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Background/Aims Kidney transplantations at our center rely mainly on living donors. The purpose of this study was to suggest future donor supply directions by reviewing changing trends in donor type. Methods During the past 40 years, 1,690 kidney transplantations were performed at our center. We divided the follow-up period into four decades and the donor population into three groups: living related, living unrelated, and deceased. We analyzed changing trends in donors from each group for each decade. Patients receiving overseas transplantation were also included. Results The proportion of living related donors decreased from 84% (54/64) in the 1970s to 61% (281/458) in the 2000s. Living unrelated donors showed a sustained proportion of around 20% after 1990. However, among living unrelated donors, the proportion of spouse donors increased from 4.6% (17/369) in the 1980s to 8.5% (39/458) in the 2000s. Transplants from deceased donors were only 3.3% (12/369) in the 1980s. However the proportion of deceased donors increased gradually, reaching 13.2% (105/799) in the 1990s and 19.9% (91/458) after 2000. Overseas transplantations increased after 2000 and reached 20% of all cases treated in our center during the 2000s. Such transplantations peaked in 2006 and decreased markedly thereafter. Conclusions The proportion of each donor type has continuously changed, and the changes were associated with changes in the social structure and system. We expect that this study could be an important reference for other countries to estimate future changes of donor type. more...

Gastrointestinal stromal tumors are the most common mesenchymal neoplasm of the gastrointestinal tract. Distant metastasis of gastrotintestinal stromal tumors occurs in ∼50% of the cases and is usually found in the liver and peritoneum. We present a patient with diplopia which was due to a metastatic gastrointestinal stromal tumor of the clivus. Transsphenoidal resection of the tumor was performed and post-operative treatment with oral imatinib mesylate was done. One month after the surgery, treatment was started with imatinib and the patient's diplopia improved within 15 days. Follow-up computed tomography was taken 2 months after the initiation of oral imatinib, and the size of the main gastric mass has decreased. To our knowledge, this is an extremely rare case of gastrointestinal stromal tumor with metastasis to the clivus with diplopia as the presenting symptom. We report our clinical findings along with a review of the relevant literature. more...

Inverted hyperplastic polyps (IHPs) of the colon are unusual variant of exophytic hyperplastic polyps that are characterized by epithelial displacement or inversion of the epithelium into the submucosa.1 To date, only a few cases of IHPs associated with adenoma or adenocarcinoma have been reported.2-4 However, due to the rarity of these polyps, their malignant potential is poorly understood. A 56-year-old man was referred to Uijeongbu St. Mary's Hospital due to a positive fecal occult-blood test during a routine health check-up. The patient had a medical history of surgery for intestinal perforation and hypertension. On admission, physical examination revealed no abnormal findings and all laboratory examination were within normal range. We performed colonoscopy for further evaluation. The colonoscopy showed a subpedunculated polyp with a large dimple, 20 mm in diameter, in the sigmoid colon (Fig. 1). An endoscopic mucosal resection (EMR) using the inject and cut technique was performed and the polyp was resected en bloc. The pathology examination showed an intramucosal cancer in an IHP (Fig. 2). The intramucosal cancer consisted mainly of well-differentiated adenocarcinoma (Fig. 2). Abdominal computed tomography showed no discernible malignant lesion. Follow-up colonoscopy revealed no remarkable findings 1 year after EMR. Fig. 1 Colonoscopy shows a subpeduculated polyp with a large dimple located in the sigmoid colon. Fig. 2 Microscopic image of the resected specimen showing an inverted hyperplastic polyp associated with intramucosal cancer, as indicated by the arrowhead in the low-magnified image (H&E stain, ×100). The intramucosal cancer consisted mainly ... IHPs of the colon were initially described by Sobin5 in 1985. They represent an unusual morphological variant of hyperplastic polyps that shows epithelial displacement into the submucosa.5 IHPs of the colon are most commonly sessile lesions and are predominantly located in the left colon.1 Although the pathogenesis and natural history remain unknown, IHPs are thought to result from local trauma.1 The characteristic endoscopic features of IHPs include sessile or superficial elevated lesions with a pitted surface or central depression.6-8 Because distinctive surface pattern of IHPs is similar to that of invasive carcinoma or depressed type adenoma, IHPs are difficult to diagnose endoscopically.2,6 Observation of the pit pattern using magnifying colonoscope may be useful to precisely diagnose IHPs because it has the same surface and cellular features as ordinary hyperplastic polyps.6 The current case showed atypical endoscopic findings with large depressed portion. In addition, the histology showed the presence of well-differentiated carcinoma in the depressed portion. To date, only a small number of cases associated with adenomas or adenocarcinoma have been described. Among them, three cases with an IHP were associated with adenomas,3 and one case with invasive cancer.4 For several years, hyperplastic polyps have been considered as non-neoplastic lesions without malignant potential. However, some hyperplastic polyps show molecular features similar to those of colorectal carcinomas. Several subtypes of serrated polyps, such as sessile serrated adenoma (traditional serrated adenoma), and mixed polyp, have been proposed to be the precursors of colorectal carcinomas.9 However, due to the rarity of IHPs, their malignant potential is poorly understood. IHPs of the colon are usually asymptomatic and are often detected incidentally on endoscopy.3 In some cases, the main clinical feature of IHPs of the colon is gastrointestinal bleeding or abdominal pain.2 Usually, an endoscopic biopsy is not sufficient to make an accurate diagnosis of an IHP of the colon. The final diagnosis of an IHP of the colon depends on the pathological examinations of EMR and endoscopic polypectomy specimens.8 Treatment for IHPs continues to be debated. Since IHPs have benign cellular characteristics of exophytic hyperplastic polyps, overtreatment should be avoided. However, endoscopic treatment is necessary in cases with associated adenomatous findings, due to their malignant potential.4 In the present case, endoscopic treatment was appropriate for the large hyperplastic polyp. In conclusion, we reported a rare case of early colon cancer developing in an IHP of the sigmoid colon treated with EMR. Further studies are needed to clarify the malignant potential of IHPs. more...

Coccidioidomycosis, a fungal infection caused by the fungus known as Coccidioides immitis, can affect many species of mammals and some reptiles. The fungus is endemic in the soil of the southwestern United States, Mexico, and parts of Central and South America. Most infections in humans are relatively mild or asymptomatic, but severe or fatal illness can also occur, especially in the elderly or immunocompromised. We report on a patient with disseminated coccidioidomycosis whose lymph nodes, skin, and especially brain were infected at diagnosis; however, the lung parenchyme was not infected. Because the brain infection could have been a fatal complication in this peculiar case, we recommended life-long fluconazole treatment for the patient. After 2 months of high doses of fluconazole, the patient's clinical signs were greatly improved with respect to fever, headache, skin lesions, and mediastinal widening on the chest X-ray. (Korean J Med 2012;82:734-738) more...