PURPOSE: Observational results on seasonal variation of interdialytic weight gain in patients with end-stage renal disease treated with hemodialysis are controversial till now. There has been no report about it for Korean patients. The relation of interdialytic weight gain and climatic factors was studied in one region of Korea. METHODS: From Jan. 2002 to Dec. 2002, fifty patients receiving conventional and regular hemodialysis three times a week in Hanyang University Hospital, Seoul, Korea, where there is distinct seasonal variation in monthly temperature, relatively humidity, and duration of sunshine, were analyzed. For each patient, body weight and blood pressure were measured before and after each dialysis treatment three times per week for one year. The monthly mean values for interdialytic weight gain and blood pressure in relation to the monthly values for climatic factors were then analyzed. RESULTS: The seasonal pattern of interdialytic weight gain was evident throughout the one-year period. The monthly mean temperature was highest in July and lowest in January and mean monthly interdialytic weight gain was lowest in July and highest in December. The difference of mean interdialytic weight gain between July and January was significant (p< 0.05). Interdialytic weight was inversely correlated with monthly mean temperature, mean maximal temperature, and mean minimal temperature(r= -0.721 with p=0.008, r=-0.714 with p=0.009, and r= -0.717 with p=0.009, respectively) but not with mean relatively humidity and duration of sunshine. Mean predialysis systolic and diastolic blood pressure were not related to changes in temperature, relative humidity, and duration of sunshine. CONCLUSION: Interdialytic weight gain in patients with end-stage renal disease treated on hemodialysis was correlated with seasonal variation in temperature, with higher values in the winter and lower values in the summer. It would be better to consider this finding to treat hemodialysis patients.
Blood Pressure ; Body Weight ; Dialysis ; Humans ; Humidity ; Kidney Failure, Chronic ; Korea ; Renal Dialysis* ; Seasons* ; Seoul ; Sunlight ; Weight Gain*

PURPOSE: To investigate the underlying causes and clinical characteristics of patients referred with intraocular pressure (IOP) elevation. METHODS: We retrospectively reviewed the medical records of patients who were referred with IOP elevation from July 2016 to July 2017. Patients with baseline IOP ≥ 22 mmHg and those who were treated and followed up for 6 months were included. The prevalence rates of the underlying diseases that caused IOP elevation were evaluated and the clinical characteristics were compared between patients with primary and secondary glaucoma. RESULTS: A total of 127 patients were included (mean age, 59.3 ± 16.8 years; baseline IOP, 31.7 ± 10.5 mmHg). Among the study participants, 22.0%, 31.5%, and 46.5% had been diagnosed with ocular hypertension, primary glaucoma, and secondary glaucoma, respectively. Among the causes of IOP elevation, open-angle glaucoma (20.5%) had the highest prevalence rate among those with primary glaucoma and inflammation-related glaucoma (12.6%) was the most prevalent cause among those with secondary glaucoma. In a comparison between patients with primary and secondary glaucoma, the percentage of IOP reduction was not significantly different at 6 months after treatment (52.1% vs. 53.9%, p = 0.603). However, the rate of patients treated with drugs other than IOP lowering agents or who underwent surgery was significantly higher in the secondary glaucoma group compared with the primary glaucoma group (all p < 0.05). At 6-month follow-up, the secondary glaucoma group showed significantly higher improvement rates of visual acuity (p = 0.004), but had a larger proportion of patients with a visual acuity of less than or equal to finger count (p = 0.027). CONCLUSIONS: Treatment and visual outcome can vary depending on the underlying cause of IOP elevation. Therefore, a thorough examination for determining the cause of IOP elevation is recommended at the initial stage.
Fingers ; Follow-Up Studies ; Glaucoma ; Glaucoma, Open-Angle ; Humans ; Intraocular Pressure ; Medical Records ; Ocular Hypertension ; Prevalence ; Retrospective Studies ; Visual Acuity

BACKGROUND: Incidence rate of diabetes mellitus (DM) after renal transplantation has been reported variably, ranging from 2.5% to 45%. The new diagnostic criterion of diabetes presented by American Diabetes Association and use of new immunosuppressants may increase the incidence of post-transplant DM. METHODS: We investigated the incidence of post- transplant DM in 135 patients, who underwent kidney transplantation at Hanyang University Hospital between March, 1998 and February, 2003. The association of risk factors (age, sex, types of immunosuppressive agents, presence of acute rejection, and relationship with donor) with post-transplant DM was retrospectively evaluated using multivariate analysis. RESULTS: The incidence of post-transplant DM was 19.3%, and the significant risk factors were age over 40 years and male sex. Presence of acute rejection and relationship between donor and recipient were not significantly associated with the occurrence of post-transplant DM. Notably, the frequencies of post-transplant DM between cyclosporine and low- dose tacrolimus were not significantly different. CONCLUSION: The incidence of post-transplant DM is higher than that of DM in general population. Blood glucose should be frequently monitored in older male patients, considering their significant risk for post-transplant DM. Low-dose tacrolimus regimen dose not seem to increase the risk for post-transplant DM compared with cyclosporine.
Blood Glucose ; Cyclosporine ; Diabetes Mellitus* ; Humans ; Immunosuppressive Agents ; Incidence ; Kidney Transplantation ; Kidney* ; Male ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Tacrolimus ; Tissue Donors

We report a case of ruptured mycotic aneurysm involving innominate artery requiring an urgent surgical treatment. A 62-yr-old woman presented with fever and dyspnea. Previously, she was diagnosed with colon cancer and received right hemicolectomy and one cycle of adjuvant chemotherapy. On echocardiogram, pericardial effusion was noted and emergency pericardiocentesis was performed. CT scan revealed aortic aneurysm involving ascending aorta and innominate artery, and thrombi surrounding those structures. Patch repair of the defect in the ascending aorta and ringed Goretex graft to bypass the innominate and ascending aorta were performed. We believe that this is the first case of ruptured mycotic aneurysm involving innominate artery.
Aneurysm, Infected/*surgery ; Aorta/pathology ; Aortic Aneurysm/surgery ; Brachiocephalic Trunk/pathology ; Colonic Neoplasms/drug therapy/surgery ; Female ; Human ; Middle Aged ; Tomography, X-Ray Computed ; Transplants

A 46-year-old woman with chronic renal failure due to polyarteritis nodosa was referred to the hospital for evaluation of abdominal pain. She had been treated with cathartics (magnesium oxidate 2.0 g/day) for constipation for several days. One day before the admission, the patient had been taken magnesium enema twice at another hospital. On admission, she was comatose, suffering from lethargy and respiratory failure. Her serum magnesium and amylase concentrations were markedly elevated (8.2 mg/dL and 1,698 IU/L respectively), and plain abdominal image and abdominal computed tomography revealed acute pancreatitis and non-obstuctive ileus. Thereafter, aggressive cardiopulomonary support with mechanical ventilation and continuous renal replacement therapy using continuous veno-venous hemofiltration (CVVH) applied due to cardio-respiratory failure and hypermagnesemia. After 3 days of CVVH treatment, the concentration of serum magnesium was normalized to 3.2 mg/dL, and respiratory failure and abdominal ileus were markedly improved. Four days after aggressive treatment, her hemodynamic and gastroenteric symptoms stabilized. Therefore, we report the case of hypermagnesemia with acute pancreatitis, severe hypotension and respiratory failure after cathartic ingestion and enema containing magnesium oxidate treated with CVVH.
Abdominal Pain ; Amylases ; Cathartics ; Coma ; Constipation ; Dialysis ; Eating ; Enema ; Female ; Hemodynamics ; Hemofiltration ; Humans ; Hypotension ; Ileus ; Kidney Failure, Chronic ; Lethargy ; Magnesium ; Middle Aged ; Pancreatitis ; Polyarteritis Nodosa ; Renal Replacement Therapy ; Respiration, Artificial ; Respiratory Insufficiency ; Stress, Psychological

PURPOSE: The purpose of this study was to investigate whether early CT scans are useful for improving the clinical management of acute biliary pancreatitis. MATERIALS AND METHODS: We retrospectively reviewed 56 consecutive patients who experienced first attack of acute pancreatitis and underwent CT scans within 48 hours of symptom onset in the emergency department, between March 2015 and March 2016. CT images were retrospectively evaluated for absence or presence, and etiology of acute pancreatitis, and probability of biliary pancreatitis. Urgent procedures for acute pancreatitis were analyzed. RESULTS: Of 56 patients, 54 (96.4%) showed acute pancreatitis and 23 (41.1%) had biliary pancreatitis on CT. The diagnostic accuracy, sensitivity, and specificity of CT-diagnosed biliary pancreatitis were 94.6% (53/56), 91.7% (22/24), and 96.9% (31/32), respectively. Of the 56 patients, 17 (30.4%) patients with biliary pancreatitis underwent urgent endoscopic retrograde cholangiopancreatography (ERCP) within 72 hours (mean time interval between CT and ERCP: 25.5 ± 19.8 hours; range: 2–67 hours). There was a significant difference in the urgent procedures between non-biliary and biliary pancreatitis groups (0 of 32 vs. 17 of 24, p < 0.001). CONCLUSION Early CT may be used in patients visiting hospital with suspected acute biliary pancreatitis to facilitate urgent treatment.

OBJECTIVES: There is a moderate but significant association between schizophrenia and violence. The purpose of this study is to investigate the relationship between violence and brain cognitive functions in schizophrenic patients who have committed homicide using neuropsychological tests. METHODS: The study involved three group of subjects: schizophrenics who have committed homicide (n=51), schizophrenics who have not committed homicide (n=50) and normal control (n=50). Intelligence test (K-WAIS), memory test (Rey-Kim Memory Test) and executive function test (Stroop test, WCST) as well as Positive and Negative Syndrome Scale (PANSS) and Structured Interview for DSM-IV Personality (SIDP) were administered by trained researchers. RESULTS: There were no significant differences in demographic variables among groups. Schizophrenic patients showed overall cognitive deficit in intelligence, memory and executive functions, regardless of homicide behavior. Homicidal schizophrenic group was not significantly different from non-homicidal schizophrenic group in every cognitive domain. There was no significant correlation between index scores of cognitive functions and Life History of Aggression assessment (LHA). However, index scores of cognitive functions were negatively correlated with the PANSS and schizotypal trait scores. CONCLUSION: Cognitive dysfunction is common across both schizophrenic groups. It doesn't significantly correlate with homicidal experience, but it correlates with the schizophrenic symptom domains.
Aggression ; Brain ; Diagnostic and Statistical Manual of Mental Disorders ; Executive Function ; Homicide* ; Humans ; Intelligence ; Intelligence Tests ; Memory ; Neuropsychological Tests ; Schizophrenia ; Violence

Evidence of the ethical appropriateness and clinical benefits of shared decision-making (SDM) are accumulating. This study aimed to not only identify physicians’ perspectives on SDM, and practices related to end-of-life care in particular, but also to gauge the effect of SDM education on physicians in Korea. Methods: A 14-item questionnaire survey using a modified Delphi process was delivered to nephrologists and internal medicine trainees at 17 university hospitals. Results: A total of 309 physicians completed the survey. Although respondents reported that 69.9% of their practical decisions were made using SDM, 59.9% reported that it is not being applied appropriately. Only 12.3% of respondents had received education on SDM as part of their training. The main obstacles to appropriate SDM were identified as lack of time (46.0%), educational materials and tools (29.4%), and education on SDM (24.3%). Although only a few respondents had received training on SDM, the proportion of those who thought they were using SDM appropriately in actual practice was high; the proportion of those who chose lack of time and education as factors that hindered the proper application of SDM was low. Conclusion: The majority of respondents believed that SDM was not being implemented properly in Korea, despite its use in actual practice. To improve the effectiveness of SDM in the Korean medical system, appropriate training programs and supplemental policies that guarantee sufficient application time are required.

1,2-Diacetylbenzene (DAB) is a metabolite of 1,2-diethylbenzene, which is commonly used in the manufacture of plastics and gasoline. We examined the neurotoxic effects of DAB in young and old rats, particularly its effects on hippocampus. Previously, we reported DAB impairs hippocampal neurogenesis but that the underlying mechanism remained unclear. In this study, we evaluate the toxicities exhibited by DAB in the hippocampi of 6-month-old (young) and 20-month-old (old) male SD rats by treating animals intraperitoneally with DAB at 3 mg/kg/day for 1 week. Hippocampal areas were dissected from brains and RNA was extracted and subjected to RNA-seq analysis. RNA results showed animals exhibited age-dependent sensitivity to the neurotoxic effects of DAB. We observed that inflammatory pathways were up-regulated in old rats but that metabolism- and detoxification-related pathways were up-regulated in young rats. This result in old rats, especially upregulation of the TREM1 signaling pathway (an inflammatory response involved in Alzheimer’s disease (AD)) was confirmed by RT-PCR. Our study results provide a better understanding of age-dependent responses to DAB and new insight into the association between DAB and AD.