Multiple Renal Artery Anastomosis in Kidney Transplantation: Clinical Outcome / 대한이식학회지

PURPOSE: Kidney transplantation with multiple renal arteries has been associated with higher incidence of vascular and urologic complications. Multiple renal arteries occur unilaterally and bilaterally in 23% and 10% of the population, respectively, so it would be clearly in the best interests to the recipients whether to include these individuals as organ donor candidates. There is an increasing requirement to use such kidneys and it is not unusual trend any more. Some authors insist the vessel anastomosis time (2nd warm ischemia time) exceeding 35 minutes may attribute to the development of acute tubular necrosis (ATN). There are various methods in anastomosis of multiple renal arteries but vascular and urologic complications depend on the technical surgical skills or methods of the vascular anastomosis. METHODS: A retrospective study was assessed for 454 kidney transplantations performed in the department of surgery, Maryknoll Medical Center between August, 1990, and May 2007. Study groups are divided into four groups according to anastomosis METHODS: Group I, a single-artery anastomosis (n=387) and others, multiple-artery anastomosis (Group II~Group IV) includes extracorporeal (Group II), intracorporeal (Group III) artery anastomosis, and polar artery ligation (Group IV). RESULTS: Among those groups, there are no significant differences in 2nd warm ischemia time, serum creatinine level, recipient and graft survival rate, acute tubular necrosis, acute rejection rate, blood pressure change, and urologic and vascular complication. CONCLUSION: Kidney transplantation of multiple renal arteries is not a difficult challenge any more and it is now more important to find out the better way and better result.

Uremic Encephalopathy Associated with Bilateral Basal Ganglia and Cerebellar Lesion in a Non-diabetic Hemodialysis Patient / 대한신장학회잡지

Involvement of central nervous system is a well- known compication in uremic patients. However, development of acute extrapyramidal symptoms with bilateral basal ganglia involvement (acute basal ganglia syndrome), especially in non-diabetic hemodialysis patient is very rare. We report a case of acute basal ganglia syndrome in a non-diabetic hemodialysis patient. A 45-year-old man with autosomal dominant polycystic kidney disease (ADPKD) on chronic hemodialysis treatment for the last 4 years was admitted due to generalized myalgia. On admission, the patient was found to have rhabdomyolysis and intractable metabolic acidosis. Nine days after admission, he suddenly developed dysarthria, lateralizing ataxia, and bradykinesia. Brain MRI demonstrated low and high signals in bilateral basal ganglia and cerebellar vermis in T1-weighted and T2-weighted images, respectively. Intensified hemodialysis treatment combined with general supportive therapy resolved the severe metabolic acidosis and the neurologic manifestations gradually improved. Follow up brain CT scan taken 3 months later showed decreased size of initial low attenuation lesions in bilateral basal ganglia and cerebellar vermis. Although no definite pathophysiology is yet established, severe metabolic disorder is believed to play an important role in development of acute basal ganglia syndrome. Correction of metabolic acidosis and hypoglycemia in our patient lead to improvement in neurologic manifestations and organic brain lesions. Our case suggests that severe metabolic acidosis and hypoglycemia in uremic patient may act as risk factors for acute basal ganglia syndrome even in non-diabetic patient.

Clinical Manifestations and Diagnosis of Extrapulmonary Tuberculosis

Since the diagnosis of extrapulmonary tuberculosis (EPT) is largely depended on the physician's suspicion in respect of the disease, we believed that it would be worthwhile to scrutinize the clinical characteristics of EPT. Thus, here we present retrospectively evaluated clinical manifestations of patients who were diagnosed as EPT cases in a tertiary referral care hospital. Medical records of 312 patients, diagnosed as having EPT at Yongdong Severance hospital from January 1997 to December 1999, were reviewed retrospectively. In total 312 patients, 149 (47.8%) males and 163 (52.2%) females aged from 13 years to 87 years, were included into this study. The most common site of the involvement was pleura (35.6%). The patients complained of localized symptoms (72.4%) more frequently than systemic symptoms (52.2%). The most common symptom was pain at the infected site (48.1%). Leukocytosis, anemia, and elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were found in 12.8%, 50.3%, 79.3% and 63.1% of the patients, respectively. Twenty-four percent of the patients had underlying medical illnesses such as, diabetes mellitus or liver cirrhosis, or were over 60 years old. In 67.3% of patients, tuberculosis was suspected at the initial visit. However, tuberculosis was microbiologically proven in only 23.7% of the patients. The time interval from the symptom onset to the diagnosis varied, with the mean duration of the period 96 days. Pulmonary parenchymal abnormal lesions were found in 133 patients (42.6%) on chest radiographs. EPT has a wide spectrum of clinical manifestations, so it is difficult to diagnose it. Based on our studies, only 11.2% of the patients were confirmed as EPT. So it is important that the physician who first examines the patient should have a high degree of suspicion based on the chest radiography, localized or systemic symptoms and several laboratory parameters reviewed in this study.

A Case of Endophthalmitis due to Group G beta-hemolytic Streptococcus Sepsis

Identified first by Lancefield and Hare in 1935, the group G streptococcus occurs as commensals in the skin, pharynx, intestine, and vagina. It has been reported to cause a variety of human infections, such as sepsis, endocarditis, peritonitis, pharyngitis, and infective arthritis. Group G streptococcus sepsis could occur in chronic states such as malignancy, diabetes, alcoholics, neurologic disease, cardiovarscular disease, and end stage renal disease, however, there has been only a few case reports of endogenous endopthalmitis caused by group G streptococcus. We report herein endogenous endopthalmitis caused by group G streptococcus sepsis in 64-year-old man of alcoholic.

A Case of Endophthalmitis due to Group G beta-hemolytic Streptococcus Sepsis

Identified first by Lancefield and Hare in 1935, the group G streptococcus occurs as commensals in the skin, pharynx, intestine, and vagina. It has been reported to cause a variety of human infections, such as sepsis, endocarditis, peritonitis, pharyngitis, and infective arthritis. Group G streptococcus sepsis could occur in chronic states such as malignancy, diabetes, alcoholics, neurologic disease, cardiovarscular disease, and end stage renal disease, however, there has been only a few case reports of endogenous endopthalmitis caused by group G streptococcus. We report herein endogenous endopthalmitis caused by group G streptococcus sepsis in 64-year-old man of alcoholic.

Vascular Manifestations in Behcet's Disease

PURPOSE: Behcet's disease, distinguished by the triad of chronic oral aphthae, recurrent genital ulcers and uveitis, is a chronic, relapsing systemic disease. Vascular complications occur in 7~29% of Behcet's patients and are the most common causes of death. Consequently, vascular surgeons should be familiar with the vascular manifestations in Behcet's disease. METHOD: Between October 1994 and July 2002, we retrospectively reviewed 779 patients diagnosed with Behcet's disease in Samsung Medical Center. RESULT: Thirty cases of the 779 patients had vascular manifestations. Male to Female ratio was 25 (83.3%) to 5 (16.7%). In age distribution, males were most frequent in their 30s, while females were equally distributed. Arterial involvement occured in 10 cases (33.3%), venous involvement in 16 (53.3%) and combined arterial and venous involvement in 4 (13.3%). As for arterial manifestations, arterial occlusion occured in 7 cases, aneurysm in 5 and pseudoaneurysm in 4. Venous manifestations were all deep vein thrombosis (DVT). Iliofemoral vein DVT occured in 14 cases, IVC thrombosis in 5, and renal vein thrombosis in 1. Surgical treatment was performed in 5 cases; one primary repair and one arterial ligation were done in 2 cases of pseudoaneurysm, two combined aneurysmal resection and bypass in 2 cases of aneurysm, and one bypass in 1 case of arterial occlusion. Radiologic intervention was done in 5 cases. Stent graft insertion was performed in 2 cases, combined thrombolysis and percutaneous transluminal angioplasty in 1 case, occluder balloon in 1 case, and inf. vena cava filter insertion in 1 case. CONCLUSION: Behcet's disease is a chronic and systemic disease that may involve multiple organs. Because of vascular involvements, in particular the high fatality of arterial complications in Behcet's disease, we must always perform early diagnosis, proper clinical intervention and continuous follow up.

A Case of Panhypopituitarism Due to Craniopharyngioma with Slipped Capitalis Femoral Epiphysis / 대한내분비학회지

Craniopharyngioma accounts for 3% to 5% of intracranial tumors and is the second most common neoplasm in the sellar region. Panhypopituitarism associated with craniopharyngioma has been reported in 7% of all patients with craniopharyngioma. Slipped capital femoral epiphysis is the condition in which the femoral head slips downward and backward on the femoral neck at the epiphyseal plate due to growth disturbance of capital physis, the actual cause of which is unknown. It is a disease of adolescence, during which many physiologic hormonal changes occur. The clinical association between slipped capital femoral epiphysis and endocrine disease is well known. There have been four cases of slipped capital femoral epiphysis associated with endocrine disorders in Korea. This is the first Korean case report of slipped capital femoral epiphysis combined with craniopharyngioma caused by hypopituitarism

Clinical Manifestations and Diagnosis of Extra pulmonary Tube rculosis / 감염

BACKGROUND: The spectrum of clinical presentations of extrapulmonary tuberculosis (EPT) is so diverse that it may mimic other systemic diseases and often leads physicians to misdiagnosis. Since its diagnosis is largely depended on physician's suspicion of the disease, it would be worthwhile to scrutinize the clinical characteristics of EPT. We retrospectively evaluated clinical manifestations of 312 patients who were diagnosed as EPT in a tertiary referral hospital. METHODS: The medical records of 312 patients, diagnosed as having EPT at Youngdong Severance hospital from January 1997 to December 1999, were reviewed retrospectively. RESULTS: Total 312 patients, 149 (47.8%) men and 163 (52.2%) women with age ranged from 13 years to 87 years, were included in this study. The most common site of the involvement was pleura (35.6%). Patients complained of localized symptoms (72.4%) more frequently than systemic symptoms (52.2%). The most common symptom was pain on infected site (48.1%). Leukocytosis, anemia, and elevated ESR and CRP were found in 12.8%, 50.3%, 79.3%, and 63.1% of the patients, respectively. Twenty-four percent of patients had underlying medical illnesses such as old age over 60 years, diabetes mellitus or liver cirrhosis. In 67.3% of patients, tuberculosis was suspected at initial visit. However, tuberculosis was microbiologically proven in only 23.7% of patients. Histopathological diagnosis of EPT was made in 48.7% of patients. The time interval from symptom onset to diagnosis varied, and mean duration was 96 days. Pulmonary parenchymal abnormal lesions were found in 133 patients (42.6%) on chest radiographs. CONCLUSION: Although EPT had a wide spectrum of clinical manifestations and its diagnostic methods were lack, high index of suspicion could be obtained from chest radiograph, localized or systemic symptoms, and several laboratory parameters reviewed in this descriptive study. In case of doubt, early treatment instead of awaiting microbiological result may be necessary to avoid the devastating complications.

Needle Localization Biopsy of Nonpalpable Lesions of the Breast

BACKGROUND: For the purpose of early detection of breast cancer, a localization biopsy is necessary in case of mammographically or ultrasonographically suspicious, but nonpalpable, breast lesions. METHODS: One hundred nine consecutive localization biopsies for nonpalpable lesions of the breast were performed upon 101 patients from May 1992 to September 1998. RESULTS: The localizations were done in 48 cases under the guidance of mammography and in 61 cases under the guidance of ultrasonography. Complications occurred in 15 cases (13.7%). The mean volume of the excised specimens was 11.6 cm3. The miss rate was 3.6% (4 cases). Malignant lesions of the breast were found in 16 cases (14.7%). Among the malignant lesions, 10 cases involved invasive ductal cancer. Among the patients diagnosed as having breast cancer, 8 patients were treated with a conservative operation, 5 patients with a modified radical mastectomy, and 2 patients with observation; 1 patient was discharged. The chance of a biopsy containing a malignant lesion was 16.7% if the biopsy was done because of mass, 9.8% for a microcalcification, and 11.1% for an abnormal asymmetric density. CONCLUSIONS: A needle localization biopsy can be performed accurately under local anethesia, and the volume of the excised specimen can be minimized, so the cosmetic effect is excellent and proper early treatment is possible in diagnosed cases of breast cancer.