Incidence of acute cholecystitis underwent cholecystectomy in incidence dialysis patients: a nationwide population-based cohort study in Korea

Patients on dialysis have numerous gastrointestinal problems related to uremia, which may represent concealed cholecystitis. We investigated the incidence and risk of acute cholecystitis in dialysis patients and used national health insurance data to identify acute cholecystitis in Korea. Methods: The Korean National Health Insurance Database was used, with excerpted data from the insurance claim of the International Classification of Diseases code of dialysis and acute cholecystitis treated with cholecystectomy. We included all patients who commenced dialysis between 2004 and 2013 and selected the same number of controls via propensity score matching. Results: A total of 59,999 dialysis and control patients were analyzed; of these, 3,940 dialysis patients (6.6%) and 647 controls (1.1%) developed acute cholecystitis. The overall incidence of acute cholecystitis was 8.04-fold higher in dialysis patients than in controls (95% confidence interval, 7.40–8.76). The acute cholecystitis incidence rate (incidence rate ratio, 23.13) was especially high in the oldest group of dialysis patients (aged ≥80 years) compared with that of controls. Dialysis was a significant risk factor for acute cholecystitis (adjusted hazard ratio, 8.94; 95% confidence interval, 8.19–9.76). Acute cholecystitis developed in 3,558 of 54,103 hemodialysis patients (6.6%) and in 382 of 5,896 patients (6.5%) undergoing peritoneal dialysis. Conclusion: Patients undergoing dialysis had a higher incidence and risk of acute cholecystitis than the general population. The possibility of a gallbladder disorder developing in patients with gastrointestinal problems should be considered in the dialysis clinic.

Inflammatory Bowel Disease and Vitamin D / 대한소화기학회지

Vitamin D contributes to bone metabolism and acts as an immune modulator for both innate and adaptive immunity. The serum level of vitamin D has been associated with inflammatory diseases, such as inflammatory bowel disease (IBD). In epidemiologic studies, IBD patients have been shown to have low levels of vitamin D. The suboptimal circulating levels of vitamin D in IBD patients may be caused by low exposure to sunlight, dietary malabsorption, and the impaired conversion of active metabolites (1,25[OH] 2D). Recent studies have demonstrated that vitamin D deficiency in IBD can increase the chance of disease recurrence, IBD-related hospitalization or surgery, and deterioration of quality of life. Supplementation with vitamin D is therefore thought to reduce the risk of flare-ups and the improvement of the quality of life in IBD patients. This review aims to summarize the latest knowledge on the effects of vitamin D deficiency on IBD and the possible benefits of vitamin D supplementation in IBD patients.

Inflammatory Bowel Disease and Vitamin D / 대한소화기학회지

Vitamin D contributes to bone metabolism and acts as an immune modulator for both innate and adaptive immunity. The serum level of vitamin D has been associated with inflammatory diseases, such as inflammatory bowel disease (IBD). In epidemiologic studies, IBD patients have been shown to have low levels of vitamin D. The suboptimal circulating levels of vitamin D in IBD patients may be caused by low exposure to sunlight, dietary malabsorption, and the impaired conversion of active metabolites (1,25[OH] 2D). Recent studies have demonstrated that vitamin D deficiency in IBD can increase the chance of disease recurrence, IBD-related hospitalization or surgery, and deterioration of quality of life. Supplementation with vitamin D is therefore thought to reduce the risk of flare-ups and the improvement of the quality of life in IBD patients. This review aims to summarize the latest knowledge on the effects of vitamin D deficiency on IBD and the possible benefits of vitamin D supplementation in IBD patients.

Alternating Hemiplegia of Childhood in Korea / 대한소아신경학회지

PURPOSE: Alternating hemiplegia of childhood(AHC) is a rare neurologic syndrome of unknown pathophysiology. The typical clinical features are characterized by recurrent hemiplegic attacks shifting from one side to the other, beginning before 18 months, dystonia, strabismus, nystagmus, epilepsy, and immediate resolution of all symptoms during sleep. This study is to access clinical features and outcome of treatment of AHC in Korea. METHODS: We sent standardized questionnaires by e-mail to 118 council members of the Korean Society of Child Neurology. We received it through e-mail from 7 centers and analyzed clinical characteristics, treatment, and outcomes. RESULTS: We collected 11 AHC patients(male 6, female 5). The mean age was 6.13+/-5.23 years. The mean age of onset of hemiplegia was 9.80+/-6.67 months. The mean frequency of episode was 10.73+/-11.44 per month and mean duration was 3.10+/-2.50 days. The manifestations were hemiplegia in 100%, dystonia in 81.8%, abnormal eye movements in 81.8%, developmental delay in 81.8%, seizure in 72.7%, autonomic phenomena in 54.5%, ataxia 45.5%, and episodes of quadriparesis in 45.5%. The onset age of seizure was 3-84 months. Psychomotor retardation was more severe in patients with seizures than in those without seizures. Magnetic resonance imaging of brain and cerebral angiography were normal in all patients. Interictal SPECT shows hypoperfusion in the frontal in 2 of 5 patients. Nine patients received flunarizine and antiepileptic drugs but two patients received antiepileptic drugs only. A favorable response was reported in 45.5%, which included excellent response to the combination therapy of flunarizine and high dose topiramate. CONCLUSIONS: Patients with seizures faired the poorer psychomotor retardation. The combination of flunarizine and high dose topiramate was very effective in AHC.

Lumbar Puncture in Patients Who Experienced First Seizure with Fever

PURPOSE: We aimed to ascertain whether lumbar punctures should be done to prove febrile seizure, and to study what conditions can delay or abolish lumbar puncture. METHODS: This retrospective study was done for four years, from January, 1996 to December, 1999. The subjects were the patients who visited Masan Samsung Hospital for the first convulsion with fever, and whose age ranged from 1-month to 5-years old. The total number of patients was 197. We investigated the rate of meningitis, which was classified by age, season, convulsion type, associated symptoms, and results of blood test. All data were tested chi-square. RESULTS: The diagnosis rate of meningitis among all 197 patients was 7.6%, and of these only one patient was proved to have bacterial meningitis. The rate was high in the young(below 6 month), in males and in summer and autumn. Although the general appearance was good after resolution of the fever, the rate of meningitis was 6.5%. Patients with nausea and vomiting totalled 11%; 9.1% of them were diagnosed with meningitis. The diagnosis rate of meningitis in cases in which additional seizures took place were 33.3%. CONCLUSION: The ultimate goal of lumbar punctures in seizure patients with accompanying fever is to rule out bacterial meningitis, which, has been demonstrated to be rare. So we think that lumbar puncture can be postponed by close observation of pediatrics specialists and skilled nurses.

Clinical Features of Nocturnal Seizure in Childhood / 대한소아신경학회지

PURPOSE: Nocturnal seizure is a common seizure disorder in childhood. But there are a few study about nocturnal seizure. To be a great of help, We investigated clinical characteristics, response of treatment and prognosis of nocturnal seiuzure in childhood. METHODS: From January to December 2001, We selected patients who had nocturnal seizure in epilepsy patients. Total 31 patients was selected and we investigated age distribution, sex ratio, type of seizure, EEG finding, brain imaging study, treatment and prognosis. RESULTS: Man and woman's ratio was no significant difference, and age distribution was mostly from 3 years old to 12 years old. Partial seizure was showed in 30 patients (96.8%). Among that patients secondary generalization of partial seizure was showed in 21 patients(67.7%). In EEG, epileptiform discharges in centrotemporal region were showed in 17 patients(54.8%), occipital region in 5 patients(16.1%), central region in 4 patients (12.9%). Brain imaging studies were normal in all patients. The most common cause of nocturnal seizure was benign childhood epilepsy with centrotemporal spikes(24 patients, 77.4%). Benign childhood epilepsy with occipital paroxysms were showed 5 patients(16.1 %). Nocturnal frontal lobe epilepsy was showed 1 patient(3.2%). 28 patients(90.3%) were treated with monotherapy. They has been no seizure during 6 months after treatment. 3 patients(9.7%) were treated with two AED therapy. They has been also no seizure during 6 months after add-on therapy. CONCLUSION: Nocturnal seizure in childhood was mostly occurred from 3 years old to 12 years old. Mostly they were partial seizure with secondary generalization and good response on AED medication and good prognosis. Therefore carbamazepine or oxcarbazepine monotherpy is more effective than valproic acid.

Pseudohyperkalemia on Maintenance Hemodialysis / 대한신장학회잡지

BACKGROUND: The serum to plasma potassium [K] difference in patients(n=42) on maintenance hemodialysis more than one year was analyzed to evaluate the prevalence of pseudohyperkalemia among them. METHODS: In all 42 hemodialysis patients, the following predialysis serum and plasma K concentration frequencies were as followed : serum K-normal (3.5-5.5 mEq/L) 24, high(>or=5.6 mEq/L) 18, low(

Moyamoya Disease in Childen / 대한소아신경학회지

PURPOSE: Moyamoya disease is a primary vascular disease characterized by stenosis that is followed by occlusion of the intracranial portion of the internal carotid artery and other vessels of the circle of Willis. Since there has not been any specific reports about clinical manifestation in children, we plan to study on clinical manifestation through these patients who have moyamoya disease. METHODS: We have reviewed our case of moyamoya disease in patients admitted to Yonsei University College of Medicine and analyzed their age & sex distribution as well as clinical manifestations, together with brain CT and angiographic findings. RESULTS: The results were as follows: 1) Fifty cases of moyamoya disease were encounted during a 10-year period. 2) The male to female ratio was 1:2.3 and mean age was 6.3 years old. 3) The most common chief complaint on admission was hemiparesis followed by convulsion. 4) 42 patients(84%) showed infarction on brain CT and only 5 patients(10%) showed hemorrhage. Most common lesion was frontal lobe. 5) Bilateral occlusion of the internal carotid arteries was most common site of lesions on cerebral angiography.

Moyamoya disease in Korea / 대한소아신경학회지

No abstract available.