Clinical Characteristics of Acute Appendicitis in Kidney Transplant Recipients / 대한이식학회지

BACKGROUND: Appendicitis is a common surgical disease. There are many problems for the early diagnosis of acute appendicitis in kidney transplant patients; differential diagnosis for acute rejection, limitation in imaging study, problems of immunosuppressant and non-characteristic symptoms. METHODS: We reviewed medical records and transplant database of 2,947 renal transplant patients between April, 1979 and September, 2009 retrospectively. Patient's characteristics, diagnostic methods for appendicitis and operative/postoperative progresses were analyzed. RESULTS: Of the 2,947 renal transplant patients, there were 15 (0.51%, 13 males and 2 females) acute appendicitis patients. Mean age at the diagnosis of appendicitis was 37.2+/-10.1 years. Fourteen (93.3%) patients suffered from prodromal symptom, such as abdominal pain, direct or rebound tenderness, nausea and vomiting. There were 12 (80%) patients with leukocytosis (WBC count >10,000/microliter). Computed tomography scans were performed in 5 (33.4%) patients for diagnosis. Laparoscopic appendectomies were applied for 8 (53.4%) patients. In pathologic diagnosis, 2 cases were reported as 'non pathologic diagnosis' complications occurred in 2 patients as remnant appendicitis and pancreatitis. However, there was no patient with mortality and renal failure during the hospitalization. CONCLUSIONS: There were no significant differences between the transplant patients and the general population in the incidence, clinical features, diagnosis and postoperative progresses of acute appendicitis.

The Correlation between Quality of Life and Functional Outcome after Restorative Proctocolectomy and Ileal Pouch-Anal Anastomosis

PURPOSE: The restorative proctocolectomy (RP) and ileal pouch-anal anastomosis (IPAA) has been accepted as the operation of choice for chronic ulcerative colitis (CUC) and familial adenomatous polyposis (FAP). However, much is still unknown about the functional outcome and the quality of life (QoL) in patients undergoing RP. The aims of this study were to evaluate the functional outcome and the QoL in patients undergoing RP and to assess the correlation between functional outcome and QoL. METHODS: The medical records of 20 patients who had undergone a RP for CUC (n=11) and FAP (n=9) from January 1993 to December 2003 were reviewed. The QoL was evaluated with the Korean version of Short Form 36 (SF-36) by telephone interview. The functional outcome was assessed by means of the Global Assessment of Function Scale (GAFS). The QoL of patients was compared with that of the general population matched for age and gender (n=107) with including the 7 men, the median age will be thought to be that of the 13 women. RESULTS: There were 7 men (35%) and 13 women (65%), and the median age was 46 years. The QoL in patients undergoing RP was comparable to that of the healthy general population on all scales. The Physical Component Summary (PCS) was correlated significantly with the daytime and the nighttime incontinence (P<0.01). The Mental Component Summary (MCS) was correlated significantly with the daytime and the nighttime incontinence and the daytime bowel movement (P<0.05). CONCLUSIONS: This study demonstrates that the QoL in patients undergoing RP is excellent and that the daytime incon tinence and the nighttime incontinence are significant factor influencing the QoL.

Characteristics of Crohn's Disease in Korea according to the Vienna Classification

PURPOSE: Crohn's disease (CD) is a chronic inflammatory disease that is difficult to treat due to various complications and frequent recurrences. There have been many studies on the clinical aspects of CD in Western countries; however, there have been few studies in Korea. We performed this study to evaluate the clinical features of CD in Korea and to assess the stability over the course of the disease according to the Vienna classification. METHODS: We reviewed the medical records of 85 patients diagnosed as having CD in Kyung Hee University Hospital from March 1986 to July 2004. RESULTS: The male-to-female ratio was 1.9:1, and the mean age at diagnosis was 27.5 years. The most common symptom was abdominal pain (82%). Perianal lesions were observed in 29 cases (34%). Fistula was the most common (26%) lesion. Extraintestinal manifestations were observed in 13 cases (15%). Stomatitis was the most common (7%) lesion. According to the Vienna classification, the group with ages at diagnosis below 40 years (A1) was 88%, and that with ages equal to or above 40 years (A2) was 12%. The location of the disease was classified as terminal ileum (L1)(15%), colon (L2)(32%), ileocolon (L3)(33%), and upper gastrointestinal (L4)(20%). The behavior of disease was classified as nonstricturing nonpenetrating (B1)(41%), stricturing (B2)(14%), and penetrating (B3)(45%). Empirical anti-tuberculous medications were administered in 23 cases (27%) before the CD had been diagnosed. CONCLUSIONS: There are differences in the locations and behaviors of Crohn's disease between Korea and Western patients. The cause of the difference is uncertain.