Feasibility of a constructed wetland and wastewater stabilisation pond system as a sewage reclamation system for agricultural reuse in a decentralised rural area

The performance of a constructed wetland (CW) and wastewater stabilisation pond (WSP) system for sewage reclamation and paddy rice irrigation in a decentralised rural area was examined using a feasibility study. The CW was satisfactory for sewage treatment, with good removal efficiency even in the winter period, but the effluent concentration was relatively high in the winter period owing to the high influent concentration. The CW effluent was further treated in a WSP and the WSP effluent was considered safe for crop irrigation with respect to sewage-borne pathogens. Reclaimed water irrigation did not adversely affect the yield of rice; on the contrary, it resulted in an approximately 50% greater yield than in controls. The chemical characteristics of the soil did not change significantly during the experimental period of irrigation with reclaimed water. In the winter, CW effluent could be stored and treated in a WSP until the spring; the water could then be discharged or reused for supplemental irrigation during the typical Korean spring drought. Overall, sewage treatment and agronomic reuse using a CW-WSP system could be a practical integrated sewage management measure for protecting receiving water bodies and overcoming water shortages in decentralised rural areas.

Evaluation of developmental toxicity of amitraz in Sprague-Dawley rats

This study investigated the potential adverse effects of amitraz on the initiation and maintenance of pregnancy in Sprague-Dawley rats as well as its effects on embryo-fetal development after maternal exposure during the entire pregnancy period. Amitraz was administered to pregnant rats by gavage from days 1 to 19 of gestation at dose levels of 0, 3, 10, and 30 mg/kg/day. All dams underwent a caesarean section on day 20 of gestation and their fetuses were examined for any external, visceral, and skeletal abnormalities. At 30 mg/kg, maternal toxicity manifested as an increase in the incidence of abnormal clinical signs and a lower body weight gain and food intake. Developmental toxicity included an increase in the fetal death rate, a decrease in the litter size, and a reduction in the fetal body weight. In addition, there was an increase in the incidence of fetal external, visceral, and skeletal abnormalities. At 10 mg/kg, maternal toxicity observed included a decrease in the body weight gain and a decrease in food intake. In addition, minimal developmental toxicity, including a decrease in the fetal body weight, an increase in the visceral and skeletal aberrations, and a delay in fetal ossification. There were no signs of either maternal toxicity or developmental toxicity at 3 mg/kg. These results show that amitraz administered during the entire pregnancy period in rats is embryotoxic and teratogenic at the maternally toxic dose (i.e., 30 mg/kg/day) and is minimally embryotoxic at a minimally maternally toxic dose (i.e., 10 mg/kg/day). Under these experimental conditions, the no-observed-adverse-effect level of amitraz for both dams and embryo-fetal development is estimated to be 3 mg/kg/day.

Effect of tacrolimus on the production of oxygen free radicals in hepatic mitochondria

OBJECTIVES

Cyclosporine (CsA) causes side effects that occur mainly in the kidney but also in the liver. Several reports have strongly suggested that the production of oxygen free radicals (OFRs) is a common mechanism of CsA toxicity. However, tacrolimus is believed to suppress the production of OFRs.

METHODS

We obtained the mitochondrial fraction with 96% purity from rat liver using a sucrose density gradient solution. Zero to 100 micromol/L tacrolimus was incubated with the mitochondrial fraction for 6 hours at 37 degrees C. OFRs were evaluated by measuring the fluorescent product from the oxidation of an oxidant-sensitive 2,7-dichlorefluorescein using a VICTOR3 multilabel counter.

RESULTS

The fluorescence units for OFR production were increased as the time of exposure to tacrolimus passed from 1 to 6 hours. The fluorescence units in 0.1 micromol/L tacrolimus were 6.0 x 10(5) at 1 hour, 7.8 x 10(5) at 2 hours, 9.0 x 10(5) at 3 hours, 10.0 x 10(5) at 4 hours, 11.1 x 10(5) at 5 hours, and 11.4 x 10(5) at 6 hours. However, the fluorescence units were similar although the tacrolimus concentration increases from 0.1 to 100 micromol/L.

CONCLUSIONS

The results in this experiment suggested that tacrolimus induced the production of OFRs depending on the exposure time.

Apoptosis by cyclosporine in mesangial cells

INTRODUCTION

The immunosuppressive agent cyclosporine (CsA) is widely used to treat allograft rejection and various autoimmune disorders. A major limiting factor in the use of CsA is chronic nephrotoxicity. The pathogenesis of CsA-induced nephrotoxicity is not fully understood. Several recent studies have suggested that CsA treatment directly induces apoptosis in several cell types. The present study was undertaken to investigate the effects of CsA on apoptosis of cultured rat mesangial cells (RMCs).

METHODS

RMCs were treated with CsA at concentrations of 0.1 to 40 mumol/L. Cell viability was determined by MTT assay. Apoptotic protein expression was determined by Western blot analysis.

RESULTS

Cell viability was decreased with increasing concentrations of CsA in dose-dependent manner. CsA produced dose-dependent induction of p53, caspase-6, and Bax protein expression. CsA treatment caused proteolytic cleavage of caspase-3 and induced the degradation of 116-kDa PARP into 89-kDa fragment. RMCs with CsA reduced Bcl-2 and cIAP expression.

CONCLUSIONS

In this study, CsA induced apoptosis by up-regulating proapoptotic factors, caspase-3 and -6, p53, Bax, cleaving PARP, and down-regulating antiapoptotic factor, Bcl-2, and cIAP. These results suggested that the increased cell apoptosis exerted by CsA may be one of the mechanisms promoting CsA-induced nephrotoxicity.

Total antioxidant status and oxygen free radicals during hepatic regeneration

OBJECTIVES

The damage induced by oxygen free radicals (OFRs) is caused by an imbalance of the production of versus the antioxidant defenses against OFRs.

METHODS

To understand hepatic damage induced by oxygen free radicals after hepatectomy in rats, total antioxidant status and total production of oxygen free radicals were serially measured in regeneration liver. At 1, 2, 3, 7, and 10 days after hepatectomy of Sprague-Dawley rats, blood was obtained into a capillary tube from a tail vein. Total antioxidant status and total production of oxygen free radicals were measured using the Randox kit, a colorimetric method, and the Free Radical Analytical System. We also measured the amount of malonyldialdehyde, which provides an indirect index of oxidative injury.

RESULTS

The level of malonyldialdehyde after hepatectomy was higher compared with that before hepatectomy. The level of total oxygen free radicals after hepatectomy was higher compared with that before hepatectomy. Total antioxidant status after hepatectomy was lower compared with that before hepatectomy.

CONCLUSIONS

The results suggested that the damage by OFRs to the regenerating liver was caused by increased production of OFRs and decreased antioxidant defense against OFRs.

Polyoma virus-associated nephropathy and concurrent cytomegalovirus infection in the kidney transplant recipients

INTRODUCTION

Cytomegalovirus (CMV) and polyoma virus BK (BKV) may both establish latency following primary infection. Frequent reactivation of these viruses can occur in the kidney transplant recipients. BKV may induce CMV gene expression by stimulating cellular regulator proteins or by its own gene regulator proteins. A high rate of concurrent CMV infections has been noted in kidney transplant recipients with polyoma virus-associated nephropathy (PVAN).

METHODS

PVAN was identified in 10 of 191 patients who received kidney transplants between October 1998 and September 2003. PVAN was confirmed by allograft kidney biopsy. Four of the 10 patients were complicated by concurrent CMV infection.

RESULTS

Two patients had only serological evidence of CMV infection and one patient had CMV gastritis. These three patients were treated with intravenous ganciclovir with good results. Disseminated ganciclovir-resistant CMV disease was demonstrated in the remaining patient. This 34-year-old kidney transplant recipient with PVAN died of multiorgan failure despite antiviral therapy with both ganciclovir and foscarnet.

CONCLUSION

PVAN with concurrent CMV infection in kidney transplant recipients showed variable clinical courses including mortality. Further studies are needed to elucidate the influence of PVAN on the pathogenesis of CMV infection.

Effects of cyclosporine and tacrolimus on the oxidative stress in cultured mesangial cells

OBJECTIVES

Cyclosporine (CsA) and tacrolimus (Tac) are two primary immunosuppressive agents used for the prevention of graft rejection. However, their use is associated with significant side effects, most notably nephrotoxicity. The mechanisms of this toxicity are not fully understood, but they seem to be associated with increases in the production of oxygen free radicals (OFRs). This present work examined the effect of CsA and Tac on the production of OFRs in cultured rat renal mesangial cells (RMCs).

METHODS

Varying concentrations of CsA and Tac (0 to 40 micromol/L) were added to RMCs and incubated for 60 minutes at 37 degrees C. The production of OFRs was evaluated by measuring the fluorescent product from the oxidation of an oxidant-sensitive 2', 7'-dichlorofluorescin.

RESULTS

At 60 minutes, the relative fluorescence units (RFU) for OFRs production in RMCs exposure to CsA were increased by 2.5%, 11.5%, 22.5%, 57.2%, and 174% at 2.5, 5, 10, 20, and 40 micromol/L, respectively. Tac increased the RFU by 15.9%, 13.6%, 14.8%, 13.2%, 21.4%, 13.2%, and 28.1% at 0.1, 1, 2.5, 5, 10, 20, and 40 micromol/L, respectively. In RMCs, the RFU produced by CsA was higher than that by Tac.

CONCLUSIONS

The results of this experiment suggest that CsA and Tac induced renal injury by OFRs.

ApoA-I mutants V156K and R173C promote anti-inflammatory function and antioxidant activities

BACKGROUND

Two mutants of apolipoprotein (apo) A-I, V156K and A158E, showed markedly different structural and functional properties in lipid-free and lipid-bound states in the authors' earlier report. The physiological activities of these mutants were compared with the wild-type (WT) and R173C mutant using in vitro and in vivo experiments.

MATERIALS AND METHODS

A reconstituted high-density lipoprotein (rHDL) with palmitoyloleoyl phosphatidylcholine (POPC), combined with each of the apoA-I variants, was injected into the tail-veins of hypercholesterolaemic mice (C57BL6/J), which had been fed a high cholesterol and high fat (HCHF; 0.5% cholesterol, 15% lard, 0.1% sodium cholate) diet for 23 weeks, once at 0 h and then every 24 h, at a dosage of 30 mg apoA-I kg(-1) of body-weight.

RESULTS

The V156K-rHDL and R173C-rHDL exhibited significantly stronger anti-oxidant activity against copper-mediated low-density lipoprotein (LDL) oxidation than did A158E in an apolipoprotein state. The mice injected with WT-rHDL or A158E-rHDL showed abrupt increases in total cholesterol concentrations (47% and 38%, respectively) as compared with the levels before injection, whereas the mice injected with V156K-rHDL and R173C-rHDL did not. Injection with V156K-rHDL improved serum lipids and anti-oxidative activities compared with the injection of WT-rHDL. Injection of WT-rHDL or A158E-rHDL increased serum interleukin-6 (IL-6) to 90-110 pg mL(-1), whereas the injection of V156K-rHDL or R173C-rHDL increased serum IL-6 to 17-25 pg mL(-1) only.

CONCLUSION

The V156K-rHDL and R173C-rHDL displayed potent beneficial effects, including anti-oxidant and anti-inflammatory activity from both in vitro and in vivo evaluations, whereas the WT-rHDL and A158E-rHDL did not.

Cyclosporine-Induced Apoptosis in Osteosarcoma Cells

INTRODUCTION

Posttransplant bone disease is one of the complications of cyclosporine (CsA), which is widely used as an immunosuppressive agent in the field of kidney transplantation. Cyclosporine treatment causes osteopenia as a result of altered bone turnover, but the pathogenic mechanisms of this process remain unclear. This study examined the ability of CsA to induce apoptosis in a rat osteoblast cell line.

RESULTS

We induced apoptosis in rat osteoblastic ROS 17/2.8 cells by exposure to CsA. MTT assay showed that CsA exhibited significant cytotoxic effects on ROS 17/2.8 cells in a dose-dependent manner. Western blot analysis showed enhanced processing of caspase-8, Bax, and p53 after CsA treatment. Expression of cleaved poly (ADP-ribose) polymerase (PARP) was elevated by CsA treatment. Pro-caspase-3 and Bcl-2 proteins were decreased by CsA.

CONCLUSIONS

These results suggested that CsA induced apoptosis of osteoblasts.

Efficacy of PET/CT in the accurate evaluation of primary colorectal carcinoma

AIM

This study was performed to assess in the accurate evaluation of primary colorectal carcinoma using PET/CT.

METHODS

One hundred patients with primary colorectal carcinoma were evaluated during 2004. All patients underwent PET/CT when their preoperative serum carcinoembryonic antigen was >or=10 ng/mL or when CT showed equivocal findings. The appropriateness of PET/CT-induced changes was noted by subsequent operative findings and follow-up.

RESULTS

PET/CT more detected 15 intra-abdominal metastatic lesions than abdomino-pelvic CT scan. PET/CT showed true negative findings in 13 patients and false positive or negative findings in 10. Due to PET/CT results, management plans were altered in 27 patients; 9 had inter-modality changes, 10 received more extensive surgery, and 8 avoided unnecessary procedures.

CONCLUSIONS

PET/CT altered management plan in 24% of patients with primary colorectal carcinoma in correct direction. These findings suggest that PET/CT should be considered a part of standard work up for preoperative evaluation in a subset of patients with colorectal carcinoma.

Therapeutic use of granulocyte-colony stimulating factor could conceal residual malignant cells in patients with AML1/ETO+ acute myelogenous leukemia

We have experienced a number of cases of AML1/ETO+ acute myelogenous leukemia that showed remission based on bone marrow (BM) morphological criteria, but that revealed clonal abnormalities in most cells by fluorescence in situ hybridization (FISH). Interestingly, most of these cases had AML with AML1/ETO rearrangement. The malignant cells were differentiated and considered mature cells after granulocyte-colony stimulating factor (G-CSF) treatment. To clarify the possible mechanisms underlying this phenomenon, we investigated the expression levels of G-CSFR in AML cells with AML1/ETO rearrangement by flow cytometry and real-time polymerase chain reaction (PCR). The number of AML1/ETO+ cells expressing G-CSFR at baseline was significantly higher than that of AML1/ETO- AML cells (2673 vs 522). In addition, the G-CSFR gene was more highly expressed in AML1/ETO+ cells than in AML1/ETO- cells by real-time PCR. This study reveals that cases showing remission after treatment with G-CSF mostly had leukemia with AML1/ETO rearrangement. This finding might be explained by the higher expression of G-CSF receptor in AML1/ETO+ cells than in AML1/ETO- cells. We recommend that remission should be confirmed by FISH, because malignant clones can be differentiated and masked in morphological examination or chromosome test, especially for AML with AML1/ETO rearrangement.

Metachronous colorectal cancer

OBJECTIVE

Although the diagnosis of metachronous colorectal cancer have increased, due primarily to improvements in diagnostic modalities, the potential risk factors for these tumours are not well known. We compared the characteristics of patients with metachronous and sporadic primary colorectal cancer to determine risk factors for its occurrence.

PATIENTS AND METHODS

We reviewed the records of 5447 patients with colorectal cancer, who had been treated at Asan Medical Centre between July 1989 and January 2004. A metachronous cancer was defined as a secondary colorectal cancer occurring more than 6 months after the index cancer.

RESULTS

Metachronous colorectal cancer occurred in 39 (0.7%) patients. Their average age was 53 years, somewhat younger than the average age of sporadic colorectal cancer patients (58 years). In patients with metachronous cancer, the cancer was more likely to be located in the right colon (P < 0.03), and the incidence of synchronous polyps or cancer was significantly higher (P < 0.001). The relative distributions of histological grades and clinicopathological characteristics were similar in index and metachronous cancers. Metachronous cancers were diagnosed more frequently at an early stage. The time interval between index and metachronous cancer ranged from 6 to 215 months (mean 39 months), with 13 (33.3%) patients diagnosed with metachronous cancer after 5 years.

CONCLUSION

We found that in patients aged < 50 years, existence of synchronous polyps or cancer influence on the development of metachronous colorectal cancer. Regular follow-up is necessary for early detection, even after 5 years, for these patients.

Pancreatic carcinoid tumor with obstructive pancreatitis: multislice helical CT appearance: case report

Carcinoid tumor of the pancreas is rare. Moreover, obstructive pancreatitis secondary to a pancreatic carcinoid tumor is extremely rare. We report a case of pancreatic carcinoid tumor in a 50-year-old male who presented with pancreatitis. On multislice helical computed tomography, the main pancreatic duct was obstructed by a small round tumor, and the main pancreatic duct proximal to the tumor was dilated. The correlation between the main pancreatic duct and the tumor was well depicted on minimum intensity projection image. This is the first report of multislice helical computed tomorgraphic and minimum intensity projection image findings of a pancreatic carcinoid tumor presenting with pancreatitis.

Concurrent chemoradiotherapy in patients with nasopharyngeal cancer: prognostic significance of low expression of bax

A randomized trial has demonstrated that concurrent chemoradiotherapy (CRT) is superior to radiotherapy (RT) alone in locally advanced nasopharyngeal cancer (NPC). Our study comprise 35 patients with locally advanced NPC (stage I: 1, II: 12, III: 7, IV: 15) with 1 cycle of induction chemotherapy (5-fluorouracil 1,000 mg/m(2)/day and cisplatin 20 mg/m(2)/day, days 1- 4) followed by concurrent CRT starting on day 22. Concurrent CRT consisted of RT (70 Gy/35 fractions for 7 weeks) with cisplatin 20 mg/m(2)/day for 4 days on weeks 1, 4, 7 of RT. Complete response (CR) was achieved in 33 patients (94%). Four-year progression-free survival (PFS) and overall survival (OS) of all patients were 57% and 65%, respectively. In analysis of prognostic factors, low expression of bax was the most significant independent predictor of poor prognosis in both PFS (p=0.002) and OS (p=0.008). In conclusion, the outcome of patients treated with this combined therapeutical modality appears to be comparable with that of Intergroup 0099 trial with high CR rate. Low expression of bax was significantly associated with poor PFS and OS.

The addition of induction chemotherapy with etoposide, ifosfamide, and cisplatin failed to improve therapeutic outcome of concurrent chemoradiotherapy in patients with locally advanced non-small cell lung cancer -- single institution retrospective analysis

Although chemoradiotherapy (CRT) is a standard treatment for unresectable locally advanced non-small cell lung cancer (NSCLC), the optimal sequencing remains to be determined. We retrospectively compared the treatment results of induction chemotherapy followed by concurrent CRT (induction group, 32 patients) with those of concurrent CRT alone (concurrent group, 41 patients) in unresectable stage IIIA/IIIB NSCLC patients. In induction group, 2 cycles of induction chemotherapy (etoposide/ifosfamide/cisplatin: 24 patients, others: 8 patients) were followed by concurrent CRT (60 Gy/30 fractions, 6 mg/m2 of cisplatin daily), while the same concurrent CRT was administered in concurrent group. Clinicopathologic characteristics including age, weight loss, histologic types, and clinical stage did not show significant differences between two groups except for a higher proportion of patients with ECOG performance status 2 in concurrent group (3% vs. 27%, p=0.015). Overall toxicity was generally acceptable with 1 treatment-related death from tracheoesophageal fistula in induction group. The response rates after concurrent CRT were 41% for induction group and 54% for concurrent group, which showed no significant difference (p=0.560). With median follow-up of 13 (1-92) months, there was a trend toward an advantage for concurrent group in median progression-free survival (6 months vs 8.3 months, p=0.067) and overall survival (12 months vs. 14.5 months, p=0.059). In multivariate analysis, only more than 10% weight loss within 6 months was significantly associated with poor survival (p=0.001). In conclusion, the addition of induction chemotherapy to concurrent CRT did not show any advantage over concurrent CRT alone in locally advanced NSCLC.

Effects of epigallocatechin gallate on the hemolysis induced by cyclosporine

INTRODUCTION

Hemolysis is one of the side effects of cyclosporine (CsA) therapy, in part due to, increased production of free radical species by CsA. Epigallocatechin gallate (EGCG), which acts as a highly efficient free radical scavenger, may have a protective effect on CsA-induced hemolysis. In this study, we measured the degree of hemolysis of as well as the amounts of hydrogen peroxide level and malondialdehyde produced by normal human erythrocytes (RBCs) incubated with CsA and with EGCG.

METHODS

Human RBCs were incubated as follows. In group 1, 4.2 x 10(6)/mL RBCs were incubated with Cremophore EL. In group 2, the RBCs were incubated with only 167 microg/mL EGCG. In group 3, the RBCs were incubated with 1.67 mg/mL CsA. In group 4, the RBCs were incubated with CsA plus EGCG.

RESULTS

The degree of hemolysis in group 2 (53.8 +/- 3.8) was significantly higher than that in group 1 (7.0 +/- 1.0). The degree of hemolysis in group 3 (86.2 +/- 2.2) was significantly higher than that in group 1 and group 2. The degree of hemolysis in group 4 (74.9 +/- 2.9) was significantly higher than in group 1 and in group 2, but lower than that in group 3. The hydrogen peroxide and malondialdehyde levels paralleled the degree of hemolysis.

CONCLUSIONS

These results suggest that CsA can induce free radical-mediated hemolysis, which can be partially prevented with EGCG.

Characterization of humic substances isolated from Han River water and change in the structural and chemical characteristics by ozonation

This study investigated the characteristics of extracted humic substances, which are ubiquitous in river waters and affect the treatment of water. Humic substances were extracted from the Han River water and analyzed using the samples obtained before/after ozonation with various analytical items. Ozonation was conducted in a batch-type reactor, and ozone was dosed from 0 to 2.0 mg O3 mg(-1) humic substances. The humic fraction was 56.0% of total organic carbon in the Han River and the ratio of fulvic to humic acids was approximately 3.46, including aromatic ring structures and/or various functional groups. Humic substances could not completely be oxidized to CO2, H2O, etc., but partly oxidized to low molecular weight matter, thus low removal efficiencies in terms of dissolved organic carbon (31% at 1.0 mg O3 mg(-1) humic substances) were observed. For UV absorbance at the wavelength 254 nm, ozone dose at 1.0 mg O3 mg(-1) humic substances showed more than 80% removal efficiencies. The molar ratios of H/C and O/C of the humic substances structure relatively increased by ozonation, indicating the degradation of aromatic groups in the humic substances molecule. The Fourier transform infrared spectra and proton nuclear magnetic resonance spectra of humic substances showed the increase in carboxylic acids and the decrease in aromatic protons through ozonation, respectively. As specific reaction sites in the humic substances including aromatic ring structures were reduced through ozone oxidation, contents of carboxylic acids, ketones and quinones in the humic substances molecule increased.

Preclinical application of radioimmunoguided surgery using anti-carcinoembryonic antigen biparatopic antibody in the colon cancer

Radioimmunoguided surgery (RIGS) has been known as a sophisticated tool to detect micrometastasis intraoperatively. A preclinical model of RIGS was designed to test the possible clinical applicability of the biparatopic antibody in detecting colorectal cancer. The biparatopic antibody was constructed using two anti-carcinoembryonic antigen (CEA)-specific antibodies, T84.66 and PR1A3, reacting against two different epitopes. (125)I-labeled biparatopic antibody was introduced via the principal colonic arteries at the end of operation in 10 operable patients with colon cancer. After 24 h, the radioactivities of the tumors and lymph nodes were counted using the gamma-detecting probe. The radioactivity count was performed ex vivo. The accurate detection in the primary tumors and metastatic lymph nodes were 100 and 88.7% respectively. False-positive detections occurred in 24 of 256 lymph nodes (9.4%), whereas false-negative detections occurred in 5 of them (2%). The most frequent cause of false-positive detection was dissociated radionuclides trapped in the lymphatic tissues. False-negative detections occurred mainly from weak targeting by radiolabeled antibody, probably due to weak expression of tumor CEA. Conclusively, as most detection errors appear to be reduced within 3 days in vivo, the biparatopic antibody can efficiently be applied to the clinical RIGS, thereby facilitating accurate detection and removal of occult cancer foci in colorectal cancer.

Small cell carcinoma of the colon: barium study and CT findings

Extrapulmonary small cell carcinoma is a rare neoplasm. It is an aggressive malignant tumour characterized by rapid local progression and early metastasis. We report a case of small cell carcinoma arising in the transverse colon in a 34-year-old man who presented with epigastric pain. On CT, a poorly enhancing bulky mass encircling the transverse colon with extensive regional lymph node metastases was observed. A segmental annular narrowing with thick interhaustral folds of the transverse colon was found by barium enema examination. This is the first report of barium study and CT findings of extrapulmonary small cell carcinoma of the colon.

Viral infection following kidney transplantation: long-term follow-up in a single center

INTRODUCTION

Viral infections are a leading cause of posttransplantation morbidity and mortality. The use of more potent immunosuppressive agents is responsible in part for the increasing incidence of some viral infections. This study summarized our experience with viral infections in 561 kidney transplant recipients.

METHODS

The spectrum of viral infections in 561 consecutive kidney transplant recipients was examined retrospectively from November 1982 to November 2002.

RESULTS

During a mean follow-up of 64.0 months, 193 virus infections in 156 of 561 kidney transplant recipients were recorded, an incidence of 34.2%. The most common viruses were cytomegalovirus (36.3%), varicella zoster virus (29.0%), herpes simplex virus (23.8%), BK virus (4.7%), hepatitis B virus (3.6%), and hepatitis C virus (2.6%). Among the CMV infections, 77.1% developed subclinical CMV infection and 22.9% had CMV disease. Generalized herpes zoster infection occurred in three cases and chicken pox in six cases. During a mean follow-up of 64.0 months, two of 159 patients died of CMV pneumonia.

CONCLUSION

Viral infections among the kidney transplant recipients continue to be a major problem despite significant progress in understanding the pathogenesis of viral infection and the advent of antiviral therapy.

Effects of polyhemoglobin-antioxidant enzyme complex on ischemia-reperfusion in kidney

INTRODUCTION

The kidney suffers ischemia-reperfusion (I/R) injury during transplantation. The purpose of the present study was to investigate the therapeutic effect of artificials cells on renal I/R injury through biochemical assays and histological examination.

METHODS

We prepared artificial cells using cross-linked hemoglobin (Hb), superoxide dismutase (SOD), and catalase. Normal male Sprague-Dawley rats were divided into 6 groups: the sham-operated control group, the group treated with polyHb,and the group treated with polyHb-SOD-catalase (PSC) (per groups were subjected to ischemia for 1 hour or 2 hours). After reperfusion for 4 hours, kidney and blood samples were obtained.

RESULTS

The levels of SOD and catalase in the PSC group were 15 and 50 times higher than those of the control group, respectively. In the polyHb group, the levels of blood urea nitrogen (BUN), serum creatinine, renal hydrogen peroxide, and renal malondialdehyde were increased. However, their levels were significantly decreased by PSC administration. Renal SOD activity did not show any significant changes in the polyHb group, but renal catalase activity was decreased by polyHb treatment in comparison with the control group. The activities of renal SOD and catalase were increased using PSC treatment. In the histological findings, the PSC group showed no evidence of acute tubular necrosis in proximal convoluted tubules; their microvilli and cytoplasmic microorganelles were relatively well preserved.

CONCLUSIONS

These results show that PSC effectively reduces renal damage via diminished oxygen free radical-mediated injury after I/R.

BK virus infection in kidney transplant recipients

INTRODUCTION

Nephropathy associated with the polyomavirus type BK virus (BKV) has emerged as a cause of allograft failure linked to immunosuppressive regimens containing tacrolimus or mycophenolate mofetil (MMF). The outcome in BKV nephropathy is generally unfavorable, namely 50% of patients lose graft function. We herein report nine cases of BKV nephropathy after kidney transplantation.

METHODS

From October 1998 to May 2003, 138 of 169 consecutive kidney transplant patients received tacrolimus-based immunosuppression, and 31 received cyclosporine-based immunosuppression. Additionally, 88.2% of the patients received mycophenolate mofetil (MMF). The diagnosis of BK infection was made by the presence of decoy cells in the urine and by allograft biopsy.

RESULTS

There were nine cases of BKV nephropathy in kidney transplant recipients, an incidence of 5.3%. All patients with BKV nephropathy received tacrolimus, MMF, and steroids. The median time to diagnosis of BKV infection was 7.8 months after transplantation. All patients experienced an elevated serum creatinine, which stabilized or decreased in seven patients with altered or decreased immunosuppression. After a mean follow-up of 11.1 months, 2 (22.2%) of nine patients lost the graft.

CONCLUSION

Because BKV nephropathy is a rare but serious complication after kidney transplantation, it should be included in the clinical differential of transplant dysfunction. In the absence of documented antiviral treatment, early diagnosis and judicious use of immunosuppressive agents is indicated to minimize the occurrence of BKV infection.

Small gastrointestinal stromal tumours with focal areas of low attenuation on CT: pathological correlation

AIM

To describe the pathology of focal areas of low attenuation in small gastrointestinal stromal tumours on contrast-enhanced computed tomography (CT), and to investigate the association of these areas as predictors of malignant potential.

MATERIALS AND METHODS

Contrast-enhanced helical CT images were obtained of 39 small (up to 5 cm) gastrointestinal stromal tumours. Focal areas of low attenuation were retrospectively evaluated and correlated with histopathological findings. The relation between the mitotic rate of and the presence of focal areas of low attenuation in the tumours was analyzed using Fisher's exact test.

RESULTS

Of the 39 small gastrointestinal stromal tumours, 15 contained focal areas of low attenuation on CT. These were found to be due to solid tumour (n=5), haemorrhage (n=3), haemorrhage with necrosis (n=2), cystic degeneration (n=2), fluid in ulcer (n=2), and fibrous septum (n=1); they were not found to be associated with a high mitotic rate (p=0.45).

CONCLUSION

Focal areas of low attenuation on CT in small gastrointestinal stromal tumours represent varying pathological conditions and do not predict malignant potential.

Ultrasound findings of iodide mumps

Iodide mumps, swelling of salivary glands after contrast medium injection, is a rare adverse reaction. We present a case in a 73-year-old man with advanced gastric cancer. About 10 min after a CT scan performed with intravenous injection of 140 ml of the low osmolality contrast agent Ioxaglate (Hexabrix 320, Guerbet, France), he complained of progressive swelling of the submandibular area. Ultrasound showed diffuse swelling and internal low echoic thick septa in the submandibular glands bilaterally. Approximately 1 h afterwards, the swelling of his submandibular glands started to regress and returned to normal within a day.

A case of fungal sepsis due to aspergillus spondylitis followed by cytomegalovirus infection in a renal transplant recipient

Although advances in immunosuppressive therapy have led to increased survival of renal transplant recipients, there are greater risks of developing infectious complications. Because of its rarity and the lack of medical awareness, aspergillus spondylitis is often misdiagnosed as tuberculous spondylitis, especially in its early stages. We report a case of aspergillus spondylitis in a renal transplant followed by cytomegalovirus (CMV) retinitis.

CASE

A 59-year-old woman was admitted due to general weakness and abdominal discomfort. She had undergone renal transplantation 3 years previously. One month before admission, she was diagnosed with CMV retinitis and treated with IV ganciclovir. On admission, she suffered from lower abdominal pain. Colonoscopy revealed multiple circular or patchy ulcers with surrounding severe mucosal edema in the sigmoid colon findings consistent with intestinal tuberculosis. On hospital day 30, she complained of lower extremity paresthesia and weakness. An MRI of the spine revealed a well-demarcated paraspinal mass around the L2-4 body; tuberculous spondylitis was initially considered. But despite antituberculosis medication, the patient progressed to spastic paraparesis and sensory changes in both lower legs, requiring urgent surgical decompression. At hospital day 60, she suffered persistent fever and developed thrombocytopenia. Wound discharge continued and paraparesis became denser. A CT of the spine showed progression of the paraspinal abscess from the L2 body to the iliac crest. CT-guided psoas muscle drainage was performed. Fungal culture showed Aspergillus species. Despite antifungal therapy, the patient died after a prolonged hospital stay due to fungal sepsis and septic shock from aspergillosis.