The Expression of C4d and CD20 in Graft Kidney with Acute Rejection / 대한이식학회지

PURPOSE: The presence of C4d in peritubular capillaries (C4d (PTC)) as a diagnostic in-situ marker of acute humoral rejection and CD20 as marker of B-cell deposition in graft kidney has been reported to be related to steroid resistance and poor outcome. In this retrospective study, we evaluated the clinical significance of C4d and CD20 in allograft renal biopsies by immunohistochemistry technique. And we also evaluated the relationships between C4d and CD20 positive B lymphocytes. METHODS: We studied 22 patients who had been biopsied for suspected acute rejection. Biopsies were classified by updated Banff 97 criteria. Of the 22 cases, borderline rejection and Banff 1A were 11 cases respectively and no case had a vascular lesion. Paraffin sections were stained with monoclonal antibodies (anti-C4d and -CD20) using an immunohistochemistry technique and the results of immunohistochemistry were analyzed by clinical data. RESULTS: Of the 22 cases, 22.7% (5/22) showed diffuse and 40.9% (9/22) showed focal C4d positivity in peritubular capillaries. The grafts failed to survive in 20% (1/5) of the diffuse (P), 44.4% (4/9) of the focal, and 0% (0/8) of the negative group for 2 years since postbiopsies, however, the C4d staining was not statistically related to graft loss and graft survival rates (P=0.091, P=0.106 respectively). The C4d positivity was significantly related to the level of serum creatinine (P=0.042) and to steroid pulsing therapy resistance (P=0.030). However C4d deposition was not associated with recipient gender, age, type of donor (living vs deceased), HLA matching, induction, and Banff classification. On the CD20 immunostaining, 50.0% (11/22) showed negative reactivity, 9.1% (2/22) one nodule, 40.9% (9/22) 2 nodules. The presence and the number of CD20 positive nodules were not correlated to the C4d clinical data. But, the degree of C4d staining was statistically related with the presence of CD20 positive nodules (P=0.029). CONCLUSION: The peritubular capillary C4d is clinically important however, not likely a significant predictor of grafts survival rates in mild rejection. The clinical implication of CD20 positive B lymphocyte nodules in acute rejection was not demonstrated in this study. But, CD20 positive B lymphocyte may be a positive linkage with C4d and participate in humoral rejection.

Dysfunctional Contracted Bladder in Renal Transplantation / 대한이식학회지

PURPOSE: This report presents our experience of the renal transplatation of a long term dysfunctional contracted bladder and its outcome. METHODS: Between March 1996 and May 2006, 425 cases of renal transplantation were performed in our medical center. We found 14 chronic renal failure patients having dysfunctional contracted bladder (DFCB) that was diagnosed through the preoperative voiding cystourethrogram. DFCB was defined as the maximal urinary bladder volume less than 100 mL. No surgical or medical preparation was done before and after renal transplantation. In 8 out of 14 cases, extravesical ureteroneocytostomy (EVUC) was conducted and the Lich's EVUC was done for the other 6 cases. Double J ureteral stent was not employed in any cases. RESULTS: The mean age of the recipients was 41.4 years. The mean capacity of these bladder was 72.1 mL (range 20 to 100 mL). Of the 14 cases, thirteen had living donor related transplantation and one received cadaveric kidney. Postoperative complication was occurred in one case, which was bleeding. There was no evidance of urinary tract complication. All patient excluding of one patient who had the episodesof chronic rejection were stable throughout the entire follow up period. CONCLUSION: DFCB in renal translpantation had no adverse effect on successful outcome in transplant operation deposite no preoperative preparation, especially cadaveric donor transplatation, it may, however, need a delicate surgical skills to perform EVUC.

Experimental Fusiform Aneurysm Model at Common Carotid Artery in Rat

PURPOSE: An ideal suturing material should be strong, easy to handle, should produce minimal tissue reaction and finally should disappear without a trace. Various micro-vascular suture materials have been produced in the past several decades in order to meet these demands. We have used nylon suturing material in experimental microsurgery because it is less expensive than polypropylene. After carotid artery end-to-end anstomosis, we found fusiform aneurysm incidentally. In this study 9-0 nylon (group I) and 9-0 polypropylene (group II) were compared to 10-0 nylon (group III), and 10-0 polypropylene (group IV) in order to survey the incidence of aneurysmal development in each material for use in microvascular surgery. METHOD: Forty Sprague-Dawley rats, 230 g to 350 g body weight, were used for this study. The carotid arteries were anastomosed end-to-end with 9-0 nylon, and 10-0 nylon, in addition to 9-0 polypropylene, and 10-0 polypropylene. The suture number of all arteries was 10 points except for two cases were 11 points due to uncontrolled bleeding. Specimens were harvested 1 week, 3 weeks, 6weeks and 10 weeks postoperatively. RESULT: The number of animals studied during the first week totaled 20 carotid arteries and they showed no interval change. After 3 weeks, we identified aneurysms in following cases: group I 3 cases, group II 2 cases, group III 1 case and group IV 1 case per five cases in each group. After 6 weeks, gross aneurysmal changes seen: group I, all (5) cases; Group II, 2 cases; group III, all (5) cases; Group IV, 3 cases. After 10 weeks, many aneurysms were observed: group I, all (5) cases; group II, all (5) cases; group III, 0 case; group IV, 2 cases. The aneurysms were measured and ranged in size from 1.3 mm to 8.1 mm. Histological analysis for inflammation, fibrosis and medial necrosis at the anastomosis site revealed no significant difference between same sized suture materials. If the experimental aneurysms were more than 5 times the diameter of the carotid artery, the aneurysms were considered to be experimental giant aneurysms. Seventy of our 34 experimental aneurysms were considered to be giant aneurysms. CONCLUSION: Our findings demonstrate that the development of aneurysms was related to size of the suture material and not the type of suturing material used. An ideal suture material for anastomosisof the carotid artery in the rat wasd a 10-0 monofilament suture material with suture numbers was above 10 points. We also made good aneurysm model. When we used 9-0 suture material and suture numbers were below 10 points multiple aneurysms developed. This model demonstrated the development mechanism of giant fusiform aneurysms.

Experimental Fusiform Aneurysm Model at Common Carotid Artery in Rat

PURPOSE: An ideal suturing material should be strong, easy to handle, should produce minimal tissue reaction and finally should disappear without a trace. Various micro-vascular suture materials have been produced in the past several decades in order to meet these demands. We have used nylon suturing material in experimental microsurgery because it is less expensive than polypropylene. After carotid artery end-to-end anstomosis, we found fusiform aneurysm incidentally. In this study 9-0 nylon (group I) and 9-0 polypropylene (group II) were compared to 10-0 nylon (group III), and 10-0 polypropylene (group IV) in order to survey the incidence of aneurysmal development in each material for use in microvascular surgery. METHOD: Forty Sprague-Dawley rats, 230 g to 350 g body weight, were used for this study. The carotid arteries were anastomosed end-to-end with 9-0 nylon, and 10-0 nylon, in addition to 9-0 polypropylene, and 10-0 polypropylene. The suture number of all arteries was 10 points except for two cases were 11 points due to uncontrolled bleeding. Specimens were harvested 1 week, 3 weeks, 6weeks and 10 weeks postoperatively. RESULT: The number of animals studied during the first week totaled 20 carotid arteries and they showed no interval change. After 3 weeks, we identified aneurysms in following cases: group I 3 cases, group II 2 cases, group III 1 case and group IV 1 case per five cases in each group. After 6 weeks, gross aneurysmal changes seen: group I, all (5) cases; Group II, 2 cases; group III, all (5) cases; Group IV, 3 cases. After 10 weeks, many aneurysms were observed: group I, all (5) cases; group II, all (5) cases; group III, 0 case; group IV, 2 cases. The aneurysms were measured and ranged in size from 1.3 mm to 8.1 mm. Histological analysis for inflammation, fibrosis and medial necrosis at the anastomosis site revealed no significant difference between same sized suture materials. If the experimental aneurysms were more than 5 times the diameter of the carotid artery, the aneurysms were considered to be experimental giant aneurysms. Seventy of our 34 experimental aneurysms were considered to be giant aneurysms. CONCLUSION: Our findings demonstrate that the development of aneurysms was related to size of the suture material and not the type of suturing material used. An ideal suture material for anastomosisof the carotid artery in the rat wasd a 10-0 monofilament suture material with suture numbers was above 10 points. We also made good aneurysm model. When we used 9-0 suture material and suture numbers were below 10 points multiple aneurysms developed. This model demonstrated the development mechanism of giant fusiform aneurysms.

Retrograde Jejunogastric Intussusception: A Rare Complication of Gastric Surgery

Retrograde jejunogastric intussusception is a rare complication of gastric surgery. We report a case of retrograde jejunogastric intussusception that developed after a gastric resection. The patient was a 62 years old female patient who complained severe epigastric pain, vomiting and hematemesis. She had a gastric resection and Billroth II anastomosis performed using the Braun procedure 6 months prior because of early gastric cancer. At the time of admission, the plain abdomen revealed an ileus change, but the vital signs and symptoms had worsened. An emergency operation was therefore performed and a strangulated retrograde jejunogastric intussusception of efferent loop was discovered. Surgical management consisted of a segmental resection of the jejunum. It is recommended that treatment be done as early as possible in order to prevent a strangulation of the invaginated segment. This case illustrates the rare complications of a type 2b retrograde jejunogastric intussusception that developed more than 6 months after a gastric resection and a Billroth II anastomosis using the Braun procedure.

Necrosis Rate of Preoperative Transcatheter Arterial Chemoemboliztion in Hepatocellular Carcinoma: A Study in 77 Patients who Underwent Surgery / 한국간담췌외과학회지

BACKGROUND/AIMS: Transcatheter arterial chemoembolization (TACE) is the one of effective methods which treat hepatocellular carcinoma (HCC) in patients who have unresectable tumors or poor liver function. The aim of this study is to evaluate the histologic necrosis rate of hepatocellular carcinoma (HCC) treated with TACE. METHODS: From 1997 to 2001, 77 patients diagnosed as a HCC with percutaneous needle biposy underwent hepatic resection, who had been treated with properative TACE. Complete necrosis rate of tumor was studied by histologic examination of resected specimens. RESULTS: A complete necrosis rate was demonstrated in 31.2% (24/77). A mean size of completely necrotized tumors was 2.8 cm, incompletely necrotized tumor size was 4.8 cm. Lymph node metastasis of 77 hepatocellular carcinoma cases was shown in 5.2% (4/77). Of 24 cases with a complete necrotized tumor, lymph node metastasis was found in one case. CONCLUSION: This study indicates the effectiveness of TACE on the destruction of HCC. However, the presence of viable residual tumors strongly argues for the necessity of surgical resection whenever it is possible.

Initial nutritional status of stomach cancer patients

The purpose of this study is to investigate initial nutritional status of stomach cancer patients. The study subjects were 88 patients with stomach cancer admitted at Kosin University Gospel Hospital in Busan. We assessed the initial nutritional status by anthropometric, biochemical and dietary intake data along with subjective global assessment(SGA). The results are as follows. 1. The mean age, weight, height, triceps skinfold thickness, mid arm circumference, and mid arm muscle circumference of the subjects were 55.9+/-11.0years, 60.0+/-9.8kg, 162.4+/-8.5cm, 10.9+/-5.7mm, 26.8+/-3.8cm, and 23.4+/-3.5cm respectively. The mean body mass index was within the normal range, with 22.7+/-2.8kg/m2, while 15.4% of the patients was underweight. The result shows that body fat mass and body protein mass of the patients with stomach cancer were decreased. 2. The mean biochemical data of the subjects were 4.0+/-0.5g/dl for albumin, 174.7+/-41.9mg/dl for cholesterol, 107.6+/-57.2mg/dl for triglyceride, 92.1microgram/dl for Zn, 297.0+/-103.1mg/dl for transferrin, 1980.0+/-0.8mm3 for total lymphocyte count. 3. Daily energy intake was 1997.8+/-579.3kcal. And the ratio of carbohydrate, protein, and lipid to energy intake was 72:14:14. 4. The patients were divided into three groups according to SGA performed by an observer. Group A(well nourished) was 55.7% with 49 patients, Group B(moderately malnourished) was 22.7 % with 20 patients, and Group C(severely malnourished) was 21.6 % with 19 patients. The three groups showed a significant difference in body weight(p<0.01), 1 month weight loss %(p<0.001), 6 months weight loss %(p<0.001), body mass index(p<0.01), and mid arm circumference(p<0.05), albumin(p<0.01), energy intake(p<0.05) as well as carbohydrate intake(p<0.05). From these results, it may be concluded that SGA can be used as a nutrition screening tool, and comprehensive nutrition assessment is desirable for those malnourished.

Abnormalities of Liver Function during Total Parenteral Nutrition (TPN): Alteration of Serum Liver Enzyme during Short-term TPN

PURPOSE: TPN has been widely used to treat nutritional depletion since the late 1960s. However, many metabolic complications may occur as a result of parenteral feeding. Among these, hepatic complications has received increasing attention. A retrospective review of liver function abnormalities in adult patients who underwent TPN was done to determine the frequency and magnitude of the abnormalities in a liver function test. METHODS: From January 2001 to Jun 2001, 160 adult patient receiving TPN were reviewed. Of these, 111 had a malignant disease and 49 had a benign disease. The duration of TPN therapy ranged from 5 days to 52 days, with a mean duration of 14 days. Abnormalities of liver function test were defined as a value greater than the upper normal limit. Forty cases of gastric cancer were analyzed to determine the risk factors that contribute to abnormal liver function in individual patients receiving TPN. RESULTS: Abnormalities of the liver function test appeared after 6~7 days of therapy. Increases in the ALP levels were noted in 34 out of 93 patients (37.6%), in the AST levels in 42 out of 116 patients (36.2%), in the ALT levels in 54 out of 125 patients (43.2%), in the LDH levels in 20 out of 72 patients (27.8%), in the gamma-GTP levels in 44 out of 81 patients (54.3%), and in the bilirubin levels in 30 out of 126 patients (23.8%). The serum ALP level rose to 1.6 times upper the limit of normal; AST, 1.7 times; ALT, 2.0 times; LDH, 1.2 times; gamma-GTP, 2.4 times; bilirubin, 2.4 times. gamma-GTP value was most sensitive. In 40 gastric cancers, factors as age, the amount of TPN solution, the duration of TPN, intraoperative chemotherapy, transfusion, and postoperative infection were investigated. However, no association with TPN-associated liver function abnormalities was found. CONCLUSION: The incidences of an abnormal liver function during TPN were 23.8~54.3%. However, the liver function abnormalities that developed during short term-TPN were reversible and not serious.

Hepatocellular Carcinoma of the Liver with Sarcomatous Feature / 한국간담췌외과학회지

One case of hepatocellular carcinoma with sarcomatous changes is presented. Histologically, the tumor was composed of hepatocellular-carcinomatous and sarcomatous components, including trabecular, pseudoglandular, and spindle-shaped varieties. There was a transitional cell form between the carcinoma and sarcomatous cells. Immunohistochemical examination for alpha-feto protein reveals positive staining in hepatocellular carcinoma component, and vimentin had positive result in most spindle-shaped sarcomatous cells and some epithelial tumor cells, whereas cytokeratin and EMA(epithelial membrane antigen) revealed negative staining in tumor cells, On the basis of this findings, the possibility of sarcomatous transformation of hepatocellular carcinoma was discussed.