In response to the increase in the prevalence of chronic kidney disease (CKD) in Korea, the growth of patients requiring renal replacement therapy and the subsequent increase in medical costs, the rapid expansion of patients with end-stage kidney disease (ESKD), and the decrease in patients receiving home therapy, including peritoneal dialysis, the Korean Society of Nephrology has proclaimed the new policy, Kidney Health Plan 2033 (KHP 2033). KHP 2033 would serve as a milestone to bridge the current issues to a future solution by directing the prevention and progression of CKD and ESKD, particularly diabetic kidney disease, and increasing the proportion of home therapy, thereby reducing the socioeconomic burden of kidney disease and improving the quality of life. Here, we provide the background for the necessity of KHP 2033, as well as the contents of KHP 2033, and enlighten the Korean Society of Nephrology’s future goals. Together with patients, healthcare providers, academic societies, and national policymakers, we need to move forward with goal-oriented drive and leadership to achieve these goals.

Dysphagia aortica is a rare form of mechanical dysphagia characterized by extrinsic compression of the esophagus by the aorta. A 69-year-old male reported experiencing swallowing difficulties for five months, along with nausea, abdominal discomfort, weight loss, and severe reflux. Considering his age and a medical history of hypertension and stenosis of the cerebral artery, poststroke dysphagia was initially suspected. However, brain magnetic resonance imaging revealed no evidence of acute or subacute stroke. Further evaluation was achieved via enhanced chest computed tomography to locate the focus of the systemic inflammation. A thoracic aortic aneurysm about 8.7×5.0 cm in size, with signs of impending rupture, was observed. This case reinforces that a high possibility for dysphagia aortica should be considered under conditions of unclear etiology of dysphagia but the presence of associated symptoms, such as progressive intolerance to solids and ultimately to liquids, weight loss, and nausea.

Presbyesophagus is a unique cause of dysphagia in the elderly, which features incomplete relaxation of the lower esophageal sphincter, dilatation of the esophagus, decreased esophageal peristaltic pressures, abnormal esophageal contractions, and delayed emptying of the esophagus. An 88-year-old woman underwent surgery for a femur fracture.The day after surgery, respiratory arrest occurred during a meal. Breathing resumed after oxygen supply with airway opening. She complained of dysphagia and nausea during a meal, and the videofluoroscopic swallowing study and esophagography showed delayed emptying of the esophagus, abnormal esophageal contraction, and dilatation of the esophagus. This case shows that esophageal dysfunction in the elderly with poor general medical conditions can worsen abruptly.

Many people with muscular dystrophy develop dysphagia that can result in an inability to use the oral route in severe cases. In such cases, an alternative feeding method is selected, including a nasogastric tube or a gastrostomy.This case report describes a 40-year-old man with muscular dystrophy who was managed for swallowing difficulty and respiratory failure. Oromotor muscle weakness caused prolonged mealtimes, difficulty with swallowing a solidform diet, aspiration signs, and weight loss. Consequently, an alternative feeding method was required. An abdominal radiograph showed massive aerophagia, and the transverse colon was located over the stomach. As a result, the colon interfered with the puncture route, which could lead to colon perforation. Therefore, cervical esophagostomy was selected, where the patient obtained nutrition through a cervical esophagostomy tube. This case showed that when gastrostomy cannot be performed due to aerophagia, cervical esophagostomy can successfully support nutrition for the mid to long-term in muscular dystrophy patients.

Acupuncture is generally regarded as a safe procedure and as a popular treatment for patients with musculoskeletal disorders. We report a case of a 47-year-old male patient with late-onset tetraplegia, developed after acupuncture. He had no trauma, medical, and social history relevant to tetraplegia. Right after the acupuncture, he felt discomfort in his right arm. After 6 days, all 4 extremity weakness developed. Whole-spine magnetic resonance imaging revealed the presence of spinal subdural hematoma extending from the C5 vertebra to the coccyx level. Hand coordination dysfunction, neurogenic bladder, and neuropathic pain were other symptoms. After the management, he recovered muscle strength, but incomplete bladder control and neuralgia were sustained. It is important to be aware of the possibilities of severe complications after acupuncture.
Acupuncture ; Arm ; Coccyx ; Extremities ; Hand ; Hematoma, Subdural, Spinal ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Muscle Strength ; Neuralgia ; Quadriplegia ; Spine ; Urinary Bladder ; Urinary Bladder, Neurogenic

Lymphedema is a common complication associated with cancer itself or with cancer treatment. Lymphedema infrequently occurs after drug therapy. Bee venom is one of the materials used in acupuncture, and it has been used in the treatment of a variety of inflammatory diseases including arthritis. We report a 74-year-old male patient with late-onset post-radiation lymphedema provoked by bee venom therapy. He was free of lymphedema for 5 years after the complete remission of prostate cancer which had been treated with transurethral resection and radiation therapy. The patient developed left leg swelling after undergoing bee venom therapy for left hip pain. Computed tomography and lymphoscintigraphy showed lymphedema without tumor recurrence or infection. The lymphatic system was suspected to be injured by bee venom therapy and lymphedema was provoked. Bee venom therapy should be used cautiously in patients prone to lymphedema.
Acupuncture ; Aged ; Arthritis ; Bee Venoms* ; Bees* ; Drug Therapy ; Hip ; Humans ; Leg ; Lymphatic System ; Lymphedema* ; Lymphoscintigraphy ; Male ; Prostatic Neoplasms ; Recurrence

A 57-year-old man who was diagnosed with Wernicke-Korsakoff syndrome showed severe impairment of cognitive function and a craving for alcohol, even after sufficient supplementation with thiamine. After completing 10 sessions of 10 Hz repetitive transcranial magnetic stimulation (rTMS) at 100% of the resting motor threshold over the left dorsolateral prefrontal cortex, dramatic improvement in cognitive function and a reduction in craving for alcohol were noted. This is the first case report of the efficacy of a high-frequency rTMS in the treatment of Wernicke-Korsakoff syndrome.
Cognition ; Craving ; Humans ; Korsakoff Syndrome* ; Middle Aged ; Prefrontal Cortex ; Thiamine ; Transcranial Magnetic Stimulation*

To reveal test discrepancies between early bedside swallowing screening test (BSST) and standard videofluoroscopic swallowing study (VFSS) and thereby to achieve an evaluation standard for post-stroke dysphagia which prevent aspiration pneumonia or unnecessary diet restrictions. Consecutive 252 first-ever stroke patients admitted to stroke unit of 1 tertiary university hospital from May 2009 to May 2010. BSST was performed within 3 days after onset and VFSS within 2 weeks after BSST. The findings between BSST and VFSS were compared. BSST and VFSS were performed in 186 patients. Of the 116 patients who passed BSST, aspiration was newly detected in VFSS in 16 patients (14%). Diet recommendation was changed in 95 of the 186 patients (51%) after VFSS, with 28% (n = 52) being changed to a more conservative level compared to the recommendation based on initial BSST. The data support the need for reassessment using VFSS even when BSST is performed in the acute stage of stroke.
Deglutition Disorders* ; Deglutition* ; Diet ; Humans ; Mass Screening* ; Pneumonia, Aspiration ; Prospective Studies* ; Stroke

Bilateral anterior opercular syndrome and partial Kluver-Bucy syndrome are associated with bilateral middle cerebral artery lesions. The combination of these two syndromes has only been reported in a child with limbic encephalitis. In this case, a 44-year-old woman with bilateral middle cerebral artery infarction, which occurred 2 years prior, could walk independently. However, she showed automatic-voluntary dissociation and anarthria with preserved writing skills. She also presented hypersexuality, hypermetamorphosis, and memory disturbances. Here, we report a case of an adult stroke patient who suffered from bilateral anterior opercular syndrome accompanied by partial Kluver-Bucy syndrome.
Adult ; Child ; Female ; Humans ; Infarction, Middle Cerebral Artery ; Kluver-Bucy Syndrome* ; Limbic Encephalitis ; Memory ; Middle Cerebral Artery ; Stroke* ; Writing

Bilateral anterior opercular syndrome and partial Kluver-Bucy syndrome are associated with bilateral middle cerebral artery lesions. The combination of these two syndromes has only been reported in a child with limbic encephalitis. In this case, a 44-year-old woman with bilateral middle cerebral artery infarction, which occurred 2 years prior, could walk independently. However, she showed automatic-voluntary dissociation and anarthria with preserved writing skills. She also presented hypersexuality, hypermetamorphosis, and memory disturbances. Here, we report a case of an adult stroke patient who suffered from bilateral anterior opercular syndrome accompanied by partial Kluver-Bucy syndrome.
Adult ; Child ; Female ; Humans ; Infarction, Middle Cerebral Artery ; Kluver-Bucy Syndrome* ; Limbic Encephalitis ; Memory ; Middle Cerebral Artery ; Stroke* ; Writing