Fatal Invasive Pulmonary Aspergillosis after Combined Induction with Rituximab and Antithymocyte Globulin for Kidney Transplantation in a Sensitized Recipient, and Early Rejection Therapy with Plasmapheresis and Low-dose Immunoglobulin / 대한이식학회지

A high degree of sensitization to human leukocyte antigen requires more intensive induction therapy; however, this increases vulnerability to opportunistic infections following kidney transplantation. Although recent studies have suggested that combined induction therapy with antithymocyte globulin and rituximab would be more effective in highly sensitized kidney recipients, we experienced a case of near-fatal invasive pulmonary aspergillosis 2 months after combined induction and early rejection therapy for graft dysfunction. Fortunately, the patient recovered with intensive antifungal treatment and lung lobectomy for a necrotic cavity. Antifungal prophylaxis should be considered in cases undergoing intensive induction therapy.

Report of Nation-wide Questionnaire Survey for Abdominal Aortic Aneurysm Treatment in Korea

While endovascular aneurysm repair (EVAR) is prevailing for the treatment of abdominal aortic aneurysm (AAA) in modern vascular practice, PURPOSE: we conducted nationwide questionnaire survey to investigate the current status of AAA treatment and their results in Korea. METHOD: We reviewed the replies from 28 hospitals (33 departments) to the questionnaire inquiring annual number, clinical features, mode of treatment and results of AAA patients during the period from Jan. 2000 to Jul. 2004. Results: 980 AAA patients were reported including 292 ruptured AAA (29.8%) and 688 non-ruptured AAA (70.2%). For treatment of AAA, 834 (85.1%) surgical repairs (SRs) and 111 (11.3%) endovascualr aneurysm repairs (EVARs) were performed while 35 patients (3.6%) died of AAA rupture before operation. The locations of AAA were infrarenal in 889 (90.7%), juxtarenal in 62 (6.3%), and suprarenal in 29 patients (3.0%). Among 834 patients undergoing SR, 577 patients (69.2%) had non-ruptured AAAs and 257 patients (30.8%) had ruptured AAAs. Mean operative mortality rate was 4.1% after elective SRs, 30.7% after SR for ruptured AAAs, and 2.3% after EVARs. The reported brand name of stent graft devices were various including domestic custom-made in 56 (50.5%), imported brand in 18 (16.2%) while 37 (33.3%) stent grafts were not reported their brand name. The frequencies of type I and III endoleaks after EVAR were reported 5.8% and 5.8% respectively in 86 patients with an available data. CONCLUSION: SR has been used as a major treatment option in Korea for the treatment of AAA patients while EVAR is increasing. The mortality rate of SR of AAA was comparable to western multi-center trial reports but mortality or morbidity rates of EVAR were unable to know in this questionnaire survey.

Iliac Artery Occlusive Disease: Open Surgical Treatment

PThe numerous options currently available for treatment of aortoiliac occlusive disease have led to considerable controversy in regard to the optional method of revascularization in such patients. Differences of options exist not only with respect to certain technical aspects of direct anatomic aortic reconstruction, which has traditionally been regarded as the "gold standard" treatment, but even more importantly as to whether alternative methods including a variety of catheter-based endoluminal therapies and extraanatomic bypasses may offer nearly equivalent results with less risk. From March 1992 to Dec 2002, 99 aortoiliac occlusive cases were surgically treated at Kyunghee university hospital. Surgical indications, combined diseases, cardiac risk assessment, type of occlusions, surgical methods and cumulative patency rate were reviewed retrospectively. Extensive disease pattern was more common in our experiences. No single option for inflow revascularization is optimal in all instances. Durability must be balanced against the possible advantages of safety and expediency. The availability and results of alternative techniques have improved, but aortofemoral bypass remains the most durable and functionally effective.

High Ligation with Sclerotherapy for Lesser Saphenous Varicose Veins

PURPOSE: The purpose of this study was to determine the validity of high ligation of saphenopopliteal junction with sclerotherapy under local anesthesia in the management of lesser saphenous vein varicosity. METHOD: Between September, 1998 and June, 2000, we managed 37 patients of lesser saphenous vein varicosity and the clinical records were reviewed retrospectively. The patients were divided into two groups: one was 27 patients treated by high ligation of saphenopopliteal junction with sclerotherapy group under local anesthesia, and the other was 10 patients by stripping of lesser saphenous vein with stab avulsion group under general anesthesia. We compared the two groups on the basis of number of sclerotherapy after operation, recurrence, total cost and measure of health outcome with Aberdeen Varicose Veins Questionnaire. Of 37 patients, 20 patients in the high ligation group and 8 patients in the stripping group were available to follow-up with telephone. The differences between groups were tested with Mann-Whitney test. RESULT: The mean age was 42.4+/-8.1 year for the high ligation group and 47.1+/-12.2 year for the stripping group and the male to female ratio was 1:5.5 and 1:2.3 respectively. The mean number of sclerotherapy after first treatment was significantly more in high ligation group than stripping group (1.4 vs 0.3; P<0.001). The mean total cost was significantly higher in the stripping group than high ligation group (646,102 won vs 323,184 won; P=0.001). There was only one case of recurrence in the high ligation group. No statistical differences could be found between the two group concerning mean score of Aberdeen Varicose Veins Questionnaire (11.10 vs 10.13; P=0.953). CONCLUSION: We conclude that the high ligation of saphenopopliteal junction with sclerotherapy under local anesthesia is very effective and sufficient treatment modality in the management of lesser saphenous vein varicosity.