Bortezomib Treatment for Refractory Antibody-Mediated Rejection Superimposed with BK Virus-Associated Nephropathy during the Progression of Recurrent C3 Glomerulonephritis / 대한이식학회지

A 38-year-old man, who underwent a second kidney transplantation (KT), was admitted because of antibody-mediated rejection (AMR) complicated by BK virus-associated nephropathy (BKVAN). He was placed on hemodialysis at the age of 24 years because of membranoproliferative glomerulonephritis. At the age of 28 years, he underwent a living donor KT from his father; however, 1 year after the transplantation, he developed a recurrence of the primary glomerular disease, resulting in graft failure 2 years after the first KT. Ten years later, he received a deceased-donor kidney with a B-cell-positive-cross-match. He received 600 mg of rituximab before the KT with three cycles of plasmapheresis and immunoglobulin (0.5 g/kg) therapy after KT. During the follow-up, the first and second allograft biopsies at 4 and 10 months after KT revealed AMR with a recurrence of primary glomerular disease that was reclassified as C3 glomerulonephritis (C3GN). He received a steroid pulse, rituximab, plasmapheresis, and immunoglobulin therapies. The third allograft biopsy demonstrated that the BKVAN was complicated with AMR and C3GN. As the azotemia did not improve after repeated conventional therapies for AMR, one cycle of bortezomib (1.3 mg/m²×4 doses) was administered. The allograft function stabilized, and BK viremia became undetectable after 6 months. The present case suggests that bortezomib therapy may be applicable to patients with refractory AMR, even in cases complicated with BKVAN.

An exclusively dopamine secreting paraganglioma in the retroperitoneum: a first clinical case in Korea / 대한외과학회지

Exclusively dopamine producing retroperitoneal paragangliomas are extremely rare. We have experienced the first Korean case managed successfully based on the proper evaluation. A 26-year-old female patient came to our attention after the accidental detection of an adrenal mass. She had no symptoms and denied any family history. Laboratory evaluations were normal but serum dopamine (425 ng/L) and 24-hour urine dopamine levels (1,565.3 microg/day) were elevated. She underwent laparoscopic right adrenalectomy. Histopathological diagnosis was a paraganglioma. After operation, dopamine levels in serum and 24-hour urine dropped to 0.09 ng/L and 388.4 microg/day. Dopamine producing paraganglioma elicit no clinical symptoms. Only the dopamine level is elevated in serum and 24-hour urine samples. Surgical resection without using preoperative alpha blockage is the treatment of choice. The prognosis for patients with this tumor tends to be poor because the diagnosis is usually delayed due to lack of symptoms.

In-Patients' Food Consumption and Perception on Foodservice Quality at Hospitals

The purposes of this research were to investigate in-patients' perception on foodservice quality and to examine factors influencing their meal consumption at hospitals. Three general hospitals with over 400 beds in Seoul and Chon-An agreed to participate in the research. A total of 516 in-patients of the hospitals were surveyed on their meal consumptions, reasons of plate wastes, perceptions of foodservice quality, and demographic information. A response rate was 76% after excluding responses with significant missing data. On average the regular diet patients consumed 72%, 69%, and 68% of rice, soups, and side dishes served, respectively; the therapeutic diet patients consumed less than 70% of the meals they were served. The consumption rates did not differ significantly by diet type, gender, age, and hospitalization period. Among the therapeutic diet patients, those who had nutrition education consumed significantly more rice than the others (p<0.05). The main reasons why the patients did not eat all food served were 'lack of energy' and 'not tasty'. The patients' perception on foodservice quality was low; the therapeutic diet patients perceived more negatively than the regular diet patients in 'keeping hot food hot, cold food cold(p<0.05)', 'maintaining consistency of taste(p<0.01)', and 'providing nutrition information(p<0.01)'. To achieve the goal of the foodservice at hospitals, the dietitians can use the findings of the research in developing and implementing strategies to improve the patients' meal consumption. Recipe standardization, employee training, and production management will be useful for improving food quality and nutrition education on therapeutic diets for the patients will improve their meal consumption at hospitals.

Three Dimensional Reconstitution of Oral Mucosal Keratinocytes and Its Biologic Characteristics

The purposes of this study were to develop an in vitro co-culture model of epithelial tissue with dermal equivalent, cultured at an air-liquid interface, and to evaluate the effects of extracellular matrix and concentration of calcium and fetal bovine serum in medium to find optimized culture condition. Oral keratinizing epithelial cells in monolayer culture were grown in Mitomycin-treated 3T3 feeder. Primary cultured oral epithelial cells were reconstituted onto the dermal equivalents consisting of 3T3 fibroblast and type I collagen, and co-culture was grown at the air-liquid interface. The histomorphological development of reconstituted oral epithelium in vitro for 21 days revealed 10~12 layered statified epithelium, closely similar to the parakeratinized gingival epithelium. Neither laminin nor type IV collagen was able to induce keratinocyte differentiation. But a mixture of laminin and type IV collagen induced well-polarized keratinizing tissue with anchoring structure of basal cells. When the reconstituted oral epithelium was incubated in 1.0% and 0.5% serum-containing medium, the granular cell layers with orthokeratinization developed. The reconstituted epidermis generated in serum-free keratinocyte growth medium (KGM)-containing pituitary extract showed features of incomplete differentiation. The present study shows that the dermal equivalents containing fibroblasts will support epidermal morphogenesis and differentiation. And these results suggest that extracellular matrix and calcium concentration are important factors during the reconstitution of keratinizing epithelium in vitro.

The clinical and radiological evaluation of pyogenic arthritis

Pyogenic arthritis remain a difficult problem, despite the availability of a wide range of powerful modernantibiotics. Early and correct diagnosis is imperative to assure the prompt initiation of an effective therapeuticregimen and the prevent of late sequela. Careful clinical, laboratory and roentgenological analysis arefundamental to early and precise diagnosis. Therefore, plain roentgenogram shold not be overlooked. A radiologicaland clinical observation was made in 51 cases of pyogenic arthritis admittted to Chosun University Hospital duringthe period from January 1976 to Dec. 1983 and following results were obtained. 1. Among the 51 cases, 36 cases(70.6%) were male and 15 cases(29.4%) were females. The most prevalent age was 5 to 9 (27.6%). 2. Symptom durationless than 5 days was in 21 cases (41.2%) and more than 31 days was in 6 cases (11.7%). 3. The most common symptomon admission was pain around the involved joint and others are limitation of motion, swelling, tenderness, fever,local heating and erythema. 4. The underlying causes were composed of unknown in 21 cases(41.2%), trauma in 18cases(35.3%), infections focus in 8 cases (15.7%) and iatrogenic reasone 4 cases(7.8%) 5. The msot commonlyaffected joint was hip joint (45.1%). The other affected sites in order of frequency were knee, ankle, shoulder,S-I and elbow joint. In infants and children, hip and knee joint are commonly affected; In adults, knee joint ismost commonly affected. 6. In laboratory findings, the number of W.B.C and E.S.R were increased in 56.9%. Symptomduration more than 31 days in 5 cases were increased E.S,R only. Causative microorganism was isolated in 31 cases;the most common microorganism was Staphylococcus auterus in 22 cases. Others are B-hemolytic Streptococcus,Enterobacteriaceae species and Pseudomonas aeruginosa. 7. In 26 cases(50.9%) of the patients, roentgenographicfinding was negative. The most common radiological findig was soft tissue swelling and the others are include inorder of frequency: joint space widening, small erosions in articular cortex, subchondral osteoporosis. The comonradiological findings of symptom duration more than 31 days in 6 cases were lost of entire cortex, ankylosis andjoint space narrwoing.

Clinical and radiological observation of the lower urinary tract injury

A clinical and radiological obsevation was made on 62 cases of urinary tract injury in the Dept. of urology,Chosun Universtiy hospital during the period from January 1979 to December 1983. The results were as follows; 1.Age distribution of the lower urinary tract injury was the highest in the age 41 to 50(39.6%). The sex ratio, maleto female was 6.8:1. 2. The most common cause of the L.U.T.I. was traffic accident in 23 cases (37.1%) and othersare fall down in 15 cases (24.2%), blunt trauma in 13 cases (21.0%), saddle injury in 8 cases(12.9%). 3. Theradiological finding of the bladder injury shows intraperitoneal extravasation in 11 caess(64.7%), extraperitonealextravasation in 5 cases(29.4%), and deformity of bladder in 12 cases(70.6%). 4. The radiological finding of theurethral injury shows extravasation of contrast media in 44 cases(97.8%). venous intravasation in 11 cases(24.4%),penile urethra in 1 case(2.3%). 6. The L.U.T.I. was associated with pelvic bone fracture in 33 cases (53.2%) esp.pubic bone fracture in 24 cases(38.7%). 7. The complication of the L.U.T.I. was urethral stricture in 24cases(38.7%), fistula formation in 3 cases(4.8%), incontinence in 2 cases(3.2%).