Predictors of Avascular Necrosis after Kidney Transplantation / 대한이식학회지

BACKGROUND: Risk factors for bone avascular necrosis (AVN), a common late complication after kidney transplantation (KT), are not well known. METHODS: Patients that underwent living-donor KT at Asan Medical Center between January 2009 and July 2016 were included in this retrospective study to determine the incidence and risk factors for AVN after KT. RESULTS: Among 1,570 patients that underwent living-donor KT, 33 (2.1%) developed AVN during a mean follow-up of 49.8±25.0months. Additionally, AVN was diagnosed at a mean of 13.9±6.6 months after KT. The mean cumulative corticosteroid dose during the last follow-up in patients without AVN (9,108±3,400 mg) was higher than that that in patients with AVN (4,483±1,114 mg) until AVN development (P < 0.01). More patients among those with AVN (n=4, 12.1%) underwent steroid pulse treatment because of biopsy-proven rejections during the first 6 months after KT than patients without AVN (n=68, 4.4%; P=0.04). Female (hazard ratio [HR], 2.29; P=0.04) and steroid pulse treatment during the first 6 months (HR, 2.31; P=0.02) were significant AVN risk factors as revealed by the Cox proportional multivariate analysis. However, no significant differences in rejection-free graft survival rates were observed between the two groups (P=0.67). CONCLUSIONS: Steroid pulse treatment within 6 months of KT and being female were independent risk factors for AVN development.

A Case of Immunoglobulin G4-Related Disease Presenting as a Pleural Mass / 결핵및호흡기질환

Immunoglobulin G4 (IgG4)-related disease is a newly recognized condition characterized by fibroinflammatory lesions with dense lymphoplasmacytic infiltration, storiform-type fibrosis and obliterative phlebitis. The pathogenesis is not fully understood but multiple immune-mediated mechanisms are believed to contribute. This rare disease can involve various organs and pleural involvement is even rarer. We report a case of IgG4-related disease involving pleura. A 66-year-old man presented with cough and sputum production for a week. Chest radiography revealed consolidation and a pleural mass at right hemithorax. Treatment with antibiotics resolved the consolidation and respiratory symptoms disappeared, but the pleural mass was unchanged. Video-assisted thoracoscopic surgery was performed. Histopathology revealed dense lymphoplasmacytic infiltration and storiform fibrosis with numerous IgG4-bearing plasma cells. The serum IgG4 level was also elevated. Further examination ruled out the involvement of any other organ. The patient was discharged without further treatment and there is no evidence of recurrence to date.

Quantitative Analysis of Patellar Tendon Reflexes with Newly Designed Percussion Instrument

OBJECTIVE: There has been some existing problems with the electrical reflex hammer. The occurrence of pressure build up with percussion and change of hammering points is one example. In order to make improvements on this device, we conducted studies with a newly designed percussion instrumental stimulator. METHOD: The data collected from the first group was based on the manual percussion of electrical reflex hammer on the patella ligament. The data collected from the second group by usage of a newly designed instrumental stimulator maintained steady pressure and time and target position on the electrical reflex hammer. Comparisons were made between the two group. RESULTS: Our single measure of latency and amplitude on the manual and instrumental percussion group resulted in the reliability of 84.67%, 91.23%, 73.63%, and 83.29%. The 10 repeated measure of latency and amplitude on the manual and instrumental percussion group resulted in the reliability of 99.95%, 99.97%, 99.90%, and 99.94%. CONCLUSION: From our experiment on the tendon reflex, we found out that it is important to have an instrumental stimulator that can maintain steady pressure while it is applying percussion to accurate data. On manual percussion, it is important to obtain data based on mean value of repeated measurements.

Lumbosacral Plexus Conduction Study by Magnetic Stimulation

OBJECTIVE: In contrast to the electrical stimulation, the magnetic stimulation of motor system is a painless and noninvasive neurophysiologic technique. We attempted to establish a clinical feasibility of lumbosacral plexus conduction study by using the magnetic stimulation. METHOD: We performed a magnetic stimulation at the L5 spinous process and obtained the compound motor action potentials(CMAP) from individual muscles of pelvic area and lower extremity. RESULTS: The onset latencies of compound muscle action potentials(CMAP) were fastest in the gluteus maximus muscle and slowest in the abductor hallucis muscle. The onset latencies of compound muscle action potentials(CMAP) showed no significant difference in both sides, however, there was a positive correlation between height and onset latency in distal leg muscles. The amplitudes of compound muscle action potentials(CMAP) were the highest in the vastus medialis and lowest in the tibialis anterior muscle. CONCLUSION: Lumbosacral plexus conduction study by magnetic stimulation was easy to obtain the compound motor action potentials(CMAP) from individual muscles and was relatively comfortable to the subjects.