Organ transplantation has become the standard of care for treatment of end stage organ failure patients medically suitable for transplantation. Unfortunately, the availability of transplantable organs has not been able to meet the high demand. The organ shortage of transplantation has become worldwide and a national crisis. Despite various attempts to expand the donor pool, the difference between organ supply and organ demand continues. This article reviews methods to increase the number of potential deceased organ donor and the number of organs per donor by aggressive donor management protocol.
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, Duk-Hee Kang Kidney transplantation is the best treatment for end-stage renal disease patients. However, the relative shortage of organs for transplantation has led to ABO-incompatible kidney transplantation as an accepted method to expand the pool of kidney donors. Recent advances in immunosuppression and antibody removal methods have made ABO-incompatible kidney transplantation more feasible, and have increased the opportunities for patients to receive kidney transplantation, as well as for special patients with ABO-compatible donor. Indeed, the outcome of ABO-incompatible kidney transplantation has shown remarkable developments and is now comparable to that of ABO-compatible kidney transplantation during last decade. However, there are still some uncertain issues to be addressed in ABO-incompatible kidney transplantation. In this article, we reviewed the current status and protocol of ABO-incompatible kidney transplantation and listed the concerns to be addressed in near future.
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, Do Kyung Lee, Su Jin Cho, Young Mi Hong, Jung Hyun Kwon We aimed to compare and distinguish the characteristics of anaphylaxis and angioedema, especially with oral mucosal involvement and treatment of patients who visited the Pediatric Emergency Department.
We retrospectively analyzed patients under age 18-year-old who were diagnosed with anaphylaxis and angioedema with oral mucosal involvement and treated with epinephrine from May 2008 to May 2013 in a single Pediatric Emergency Department in Seoul, Korea. We evaluated their past history, possible triggering causes, symptoms, vital signs and treatment and discharge with education.
During the study period the total cases of anaphylaxis were 79 and angioedema with oral mucosal involvement were 218. The age of patients with anaphylaxis was significantly higher (6.6±4.9 years vs. 4.1±3.3 years). The heart rate relative to age was significantly higher in the anaphylaxis group (49.4% vs. 36.2%). After discharge from the Emergency Center, 3.8% of anaphylaxis patients were prescribed an epinephrine injection. Education to avoid the triggering factor was provided in 32.9% of anaphylaxis group and 17.4% in the angioedema group.
Besides blood pressure, we should pay attention to the heart rate in pediatric patients with severe allergic reactions. More active follow-up of anaphylaxis and angioedema with oral mucosal involvement is needed to educate parents and prescribe emergency medication.
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, So-I Kim, Seong-Eun Kim, Hye-Kyung Jung, Tae-Hun Kim The prevalence of constipation is high after stroke. Multiple factors such as long-term bed-ridden status, comorbidity, medical illnesses are combined in this condition. However, the change of bowel movement during the early stage of stroke remains uncertain.
Patients with first stroke who admitted in a single institute from 2008 to 2009 were reviewed retrospectively and 36 patients were enrolled. As a control group, 47 consecutive orthopedic patients needing bed rest without surgery in the same period were enrolled. Data of stroke associated factors, frequency of BM (bowel movement) during 5 weeks, use of gastrointestinal medications, and outcomes were collected from the medical records.
The cumulative incidence of decreased (<3/week) and severely decreased BM (<1/week) were 80.6% and 69.4% in stroke patients and 53.2% and 14.9% in control group (P<0.05). The cumulative incidence of increased BM (>3/day) was 38.9% in stroke and 14.9% in control group. In acute stroke, 58% of patient showed severely decreased BM in first week, and the proportion was rapidly decreased below 15% from second week. However, laxative use increased with hospital days. The occurrence of severely decreased BM in stroke patients was associated with National Institutes of Health Stroke Scale (NIHSS; P=0.004). Severely decreased BM was not associated with poor outcomes including death, morbidity, and stroke recurrence.
Decreased BM is common in acute stroke. The occurrence of severely decreased BM is associated with NIHSS. However, the severe manifestation occurred mainly in the first week, and considered to be well controlled by laxatives.
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, Soo Kyung Lim, Ji young Chang, Eun kyo Jung, Youn-i Choi, Jee-Young Oh, Youngsun Hong, Yeon-Ah Sung, Hyejin Lee Gestational diabetes mellitus (GDM) affects 2%-4% of the all pregnant women, and it is a major risk factor for development of type 2 DM. We performed this cross-sectional study to determine whether there were defects in insulin secretory capacity or insulin sensitivity in women with previous GDM.
On 6-8 weeks after delivery, 75 g oral glucose tolerance test was performed in 36 women with previous GDM and 19 non-pregnant control women matched with age and weight. Intravenous glucose tolerance test was performed on 10-14 weeks after delivery. Insulin secretory capacity measured as the acute insulin response to glucose (AIRg) and insulin sensitivity as minimal model derived sensitivity index (SI) were obtained. AIRg×SI (β-cell disposition index) was used as an index of β-cell function.
Women with previous GDM were classified into normal glucose tolerance (postpartum-NGT, n=19) and impaired glucose tolerance (postpartum-IGT, n=17). Postpartum fasting glucose levels were significantly higher in postpartum-IGT compared to postpartum-NGT and control (P<0.05). AIRg×SI was significantly lower in postpartum-IGT compared to control (P<0.05). SI was lower in postpartum-NGT and postpartum-IGT compared to control, but the difference did not have the statistical significance. Frequency of parental history of type 2 diabetes was significantly greater in postpartum-IGT compared to postpartum-NGT (P<0.05).
Women with previous GDM showed impaired insulin secretion although their glucose tolerance states were restored to normal. It suggests impaired early insulin secretion may be a major pathophysiologic factor for development of type 2 DM, and this defect may be genetically determined.
, Youn Kyung Kee, Eunyoung Lee, Choong-kun Lee, Seung Gyu Han, Su Jin Heo, Tae-Hyun Yoo Malakoplakia is an uncommon chronic granulomatous inflammatory disease which is associated with immunocompromised conditions such as malignancy, autoimmune disease, chronic alcohol intake, poorly controlled diabetes and long-term steroid use. Malakoplakia can occur at various sites, most commonly in the genitourinary tract including urinary bladder and the ureter. Renal parenchymal involvement is relatively uncommon, accounting for 15% of all malakoplakia. A few cases of renal malakoplakia have been reported in Korea, and only one case was accompanied by acute kidney injury. Here we report an 80-year-old female patient with renal parenchymal malakoplakia and acute interstitial nephritis presented as acute kidney injury with literature review.
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, Jin Young Choi, Ho Jun Kang, Ji Hee Sung, Sang Jong Park, Sun Hong Yoo, Young Min Park Vitamin A deficiency can occur as a result of malnutrition, malabsorption, or poor vitamin metabolism due to liver disease and night blindness might develop as the first symptom. Although there have been foreign reports about night blindness due to vitamin A deficiency which was derived from liver cirrhosis, primary biliary cirrhosis, intestinal bypass surgery or bariatric operation, it is hard to find reports about night blindness after percutaneous transhepatic biliary drainage for external bile drainage. We report a case of night blindness derived from fat-soluble vitamin A deficiency developed after long-term (18 months) external bile drainage for benign biliary stricture occurred after left hepatic lobectomy and hepaticojejunostomy due to the Klatskin tumor (IIIb). Her night blindness and low serum retinol level (0.02 mg/L) was dramatically improved after vitamin A supplementation. We recommend lipid-soluble vitamin supplementation on the case of long-term external bile drainage.
, Seung Taek Lim, Yeon Seok Choi, Tae Soo Jang, Sun Hee Oh, Joo Ah Lee, Do Yeun Cho Ovarian cancer is generally primary cancer and less frequently originates from metastasis from non-gynecological cancer. Ovarian metastasis from lung cancer represents only 2~4% of all ovarian metastatic cancers. We report a case of ovarian metastasis of non-small cell lung cancer with epidermal growth factor receptor mutation. The patient underwent cytoreductive surgery for the ovarian mass and erlotinib therapy for the metastatic lung cancer. Erlotinib therapy markedly decreased the size of lung mass.
, Ji Young Chang, Min Kyung Chung, Hyo Moon Son, Chung Hyun Tae, Jung Hyun Chang, Ki-Nam Shim Gastric sarcoidosis is a rare disease accounting for 0.1~0.9% of all sarcoidosis cases. It presents either as a systemic disease or as an isolated finding. Diagnosis is established with biopsy of a lesion. It is important to distinguish between sarcoidosis and a sarcoid-like reaction, which can be caused by Crohn's disease, foreign body reaction, fungal infection, tuberculosis, or malignancy. We report a 60-year-old woman with both gastric and pulmonary sarcoidosis.
, Chung Kang, Il Hyung Jung, Hyun Gee Moon, Bo Ram Youn, Nam Hun Lee Pseudomembranous colitis (PMC) is a frequent cause of morbidity and mortality among hospitalized patients. Although diarrhea is the most common manifestation, PMC may be associated with intraperitoneal fluid accumulation in the severe cases. And a few cases showing both ascites and pleural effusion have been reported in patients with PMC. We report a case of PMC who showed elevated serum and ascites levels of carcinoembryonic antigen (CEA) with a normal CEA level in pleural effusion and who successfully recovered after oral administration of metronidazole. After treatment, the serum CEA level returned to the reference range.
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