Transmesenteric hernias have bimodal distribution and occur in both pediatric and adult patients. In the adult population, the cause is iatrogenic, traumatic, or inflammatory. We report a case of transmesocolic hernia in an elderly person without any preoperative history. An 84-year-old Korean female was admitted with mid-abdominal pain and distension for 1 d. On abdominal computed tomography, we diagnosed transmesocolic hernia with strangulated small bowel obstruction, and performed emergency surgery. The postoperative period was uneventful and she was discharged 11 d after surgery. Hence, it is important to consider the possibility of transmesocolic hernia in elderly patients with signs and symptoms of intestinal obstruction, even in cases with no previous surgery.

ing on the country or region [2]. The clinical features of COVID-19 are diverse, ranging from minor symptoms to death, after an incubation period of 5-14 days [1].According to a recent meta-analysis, severe COVID-19 was associated with older age and underlying comorbidities, such as hypertension, diabetes, heart disease, and chronic obstructive pulmonary disease [3]. Notably, older age and underlying comorbidities were independently associated with mortality in patients undergoing solid organ transplantation [4]. Korean surveillance data showed that COVID-19 posed a higher risk of fatality in solid organ transplant recipients than in the general population aged

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Background: BK virus nephropathy, which occurred after a kidney transplant, has not yet established a clear treatment. In the absence of a specialized antiviral drug for BK virus, there is a concern of a concurrent rejection reaction when immunoglobulin is administered to reduce or neutralize immunosuppressants. The authors report that they have experienced successful treatment of the chronic active T-cell-mediated rejection, which occurred four months after administering high dose immunoglobulin to BK virus nephropathy, which deteriorates in the reduction and modification of immunosuppressants. Case report: A 28-year-old male patient with end-stage renal disease was hospitalized three months after receiving a deceased donor kidney transplant with elevated serum creatinine. A biopsy of the transplanted kidney was diagnosed as BK virus nephropathy stage A (Banff score: i1 ci1 ct1 ah2 i IF/TA2 ti2 as3). At the time of diagnosis, the BK viral load was 6 log copies/mL in serum, and 9 log copies/mL in urine. Immediately, mycophenolate was discontinued, and tacrolimus was changed to sirolimus. After 1 month, the patient's serum creatinine continued to increase, and high-dose immunoglobulin (2 g/kg) was administered, and a gradual decrease in serum creatinine was observed. After 2 months of immunoglobulin administration, serum BK virus DNA polymerase chain reaction was negative and showed improvement clinically. Two months later, he was hospitalized due to elevated serum creatinine, and a graft biopsy was performed again. Graft kidney biopsy showed chronic active T-cell-mediated rejection, grade 1B (Banff i0 t3 ci3 ct3 ptc1 i IF/TA3). Sirolimus was changed back to tacrolimus, mycophenolate was added again, and steroid pulse treatment was performed. Conclusions: After that, a gradual decrease in serum creatinine was observed over 1 year, and it has now decreased to a normal level. The patient is currently under observation at the outpatient clinic.

Conversion of immunosuppressants to sirolimus, an inhibitor of mammalian target of rapamycin, is a useful treatment option for prevention of the adverse events of immunosuppressants such as calcineurin inhibitor in renal transplantation recipients. In addition, sirolimus has been improving the quality of life and increasing the survival of patients with renal transplantation by decreasing immunosuppression-related malignancies, particularly skin cancer. However, complete remission of skin squamous cell carcinoma after renal transplantation only by conversion to sirolimus has not been well reported, although its preventive effect on skin cancer is well known. We report on a 72-year-old male with squamous cell carcinoma in his nasal cavity consequent to renal transplantation, which was treated completely with the conversion of cyclosporine to sirolimus without surgical removal or chemotherapy.