Risk Factors for Subsequent Contralateral Hip Fracture following Osteoporotic Hip Fracture Surgery

Purpose@#This study examined the risk factors contributing to subsequent hip fractures in patients with osteoporotic hip fractures. @*Materials and Methods@#Between March 2008 and February 2016, 68 patients sustained a subsequent contralateral hip fracture after surgery for a primary osteoporotic hip fracture (Study group). The patients were compared with 475 patients who had been followed up for a minimum of one year with a unilateral osteoporotic hip fracture (Control group). The demographic data, bone mineral density (BMD), osteoporosis medication, osteoporotic fracture history, comorbid disease, type of surgery, preoperative, postoperative ambulatory capacity, and postoperative delirium in the two groups were compared. @*Results@#The demographic data, BMD, osteoporosis medication history, comorbid disease, type of surgery, and postoperative delirium were similar in the two groups. At three months after the primary surgery, the poor ambulatory capacity was significantly higher in the study group than the control group (p<0.001). @*Conclusion@#The ambulatory capacity after primary surgery is an important risk factor in the occurrence of subsequent hip fractures after osteoporotic hip fracture. Cause analysis regarding the poor ambulatory capacity after surgery will be necessary, and the development of a functional recovery program and careful management of the walking ability recovery will be needed.

Risk Factors for Subsequent Contralateral Hip Fracture following Osteoporotic Hip Fracture Surgery

Purpose@#This study examined the risk factors contributing to subsequent hip fractures in patients with osteoporotic hip fractures. @*Materials and Methods@#Between March 2008 and February 2016, 68 patients sustained a subsequent contralateral hip fracture after surgery for a primary osteoporotic hip fracture (Study group). The patients were compared with 475 patients who had been followed up for a minimum of one year with a unilateral osteoporotic hip fracture (Control group). The demographic data, bone mineral density (BMD), osteoporosis medication, osteoporotic fracture history, comorbid disease, type of surgery, preoperative, postoperative ambulatory capacity, and postoperative delirium in the two groups were compared. @*Results@#The demographic data, BMD, osteoporosis medication history, comorbid disease, type of surgery, and postoperative delirium were similar in the two groups. At three months after the primary surgery, the poor ambulatory capacity was significantly higher in the study group than the control group (p<0.001). @*Conclusion@#The ambulatory capacity after primary surgery is an important risk factor in the occurrence of subsequent hip fractures after osteoporotic hip fracture. Cause analysis regarding the poor ambulatory capacity after surgery will be necessary, and the development of a functional recovery program and careful management of the walking ability recovery will be needed.

Clinical Outcomes and Radiologic Characteristics of Insufficiency Femoral Neck Fracture in Elderly Patients

Purpose@#In elderly patients, femoral neck insufficiency fractures that occur without a history of trauma are difficult to diagnose and treat, so it is emphasized that early suspicion of fractures and additional diagnostic tests are conducted. @*Materials and Methods@#Between December 2010 to December 2019, 12 femoral neck insufficiency fractures (group 1) were evaluated by comparing them with 50 traumatic femoral neck fractures of a similar age. Along with demographic data, neck cortical thickness, shaft cortical thickness, head diameter, neck width, trochanter width, shaft width, neck-shaft angle, hip axis length, femoral neck index on the simple radiographic image were compared. @*Results@#Seven of the 12 cases were non-displaced fractures, and it took an average of 19.2 days to diagnose the fracture after the symptoms occurred. The height was smaller than the control group at 149.1 cm in group 1 and 157.2 cm in group 2 (p<0.001). The cortical thickness of the medial femoral neck showed significant differences between the two groups: 3.16 mm in group 1 and 4.11 mm in group 2 (p=0.004). There was no statistical difference in the other measurements. @*Conclusion@#Femoral neck insufficiency fracture often has a delayed diagnosis because of the characteristics of the fracture. The cortical thickness of the medial femoral neck in simple radiographic images can help suspect femoral insufficiency fractures in elderly patients when considered with detailed medical history taking and a physical examination.

The KAAACI/KDA Evidence-Based Practice Guidelines for Chronic Spontaneous Urticaria in Korean Adults and Children: Part 1. Definition, Methodology and First-line Management

Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.

The KAAACI/KDA Evidence-Based Practice Guidelines for Chronic Spontaneous Urticaria in Korean Adults and Children: Part 1. Definition, Methodology and First-line Management

Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.

KAAACI Evidence-Based Clinical Practice Guidelines for Chronic Cough in Adults and Children in Korea

Chronic cough is common in the community and causes significant morbidity. Several factors may underlie this problem, but comorbid conditions located at sensory nerve endings that regulate the cough reflex, including rhinitis, rhinosinusitis, asthma, eosinophilic bronchitis, and gastroesophageal reflux disease, are considered important. However, chronic cough is frequently non-specific and accompanied by not easily identifiable causes during the initial evaluation. Therefore, there are unmet needs for developing empirical treatment and practical diagnostic approaches that can be applied in primary clinics. Meanwhile, in referral clinics, a considerable proportion of adult patients with chronic cough are unexplained or refractory to conventional treatment. The present clinical practice guidelines aim to address major clinical questions regarding empirical treatment, practical diagnostic tools for non-specific chronic cough, and available therapeutic options for chronic wet cough in children and unexplained chronic cough in adults in Korea.

The KAAACI Standardization Committee Report on the procedure and application of the bronchial provocation tests

Bronchial provocation tests are of value in the evaluation of airway hyperresponsiveness. Nonspecific bronchial challenge (methacholine, mannitol, exercise, etc.) is used when the symptoms, physical examination, and measurements of pulmonary function are unremarkable in the diagnosis of asthma, when a patient is suspected of having occupational asthma or exercise-induced bronchoconstriction (EIB), and when a screening test for asthma or EIB is required for some occupational groups in whom bronchospasm would pose an unacceptable hazard. Methacholine inhalation challenge is most widely used pharmacologic challenge and highly sensitive. For appropriate interpretation of the results of methacholine provocation, it is important to perform the test with the standardized protocol and to recognize that inhalation methods significantly influence the sensitivity of the procedure. Indirect challenges (e.g., mannitol and exercise) correlate with airway inflammation and are more specific but less sensitive for asthma. Indirect provocation tests are used to confirm asthma, to differentiate asthma from other airway diseases, and to evaluate EIB.

KAAACI Standardization Committee Report on the procedures and applications of the diagnostic tests for drug allergy

Diagnostic methods for drug allergy include the patient's history, in vivo skin test, in vitro laboratory test, and provocation test. However, the history is often not reliable, procedures for in vivo and in vitro tests are not standardized, and provocation tests are sometimes harmful to patients. Generally, skin prick and intradermal tests are useful for immediate reactions; in contrast, patch test and delayed reading of both skin prick and intradermal tests are helpful for delayed reactions. A drug provocation test is the gold standard for both responses, and it is necessary to be aware of exact indications and contraindications with appropriate drugs, doses, and intervals. To date, several methods have been developed to detect culprit agents for drug hypersensitivity reactions, but they are neither completely well validated nor standardized. Based on this awareness and necessity, the Korean Academy of Asthma, Allergy and Clinical Immunology launched the Standardization Committee to review the international guidelines and the literature, and then developed the consensus report on the procedures and applications of diagnostic tests for drug allergy.

Korean version of the Cough Symptom Score: clinical utility and validity for chronic cough

BACKGROUND/AIMS: The Cough Symptom Score (CSS) is a simple, useful tool for measuring cough severity. However, there is no standard Korean version of the CSS. We developed a Korean version of the CSS and evaluated its clinical utility and validity for assessing chronic cough severity. METHODS: The CSS was adapted for Korean use following a forward-backward translation procedure. Patients with chronic cough enrolled from five university hospitals were graded using the CSS and a 100-mm linear visual analog scale (VAS) of cough severity at each visit. Patients completed the Leicester Cough Questionnaire (LCQ) upon presentation and completed the LCQ and Global Rating of Change at follow-up visits after 2 to 4 weeks. The concurrent validity, repeatability, and responsiveness of the Korean version of the CSS were determined. RESULTS: Correlation coefficients between the CSS and LCQ, and between the CSS and VAS, were –0.66 and 0.52, respectively. There was a weak correlation between the scores for night and day symptoms (r = 0.24, p = 0.0006). The repeatability of the CSS in patients with no change in cough (n = 23) was high (intra-class correlation coefficient, 0.75; 95% confidence interval [CI], 0.51 to 0.88). Patients who reported an improvement in cough (n = 30) at follow-up visits had a significant improvement in the CSS (median, −2; 95% CI, −3 to −1; p = 0.0003). CONCLUSIONS: The Korean version of the CSS correlated well with other tools for accessing cough severity in chronic cough patients. Therefore, it could be a reliable method for measuring chronic cough severity.

The KAAACI Standardization Committee Report on the procedure and application of fractional exhaled nitric oxide measurement

Fractional exhaled nitric oxide (FeNO) is a biomarker for type 2 inflammation in the airways, and its measurement has the distinct strengths of being simple, rapid, convenient, and reproducible. Since the discovery of FeNO in the 1990s, its measurement tools have been extensively developed and validated by several researchers. In particular, FeNO showed the potential to support the diagnosis of asthma and eosinophilic bronchitis. Since it has begun to be widely utilized in clinical research areas as well as daily practice, we summarized the standardized diagnostic procedures and suggested the clinical application of FeNO measurement in Korean population.

Analysis of Adverse Drug Reactions in Elderly Patients Based on a Spontaneous Reporting System in a Single Tertiary Hospital / 대한내과학회지

BACKGROUND/AIMS: Several factors contribute to the greater propensity for adverse drug reactions (ADRs) in the elderly, including the use of multiple drugs and pharmacokinetic and pharmacodynamic alterations due to aging. We evaluated the characteristics of ADRs in elderly versus younger adults. METHODS: ADRs were collected from a spontaneous reporting system at Seoul National University Hospital from February 2010 to September 2013. We analyzed causative drugs, clinical manifestations, and the severity of ADRs. RESULTS: In total, 15,541 ADRs were reported in patients 18 years of age or older. Common causative drug categories included nervous system, anti-neoplastics, and anti-infectives. The prevalence of ADRs due to respiratory drugs and cardiovascular drugs was higher in the elderly group (≥ 60 years) than in other groups. The most common clinical types were gastrointestinal and skin and appendage issues. The elderly group had a tendency to show a higher proportion of psychiatric, cardiovascular, hematological, and genitourinary symptoms. The proportions of severe ADRs were higher in the elderly groups and in male patients. CONCLUSIONS: Elderly patients were susceptible to ADRs related to respiratory and cardiovascular drugs. Psychiatric, cardiovascular, hematological, and genitourinary disorders account for a higher proportion of ADR symptoms in the elderly than in other age groups. Further efforts to understand, manage, and prevent ADRs in the elderly are required.

KAAACI Standardization Committee report on the procedure and application of induced sputum examination

Induced sputum and sputum cell count analysis is a test for the diagnosis of various respiratory diseases. In particular, it has long been used as an important biomarker in the diagnosis or characterization of asthma or eosinophilic bronchitis. Despite a relatively long history of this test, there has been no consensus report for conducting and interpreting the analyses in Korea. Based on this awareness and necessity, the Korean Academy of Asthma, Allergy and Clinical Immunology launched the Standardization Committee to review the international guidelines and the literature and to develop a consensus report on the diagnostic procedure and interpretation of the sputum induction test.

Revision Total Hip Arthroplasty with Constrained Liner in Patients with Abductor Insufficiency / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate clinical and radiographic results of revision total hip arthroplasty with constrained liner in patients with abductor insufficiency. MATERIALS AND METHODS: In this study, 30 patients treated with constrained liner during revision total hip arthroplasty due to abductor insufficiency were evaluated after minimum 2-year follow-up. There were 14 men and 16 women and the mean follow-up period was 4.6 years. Re-dislocation and aseptic loosening of the implant were defined as a failure of the constrained liner. Harris hip score and ambulatory function were evaluated as a clinical parameter and osteolysis, aseptic loosening of the implant and other complications were evaluated as a radiologic parameter. RESULTS: During the follow-up period, there were 4 cases (13.3%) of constrained liner failure including two cases of re-dislocation and two cases of acetabular cup aseptic loosening. The average Harris hip score was improved from 38.3 points preoperatively to 73.4 points at last follow up. At the final follow-up, there were 20 cases (66.7%) of improvement in ambulatory function. There was 1 case of infection and 1 case of periprosthetic fracture. CONCLUSION: Use of a constrained liner during revision total hip arthroplasty showed satisfactory results for prevention of re-dislocation in patients with abductor insufficiency. However longer term studies on loosening of implants are needed.

Periprosthetic Atypical Femoral Fracture-like Fracture after Hip Arthroplasty: A Report of Three Cases / 대한고관절학회지

Atypical femoral fractures are stress or insufficient fractures induced by low energy trauma or no trauma and have specific X-ray findings. Although the American Society for Bone and Mineral Research has excluded periprosthetic fractures from the definition of an atypical femoral fracture in 2013, this is still a matter of controversy because some authors report periprosthetic fractures showing specific features of atypical fractures around a well-fixed femoral stem. We report 3 cases of periprosthetic femur fractures that had specific radiographic features of atypical femoral fractures in patients with a history of prolonged bisphosphonate use; we also review relevant literature.

Reduced IRF7 response to rhinovirus unrelated with DNA methylation in peripheral mononuclear cells of adult asthmatics

BACKGROUND: Human rhinoviruses are the major cause of asthma exacerbation in both children and adults. Recently, impaired antiviral interferon (IFN) response in asthmatics has been indicated as a primary reason of the susceptibility to respiratory virus, but the mechanism of defective IFN production is little understood to date. The expression of IFN regulatory factor 7 (IRF7), a transcriptional factor for virus-induced type I IFN production is known to be regulated epigenetically by DNA methylation. OBJECTIVE: We aimed to investigate the expression of IFN-α, IFN-β, and IRF7 in response to rhinovirus infection in the adult asthmatics and evaluate DNA methylation status of IRF7 gene promotor. METHODS: Twenty symptomatic adult asthmatics and 10 healthy subjects were enrolled and peripheral blood was collected from each subject. Peripheral blood mononuclear cells (PBMCs) were isolated, cultured, and ex vivo stimulated with rhinovirus-16. The mRNA expressions of IFN-α, IFN-β, and IRF7 were analyzed using real time quantitative polymerase chain reaction. Genomic DNA was isolated from untreated PBMCs and the methylation status of IRF7 gene promotor was investigated using bisulfite pyrosequencing. RESULTS: The mean age of asthmatics was 45.4 ± 15.7 years and 40% was male, which were not different with those of control group. Asthmatics showed significantly decreased mRNA expressions (relative expression to beta-actin) of IFN-α and IFN-β compared with normal control. The mRNA expression of IRF7 in the asthmatics was also significantly lower than those in the normal control. No significant difference of DNA methylation was observed between asthmatics and controls in all analyzed positions of IRF7 promotor CpG loci. CONCLUSION: The mRNA expression of type I IFN in response to rhinovirus was impaired in the PBMCs of adult asthmatics. The mRNA expression of IRF7, transcriptional factor inducing type I IFN was also reduced, but not caused by altered DNA methylation in the IRF7 gene promotor.

Reliability and Validity of a Korean Version of the Leicester Cough Questionnaire

PURPOSE: There are no specific tools for measurement of the severity of chronic cough in Korea. We developed a Korean version of the Leicester Cough Questionnaire (LCQ) and tested its scaling and clinical properties. METHODS: The LCQ was adapted for Korean conditions following a forward-backward translation procedure. All patients referred to chronic cough clinics at 5 university hospitals between May 2011 and October 2013 completed 2 questionnaires, the LCQ and the Short-Form 36 (SF-36), upon presentation and completed the LCQ and the Global Rating of Change (GRC) upon follow-up visits after 2 or 4 weeks. Concurrent validation, internal consistency, repeatability, and responsiveness were determined. RESULTS: For the concurrent validation, the correlation coefficients (n=202 patients) between the LCQ and SF-36 varied between 0.42 and 0.58. The internal consistency of the LCQ (n=207) was high for each of the domains with a Cronbach's alpha coefficient of 0.82-0.94. The repeatability of the LCQ in patients with no change in cough (n=23) was high, with intra-class correlation coefficients of 0.66-0.81. Patients who reported an improvement in cough (n=30) on follow-up visits demonstrated significant improvement in each of the domains of the LCQ. CONCLUSIONS: The Korean version of the LCQ is a valid and reliable questionnaire for measurement of the severity of cough in patients with chronic cough.

Mid-term Results of Revision Total Hip Arthroplasty Using Modular Cementless Femoral Stems / 대한고관절학회지

PURPOSE: The purpose of this study was to evaluate the clinical and radiological results of revision total hip arthroplasty using modular distal fixation stems for proximal femoral deficiency. MATERIALS AND METHODS: Forty-five patients (47 hips) were analyzed more than 24 months after revision total hip arthroplasty that used modular distal fixation stems and was performed between 2006 and 2012. There were proximal femoral defects in all cases. Preoperative femoral defect classification revealed Paprosky type II in 31 cases, type IIIA in 7, and type IIIB in 9. The mean duration of follow-up was 53.4 (25-100) months. We evaluated the Harris hip score (HHS), walking ability according to Koval as clinical parameters, stem stability, and stem position change as radiographic parameters. Kaplan-Meier survival analysis was performed. RESULTS: The average HHS improved form 39.5 points to 91.3 points and walking ability also improved in most cases; all patients had stable fixation of the femoral stem. Postoperative complications included 5 cases of infection and 2 cases of dislocation. The survival rate with the end point of re-revision surgery due to infection or dislocation was 86% after 8-year follow-up. CONCLUSION: Cementless revision total hip arthroplasty using modular femoral stems is useful because the stems can be stably fixed on the diaphyseal portion of the femur, which has relatively good bone quality at mid-term follow-up.

Successful desensitization of trimethoprim-sulfamethoxazole in Stenostrophomonas maltophilia osteomyelitis

Stenotrophomonas maltophilia is an emerging pathogen associated with morbidity and mortality in hospitalized patients. The treatment of S. maltophilia infection is challenging because clinical isolates are frequently resistant to most antimicrobial agents except trimethoprim-sulfamethoxazole (TMP-SMX). S. maltophilia osteomyelitis is a rare disease and requires a prolonged treatment with TMP-SMX. Here, we report an interesting case of a patient with S. maltophilia osteomyelitis who developed a delayed hypersensitivity reaction during TMP-SMX treatment and successfully treated after desensitization. TMP-SMX desensitization should be considered in patients with hypersensitivity to TMP-SMX, especially when there are no effective alternative drugs in S. maltophilia infection.

Cross-reactivity to Acetaminophen and Celecoxib According to the Type of Nonsteroidal Anti-inflammatory Drug Hypersensitivity

PURPOSE: Identification of tolerable alternative analgesics is crucial for management in nonsteroidal anti-inflammatory drug (NSAID)-sensitive patients. We investigated cross-reactivity of acetaminophen and celecoxib according to the type of aspirin/NSAID hypersensitivity and aimed to determine the risk factors for cross-intolerance. METHODS: We retrospectively reviewed the medical records of patients intolerant to aspirin and NSAIDs who had undergone an acetaminophen and/or celecoxib oral provocation test. Aspirin/NSAID hypersensitivity was classified into 4 types according to a recently proposed classification: aspirin-exacerbated respiratory disease (AERD), aspirin-exacerbated chronic urticaria (AECU), aspirin-induced acute urticaria/angioedema (AIAU), and NSAID-induced blended reaction (NIRD). RESULTS: A total of 180 patients with hypersensitivity to aspirin and NSAIDs were enrolled; 149 acetaminophen provocation test results and 145 celecoxib provocation test results were analyzed. The overall cross-reaction rates to acetaminophen and celecoxib were 24.8% and 10.3%, respectively. There was a significant difference in the cross-reactivity to acetaminophen according to the type of NSAID hypersensitivity. Cross-reactivity to acetaminophen was highest in the AECU group (43.9%), followed by the AERD (33.3%), NIBR (16.7%), and AIAU (12.5%) groups. Underlying chronic urticaria was more prevalent in patients with cross-intolerance to both acetaminophen (P=0.001) and celecoxib (P=0.033). Intolerance to acetaminophen was associated with intolerance to celecoxib (P<0.001). CONCLUSIONS: Acetaminophen and celecoxib may induce adverse reactions in a non-negligible portion of aspirin/NSAID-sensitive patients. Physicians should be aware of the possible cross-reactions of these alternative drugs and consider an oral challenge test to confirm their tolerability.

Basophil Activation Test with Food Additives in Chronic Urticaria Patients

The role of food additives in chronic urticaria (CU) is still under investigation. In this study, we aimed to explore the association between food additives and CU by using the basophil activation test (BAT). The BAT using 15 common food additives was performed for 15 patients with CU who had a history of recurrent urticarial aggravation following intake of various foods without a definite food-specific IgE. Of the 15 patients studied, two (13.3%) showed positive BAT results for one of the tested food additives. One patient responded to monosodium glutamate, showing 18.7% of CD203c-positive basophils. Another patient showed a positive BAT result to sodium benzoate. Both patients had clinical correlations with the agents, which were partly determined by elimination diets. The present study suggested that at least a small proportion of patients with CU had symptoms associated with food additives. The results may suggest the potential utility of the BAT to identity the role of food additives in CU.