Sequential Bilateral Hip Fractures in Elderly Patients / 대한고관절학회지

Purpose@#To evaluate the incidence and presentation of osteoporotic sequential bilateral hip fractures (SBHF) in Center for Joint Disease, Chonnam National University Hwasun Hospital as there are limited studies with variable results reported in Korea. @*Materials and Methods@#Records of 507 patients aged >60 years old presenting with osteoporotic hip fractures between 2009 and 2015 were retrospectively reviewed to document the occurrence and presentation of sequential hip fractures; mean post-treatment follow-up was 48 months. Additionally, any correlations between sequential fractures and initial fracture and risk factors were assessed. Bone mineral density (BMD) was measured before and after sequential hip fracture for comparison. @*Results@#There were 246 femoral neck (Group A) and 261 intertrochanteric (Group B) fractures. The cumulative incidence of SBHF was 8.2% (42 patients total; 29 in Group A and 13 in Group B). Average interval of SBHF for Group A and Group B were 37.4 months and 29.9 months, respectively. There was significant correlation between the initial fracture type and sequential fractures, particularly the trochanteric and subgroup of those with neck fractures. Hypertension as a co-morbidity and female sex have been identified as risk factors for SBHF. No significant findings were noted regarding BMD and risk factors in both groups. @*Conclusion@#The clinical presentations of SBHF noted here concur with other worldwide studies and may guide efforts to develop relevant programs to prevent SBHF.

Maximal strength and endurance scores of the tongue, lip, and cheek in healthy, normal Koreans

OBJECTIVES: The purpose of this study was to establish normative data for healthy Korean adults by measuring the maximal strength and endurance scores of the tongue, lip, and cheek, and to examine correlations between these measurements. MATERIALS AND METHODS: This study included 120 subjects that were divided into three groups according to age: young (20-39 years), middle-aged (40-59 years), and older (over 60 years); and by gender. Measurements were taken using the Iowa Oral Performance Instrument (IOPI). RESULTS: The mean maximal tongue strengths were as follows: young men (46.7±10.2 kPa) and women (32.1±7.9 kPa), middle-aged men (40.9±9.3 kPa) and women (36.9±8.6 kPa), and older men (35.2±9.0 kPa) and women (34.5±6.9 kPa). The mean tongue endurance scores were: young men (28.8±12.6 seconds) and women (20.8±13.5 seconds), middle-aged men (17.0±8.5 seconds) and women (15.3±5.2 seconds), and older men (15.8±6.7 seconds) and women (17.9±8.1 seconds). The mean maximal lip strengths were: young men (11.6±3.0 kPa) and women (11.4±3.8 kPa), middle-aged men (11.4±4.2 kPa) and women (11.1±5.1 kPa), and older men (14.5±3.9 kPa) and women (11.7±2.6 kPa). The mean lip endurance scores were: young men (41.1±23.9 seconds) and women (22.4±21.7 seconds), middle-aged men (24.3±10.3 seconds) and women (30.5±13.4 seconds), and older men (24.9±11.0 seconds) and women (12.8±7.6 seconds). The mean maximal cheek strengths were: young men (24.5±4.6 kPa) and women (20.5±4.3 kPa), middle-aged men (25.2±6.4 kPa) and women (21.2±5.5 kPa), and older men (22.4±5.3 kPa) and women (18.0±4.8 kPa). The mean cheek endurance scores were: young men (47.8±24.4 seconds) and women (43.9±25.0 seconds), middle-aged men (27.3±11.3 seconds) and women (20.0±14.6 seconds), and older men (21.7±14.5 seconds) and women (17.2±11.4 seconds). CONCLUSION: The data collected in this study will provide an important database of standardized measurements for maximal strength and endurance scores of the tongue, lip and cheek in healthy, normal Koreans.

The Clinical Utility of End-tidal Carbon Dioxide as a Non-invasive Monitoring of Hyperventilation in Severe Brain Injury

PURPOSE: Hyperventilation is no longer recommended as a prophylactic intervention during the first 24 hours after severe head injury. The vasoconstriction caused by reducing carbon dioxide (CO2) levels leads to cerebral ischemia, and multiple arterial punctures may be required in order to monitor hyperventilation in severe brain injury. However, end-tidal CO2 (Petco2) reflects arterial CO2 (Paco2) noninvasively. The aim of this study was to determine whether Petco2 can be successfully used instead of Paco2 to monitor hyperventilation in brain injury patients. METHODS: From July 1, 2006 to June 30, 2007, 71 patients who visited the emergency department of a hospital after severe brain injury (trauma or acute cerebral disorder) were enrolled. Ten patients with chest trauma, 6 patients who received CPR in the emergency department (ED), and 1 patient who had COPD were excluded. Hemodynamic variables (Glasgow coma scale, mean arterial pressure, heart rate, respiration rate, body temperature, emergency operation, serum lactate concentration) under mechanical ventilation support were measured. The concordance between Petco2 and Paco2 was analyzed by employing a Bland-Altman plot. We defined the normal range for Paco2 and Petco2 [P(a-et)co2] is -5~5 mmHg. We compared the normal and high P(a-et)co2 groups to identify factors affecting the P(a-et)co2. RESULTS: Excepting 17 patients under exclusion criteria, we analyzed 54 of the total of 71 patients. Thirteen patients (24.1%) were seen to be below 30 mmHg for Paco2. The Pearson correlation coefficient between Paco2 and Petco2 is 0.834 (p < 0.001), and the concordance between Paco2 and Petco2 was similarly high. The patients with high P(aet) co2 showed significantly lower mean arterial pressure and lower arterial pH than patients with normal P(a-et)co2. CONCLUSION: Petco2 shows high concordance with Paco2 in severe brain injury. However, patients with high P(a-et)co2 showed evidence of poor tissue perfusion. Therefore, the hemodynamic and tissue perfusion state should be considered when attempting to monitor hyperventilation in severe brain injury patients using Petco2.