IntraBrain Injector (IBI): A StereotacticGuided Device for Repeated Delivery of Therapeutic Agents Into the Brain Parenchyma

Background@#To deliver therapeutics into the brain, it is imperative to overcome the issue of the blood-brain-barrier (BBB). One of the ways to circumvent the BBB is to administer therapeutics directly into the brain parenchyma. To enhance the treatment efficacy for chronic neurodegenerative disorders, repeated administration to the target location is required. However, this increases the number of operations that must be performed. In this study, we developed the IntraBrain Injector (IBI), a new implantable device to repeatedly deliver therapeutics into the brain parenchyma. @*Methods@#We designed and fabricated IBI with medical grade materials, and evaluated the efficacy and safety of IBI in 9 beagles. The trajectory of IBI to the hippocampus was simulated prior to surgery and the device was implanted using 3D-printed adaptor and surgical guides. Ferumoxytol-labeled mesenchymal stem cells (MSCs) were injected into the hippocampus via IBI, and magnetic resonance images were taken before and after the administration to analyze the accuracy of repeated injection. @*Results@#We compared the planned vs. insertion trajectory of IBI to the hippocampus.With a similarity of 0.990 ± 0.001 (mean ± standard deviation), precise targeting of IBI was confirmed by comparing planned vs. insertion trajectories of IBI. Multiple administrations of ferumoxytol-labeled MSCs into the hippocampus using IBI were both feasible and successful (success rate of 76.7%). Safety of initial IBI implantation, repeated administration of therapeutics, and long-term implantation have all been evaluated in this study. @*Conclusion@#Precise and repeated delivery of therapeutics into the brain parenchyma can be done without performing additional surgeries via IBI implantation.

Effect of Liquefied Digestive Medicine on the Surface of Composite Resin / 치위생과학회지

Background@#The purpose of this study is to investigate the effect of liquefied digestive medicines on the composite resin surface. @*Methods@#Three types of liquefied digestive medicines (Gashwalmyeongsu, Wicheongsu, and Saengrokcheon) were selected as experimental groups, Samdasoo and Chamisul as negative controls, and Trevi as positive controls were selected to measure pH and titratable acidity. The samples filled with resin at acrylic were made total 300, 50 per group. To evaluate the erosion risk of the composite resin, the specimens were immersed in a liquefied medicine for 1, 3, 5, 15, and 30 minutes, and then the surface microhardness was measured using the Vickers Hardness Number, and the surface change was observed with scanning electron microscope (SEM). @*Results@#The average pH of the three liquefied medicine was 3.75±0.30, the Saengrokcheon was the lowest at 3.45±0.01, and the Trevi was 4.66 and Samdasoo and Chamisul were 7.40 and 8.58, respectively. The amount of NaOH reaching pH 5.5 and 7.0 was the lowest in the order of Trevi, Gashwalmyeongsu, Wicheongsu, and Saengrokcheon. The largest surface hardness reduction value was shown in Gashwalmyeongsu (−11.85±3.73), followed by Saengrokcheon (−9.79±3.11) and Wicheongsu (−8.28±2.83), and Samdasoo (−0.84±1.56) and Chamisul (−6.24±0.42) had relatively low surface hardness reduction values. However, Trevi (−16.67±5.41), a positive control group containing carbonic acid, showed a higher decrease in surface hardness than the experimental group. As a result of observation with SEM, experimental group and positive control group, showed rough surfaces and irregular cracks, and negative control groups showed smooth patterns similar to before immersion. @*Conclusion@#The liquefied digestive medicine with low pH could weaken the composite resin surface, and the carbonic acid component could more effect on the physical properties of the composite resin than pH.

Primary Cilia Mediate Wnt5a/β-catenin Signaling to Regulate Adipogenic Differentiation of Human Umbilical Cord Blood-Derived Mesenchymal Stem Cells Following Calcium Induction

Background@#Regeneration of soft tissue defects is essential for adipose tissue pathologies and disease, trauma, or injury-induced damage. Here, we show that umbilical cord blood-derived mesenchymal stem cells could potentially be tailored and used for the reconstruction of specific damaged sites. Adipogenesis can be exploited in soft tissue reconstruction. Also, primary cilia play a role in the control of adipogenesis. @*Methods@#The adipogenic differentiation capacity of mesenchymal stem cells (MSCs) was shown to influence ciliogenesis. MSCs transfected with intraflagellar transport 88 (IFT88) small interfering RNA (siRNA), which blocks the assembly and maintenance of cilia, were examined to confirm the relationship between adipogenesis and ciliogenesis. Also, 1,2-Bis(2-aminophenoxy) ethane-N,N,N′,N′-tetraacetic acid tetrakis(acetoxymethyl ester) (BAPTA-AM), calcium chelator, inhibited the ciliogenesis of MSCs in adipogenic differentiation. @*Results@#IFT88-knockdown led to decreased cilia formation and limitation of cilia elongation in adipogenesis. Additionally, intracellular calcium triggered cilia formation in MSCs adipogenesis. Interestingly, intracellular calcium cannot overcome the inhibition of adipogenesis caused by low numbers of cilia in MSCs. @*Conclusion@#Our data suggested that ciliogenesis was negatively regulated by Wnt5a/β-catenin signaling during adipogenesis. Thus, we suggest that calcium induction triggers adipogenesis and ciliogenesis.

Disability Registration State of Children With Cerebral Palsy in Korea

OBJECTIVE: To investigate the disability registration state of children with cerebral palsy (CP) in Korea. METHODS: Based on the National Health Information Database, the disability registration state was examined for brain lesion disability and other possible complicated disabilities accompanying brain disorder in children diagnosed with CP aged up to 5 years old who were born between 2002 and 2008. RESULTS: Of children diagnosed with CP, 73.1% were registered as having brain lesion disability for the first time before they turned 2 years old. The younger the children, the more likely they will have 1st and 2nd degree disability. However, when the age of children is increased, such likelihood is decreased. The percentage of children registered as having overlapping disabilities was 7%–20%. CONCLUSION: It is important to establish a more accurate standard to rate disability and provide national support systems for children with CP with various severities and multiple disabilities. By reorganizing the current disability registration system for pediatric brain lesions, the system could serve as a classification standard to provide medical and social welfare services.

Optimal Dose and Timing of Umbilical Stem Cells Treatment in Pulmonary Arterial Hypertensive Rats

PURPOSE: Pulmonary arterial hypertension (PAH) is a fatal disease which is characterized by an increase in pulmonary arterial pressure leading to increases in right ventricular afterload. Human umbilical cord blood derived-mesenchymal stem cells (hUCB-MSCs) administered via the jugular vein have been previously shown to improve PAH by reversal treatment. However, the effect of low dosage and transfusion timing of hUCB-MSCs on PAH has not yet been clearly established. Obviously, low dosage treatment can lead to a reduction in costs. This is the first study on early transfusion effect. MATERIALS AND METHODS: This study was divided into two parts. The first part is an investigation of dose-dependent effect. hUCB-MSCs were administered into 3 groups of rats (UA: 3×10⁶ cells, UB: 1.5×10⁶ cells, UC: 3×10⁵ cells) via the external jugular vein at week 1 after monocrotaline (MCT) injection. The second part is a search for optimal treatment timing in 3×10⁵ cells dose of hUCB-MSCs administered at day 1 for UD group (low dose of hUCB-MSCs at day 1), at day 1 and week 1 for the UE group (dual transfusion of low dose of hUCB-MSCs at day 1 and week 1) and at 1 week for the UF group (reversal treatment of low dose hUCB-MSC at week 1) after MCT injection. RESULTS: The administration of 3×10⁵ hUCB-MSCs was as effective as the 3×10⁶ dose in decreasing mean right ventricle (RV) pressure and pulmonary pathological changes. Early treatment with hUCB-MSCs improved mean RV pressure, pulmonary pathological changes and heart collagen 3 protein expression levels in PAH. CONCLUSION: Low-dose early treatment of hUCB-MSCs is as effective as a high dose treatment of hUCB-MSCs in improving PAH although dual or reversal treatment is still more effective.

Changes in Caspase-3, B Cell Leukemia/Lymphoma-2, Interleukin-6, Tumor Necrosis Factor-alpha and Vascular Endothelial Growth Factor Gene Expression after Human Umbilical Cord Blood Derived Mesenchymal Stem Cells Transfusion in Pulmonary Hypertension Rat M

BACKGROUND AND OBJECTIVES: Failure of vascular smooth muscle apoptosis and inflammatory response in pulmonary arterial hypertension (PAH) is a current research focus. The goals of this study were to determine changes in select gene expressions in monocrotaline (MCT)-induced PAH rat models after human umbilical cord blood derived mesenchymal stem cells (hUCB-MSCs) transfusion. MATERIALS AND METHODS: The rats were separated into 3 groups i.e., control group (C group), M group (MCT 60 mg/kg), and U group (hUCB-MSCs transfusion) a week after MCT injection. RESULTS: TUNEL assay showed that the U group had significantly lowered positive apoptotic cells in the lung tissues, as compared with the M group. mRNA of caspase-3, B cell leukemia/lymphoma (Bcl)-2, interleukin (IL)-6, tumor necrosis factor (TNF)-alpha and vascular endothelial growth factor (VEGF) in the lung tissues were greatly reduced at week 4 in the U group. Immunohistochemical staining of the lung tissues also demonstrated a similar pattern, with the exception of IL-6. The protein expression of caspase-3, Bcl-2 VEGF, IL-6, TNF-alpha and brain natriuretic peptide in the heart tissues were significantly lower in the U group, as compared with the M group at week 2. Furthermore, the protein expression of VEGF, IL-6 and BNP in the heart tissues were significantly lower in the U group at week 4. Collagen content in the heart tissues was significantly lower in the U group, as compared with M group at weeks 2 and 4, respectively. CONCLUSION: hUCB-MSCs could prevent inflammation, apoptosis and remodeling in MCT-induced PAH rat models.

The Therapeutic Effects of Optimal Dose of Mesenchymal Stem Cells in a Murine Model of an Elastase Induced-Emphysema / 결핵및호흡기질환

BACKGROUND: Chronic obstructive pulmonary disease is characterized by emphysema, chronic bronchitis, and small airway remodeling. The alveolar destruction associated with emphysema cannot be repaired by current clinical practices. Stem cell therapy has been successfully used in animal models of cigarette smoke- and elastase-induced emphysema. However, the optimal dose of mesenchymal stem cells (MSCs) for the most effective therapy has not yet been determined. It is vital to determine the optimal dose of MSCs for clinical application in emphysema cases. METHODS: In the present study, we evaluated the therapeutic effects of various doses of MSCs on elastase-induced emphysema in mice. When 3 different doses of MSCs were intravenously injected into mice treated with elastase, only 5x10(4) MSCs showed a significant effect on the emphysematous mouse lung. We also identified action mechanisms of MSCs based on apoptosis, lung regeneration, and protease/antiprotease imbalance. RESULTS: The MSCs were not related with caspase-3/7 dependent apoptosis. But activity of matrix metalloproteinase 9 increased by emphysematous lung was decreased by intravenously injected MSCs. Vascular endothelial growth factor were also increased in lung from MSC injected mice, as compared to un-injected mice. CONCLUSION: This is the first study on the optimal dose of MSCs as a therapeutic candidate. This data may provide important basic data for determining dosage in clinical application of MSCs in emphysema patients.

The Effect of Umbilical Cord Blood Derived Mesenchymal Stem Cells in Monocrotaline-induced Pulmonary Artery Hypertension Rats

Pulmonary arterial hypertension (PAH) causes right ventricular failure due to a gradual increase in pulmonary vascular resistance. The purposes of this study were to confirm the engraftment of human umbilical cord blood-mesenchymal stem cells (hUCB-MSCs) placed in the correct place in the lung and research on changes of hemodynamics, pulmonary pathology, immunomodulation and several gene expressions in monocrotaline (MCT)-induced PAH rat models after hUCB-MSCs transfusion. The rats were grouped as follows: the control (C) group; the M group (MCT 60 mg/kg); the U group (hUCB-MSCs transfusion). They received transfusions via the external jugular vein a week after MCT injection. The mean right ventricular pressure (RVP) was significantly reduced in the U group after the 2 week. The indicators of RV hypertrophy were significantly reduced in the U group at week 4. Reduced medial wall thickness in the pulmonary arteriole was noted in the U group at week 4. Reduced number of intra-acinar muscular pulmonary arteries was observed in the U group after 2 week. Protein expressions such as endothelin (ET)-1, endothelin receptor A (ERA), endothelial nitric oxide synthase (eNOS) and matrix metalloproteinase (MMP)-2 significantly decreased at week 4. The decreased levels of ERA, eNOS and MMP-2 immunoreactivity were noted by immnohistochemical staining. After hUCB-MSCs were administered, there were the improvement of RVH and mean RVP. Reductions in several protein expressions and immunomodulation were also detected. It is suggested that hUCB-MSCs may be a promising therapeutic option for PAH.

Microarray analysis after umbilical cord blood derived mesenchymal stem cells injection in monocrotaline-induced pulmonary artery hypertension rats / 대한해부학회지

Pulmonary arterial hypertension (PAH) is associated with structural alterations of lung vasculature. PAH is still a devastating disease needing an aggressive therapeutic approach. Despite the therapeutic potential of human umbilical cord mesenchymal stem cells (MSCs), the molecular parameters to define the stemness remain largely unknown. Using high-density oligonucleotide microarrays, the differential gene expression profiles between a fraction of mononuclear cells of human umbilical cord blood (UCB) and its MSC subpopulation were obtained. Of particular interest was a subset of 46 genes preferentially expressed at 7-fold or higher in the group treated with human UCB-MSCs. This subset contained numerous genes involved in the inflammatory response, immune response, lipid metabolism, cell adhesion, cell migration, cell differentiation, apoptosis, cell growth, transport, cell proliferation, transcription, and signal transduction. Our results provide a foundation for a more reproducible and reliable quality control using genotypic analysis for the definition of human UCB-MSCs. Therefore, our results will provide a basis for studies on molecular mechanisms controlling the core properties of human MSCs.

Long-Term (Postnatal Day 70) Outcome and Safety of Intratracheal Transplantation of Human Umbilical Cord Blood-Derived Mesenchymal Stem Cells in Neonatal Hyperoxic Lung Injury

PURPOSE: This study was performed to evaluate the long-term effects and safety of intratracheal (IT) transplantation of human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs) in neonatal hyperoxic lung injury at postnatal day (P)70 in a rat model. MATERIALS AND METHODS: Newborn Sprague Dawley rat pups were subjected to 14 days of hyperoxia (90% oxygen) within 10 hours after birth and allowed to recover at room air until sacrificed at P70. In the transplantation groups, hUCB-MSCs (5x10(5)) were administered intratracheally at P5. At P70, various organs including the heart, lung, liver, and spleen were histologically examined, and the harvested lungs were assessed for morphometric analyses of alveolarization. ED-1, von Willebrand factor, and human-specific nuclear mitotic apparatus protein (NuMA) staining in the lungs and the hematologic profile of blood were evaluated. RESULTS: Impaired alveolar and vascular growth, which evidenced by an increased mean linear intercept and decreased amount of von Willebrand factor, respectively, and the hyperoxia-induced inflammatory responses, as evidenced by inflammatory foci and ED-1 positive alveolar macrophages, were attenuated in the P70 rat lungs by IT transplantation of hUCB-MSCs. Although rare, donor cells with human specific NuMA staining were persistently present in the P70 rat lungs. There were no gross or microscopic abnormal findings in the heart, liver, or spleen, related to the MSCs transplantation. CONCLUSION: The protective and beneficial effects of IT transplantation of hUCB-MSCs in neonatal hyperoxic lung injuries were sustained for a prolonged recovery period without any long-term adverse effects up to P70.

Long Term Outcomes for Living Renal Donors / 대한이식학회지

BACKGROUND: Kidney donation is a relatively safe procedure with minimal adverse effects. But some reports have described the development of proteinuria and hypertension in donors after nephrectomy. There have been a number of non-Korean studies which conclude that the procedure is relatively safe and a good quality of life is expected for living donors after kidney transplantation, but not enough of these studies have been published in Korea. We evaluated the physiologic and psychosocial impacts after kidney donation in this study. METHODS: Between April 1988 and April 2010, we performed 201 living donor nephrectomies and obtained information for 88 (43.7%) of the donors. We measured their estimated glomerular filtration rate (GFR), blood pressure, body mass index, hemoglobin and cholesterol level, and assessed the prevalence of hypertension and proteinuria in this group. These donors completed a questionnaire regarding their health status and psychosocial outcomes after donation. RESULTS: The average time of the donor assessment after nephrectomy was 95.05+/-85.45 months (range, 6~261). The left kidney was used in 76 patients (86%). There was a total complication rate of 8%, but no serious complications were observed. Proteinuria was found in 9 patients (10%) and hypertension in 11 patients (11%). GFR decreased from 103.65+/-25.02 mL/min to 76.12+/-19.90 mL/min (P<0.001) and hemoglobin decreased from 13.91+/-1.62 g/dL to 13.01+/-1.72 g/dL (P<0.001). Five patients (6%) developed a post-donation GFR between 40 and 60 mL/min, with 2 patients being observed to have a post-donation GFR below 20 mL/min. In the questionnaire responses, most donors did not report problems affecting routine life or any economic impact. Their donation satisfaction results were very high (92%). CONCLUSIONS: Living kidney donors were observed to result in reduced GFR after nephrectomy. Follow-up visits with living kidney donors is essential in order to monitor risk factors related to the deterioration of their residual kidney function.

A Case of Intestinal Hemangioma Complicated with Thrombocytopenia (Kasabach-Merritt syndrome) in Premature Infant

Kasabach-Merritt syndrome is a rare thrombocytopenic consumptive coagulopathy associated with a giant hemangioma. We experienced a case of unexplained ascites with thrombocytopenia in a 32 week premature infant. An exploratory laparotomy was performed to determine the cause of the refractory ascites and thrombocytopenia. An intestinal hemangioma was found, but, surgical removal was not performed due to the extensive involvement. Hemangioma was confirmed by SPECT (single-photon emission computed tomography) and the thrombocytopenia was treated with steroid therapy. It is recommended that hemangioma of the visceral organs should be suspected when unexplained thrombocytopenia and disseminated intravascular coagulopathy persist.

A Large Hematoma Due to Benign Ulcer Perforation of the Gastric Fundus Resembling Submucosal Tumor / 대한소화기내시경학회지

The gastric fundus is a rare site for benign ulcer and perforation to occur. A 47 year-old male presented to the emergency department with epigastric pain. An endoscopic examination revealed a submucosal tumor-like lesion with friable, superficial ulceration in the high body of the stomach. We performed surgical resection to rule out malignancy because of the lesion's large size and we found chronic gastric ulcer perforation, which was pathologically diagnosed. We presumed that the formation of the large hematoma, which mimicked a submucosal tumor, was a result of repeated bleeding, perforation and healing. We report here on a case of a large hematoma due to a benign gastric ulcer perforation in the fundus, and this all mimicked a submucosal tumor.

Clinical Implications of Multiple Endovascular Treatments for Patients with Lower Limb Deep Vein Thrombosis

PURPOSE: The aim of this study is to assess the clinical benefits of endovascular treatment for lower extremity deep vein thrombosis. Particularly, we wanted to define the factors that affect the recurrence of deep vein thrombosis (DVT) after repeated endovascular treatments. METHODS: Eighty six patients who were diagnosed with DVT from January 2003 to December 2008 were retrospectively examined. All the patients were diagnosed by lower extremity computed tomography scanning. Multimodality therapy was performed to achieve primary venous patency. The multimodality strategy included catheter-directed thrombolysis followed by percutaneous transluminal balloon angioplasty and stenting for any residual stenosis. RESULTS: Fifteen patients (17%) underwent repeated endovascular treatment. The onset of symptoms and a history of DVT were the factors that affected the recurrence of DVT. Repeated endovascular treatment showed considerably significant differences for recurrence between the single and multiple groups (28/71 [39.6%] vs. 9/15, respectively, [60%]) and for the mean venous patency duration (29.1 months [confidence interval (CI), 22.6~35.7] vs. 12.4 months, respectively, [CI, 6.7~20.2]) (P=0.001). CONCLUSION: Although multiple endovascular treatment demonstrated a favorable primary outcome, there were no definite benefits of multiple endovascular treatment on the long term follow-up. In the subgroup that has focal remnant thrombus, one more additional endovascular treatments would benefit for the recurred lower extremity deep vein thrombosis.

Effects of Heme Oxygenase-1 Expression in Mycophenolic Acid Induced Apoptosis of Jurkat Cell Lines

PURPOSE: This study demonstrates that pharmacologic induction of heme oygenase-1 (HO-1) along with catalytic activation significantly modulated apoptosis of Jurkat cells induced by mycophenolic acid (MPA). METHODS: Cells were cultured with the presence or absence of MPA. Flow cytometric analysis was performed after propidium iodide staining. Western blotting of HO-1, Bcl, and Bax was also performed. Cells were stained 4'-6-Diamidino-2-phenylindole (DAPI) and measured by flow cytometry in the absence or presence of CoPPIX. RESULTS: Treatment of MPA decreased cell viability in a dose- and time-dependent manner. MPA-induced cell death was confirmed as apoptosis characterized by sub G0/G1 phase arrest. Expression of HO-1 assumes a pattern of decline after rising at the initial phase. CoPPIX, HO-1 inducer, significantly inhibited the cisplatin-induced apoptosis. Treatment of MPA resulted in reactive oxygen species (ROS) generation in Jurkat cells. CoPPIX attenuated ROS production in MPA-treated cells. CONCLUSION: This result suggests that the protective mechanism of HO-1 on MPA-induced cytotoxicity is associated with direct inhibition of ROS generation and mitochondrial permeability transition.

Bilaterality of Inguinal Hernia in Adult Patients: Synchronous Bilateral and Metachronous Contralateral Hernia

PURPOSE: We are to describe the incidence and accordance rate of hernia type in synchronous bilateral and metachronous contralateral inguinal hernia. METHODS: We retrospectively reviewed the medical records of 625 adult patients who underwent inguinal hernia repair by a single surgeon at our institute between November 2001 and October 2008. We divided the patients into 3 groups; Synchronous bilateral inguinal hernia group (SH), Metachronous contralateral inguinal hernia group (MH) and Unilateral inguinal hernia group (UH) and analyzed patients' general clinical features and outcomes. RESULTS: Male patients numbered 578 (92.5%) and female patients numbered 47 (7.5%), so the male to female ratio was 12.3:1. Each number of SH and MH were 49 (7.8%) and 59 (9.4%). In MH, the mean interval of counterlateral hernia development following ipsilateral hernia repair was 8.9 years and 20 (33.9%) were developed in a 3-year period. And the incidence of right hernia development after repair of left hernia predominated over left hernia development after repair of right hernia by a ratio of 1.27:1. Accordance rate of hernia type in both sides was 83.8% in SH and 91.2% in MH. CONCLUSION: The incidence of SH and MH were each 7.8% and 9.4% and accordance rate of hernia type is very high in SH and MH. In MH, many patients (33.9%) developed in 3 years after ipsilateral hernia repair. In this study, patients have high accordance rate of hernia type in both sides and indirect type is dominant, especially in MH.

A Transmesenteric Hernia in a Child: Gangrene of a Long Segment of Small Bowel through a Large Mesenteric Defect / 대한소화기학회지

Intestinal obstruction is a common surgical emergency. Transmesenteric hernia is an unusual cause of bowel obstruction that may result in irreversible damage of the bowel and a fatal outcome. Once incarceration of the bowel occurs, strangulation and gangrene follow immediately. The mortality rate associated with this condition is about 15%, but in the presence of gangrene of the bowel, the mortality rate is more than 50%. An accurate preoperative diagnosis of a transmesenteric hernia is very difficult and rarely made. Therefore, in patients with small bowel obstruction, in the absence of a history of previous surgery to suggest adhesions or an external hernia, the possibility of a transmesenteric hernia must be considered. We describe a case with gangrene of a long segment of the small bowel caused by a transmesenteric hernia through a large defect of small bowel mesentery in a child.

Decision Factors on Mycophenolic Acid Dose after Renal Transplantation / 대한이식학회지

BACKGROUND: Triple immunosuppressant therapy including anti-metabolites is the representative immunosuppressive therapy after renal transplantation. This study is to evaluate the factors that influence Mycophenolate sodium (MPS, Myfortic, Novartis, Basel, Switzerland) dosage patterns in renal transplantation patients who take MPS as an inosine monophosphate dehydrogenase (IMPDH) among antimetabolites. METHODS: From May 2007 to April 2008, 16 clinical departments of 14 transplantation centers in Korea retrospectively performed a survey on 650 renal transplantation recipients taking MPS. This survey collected personal information, clinical factors related to transplantation and immunosuppressive therapy. RESULTS: The mean age of the patients was 43.0+/-12.0 (7~75) and the study included 364 males (56.0%) and 286 females (44.0%). The average follow up period after renal transplantation was 49.5+/-53.4 (1~307) months. There were 366 (56.3%) living related cases, 145 (22.3%) living non-related cases and 139 (21.4%) deceased donor cases. Cyclosporine was the most common calcineurin inhibitor (CNI) used in combination therapy with MPS (476 cases, 73.2%) followed by tacrolimus (169 cases, 26.0%). The mean daily dose of MPS was 909.7+/-336.3 (180~1,620)mg and the mean daily dose per kg was 15.3+/-5.9 (2.65~32.73)mg/kg. The daily dose showed significant positive correlation with patient body weight but the daily dose per kg showed negative correlation. The daily dose of MPS was significantly higher in the combination therapy with cyclosporine than that with tacrolimus. The daily dose and the dose per kg decreased with increment of recipient age and post-transplant period. CONCLUSIONS: Our study concluded that MPS dosages correlated with the combined type of CNI, post-transplant period and age.

Chronic Constipation Led to Sigmoid Volvulus in a Child

Sigmoid volvulus is uncommon in children. Chronic constipation rarely leads to sigmoid volvulus. We report the experience of a case of sigmoid volvulus led by chronic constipation in a child. An 11-year-old girl complained abdominal pain and constipation, which had continued for previous 3 years. Under the impression of sigmoid volvulus by simple abdominal x-ray and abdominal computed tomography, emergency colonoscopic reduction of the volvulus tried to fail to the emergency segmental resection of the twisted sigmoid colon. After 3 months of operation, her constipation improved gradually with no other untoward symptoms so far.

Retraction: A Transmesenteric Hernia in a Child: Gangrene of a Long Segment of Small Bowel through a Large Mesenteric Defect / 대한소화기학회지

No abstract available.