The Efficacy of Suture Fixation of the Greater Trochanter in Unstable Intertrochanteric Fractures

Background@#Intertrochanteric fractures are one of the most common fractures in the elderly, especially those having osteoporosis. Stable intertrochanteric fractures may be fixed with implants including the dynamic hip screw and proximal femoral nail antirotation; however, this method is difficult to apply to unstable fractures. Bipolar hemiarthroplasty can be applied to unstable fractures and it prevents complications by facilitating early ambulation in the elderly. Many studies reported on how to fix the greater trochanter in unstable fractures during arthroplasty. We suggest that suture fixation alone can be a useful, effective, and affordable method. @*Methods@#We retrospectively enrolled 294 patients who underwent hemiarthroplasty for an unstable intertrochanteric fracture, and 225 patients were included in this study after excluding 69 patients who had not been available for follow-up until 1 year after surgery or died. The patients were divided into suture fixation and wiring fixation groups. Relationships of operation time, estimated blood loss, tip-to-stem distance, union rate, and physical performance in the groups of suture fixation and wiring were analyzed respectively. @*Results@#Changes in the tip-to-stem distance between the initial assessment at 1 year after surgery were statistically significantly different between the suture fixation group and wiring group (p < 0.001). There was no significant difference in change of the Koval score between the suture fixation and wiring groups (p = 0.362). The operation time and estimated intraoperative blood loss were statistically significantly lower in the suture group than in the wiring group (p < 0.001). There was no significant difference in the union rate between the groups (p = 0.470). @*Conclusions@#Compared to tension-band wiring, the suture fixation technique demonstrated an effective fixing force. In addition to the clinical results, it had an advantage of preventing complications due to shortening of the operation time and estimated intraoperative blood loss. Suture fixation of the greater trochanter is recommended for elderly patients with unstable intertrochanteric fractures.

Assessing Low Skeletal Mass in Patients Undergoing Hip Surgery: The Role of Sonoelastography / 대한고관절학회지

Purpose@#To analyze the utility of sonoelastography–a radiation-free procedure to characterize muscle properties–as an instrument to qualitatively and quantitatively assess the rectus femoris muscle. @*Materials and Methods@#Fifty-one consecutive patients who underwent a pelvic computed tomography (CT) exam were enrolled prospectively. The final analysis was conducted using data from 39 patients after 12 were removed due to exclusion criteria (muscle strength could not be measured due to poor cognition [n=11]; too young [n=1]). The potential correlation between average Hounsfield unit (HFU) at the rectus femoris muscle (measured by CT) and muscle quality grade (determined by sonoelastography) was assessed along with a retrospective analysis of the relationship between hand grip strength, knee extensor power, history of intensive care unit stay, length of hospital day and sonoelastographic grade. @*Results@#There was a significant correlation between sonoelastographic grade and the average HFU (P<0.001).Furthermore, hand grip strength (P<0.001) and knee extensor power (P<0.001) decreased significantly as the sonoelastographic grade increased. The likelihood of an intensive care unit stay and prevalence of low skeletal mass increased significantly with an increase in sonoelastography grade (P=0.037, P<0.001, respectively). The sensitivity, specificity, and accuracy of sonoelastographic images for predicting low skeletal mass were 77.3%, 100%, and 87.5%, respectively. @*Conclusion@#Sonoelastography advantages, including the lack of radiation and greater accessibility, may make it a valuable alternative to qualitatively and quantitatively identify sarcopenia and low skeletal mass.

Assessing Low Skeletal Mass in Patients Undergoing Hip Surgery: The Role of Sonoelastography / 대한고관절학회지

Purpose@#To analyze the utility of sonoelastography–a radiation-free procedure to characterize muscle properties–as an instrument to qualitatively and quantitatively assess the rectus femoris muscle. @*Materials and Methods@#Fifty-one consecutive patients who underwent a pelvic computed tomography (CT) exam were enrolled prospectively. The final analysis was conducted using data from 39 patients after 12 were removed due to exclusion criteria (muscle strength could not be measured due to poor cognition [n=11]; too young [n=1]). The potential correlation between average Hounsfield unit (HFU) at the rectus femoris muscle (measured by CT) and muscle quality grade (determined by sonoelastography) was assessed along with a retrospective analysis of the relationship between hand grip strength, knee extensor power, history of intensive care unit stay, length of hospital day and sonoelastographic grade. @*Results@#There was a significant correlation between sonoelastographic grade and the average HFU (P<0.001).Furthermore, hand grip strength (P<0.001) and knee extensor power (P<0.001) decreased significantly as the sonoelastographic grade increased. The likelihood of an intensive care unit stay and prevalence of low skeletal mass increased significantly with an increase in sonoelastography grade (P=0.037, P<0.001, respectively). The sensitivity, specificity, and accuracy of sonoelastographic images for predicting low skeletal mass were 77.3%, 100%, and 87.5%, respectively. @*Conclusion@#Sonoelastography advantages, including the lack of radiation and greater accessibility, may make it a valuable alternative to qualitatively and quantitatively identify sarcopenia and low skeletal mass.

Observation of Emergency Department Adult Patient Presenting Primary Symptoms of Upper Digestive Tract Oreign Body Ingestion

PURPOSE: The purpose of this study is to search for factors which can help in deciding on proper treatment for patients who visit the Emergency department (ED) with symptoms of foreign body ingestion. METHODS: This study was a retrospective review of medical records of ED patients with primary symptoms of foreign body ingestion. The patients' demographic data, elapsed time since the ingestion, type of foreign body, symptoms, and the method of removal were analyzed. Receiver operating characteristic (ROC) curve was used for analysis of whether these factors can be used to decide on proper treatment. RESULTS: Among 321 patients, a foreign body was removed successfully in 285 patients and the foreign body was not found in the remaining 36 patients. Of the successfully treated cases, 76 were removed grossly, 133 were removed using a laryngoscope, 74 were removed with endoscopy, and 2 were removed spontaneously. Comparing the group in which a foreign body was found and the other group, there was a significant difference in elapsed time since the onset of symptoms (p=0.013) and the type of foreign body (p=0.001). There was no significant reliable factor which can predict the existence of a foreign body. CONCLUSION: There was no significant factor which can predict the existence of a foreign body. Considering that the foreign body was found in most suspected patients, and that numerous patients in which a foreign body was not found had shown signs of complications due to foreign body, constructive treatment should be advocated.

Prediction of Complicated Acute Cholecystitis During Emergency Department Stay

PURPOSE: The aim of the study was to determine the factors associated with complicated acute cholecystitis of initial clinical findings during an emergency department (ED) visit, and to use them as a guideline for consideration of early and active surgical intervention, to improve the prognosis of acute cholecystitis. METHODS: Medical records of adult patients diagnosed and treated in the ED as acute cholecystitis were reviewed retrospectively. Clinical findings including demographic data, past medical history, symptoms, physical exam, and laboratory test results were included in the analysis. A case associated with gall bladder empyema, gangrene, perforation, hydrops, or failure of initial laparoscopic approach was defined as complicated acute cholecystitis. Factors showing significance in univariate analyses were included in binary logistic regression analysis for prediction of complicated acute cholecystitis. RESULTS: Age, sex, hypertension history, anorexia, body temperature, white blood cell count (WBC), aspartate aminotransferase, creatinine, total bilirubin, amylase, and lipase were significant in univariate analyses, and included in multivariate analysis. Age (p=0.039), male sex (p=0.004), and WBC (p=0.019) were significant in multivariate analysis. CONCLUSION: Age, sex, and initial WBC of patients diagnosed and treated in the ED as acute cholecystitis were independently associated with complicated acute cholecystitis.

Analysis of Factors Affecting Length of Hospital Stay in Geriatric Patients Transferred from Long-term Care Hospitals

PURPOSE: The number of geriatric patients transferred from long-term care hospitals to emergency department (ED) is increasing because the number of long-term care hospitals has increased significantly in recent years. Only a few studies showing the characteristics of geriatric patients transferred from long-term care hospitals to ED have been reported. We assessed factors affecting length of hospital stay in geriatric non-trauma patients transferred from long-term care hospital to ED. METHODS: This study was a retrospective review of the medical records of 143 patients who were transferred from long-term care hospital to ED. Admitted patients were classified according to two groups (general ward group and intensive care unit group). Univariate analyses were performed relating initial vital signs and laboratory methods for prediction of the length of hospital stay. Cox proportional hazard analysis was then derived, with all variables in the final model significant at p<0.05. RESULTS: A total of 189 patients were enrolled in the study. Results of univariate analysis for Glasgow Coma Scale, heart rate, oxygen saturation, white blood cell count, segmented granulocyte percent, erythrocyte sedimentation rate, and C-reactive protein were significant. In multivariate analysis results for oxygen saturation (p=0.014, hazard ratio=1.065) and segmented granulocyte percent (p=0.025, hazard ratio=0.975) were significant. CONCLUSION: Higher oxygen saturation and lower segmented granulocyte percent are independent factors leading to earlier discharge from the hospital in geriatric non-trauma patients transferred from long-term care hospitals.

Relationship of Angiopoietin-2 Expression to Atherosclerosis in Middle Cerebral and Coronary Arteries / 대한해부학회지

Atherosclerosis is a systemic and multifactorial disease, its incidence is raised recently. Cerebral and coronary atherosclerosis have some similar pathogenesis, but their relationship and mechanisms are still remain unclear. Intimal neovascularization in the atherosclerotic plaque was focused with respect to its pathological roles, intimal thickening and atherosclerotic progression. Ang-2, which is an angiogenesis regulating factor, provides a destabilizing signal for endothelial cells, leading to vessel regression or sprouting. However the role and distribution of Ang-2 in atherosclerotic coronary and cerebral arteries are still not well known. Thus, we analyzed 1) atherosclerotic lesion progression 2) relationship of atherosclerosis to Ang-2 expression in human middle cerebral and coronary artery. Paraffin sections from 25 human coronary (COA) and 36 middle cerebral arteries (MCA) were characterized according to AHA classification. In the same person, the score of atherosclerosis progression in COA was higher than that of MCA. In the two kinds of arteries having same atherosclerotic progression, the degree of intimal proliferation and luminal stenosis in COA was higher than that of MCA. Expression of Ang-2 was not shown in normal artery but localized in lumen-lining endothelium, macrophage in preatheroma, atheroma and complicated lesion. Ang-2 expression and infiltration of macrophages were rich in COA than MCA. Our result indicated that cerebral atherosclerosis has some different pathogenic mechanisms with coronary atherosclerosis according to difference of progression and angiogenic factor Ang-2 expression. Thus this is a fundamental study for understanding the progression of atherosclerosis in different vascular beds.