A 37-year-old male presented with a mass measuring 2.5 cm in size in the midbrain and obstructive hydrocephalus, which had manifested as a headache and dizziness. Magnetic resonance (MR) imaging of the brain showed intermediate enhancement on T1-weighted MR imaging and a high intensity of enhancement on T2-weighted MR. Neurosurgeons performed an occipital craniotomy with partial removal of the tumor and the postoperative diagnosis was a pineal parenchymal tumor with intermediate differentiation. He had undergone irradiation with 54 Gy of radiation on 27 fractions for removal of the remaining tumor approximately one month after surgery. However, in follow-up imaging performed four months after radiotherapy, a remnant mass in the superoposterior aspect of the midbrain was found to have extended to the hypothalamus and the third ventricle. He was treated with six cycles of procarbazine, lomustine, vincristine chemotherapy. At five months since the completion of chemotherapy, the brain MR imaging showed no evidence of any remaining tumor and he no longer displayed any of his initial symptoms.
Adult ; Brain ; Craniotomy ; Dizziness ; Follow-Up Studies ; Headache ; Humans ; Hydrocephalus ; Hypothalamus ; Lomustine ; Magnetics ; Magnets ; Male ; Mesencephalon ; Pinealoma ; Procarbazine ; Third Ventricle ; Vincristine

PURPOSE: Influenza B-associated myositis is an infrequent and poorly known complication of influenza B virus infection in children. The aim of this study was to describe the clinical and laboratory manifestations, diagnosis, and outcomes of influenza B-associated myositis in Korean children. METHODS: A retrospective analysis was conducted in patients aged <16 years who had been diagnosed with influenza B-associated myositis at the Catholic University Bucheon Saint Mary's Hospital between April 2010 and May 2010. RESULTS: Overall, 16 cases were analyzed. Influenza B-associated myositis typically occurred in preschool-aged children with a 3:1 male predominance. The mean age was 4.6 years (range, 3 to 7 years). The median interval between onset of influenza infection and onset of influenza B-associated myositis was 3 days (range, 1 to 7 days). Only the calf muscles were involved in all patients. Blood creatine phosphokinase concentration was elevated in most patients. Median duration to clinical recovery was 3 days (range, 1 to 4 days). No patient had rhabdomyolysis, renal failure, or related sequelae. All patients had a favorable outcome without administration of antiviral drugs. CONCLUSION: Clinical and laboratory findings of influenza B-associated myositis are very characteristic and allow a rapid diagnosis during the influenza season. Outcomes of influenza B-associated myositis are good with only proper supportive treatment.
Aged ; Child ; Creatine Kinase ; Humans ; Influenza B virus ; Influenza, Human ; Male ; Muscles ; Myositis ; Renal Insufficiency ; Retrospective Studies ; Rhabdomyolysis ; Saints ; Seasons

PURPOSE: Observational results on seasonal variation of interdialytic weight gain in patients with end-stage renal disease treated with hemodialysis are controversial till now. There has been no report about it for Korean patients. The relation of interdialytic weight gain and climatic factors was studied in one region of Korea. METHODS: From Jan. 2002 to Dec. 2002, fifty patients receiving conventional and regular hemodialysis three times a week in Hanyang University Hospital, Seoul, Korea, where there is distinct seasonal variation in monthly temperature, relatively humidity, and duration of sunshine, were analyzed. For each patient, body weight and blood pressure were measured before and after each dialysis treatment three times per week for one year. The monthly mean values for interdialytic weight gain and blood pressure in relation to the monthly values for climatic factors were then analyzed. RESULTS: The seasonal pattern of interdialytic weight gain was evident throughout the one-year period. The monthly mean temperature was highest in July and lowest in January and mean monthly interdialytic weight gain was lowest in July and highest in December. The difference of mean interdialytic weight gain between July and January was significant (p< 0.05). Interdialytic weight was inversely correlated with monthly mean temperature, mean maximal temperature, and mean minimal temperature(r= -0.721 with p=0.008, r=-0.714 with p=0.009, and r= -0.717 with p=0.009, respectively) but not with mean relatively humidity and duration of sunshine. Mean predialysis systolic and diastolic blood pressure were not related to changes in temperature, relative humidity, and duration of sunshine. CONCLUSION: Interdialytic weight gain in patients with end-stage renal disease treated on hemodialysis was correlated with seasonal variation in temperature, with higher values in the winter and lower values in the summer. It would be better to consider this finding to treat hemodialysis patients.
Blood Pressure ; Body Weight ; Dialysis ; Humans ; Humidity ; Kidney Failure, Chronic ; Korea ; Renal Dialysis* ; Seasons* ; Seoul ; Sunlight ; Weight Gain*

BACKGROUND: Crescentic glomerulonephritis is expressed pathologically by crescent formation in Bowman's capsule and clinically by rapidly progressive loss of renal function. The pathologic experience of crescentic glomerulonephritis in one institution was analyzed here. METHODS: We classified 25 cases of crescentic glomerulonephritis patients into 4 categories and reviewed the cases pathologically and clinically. RESULTS: We found no case with group I (anti- GBM disease), 8 cases in group II (immune complex glomerulonephritis) including 3 patients with IgA nephropathy, 2 patients with Henoch-Sch nlein purpura and 3 patients with APSGN, 12 cases in group III (ANCA-associated glomerulonephritis) including 7 patients with microscopic polyangitis, 4 patients with Wegener's granulmatosis and 1 patient with ANCA GN, and 5 cases in group IV (idiopathic crescentic glomerulonephritis). The mean ages of patients with group II, III, and IV were 32.0, 59.3 and 39.0 years old, respectively, and mean serum creatinine levels at the time of biopsy were measured as 9.1, 5.2, 8.8 mg/dL in each group. On light microscopic findings, the frequency of crescents in glomeruli was 64.4% in group II, 43.7% in group III, and 51.2% in group IV. The score of infiltration into tubules of inflammatory cells was 0.8 in group II, 0.4 in group III, and 0.6 in group IV and the score of fibrosis in interstitium was 1.0 in group II, 0.8 in group III and 1.2 in group IV. The score of atherosclerosis in arteries was 1.4, 0.9 and 1.6 in each group. CONCLUSION: We conclude that the precise diagnosis and classification of crescentic glomerulonephritis by an early renal biopsy and clinical assessments are important in the management of rapidly progressive (crescentic) glomerulonephritis. Since the number of the cases was not so enough, we could not analyze the statistical significance between morphologic differences of each group of crescentic glomerulonephritis, but if more cases were collected, acknowledgements of differences and prognostic factors in pathologic findings could be possible.
Antibodies, Antineutrophil Cytoplasmic ; Arteries ; Atherosclerosis ; Biopsy ; Bowman Capsule ; Classification ; Creatinine ; Diagnosis ; Fibrosis ; Glomerulonephritis* ; Glomerulonephritis, IGA ; Humans ; Purpura

PURPOSE: To evaluate the clinical and urodynamic significance of the beaking sign at cystography in patients with stress urinary incontinence (SUI). MATERIALS AND METHODS: We retrospectively reviewed the cystograms of 253 patients with SUI, defining the beaking sign as the triangular contrast collection below the bladder base in the resting state without overt leakage. Various clinical parameters including patient age, symptom duration, parity, the one-hour pad test, and urodynamic study data including Valsalva leak point pressure (VLPP) and maximal urethral closing pressure (MUCP) were compared between the beaking-positive and the beaking-negative group. The distribution of Blaivas type in SUI between these two groups was also analysed. RESULTS: The beaking sign was observed in 153 patients (60%). Those who were older and showed greater parity more often belonged to the beaking-positive group than the beaking-negative (p<0.05). Both VLPP and MUCP were significantly lower in the beaking-positive group than in beaking-negative group (p=0.03; p=0.01, respectively). Type-0 or -I SUI was more common in the beaking-negative group, while the frequency of other types was similar between the two groups. CONCLUSION: The beaking sign has clinical and urodynamic significance, reflecting functional deficiencies of the intrinsic sphincter, and may possibly be regarded as an additional parameter in the planning of treatment.
Animals ; Beak* ; Female ; Humans ; Parity ; Retrospective Studies ; Urinary Bladder ; Urinary Incontinence* ; Urodynamics

OBJECTIVE: Cyclosporine(CsA) and tacrolimus, albeit different in structure, exert immunosuppressive effect by similar mechanism. Although most of clinical manifestations, including nephrotoxicity, are similar in the patients using these drugs, there are some differences including gum hyperplasia, neurotoxicity, and hepatic fibrosis between two drugs. There are several reports about association between reactive oxygen species(ROS) and CsA. In contrast, tacrolimus is known to decrease ROS in central nervous system. Thus, we investigated the possibility of different effects of tacrolimus and CsA on the generation of ROS, on the synthesis and degradation of collagen. METHODS: Experiments were done in primary cultured mesangial cells between 4th and 8th passages. CsA was added to the culture dishes in different concentration(making final CsA concentration of 0, 2, 4, 8 microgram/milliliter) and N-acetylcysteine(NAC) was also added in another mesangial cell culture at 4 microgram/milliliter of CsA concentration; tacrolimus was added in similar pattern(making final tacrolimus concentration of 0, 0.1, 0.2, 0.4 microgram/milliliter, NAC in 0.2 microgram/milliliter of tacrolimus concentration). RESULTS: No significant decrease in viability was noted in both cell groups, but growth retardation was weak in tacrolimus treated cells comparing with CsA treated cells. By flow cytometry, we could find the generation of ROS in CsA treated cells, but not in tacrolimus treated cells. In RT-PCR, there is no significant difference in m-RNA expression for a number of molecules including collagen III, MMP-2, TIMP-2, MT1-MMP in either CsA treated cells or tacrolimus cells. But in zymogram, MMP-2 activities were decreased at higher CsA concentration, then increased with addition of NAC. In tacrolimus cells, MMP2 activity was not changed at 0.1 and 0.2 microgram/milliliter; but, at the concentration of 0.4 microgram/milliliter, changed and not reversed by NAC. MMP-9 activity was similar in both cells. CONCLUSION: We could find ROS generation in CsA treated human mesangial cells, but not in tacrolimus treated cells. We think this difference resulted in the decrease of post-transcriptional MMP-2 activity in CsA treated cells and we also think tacrolimus cells in our experiments were not influenced by ROS. From these results, tacrolimus and CsA are different in the generation of ROS that have some effects in the matrix accumulation in mesangial cells. These result does not mean that tacrolimus is superior to CsA in nephrotoxicity, because nephrotoxicity is similar between two drugs. In conclusion, the mechanisms of nephrotoxicity are different between CsA and tacrolimus.
Central Nervous System ; Collagen ; Cyclosporine* ; Extracellular Matrix* ; Fibrosis ; Flow Cytometry ; Gingiva ; Humans* ; Hyperplasia ; Matrix Metalloproteinase 14 ; Mesangial Cells* ; Oxygen ; Tacrolimus* ; Tissue Inhibitor of Metalloproteinase-2

Parvovirus B19 infection is known to cause chronic anemia in immunocompromised hosts, including organ transplant recipients. We report a case of pure red cell aplasia caused by parvovirus B19 in renal transplants. The patient was 16-year-old male who was diagnosed as chronic renal failure 7 years ago and had been on hemodialysis twice a week. He got renal transplantation in June 1999. But anemia was not improved in first postoperative period. On admission hemoglobin was 43.0 g/L, hematocrit was 12.7%. The bone marrow biopsy revealed severe erythroid hypoplasia with giant pronormoblasts. The pronormoblasia with giant prominent intranuclear inclusions, characteristic of parvovirus B19 infection. The parvovirus B19 PCR and anti-parvovirus B19 IgM were positive. The patient was treated with intravenous immunoglobulin and then reticulocyte count was increased 5 days later. Hemoglobin level restored to 104 g/L teo months later.
Adolescent ; Anemia ; Biopsy ; Bone Marrow ; Erythroblasts ; Hematocrit ; Humans ; Immunocompromised Host ; Immunoglobulin M ; Immunoglobulins ; Intranuclear Inclusion Bodies ; Kidney Failure, Chronic ; Kidney Transplantation ; Male ; Parvovirus* ; Polymerase Chain Reaction ; Postoperative Period ; Red-Cell Aplasia, Pure* ; Renal Dialysis ; Reticulocyte Count ; Transplants

OBJECTIVE: Treatment with cyclosporine(CsA) for a long-term period may induce renal glomerulosclersosis and interstitial fibrosis. Reactive oxygen species(ROS) seems to be involved in the process of glomerulosclersosis and interstitial fibrosis. We investigated the effect of CsA on the generation of ROS and extracellular matrix accumulation in cultured human mesangial cells. We also studied the relationship between ROS formation and extracellular matrix and the effect of antioxidant on ROS formation and/or extracellular matrix degradation. METHODS: Mesangial cells were treated with varying dose of Cyclosporine(0, 2.5, 5, 7.5 and 10microgram/ mL) and also with cyclosporine(5microgram/mL) plus N- acetylcysteine(1mM). ROS was measured by flow cytometric analysis. mRNA expression of MMP-2, TIMP-2, MT1-MMP and collagen III was assessed by RT-PCR method. MMP-2 activity was measured by gelatin zymography. RESULTS: No significant difference was noted in cell viability with each CsA concentration. CsA inhibited the cell proliferation in a dose dependent manner and induced the expression of ROS. Antioxidant NAC reversed the effect of cyclosporine. CsA had no effect on the mRNA expression of collagen III, MMP-2, TIMP-2, MT1-MMP. However CsA decreased the MMP-2 activity in a dose dependent manner, which was also reversed by NAC. CONCLUSION: Cyclosporine-induced ROS may be associated with the extracellular matrix accumulation, that is glomerulosclersosis and interstitial fibrosis by inhibiting the cell proliferation and by decreasing the degradation of extracellular matrix. Antioxidant, at least in vitro, may prevent some of the adverse effects of CsA on renal function.
Cell Proliferation ; Cell Survival ; Collagen ; Cyclosporine* ; Extracellular Matrix* ; Fibrosis ; Gelatin ; Humans* ; Matrix Metalloproteinase 14 ; Mesangial Cells* ; Oxygen ; RNA, Messenger ; Tissue Inhibitor of Metalloproteinase-2

Uterine myoma is the most common neoplasm of women and occurs in up to 20% of reproductive women. Leiomyoma may undergo secondary degeneration such as hyaline degeneration, sarcomatous change, and necrosis. This report presents a case of acute cortical necrosis(ACN) and disseminated intravascular coagulation caused by a uterine myoma necrosis. The uterine myoma of this patient was diagnosed and observed 10 months ago at other hospital. She complained of low abdominal pain with vaginal bleeding and anuria from the previous day. The laboratory findings were as follows:platelets 49,000/ mm3; prothrombin time 38%(normal control, 12 seconds); aPTT 41seconds(normal control, 26seconds); fibrinogen 81mg/dL; FDP<10 microgram/mL; BUN/sCr 23/ 2.9mg/dL. Acute cortical necrosis was diagnosed by radiologic grounds including abdominal computerized tomography(CT), which demonstrated decreased cortical contrast enhancement, normal medullary contrast enhancement, and preserved cortico-medullary differentiation. The patient was treated conservatively and underwent a CAPD operation later in her hospital course. On the 135th day after diagnosis, the ultrasonography, done in outpatient department, revealed the decreased size of both kidneys, respectively 7.5cm and 7.8cm. Urine output was about 800cc/day and the creatinine clearance of this patient was 9.2mL/ min.
Abdominal Pain ; Acute Kidney Injury ; Anuria ; Creatinine ; Diagnosis ; Disseminated Intravascular Coagulation ; Female ; Fibrinogen ; Humans ; Hyalin ; Kidney ; Leiomyoma* ; Necrosis* ; Outpatients ; Peritoneal Dialysis, Continuous Ambulatory ; Prothrombin Time ; Ultrasonography ; Uterine Hemorrhage

We studied the chronic renal allograft dysfunction in Korean renal transplants from 1 year after transplantation to 5 years. We evaluated renal function by simply using the reciprocal serum creatinine level and sought to find factors affecting the value of the reciprocal serum creatinine and graft survival, and changes of the slope of reciprocal serum creatinine. We also estimated the reciprocal serum creatinine from demographic parameters and routine laboratory results. This study included 114 patients, 87 male and 27 female who underwent renal transplantations and had functioning allografts for more than 18 month after transplantation. The results were as follows. 1) The reciprocal serum creatinine level decreased slowly and linearly. 2) There were many factors related to the reciprocal creatinine, including blood urea nitrogen, serum uric acid level, age of donors, sex of recipients, presence of acute rejecton, age of recipient, serum phosphorus, white cell count in blood, cyclosporine level in blood, hemoglobin level, posttransplantation period. We could derive the estimated reciprocal serum creatinine from data of the patients. 3) The age of the recipient and cyclosporine level at 1 year after transplantation affected the slope of the reciprocal serum creatinine during follow-up time. 4) There were 16 graft loss, including 3 functioning graft loss and 13 graft loss due to chronic allograft dysfunction. 5) Besides creatinine and BUN level at 1 year, higher blood pressure and proteinuria and lower hemoglobin levels at 1 year after transplantation were related to the graft loss from chronic allograft dysfunction. 6) There were more chronic allograft loss in patients who had lower actuarial reciprocal serum creatinine than estimated reciprocal serum creatinine. Because follow-up time was relatively short and there were only mild increases in serum creatinine level in our study, follow up of our patients for a longer-term period is required to find other factors affecting the renal allograft dysfunction.
Allografts* ; Blood Pressure ; Blood Urea Nitrogen ; Cell Count ; Creatinine ; Cyclosporine ; Female ; Follow-Up Studies ; Graft Survival ; Humans ; Kidney Transplantation ; Male ; Phosphorus ; Proteinuria ; Tissue Donors ; Transplants ; Uric Acid