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신이식 환자에서 발생한 뇌 Aspergillosis 에서 Liposomal Amphotericin B 와 내시경적 수술을 이용한 성공적인 치료
우영식(Young Sik Woo),김미정(Mi Jung Kim),장재혁(Jae Heuk Jang),황수은(Soo Eun Hwang),정지성(Ji Sung Chung),신미정(Mi Jung Sin),양철우(Chul Woo Yang),김용수(Yong Soo Kim),방병기(Byung Kee Bang),박주현(Joo Hyun Park) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.4
Aspergillosis involving central nervous system is a rare but life-threatening complication in renal transplant recipients. Its mortality rate approaches almost 100% in spite of various therapeutic regimens. We here report a case of successful treatment of brain aspergillosis with liposomal amphotericin B and endoscopic surgery. A 58-year- old renal transplant recipient admitted due to headache which was developed 5 months ago. He received renal transplant 10 years ago. After admission, brain MRI revealed brain abscess on frontal lobe and this was treated with antibiotics and amphotericin B. On 20 th hospital day, endoscopic surgery via intranasal approach was performed and pathologic finding was consistent with aspergillosis. During treatment, his graft function was progressively deteriorated(serum creatinine level 2.27 mg/dL4.1 mg/dL) and amphoterinc B was replaced with ambisome. Thereafter, renal function was improved(serum creatinine 2.0 mg/dL on 46 th hospital day). Second operation was performed on 50 th hospital day to remove remnant pathologic lesion, and ambisome was continously adminstered. The brain MRI which was performed on 70 th hospital day showed much improvement. He was discharged with oral antifungal drug(itraconazole). Our case demonstrates the successful treatment of brain aspergillosis with medial treatment and minimal invasive surgery.
Ketan Mehra,Kushal Kapashi,Sajni Khemchandani,Pranjal Ramanlal Modi,Syed Jamal Rizvi 대한이식학회 2022 Korean Journal of Transplantation Vol.36 No.4
Background: The use of sutures as ligatures has proven to be safe and reliable for the control of lymphatic vessels. The electrothermal bipolar vessel sealer (EBVS) is a relatively new type of device that can be used to seal lymphatics. We conducted a study to evaluate the safety and efficacy of EBVS for preparation of the recipient vessel during renal transplantation. Methods: In this prospective randomized controlled study, EBVS (Medtronic) was compared with conventional ligature for the control of perivascular lymphatics in kidney transplant recipients. A total of 52 kidney transplant recipients were randomly assigned to two groups. In group 1, EBVS was used to control perivascular lymphatics, while conventional silk ligatures were used in group 2. Demographic characteristics, as well as preoperative, perioperative, and postoperative variables, were noted and compared between the groups. Results: The mean recipient vessel preparation time was 8.3±1.9 minutes in group 1 and 14.5±4 minutes in group 2 (P<0.001). The mean anastomosis time was 28.2±5.4 minutes in group 1 and 28.2±4.2 minutes in group 2 (P=1.000). The mean estimated blood loss was 101.54±44.60 mL in group 1 and 125.19±74.17 mL in group 2 (P=0.270), and the mean drain output was 51.42 mL per day and 57.50 mL per day in groups 1 and 2, respectively (P=0.590). Conclusions: EBVS can be employed safely and effectively for recipient iliac lymphatic vessel dissection and sealing. EBVS is a fast, secure, and effective choice to permanently fuse the vessels and is a good option to avoid posttransplant lymphatic complications.
Yi Yi Htun,Nwe Nwe Than,Htar Kyi Swe 대한이식학회 2020 Korean Journal of Transplantation Vol.34 No.1
Background: Renal transplant is an effective treatment option for end-stage kidney disease and tacrolimus is one of the most commonly used immunosuppressant drugs in renal transplant patients. Tacrolimus is a substrate of cytochrome P450 3A5 (CYP3A5), and a narrow therapeutic index and large inter-individual variability. The objective of this study was to determine the frequency of CYP3A5*3 polymorphism and its effect on the pharmacokinetics of tacrolimus in post-renal transplant patients at Mandalay General Hospital. Methods: Three different genotypes of CYP3A5 were determined by polymerase chain reaction-restriction fragment length polymorphism in 54 post-renal transplant recipients. Tacrolimus trough concentrations (Ctrough) were measured by enzyme multiplied immunoassay technique following method validation. The apparent clearance (CL/F) was calculated from measured Ctrough. Results: The frequency of CYP3A5*1 allele was 0.24 and that of CYP3A5*3 allele was 0.76 in the study sample. There were a total of 33 CYP3A5 non-expressors (patients with CYP3A5*3/*3 genotype) and 21 CYP3A5 expressors (patients with CYP3A5*1/*1 or CYP3A5*1/*3 genotype), respectively. CL/F was significantly lower in the non-expressor group than in the expressor group (mean±standard deviation, 12.53±5.28 vs. 21.22±5.95 L/hr; P<0.001). The mean Ctrough and concentration dose ratio (C/D) for tacrolimus in CYP3A5 non-expressors were significantly higher than those in CYP3A5 expressors (Ctrough, 7.14±2.56 vs. 5.92±1.76 ng/mL; C/D, 6.92±4.11 vs. 2.89±1.85 ng/mL/mg), respectively (P<0.05). Conclusions: In this study, 76% of the Myanmar renal transplant recipients carried the CYP3A5*3 allele that was associated with lower functional activity of the CYP3A5 enzyme a lower CL/F of tacrolimus in these Thus, CYP3A5 polymorphism influences the pharmacokinetics of tacrolimus, which may affect the pharmacological response to tacrolimus.
김지욱 ( Jee Ook Kim ),김기훈 ( Gi Hun Kim ),이규석 ( Kyu Suk Lee ),김현철 ( Hyun Chul Kim ) 대한피부과학회 2003 大韓皮膚科學會誌 Vol.41 No.1
Background : As the renal transplantation is rapidly becoming a standard treatment of end stage renal disease, a varieties of skin lesions in renal transplant recipients are being encountered in Korea. However, there have been little studies concerning th
제 2형 당뇨를 동반한 신장이식환자에서 조기 진단 및 성공적으로 치료된 공동을 동반한 폐 털곰팡이증 1예 증례보고
김선혜 ( Seon Hye Kim ),임천규 ( Chun Gyu Ihm ),이태원 ( Tae Won Lee ),정경환 ( Kyung Hwan Jeong ),이미숙 ( Mi Suk Lee ),황인경 ( Il Kyoung Hwang ),이운주 ( Un Joo Lee ),김진숙 ( Jin Sug Kim ) 전북대학교 의과학연구소 2014 全北醫大論文集 Vol.38 No.1
털곰팡이증(Mycormycosis)은 당뇨, 고형장기 이식 또는 조혈줄기세포 이식, 백혈구감소증, 암 또는 후천성 면역결핍 증후군 환자와 같은 면역저하 환자에서 특징적으로 발생하는 드문 기회 진균 감염이다. 털곰팡이증 감염의 23%는 혈관내피세포를 침범하여 전신으로 파급되며, 이 경우 생명을 위협할 수 있기 때문에 초기에 적절한 진단과 치료가 필요하다. 또한 신장 이식 환자에 있어서 기회 감염은 수술 후 1개월 전, 1개월에서 6개월까지, 6개월 이후 시기에 따라 다르게 나타나며털곰팡이증은 보통 6개월 이후에 나타나는 경우가 많다. 저자들은 제 2형 당뇨를 동반한 신장 이식을 받은 지 1달 이내의 환자에서 공동을 동반한 폐 털곰팡이증 1예를 경험하였으며, 감염이 전신으로 파급되기 전에 조기에 발견되어 수술적 치료 및 암포테리신 B 치료를 받아 성공적으로 치료되었다. 따라서 이증례의 진단 및 치료 경과를 기존의 문헌고찰과 함께 보고하는 바이다. Mucormycosis, or zygomycosis, is an opportunistic fungal infection that occurs characteristically in immunocompromised individuals, including those with diabetes -mellitus, solid organ or hematopoietic stem cell transplantation, neutropenia, cancer and AIDS. The infection becomes life-threatening when it invades the blood vessel endothelium and disseminates throughout the body. Dissemination may develop in 23% of cases. Herein we report a case of pulmonary mucormycosis with a cavitary lesion in a kidney transplant recipient with type 2 diabetes. This infection was discovered before it progressed and was treated successfully with a wedge resection and liposomal amphotericin B. Function in the newly received kidney was preserved. Therefore early recognition and appropriate therapy of this infection, before dissemination, can result in a favorable outcome.
김지연,최태윤,이동화 대한감염학회 1995 감염 Vol.27 No.2
신 이식을 받고 면역억제제를 투여받고 있는 환자에서 발생한 불명열의 원인을 규명하기 위하여 폐 병변에 대한 개흉 폐생검술을 실시한후 미생물 배양검사를 시행한 결과 Nocardia 감염증으로 진단되어 trimethoprim/sulfamethoxazole로 치료된 3예가 있었기에 문헌 고찰과 함께 보고하는 바이다. Nocardiosis most often begins in the lung and usually affects the immunocompromised host. We report three cases of pulmonary nocardiosis in renal transplant recipients with reviews of literature. The diagnosis was made by the demonstration of branching filamentous Gram-positive organisms in the touch imprint smears of open lung biopsy specimens. The organisms were acid-fast by the modified Ziehl-Neelson method and identified as Nocardia asteroides. Patients were treated with trimethoprim/sulfamethoxazole and improved.