of the gastrointestinal tract. Pseudomembranous colitis occurs as a result of a severe inflammatory response to Clostridium difficile toxins. Pseudomembranous colitis is an increasingly frequent cause of morbidity and mortality among elderly hospitalized patients. Diarrhea is the most common manifestation. According to the literature, stools are almost never grossly bloody, and range from soft and unformed to watery or mucoid in consistency. We now report the cases of three patients with pseudomembranous colitis whose main clinical manifestation was hematochezia.
Aged ; Clostridium difficile ; Diarrhea ; Enterocolitis, Pseudomembranous ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Humans

Rendu-Osler-Weber disease is characterized by hereditary transmission, and by the presence of multiple telangiectases of the skin, mucous membranes, and internal organs. We present a case of Rendu-Osler-Weber disease with bleeding from gastric telangiectases that was successfully treated by endoscopy with the use of argon plasma coagulation (APC). A 65-year-old woman presented with melena. Endoscopy disclosed multiple telangiecatses in the whole stomach. APC was performed at an output of 50 W and with an argon gas flow rate of 2 L/min. Only multiple ulcers at the treated sites were seen 7 days after the procedure and fibrotic scars with contracted mucosal folds without active bleeding signs were noted 2 months later.
Aged ; Argon ; Argon Plasma Coagulation ; Cicatrix ; Contracts ; Endoscopy ; Female ; Hemorrhage ; Humans ; Melena ; Mucous Membrane ; Skin ; Stomach ; Telangiectasia, Hereditary Hemorrhagic ; Telangiectasis ; Ulcer

BACKGROUND/AIMS: Left colonic diverticulitis is relatively common in western nations. Although the incidence of colonic diverticulitis is increasing in Korea, very little is known regarding its clinical characteristics in korean patients. METHODS: We compared the clinical characteristics of right versus left colonic diverticulitis via the retrospective review of 37 cases treated at the Kyungpook National University Hospital, Korea, from July 1998 to December 2006. Diagnosis was confirmed via computed tomography (CT), barium study, colonoscopy, and/or surgery. RESULTS: Eighteen men and 19 women (median age, 45.0 years; range, 21~75 years) were included. The ratio of right to left colonic diverticulitis was 30:7. The male to female ratio for right colonic diverticulitis was 16:14 and the median age was 38.5 years (range, 21~72 years). The male to female ratio for left colonic diverticulitis was 2:5 and the mean age was 57.0 years (range, 45~75 years). Left colonic diverticulitis was more frequently associated with intestinal perforation (p=0.001) and old age (p=0.005). Surgical intervention was more common in left versus right colonic diverticulitis (p=0.009). CONCLUSIONS: These results indicate that although left colonic diverticulitis is relatively rare among koreans, it develops later in life and is more frequently complicated than right colonic diverticulitis.
Barium ; Colon ; Colonoscopy ; Diverticulitis, Colonic ; Female ; Humans ; Incidence ; Intestinal Perforation ; Korea ; Male ; Retrospective Studies

A 68-year-old woman visited our emergency center because of hematemesis. An emergency endoscopy showed an exposed vessel with blood flowing into the upper esophagus. Angiography revealed the presence of extravasation of contrast at the level of the aortic arch and a tortuous fistula between the aortic arch and esophagus. Chest computerized tomography demonstrated the presence of an aortoesophageal fistula and air bubbles inside the fistula. The patient had emergency surgery and the intraoperative findings revealed an aortoesophageal fistula and necrotic materials with a foul odor at the upper esophagus. Primary closure and wrapping of the aorta were performed, but primary closure of the esophagus was impossible because of necrosis. An aortoesophageal fistula is a rare but life-threatening disease. As shown for this patient, an exposed vessel without ulceration at the upper esophagus should raise suspicion of an aortoesophageal fistula and a CT scan or angiography should be performed before endoscopic intervention.
Aged ; Angiography ; Aorta ; Aorta, Thoracic ; Emergencies ; Endoscopy ; Esophagus ; Female ; Fistula* ; Hematemesis ; Humans ; Necrosis ; Odors ; Thorax ; Tomography, X-Ray Computed ; Ulcer

BACKGROUND: The aim of this study is to evaluate success rate and patency rate after percutaneous transluminal angioplasty (PTA) and to determine the factors affecting patency rate afterPTA in the management of insufficient arteriovenous fistula of hemodialysis patients. METHODS: Ninety-two cases of insufficient arteriovenous fistulae in 73 hemodialysis patients underwent angiography of the fistula and were treatedby PTA (native AVF: 67 cases, AV graft: 10 cases, central vein: 15 cases). The initial success rate and complications of PTA were evaluated. All patients were divided into two groups according to the age, sex, the duration of hemodialysis, a history of diabetes mellitus, the numbers of AVF operation, and the presence or absenceof thrombus. The patency rate was compared with the Kaplan-Meier method with log-rank test. To determine the clinical factors that affect vascular access failure rate, Cox regression method was used. RESULTS: The initial success rate of PTA was 78.2% (72/92). The patency rate after successful PTA was 80.0% at 6 months, and 73.2% at 12 months. The patency rate after successful PTA was significantly lower in cases which had two or more AVF operation (62.3% and 48.5% at 6 and 12 months) than just one (87.8% and 80.5% at 6 and 12 months). The most common PTA related complications were vessel spasm (3.9%) and hematoma (3.9%). CONCLUSIONS: The numbers of AVF operation was the only risk factor which affected the patency rate.
Angiography ; Angioplasty* ; Arteriovenous Fistula* ; Diabetes Mellitus ; Fistula ; Hematoma ; Humans ; Renal Dialysis ; Risk Factors ; Spasm ; Thrombosis ; Transplants ; Veins

Cytomegalovirus (CMV) remains an important pathogen in organ transplant patients. However, cutaneous lesions are rare manifestation of systemic CMV infection. We report a case of CMV panniculitis in a 47-year-old renal transplant recipient. She admitted due to fever, local pain in the left pelvic area, and erythematous tender palpable mass for 2 weeks. Twenty years ago, she underwent renal transplantation and had taken azathioprin 100 mg and prednisone 10 mg daily. Serum creatinine had been preserved between 2.5 and 3.5 mg/dL. Bacterial, fungal, and AFB cultures of skin lesion and drained pus were negative. CMV antigenemia was noted. Skin biopsy revealed multinucleated dermal histiocytes and positive for CMV antibody by immunohistochemical staining. Polymerase chain reaction testing of skin tissue and drained pus revealed CMV DNA. She was treated with ganciclovir for four weeks and skin lesion was completely resolved without recurrence.
Biopsy ; Creatinine ; Cytomegalovirus* ; DNA ; Fever ; Ganciclovir ; Histiocytes ; Humans ; Kidney Transplantation* ; Middle Aged ; Panniculitis* ; Polymerase Chain Reaction ; Prednisone ; Recurrence ; Skin ; Suppuration ; Transplantation ; Transplants

BACKGROUND: TGF-beta is involved in the pathogenesis of various kidney diseases characterized by glomerulosclerosis and tubulointerstitial fibrosis. It is reported that urinary TGF-beta reflects the grade of interstitial fibrosis in glomerular disease. Here, we evaluated the relationship between the histological findings and beta ig-h3 in IgA nephropathy. METHODS: In patients with IgA nephropathy, we measured blood pressure (BP), serum creatinine, 24-hour urinary protein excretion (UTp), creatinine clearance (Ccr), serum and urine beta ig-h3 levels, and urine TGF-beta levels at the time of renal biopsy. Histologic findings were semiquantitively scored according to the extent of glomerulosclerosis (GG), tubulointerstitial fibrosis (TIG) and hyaline arteriolosclerosis (HA) by the criteria suggested by To. Semiquantitive scoring of immunohistochemistry for beta ig-h3 was done. RESULTS: Mean BP 95.4+/-14.5 mmHg, serum creatinine 1.06+/-0.35 mg/dL, 24-hour UTp 1, 423+/-1, 439 mg/day, and Ccr was 97.84+/-59.73 mL/min. The number of patients that showed GG 3 were 5, GG 2 was 1, GG 1 were 12. And, the number of patients that showed TIG 3 were 2, TIG 2 were 5, TIG 1 were 11. HA was shown in 4 patients. beta ig-h3 immunostaining was observed in glomerular Bowman's capsules and basement membrane of proximal tubules. The degree of beta ig-h3 immunostaining was positively correlated with the degree of glomerulosclerosis (r=0.72, p<0.001), interstitial fibrosis (r=0.91, p<0.001), serum creatinine (r=0.592, p<0.05) and Ccr (r=-0.626, p<0.05), but not with 24-hour UTp. Serum and urine beta ig-h3 levels did not correlate with any of these parameters. CONCLUSION: Renal beta ig-h3 expression in patients with IgA nephropathy may be related to glomerulosclerosis and interstitial fibrosis. However, urinary beta ig-h3 levels did not represent the pathologic changes of IgA nephropathy. Long-term study to measure renal beta ig-h3 expression and urinary beta ig-h3 is required to elucidate the roles of beta ig-h3 in IgA nephropathy.
Arteriolosclerosis ; Basement Membrane ; Biopsy ; Blood Pressure ; Capsules ; Creatinine ; Fibrosis ; Glomerulonephritis, IGA* ; Humans ; Hyalin ; Immunoglobulin A* ; Immunohistochemistry ; Kidney Diseases ; Transforming Growth Factor beta ; Uridine Triphosphate

PURPOSE: The medical records of 524 renal recipients who have been transplanted until December 2000 in our hospital were reviewed in order to compare the incidence of the surgical and medical complications according to their different treatment protocols. METHODS: To compare the surgical complications, the recipients were divided according to their ureter reconstruction method and donor type. Group 1; living donor and modified Politano method are done. Group 2; living donor but an extravesical ureteroneocystostomy. Group 3; cadaver donor and an extravesical anastomosis. Regarding the medical complications, recipients who received Sandimmun based immunosuppression (with steroid and/or azathioprine) were grouped as 1, those recipients with Neoral based immunosuppression (with steroid and/or cellcept) were grouped as 2, and re-cipients immunosuppressed by prograf based immunosuppression (with steroid and/or cellcept) were grouped as 3. The incidence of complications and adverse effects in each group and per recipient were described as the percentage of the total incidence. RESULTS: Most of the surgical complications including an allograft rupture, ureteral fistula, lymphocele and reoperation due to bleeding were developed during the first month after transplantation but decreasing in group 2 and 3. An ureter stricture and renal artery stenosis developed after 6 months. Infectious complications were developed in 60.7% of recipients and among them, a viral infection occurred in 41.9% which was followed by bacterial and fungal infection. However, the incidence of infection also decreased in group 3. Herpes infections were the most common in viral infection and their incidence showed a dual peak (within 6 months and after 1 year). The recurrence of the original disease, mostly a focal sclerosing glomerulosclerosis, and de novo cancer showed lower incidence in group 3 but the follow up duration should be considered. Tremor and hirsutism are two of the most common adverse effects but showed a different incidence in group 3. Some side effects such as diarrhea, post-transplant diabetes were more common in group 3 than in group 1 and 2. CONCLUSION: The decreasing incidence of complications and the drug side effects in recent days might be due to a better understand of the surgical procedures and the development of new immunosuppressants. However, new side effects or toxicity by new immunosuppressant must be considered seriously.
Allografts ; Cadaver ; Clinical Protocols ; Constriction, Pathologic ; Cyclosporine ; Diarrhea ; Fistula ; Follow-Up Studies ; Hemorrhage ; Hirsutism ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Incidence ; Kidney Transplantation* ; Living Donors ; Lymphocele ; Medical Records ; Recurrence ; Renal Artery Obstruction ; Reoperation ; Rupture ; Tacrolimus ; Tissue Donors ; Tremor ; Ureter

Kidney Transplantation* ; Respiratory Distress Syndrome, Adult ; Tuberculosis, Miliary*