Vitamin D Deficiency in Nursing Home Elderly in Korea

BACKGROUND: Recent studies report that nursing home elderly (NHE) have significantly lower serum levels of 25-hydroxy-vitamin D (25-OHD) than community dwelling elderly (CDE); however, in Korea such studies are lacking. We aimed to compare the vitamin D status between NHE and CDE in Korea. METHODS: This study included 203 patients over 65 years, admitted to the geriatric department of Seoul Medical Center between 01/2015 and 12/2015. Their medical records were reviewed for demographic data, type of residence, medical and drug history, serum 25-OHD, albumin, creatinine, and calcium levels, and geriatric assessment results. After excluding 36 subjects who had taken vitamin D supplements, anticonvulsants, or steroids, 33 NHE and 134 CDE were included for final analysis. RESULTS: Almost 80% of subjects showed a vitamin D deficiency (25-OHD <20 ng/mL); 54% were severely deficient (25-OHD <10 ng/mL). NHE had a significantly lower serum 25-OHD level than CDE (5.47±2.95 ng/mL vs. 14.72±11.35 ng/mL, p<0.001). Serum 25-OHD level was related to serum albumin level, the Geriatric Depression Scale score, and the Korean version of the Mini Mental State Examination score (p=0.004, p=0.041, p=0.032, respectively). After adjustment for confounding factors using multiple logistic regression analysis, diagnosis of severe vitamin D deficiency was more likely in NHE than CDE (odds ratio, 8.72; 95% confidence interval, 1.53-49.81). CONCLUSION: This study suggests a high prevalence of vitamin D deficiency in Korean NHE. To prevent falls and osteoporotic fractures in this population, vitamin D supplementation should be considered.

Repeatability of QuantiFERON-TB Gold In-Tube Assay Results Near Cut-Off Points

No abstract available.

Transfusion Premedication: A Single Center Study / 대한수혈학회지

BACKGROUND: Acute transfusion reaction occurs during or within a few hours of transfusion with 0.5~3% of blood transfusion. Febrile non-hemolytic transfusion reactions (FNHTRs) and allergic transfusion reactions (ATRs) are the most common transfusion reactions. Premedication with acetaminophen and diphenhydramine has been used to prevent these reactions in 50~80% of transfusions. The purpose of this study was to describe the frequency of premedication and FNHTRs and ATRs according to premedication in Korea. METHODS: Between January 1 and 31, 2013, analysis of the first transfusion was performed retrospectively with chart review. A total of 549 cases were analyzed with regard to product of blood, care area, premedication, and FNHTRs and ATRs. RESULTS: Premedication was administered in 88.2% (484/549) of transfusions; 4 mg chlorphenamine, a well-known antihistamine, was used as premedication in all cases. Occurrence of FNHTRs was 7.7% without premedication and 3.7% with premedication. Occurrence of ATRs was 0% without premedication and 0.8% with premedication. The frequency of premedication was related to care area but not blood products. CONCLUSION: Premedication use was more frequent than previously reported. However, the sample size in this study is small; therefore, conduct of further prospective multicenter studies is needed.

Malignant Inflammatory Myofibroblastic Tumor of the Bladder with Rapid Progression

A 71-year-old man was referred for painless hematuria and a bladder tumor. Cystoscopy and computed tomography revealed a 3-cm oval nodular mass on the left lateral side of the bladder. The patient underwent a complete transurethral resection of the lesion and histology showed a proliferation of atypical spindle cells with inflammation consistent with a myofibroblastic tumor. After 4 and 7 months, follow-up cystoscopy demonstrated nodular mass lesions and transurethral resection of bladder tumor was done, which showed chronic cystitis and a recurred myofibroblastic tumor, respectively. Five months later, multiple lymph node, bone, and soft tissue metastases were found by positron emission tomography. The patient was treated first with palliative chemotherapy, including doxorubicin and cisplatin. After that, radiologic studies showed disease progression but the patient refused further treatment and died 6 months later.

Relationship Between Blood Mercury Concentration and Waist-to-Hip Ratio in Elderly Korean Individuals Living in Coastal Areas / 예방의학회지

OBJECTIVES: This study investigated the relationship between the blood mercury concentration and cardiovascular risk factors in elderly Korean individuals living in coastal areas. METHODS: The sample consisted of 477 adults (164 males, 313 females) aged 40 to 65 years who visited a Busan health promotion center from June to September in 2009. The relationship between blood mercury concentration and cardiovascular risk factors including metabolic syndrome, cholesterol profiles, blood pressure, body mass index (BMI), waist circumference and waist-to-hip ratio (WHR), was investigated. Variables related to blood mercury concentration were further evaluated using multiple regression analysis. RESULTS: The blood mercury concentration of the study population was 7.99 (range, 7.60 to 8.40) microg/L. In males, the blood mercury concentration was 9.74 (8.92 to 10.63) microg/L, which was significantly higher than that in females (7.21, [6.80 to 7.64] microg/L). The blood mercury concentration of the study population was related to several cardiovascular risk factors including low-density lipoprotein (LDL) cholesterol (p=0.044), high-density lipoprotein (HDL) cholesterol (p=0.034), BMI (p = 0.006), waist circumference (p = 0.031), and WHR (p < 0.001). In males, the blood mercury concentration was significantly correlated with WHR in the multiple regression analysis. CONCLUSIONS: In males, the blood mercury concentration was related to waist-to-hip ratio, which is a central obesity index and cardiovascular risk factor. Our finding suggests that cardiovascular disease risk in males was increased by mercury exposure via an obesity-related mechanism.

Complications and Revision Rate as the Type of Prosthesis of Total Elbow Replacement: Long-term Follow-up in Korea / 대한정형외과학회잡지

PURPOSE: Few studies have compared the outcomes, complications and revision rate of a total elbow replacement (TER) prosthetic design. This study examined a series of patients with semiconstrained and unconstrained total elbow replacements (TER) and evaluated them for any functional differences, complications and revision rates that might be attributable to the prosthetic design. MATERIALS AND METHODS: A total 78 cases of primary TER was performed in 71 patients. Their mean age at TER was 54 years. The causes of TER were rheumatoid arthritis in 42, post-traumatic arthritis and osteoarthritis 24 and 5 patients, respectively. Unconstrained and semiconstrained TER was employed in 35 and 43 cases, respectively. The end results of TER by the Mayo elbow performance score (MEPS), their elbow range of motion before and after surgery, their complications and revision rates after an average 13 year follow-up were evaluated. RESULTS: The MEPS was improved from 33 points pre-operatively to 87 points post-operatively (p<0.001). Active flexion-extension elbow motions were also improved markedly from 27degrees-86degrees pre-operatively to 16degrees-128degrees postoperatively (p<0.001). There was no significant difference between the semiconstrained and unconstrained TER in the post-operative MEPS (p=0.764) and range of motion (p=0.728). The complication rate was much higher in the unconstrained groups than in the semiconstrained group (p=0.014). The mean total revision rate was 29.5%. There was no significant difference in revision rate between the unconstrained and semiconstrained groups (p=0.402). Loosening was found in a total of 12 cases (15.4%). There was also no significant difference in loosening between the semiconstrained and unconstrained groups (p=0.382). CONCLUSION: Favorable results of MEPS and elbow motion were obtained in both the unconstrained and semiconstrained types after an average 13 year follow up after TER. However, the semiconstrained type of TER showed a lower complication rate than the unconstrained type of TER.

Gene Expression in the Capsule Tissue of the Frozen Shoulder / 대한정형외과학회잡지

PURPOSE: To investigate the overall expression of extracellular matrix (ECM) and adhesion molecule genes using a gene array technique in the joint capsule of a frozen shoulder. MATERIALS AND METHODS: Tissues from 20 human shoulder joint capsules were harvested intraoperatively from patients (15 primary frozen shoulders, 5 controls) in our hospital. The RNA was isolated from the capsule tissue and the gene expression of ECM and adhesion molecules was analyzed using an oligo-array technique. RESULTS: The expression of several genes of the ECM and cell adhesion molecules was significantly higher in the capsule tissue from patients with a frozen shoulder than the controls. The gene expression of the collagen V alpha1/alpha3, VI alpha2/alpha3, VIII alpha1/alpha2, XV alpha1, XVIII alpha1 and ECM proteins including CD 44, connective tissue growth factor (CTGF), matrix metalloproteinase (MMP)-9/14, osteonectin, veriscan, hyaluronan synthase (HAS)-1, extra-cellular matrix (ECM)-1, secreted phosphoprotein (SSP)-1, tenascin C (TNC), thrombospondin 2/4 was two times higher in the frozen shoulder than the control. Several cell adhesion molecules genes including catenin alpha1, seletin p, integrin alpha3, beta2, beta4, beta5 and laminin alpha4, alpha5 were also two times higher in the in the patients with a frozen shoulder than the control. CONCLUSION: The gene expression of several ECM proteins and adhesion molecules is significantly higher in patients with frozen shoulder.

A Prospective, Multicenter, Randomized Trial for Duration of the Prophylactic Antibiotics after Elective Colorectal Surgery: 3 Days versus 5 Days

PURPOSE: The use of prophylactic antibiotics in elective colorectal surgery is essential. Although postoperative prophylactic antibiotics are recommended within 24 hr, the optimal duration of the use of prophylactic antibiotics after colorectal surgery has not yet been fully proven in Korea. The aim of this study was to compare infectious outcomes in elective colorectal cancer surgery between postoperative 3-day antibiotic therapy and 5-day therapy. METHODS: We conducted a multicenter, randomized trial of a 3-day use vs. a 5-day use of the second-generation cephalosporin cefotetan after elective colorectal surgery. The main outcome measures were the incidences of surgical site infection and all other infectious complications within 21 days after surgery. RESULTS: A total of 306 patients were enrolled. Fifty-one patients were excluded because they received additional surgery or dropped out during the study. Two-hundred fifty-five patients were analyzed in this study. The two groups were similar in terms of demographics, ASA score, tumor location, tumor stage, surgical approach (conventional open vs. laparoscopy-assisted vs. robotic-assisted), and type of operation. The incidences of surgical site infection were not significantly different between the 3-day use group (4/130 or 3.1%) and the 5-day use group (3/125 or 2.4%) (P=1.000). Incidences of overall infectious diseases did not differ significantly between the two groups. Postoperatively, both groups had similar values in their white blood cell count, absolute neutrophil count, and C-reactive protein levels. However, the number of patients is small to draw a definite conclusion in this study. CONCLUSION: Three-day cefotetan administration may be not inferior in preventing surgical site infection compared to 5-day antibiotic administration. However, further studies with a large number of patients are needed before a definite conclusion can be drawn.

Prediction of Perineural Invasion and Its Prognostic Value in Patients with Prostate Cancer

PURPOSE: The prognostic significance of perineural invasion by prostate cancer is debated. We investigated the association between perineural invasion and clinicopathological factors and the effect of perineural invasion on survival in patients with prostate cancer. MATERIALS AND METHODS: A total of 361 patients with prostate cancer without any neoadjuvant therapies prior to surgery from 1999 to 2010 were analyzed retrospectively. Whole-mount sections of surgical specimens from all patients who underwent radical prostatectomy were evaluated. Positive perineural invasion was defined as infiltration of cancer cells in the perineurium or neural fascicles. The relationship of perineural invasion with clinicopathological features and prognosis of prostate cancer was studied. We also researched preoperative factors that were associated with perineural invasion. RESULTS: Perineural invasion in a prostatectomy specimen (PNIp) was positive in 188 of 361 patients (52.1%). In the multivariate analysis of the preoperative variables, PNIp was related to the primary Gleason grade (p=0.020), the number of positive cores (p=0.008), and the percentage of tumor cells in positive cores (p=0.021), but not to perineural invasion of a prostate biopsy. In the evaluation between PNIp and pathologic findings of the prostatectomy specimen, PNIp was related to the Gleason score (p=0.010), T-stage (p=0.015), and lymphovascular invasion (p=0.019). However, by multivariate analysis, the PNIp was not an independent prognostic factor of biochemical serum recurrence (p=0.364) or cancer-specific survival (p=0.726). CONCLUSIONS: PNIp was significantly related to biologically aggressive tumor patterns but was not a prognostic factor for biochemical serum PSA recurrence or cancer-specific survival in patients with prostate cancer.

Effect of Regional Nerve Block in Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: The goal of this study is to evaluate the efficacy of femoral, obturator, and sciatic nerve regional blocks with using ropivacaine during total knee arthroplasty. MATERIALS AND METHODS: As a prospective study, we performed total knee arthroplasty for 383 patients from Oct. 2004 to Feb. 2009. There was 139 cases of femoral and obturator nerve regional block, 123 cases of femoral, obturator, and sciatic nerve regional block, and 121 cases of lidocaine local anesthesia at the synovium and subcutaneous tissue during wound closure. All the femoral nerve block cases used a femoral catheter for an additional ropivacaine injection at 10 hours after surgery. The pain was examined using a visual analogue scale (VAS). The VAS scores were checked on the day of surgery and at post operative 24 hours, 48 hours and 6 days. The pain control effects among the 3 groups were compared with one-way ANOVA test and Scheffe`s multiple comparison test. RESULTS: The mean postoperative VAS score on the day of surgery and at post operative 24 hours, 48 hours and 6 days in the femoral and obturator nerve block group, were 6.3, 5.6, 5.3, and 4.7, respectively. For the cases of femoral, obturator and sciatic nerve block, the VAS scores were 3.9, 4.3, 3.5 and 1.9, respectively, and the VAS scores in the lidocaine local anesthetic group were 7.1, 6.1, 5.8 and 5.2, respectively. There was a statistical significance in all three groups (p<.0001), and the additional sciatic nerve block groups had significant effectiveness. CONCLUSION: Pain control with the ropivacaine regional nerve block is more effective than the lidocaine local anesthesia, and additional sciatic nerve block is a important factor for decreasing the postoperative pain after total knee arthroplasty.

Autologous Chondrocyte Implantation for Articular Cartilage Defect of Femoral Condyle / 대한정형외과학회잡지

PURPOSE: To evaluate the midterm clinical and histological results after autologous chondrocyte implantation (ACI) for an articular cartilage defect of the distal femoral condyle. MATERIALS AND METHODS: Twenty four cases with an articular cartilage defect (Outerbridge grade IV) of the femoral condyle that was confirmed by MRI and the arthroscopic findings underwent ACI. Their mean age at the time of surgery was 42.8 years and the mean follow-up period was 53.2 months (range, 20-82 months). At the last follow up, the articular cartilage view (SPGR) of MRI was examined and the clinical results were evaluated using the HSS and Lysholm scores. In 8 cases, second-look arthroscopy and biopsy were performed and evaluated using histological and histochemical methods. RESULTS: All cases except for one showed well-regenerated articular cartilage on MRI. All cases showed significant clinical improvement in the HSS and Lysholm scores (p<0.0001), with the exception of the Lysholm score of an articular cartilage fracture. Histologically, the regenerated tissue appeared to be a hyaline-like cartilage in all specimens. CONCLUSION: ACI for the treatment of articular cartilage defects of the distal femoral condyle showed a good clinical and MRI results. In OA, the clinical results were relatively acceptable after an associated high tibial valgus osteotomy. However, a longer term follow-up study will be needed to reach a final conclusion.

A Novel Autogenous Iliac Bone Graft Technique for Distal Humeral Bone Loss in Revisional Total Elbow Arthroplasty: A Technical Note / 대한정형외과학회잡지

As the incidence of total elbow arthroplasty has increased, revisions of the procedure also increase including reconstruction of bony defects caused by bone destruction. Reconstruction techniques depend on location and severity of the bony defect, and allografts are useful in cases of substantial bone loss. However, this procedure is technically difficult and has a high complication rate. Here, we describe a novel autogenous bone graft technique using tricortical iliac bone for reconstruction of a distal bone loss in a revisional total elbow arthroplasty, providing an additional method to restore bone stock.

Gene Expression Profile Analysis by cDNA Array in the Subacromial Bursa of Patients with Rotator Cuff Disease / 대한정형외과학회잡지

PURPOSE: To examine the expression pattern of inflammatory cytokines/receptors in the subacromial bursa of patients with rotator cuff disease using a cDNA(Complement DNA) Array technique. MATERIALS AND METHODS: Twenty two human subacromial bursal specimens were obtained intraoperatively from patients during shoulder surgery (18 bursitis, 4 normal bursa). The RNA was isolated from the bursal tissues and the presence of gene expression was analyzed using a cDNA Array technique. The statistical differences between bursitis and the normal bursa specimens were determined using a Mann Whitney U test and Student's t-test. RESULTS: cDNA Array analysis revealed a significant increase in the expression of several cytokine genes and their receptors in patients with subacromial bursitis compared with the controls (p<0.05). These cytokines included the interleukins (IL-1, 6, 12, 13, 15, 16, 17) and their receptors, lymphotoxin, small inducible cytokines, chemokine receptor (CCR 4, 6, 7) and stromal cell derived factor-1 (SDF-1). CONCLUSION: This study demonstrated a significant increase in many inflammatory cytokines in the subacromial bursa of patients with rotator cuff disease. This suggests that there is an active inflammatory reaction at the subacromial bursa in rotator cuff disease.

Hazards Exposed to Firefighters in Fire: Physical, Chemical, and Biologic factors

According to National Emergency Management Agency in Korea, numbers of death and injured in firefighters were 34 and 1,555 persons, respectively, between 2003 and 2007. Firefighting is a very dangerous and difficult work because of physical, chemical, and biological hazards. Firstly, physical hazards include burn induced by smoke and other combustion products, heat, noise, and ergonomic factors. Secondly, chemical hazards include chemical asphyxiants such as carbon monoxide, hydrogen cyanide, and hydrogen sulfide, simple asphyxiants such as carbon dioxide, chemical irritants including as hydrogen chloride, and acrolein, and so on, and other carcinogens. Finally, biological hazards include infectious agents such as hepatitis, tuberculosis, and so forth. We expect this study to help management andpromotion of firefighters' health.

The Prevalence of Anemia in Recreational Runner

OBJECTIVE: To evaluate the prevalence and characteristics of anemia in the long distance runners. METHOD: Subjects included 61 long distance runners and 40 control. The 61 subjects averaged 39.9+/-4.5 years of age. Long distance runners has been training for at least 6 months. Hemoglobin, iron, total iron binding capacity, reticulocyte count, peripheral blood smear, urine hemosiderin were evaluated. WHO criteria cut off value of hemoglobin for the diagnosis of anemia was used, 13 g/dl in men and 12 g/dl in women. Iron deficiency was defined as the percent transferrin saturation less than 15. The percent transferrin saturation was calculated by dividing the serum iron level by the total iron-binding capacity. RESULTS: Anemia occurred in only 2.0% and 9.0% of the male and female long distance runners respectively and other laboratory findings supported diagnosis of iron deficiency anemia. The percentage of iron deficiency anemia was lower than normal control. Iron deficiency was evident in 6.0% and 18.1% of the male and female long distance runners respectively. CONCLUSION: Recreational long distance runners were at no greater risk for developing a frank anemia than the non-exercising population.

Clinical results of Anterior Cruciate Ligament(ACL) Reconstruction: Bone-patellar Tendon-bone Autograft Versus Allograft

PURPOSE: To compare the clinical results of anterior cruciate ligament(ACL) reconstruction between the bone-patellar tendon-bone(BPTB) autograft and the allograft. MATERIALS AND METHODS: The clinical results of thirty-three patients of BPTB autograft and thirty-six patients of BPTB allograft performed between the periods of May 1994 and March 2004 were compared retrospectively in terms of Lysholm score, IKDC knee rating system, Tegner scale, physical examination, and KT-1000 arthrometry. Minimum follow-up period was 2 years(range: 24 to 144 months, average: 51.9 months). RESULTS: The postoperative Lysholm score at final follow-up was 89.4 in autograft group and 90.1 in allograft group on average. The difference between the two groups was not significant statistically in postoperative Lysholm score, IKDC knee rating system, and Tegner scale. Twenty-seven cases(81.8%) of autograft group had a negative Lachman test versus thirty-one cases(86.1%) of allograft goup, postoperatively. There was no significant difference in Lachman test, flexion-rotation-drawer(FRD) test, pivot shift test, and KT-1000 arthrometry between the two groups. CONCLUSION: The clinical results of ACL reconstruction using the BPTB autograft or allograft was equally good without statistically significant difference.

Treatment of Transverse Patellar Fracture with Cannulated Screws

PURPOSE: To assess the indication and effect of screw fixation in the transverse patellar fractures. MATERIALS AND METHODS: We analysed the results of 14 transverse patellar fractures fixed with screws from January 1991 to May 2005. Mean follow-up period was 47 months (range, 12~143 months). We analysed the radiologic union, operation time, ROM and postoperative Lysholm score. RESULTS: All fractures healed uneventfully. The mean displacement was decreased from 2.2 mm preoperatively to 0.3 mm postoperatively (p=0.001, Wilcoxon signed rank test). The mean operation time was 34 minutes (range, 20 to 60 minutes). Normal range of motion was achieved in 13 knees (92.9%). Average Lysholm score was 95.9 at final follow-up. CONCLUSION: Screw fixation seemed to be useful for treatment of transverse patellar fracture even in comminuted fractures with large fragments. The advantage of this technique was the preservation of extensor mechanism, simplicity, short operation time and good cosmesis.

The Thickness of Normal and Repaired Rotator-cuff Measured in MRI

Purpose: To compare the thickness of the repaired full-thickness rotator-cuff tear to that of normal rotator-cuff in young and old persons and evaluate the relationship between the tear size and the repaired thickness in the full-thickness tear using MRI. Materials and Methods: The thickness of the rotator-cuff of the repaired full thickness tear(age: 45~77, mean 63.3 years, 19 patients: group 1) were compared with those of old intact patients (age: 46~69, mean 57.9 years, 23 patients: group 2) and young intact patients (age: 18~30, mean 23.3 years, 22 patients: group 3). The tear length and width was measured in oblique coronal and oblique sagittal view of MRA, respectively, and the thickness was measured in coronal oblique view 15mm anterior to the posterolateral margin of the glenoid. Correlation between the preoperative tear size (the bigger one between the length and the width) and the postoperative thickness in group 1 was also evaluated statistically. Results: The postoperative rotator-cuff thickness in group 1 was 3.0 mm in average, which was inversely proportional to the preoperative tear size (P<0.001). The rotator-cuff thickness was 3.9mm in group 2 and 5.0mm in group 3, and there was statistically significant difference among the three groups(P<0.05). Conclusion: The rotator-cuff thickness decreases with age and the postoperative thickness in the full-thickness tear was inversely proportional to the tear size, smaller than that of the intact rotator-cuff.

5 Year Follow-up Results of Endoscopic Primary Realignment in Urethral Injury / 대한비뇨기과학회지

PURPOSE: The standard management of posterior urethral injury is controversial with regard to immediate primary realignment versus delayed urethroplasty. We analyzed the long-term results of treatment for urethral injury with performing immediate primary realignment. MATERIALS AND METHODS: 19 patients with urethral injury were treated by endoscopic primary realignment from March 2000 to March 2002. Anterior and posterior urethral injuries were classified into the A and P groups, respectively, and the A and P groups had 11 and 8 patients, respectively. We investigated 5-years of follow-up complications, which were composed of urethral stricture, incontinence and impotence. The mean follow-up period was 69.8 months after injury, and the follow-up status was obtained from a patient questionnaire or a telephone interview. RESULTS: 6(75%) of the P group had post-realignment stricture. However, 2 patients(25%) were considered to have mild strictures that were easily managed with a urethral sound, and 4(50%) had more significant stricture that required visual internal urethrotomy(VIU). 2(18%) of the A group needed only a sound and 4(36%) were managed via VIU. 1(13%) of the P group reported mild stress incontinence, but the patient did not need padding. 6(75%) of the P group had no erectile dysfunction, 1(13%) reported a decreased quality of erection that required only oral phosphodiesterase 5 inhibitor and 1(13%) required intracavernosal injection therapy. CONCLUSIONS: Endoscopic primary realignment of urethral injury is a simple, safe, rapid and nontraumatic technique. It reduces the incidence and extent of the complications such as stricture, erectile dysfunction and incontinence. Therefore, we recommend this endoscopic primary realignment for the initial management of posterior urethral injury, as well as for anterior urethral injury.

Comparison of Clinical Characteristics between Intraperitoneal and Extraperitoneal Bladder Rupture / 대한비뇨기과학회지

PURPOSE: To compare the clinical characteristics between intraperitoneal and extraperitoneal bladder ruptures. MATERIALS AND METHODS: 58 patients with a bladder rupture were divided into group A (34 intraperitoneal rupture) and group B (24 extraperitoneal rupture). The medical records and radiological findings were retrospectively reviewed. RESULTS: The follow up period in all patients was 5.8 4.5 months (1-20 months). The male to female ratios and the mean ages in groups A and B were 14:3, 17:7 and 43.9+/-14.2, 46.4+/-14.8 years, respectively (p>0.05), with the peak incidence being in the fifth and sixth decades. There were no statistical differences in the urologic symptoms and signs between groups A and B. The common cause of injuries in groups A and B were direct blow (41.3%) and out-car traffic accident (54.1%), respectively (p<0.05). The main associated injuries in groups A and B were pelvic bone fractures or intestinal injuries and pelvic bone fractures, respectively. The treatment modalities were an operation in 32 (94.1%) in group A; all group B cases were conservatively managed. The durations of catheter indwelling were 17.0+/-9.4 and 22.7+/-10.9 days in groups A and B, respectively (p<0.05). CONCLUSIONS: The bladder rupture occurred commonly in the fifth and sixth decades, especially in males. The most frequent causes of intraperitoneal and extraperitoneal ruptures were a direct blow and a traffic accident, respectively. Pelvic bone fractures were the most common associated injury, especially with extraperitoneal ruptures. In contrast to an extraperitoneal rupture, most intraperitoneal ruptures were managed by operative methods. The duration of catheter indwelling was significantly shorter with intraperitoneal than extraperitoneal ruptures.