Cementless Hip Arthroplasty Using a Long Double-Tapered Rectangular Stem in Patients with Osteoporotic Proximal Femoral Fractures or Reoperation / 대한정형외과학회잡지

Purpose@#This study examined the clinical and radiological results of cementless hip arthroplasty using a long double-tapered rectangular stem in cases with osteoporotic proximal femoral fractures or in reoperation cases. @*Materials and Methods@#This was a retrospective study on patients treated with a Benfix ® stem (Corentec, Cheonan, Korea) by a single surgeon at a single tertiary institution from September 2011 to August 2020, where 92 hips were treated. Thirty-nine patients were followed up for less than one year. Excluding those patients, the mean follow-up duration was 3.0 years (range 1–8 years). The patients’ deaths were confirmed through data from the Ministry of Interior and Safety. Clinical outcomes were assessed using a modified Harris hip score (mHHS), and radiologic outcomes, such as fixation and subsidence, were assessed by surgeons who did not participate in the surgery. @*Results@#mHHS improved from 45 to 79 points at the latest follow-up, and thigh pain was not observed in 53 patients who were followed up for more than one year. Notching of the stem was not noted. The average subsidence was approximately 1 mm in postoperative one year.Three peri-prosthetic fractures (PPF), one deep prosthetic infection, and one superficial wound infection were observed. Stem loosening occurred in one of these PPF cases, and stem revision surgery was done. All complications occurred within one year postoperatively. The one- and five-year mortality were 21.1% and 50.0%, respectively. @*Conclusion@#The short-term and mid-term results of the cementless hip arthroplasty using long double-tapered rectangular stem appeared encouraging and could be a viable option in osteoporotic proximal femoral fractures or reoperation cases. However, most complications occurred within one postoperative year, and the one-year mortality was relatively high. A long-term follow-up would be necessary with a larger cohort to evaluate its longevity.

The Comparison of Body Fat Rate and Body Mass Index through the Relationship with Cardiovascular Risk Factors

BACKGROUND: Obesity has been generally diagnosed by 'Body Mass Index (BMI)' in primary care. Recently the use of Bioelectrical Impedance Analyzer' has become popular in Korea to evaluate body fat rate (BFR), as cost is inexpensive and the method to use is simple. As a result, the opposed finding of normal BMI and elevated BFR vice versa in same individuals are being encountered frequently. We designed this study to find out the characteristics and cardiovascular risk of people in these groups. METHODS: The medical records of health promotion center were obtained and 22,704 applicants visitor who undeerwent health risk questionnaire, screening tests and physical examination for cardiovascular disease were reviewed. RESULTS: After adjusting for age, sex, exercise and education level, cardiovascular risk such as hypertension, DM, and hypercholesterolemia, LDL tended to increase linearly and HDL tended to decrease linearly with increase of BFR or BMI. In comparison with normal BMI and BFR group, the odds ratios of normal BMI and elevated BFR group or vice versa were increased. CONCLUSION: If either one of BMI or BFR of a person was elevated, even though the other was within normal range, the cardiovascular risk of that person was shown to be high.

Factors Relating to Bone Mineral Density of Adult Man in Korea

BACKGROUND: The bone mineral densities of men decrease with increasing age like women. The incidence of osteoporosis gradually increase according to increasing proportion of older people, but the studies on osteoporosis of men are now beginning. The association between the bone mineral density and behavioral factors among adult men in Korea were studied. METHODS: The study subjects who visited health promotion center of one hospital located in Seoul from April to May 2001, aged 28 to 76 years, were all mearsured bone mineral density at left calcaneus using quantitative ultrasonography (QUS). We interviewed all subjects to get the information about past medical history and behavioral risk factors such as smoking, drinking, intake of dairy food, and exercise patterns. We also checked height, weight, blood chemistry including alkaline phosphatase and Prostate Specific Antigen. We calculated the Pearson's partial correlation coefficient between Speed of Sound (SOS) and each variables after adjusting age and body weight, and compare the mean SOS among each categories of the variables using Analysis of Covariance (ANACOVA). Finally, multiple regression analysis was done, using the model including significant variables of baseline analysis. RESULTS: One hundred six men, who did not have any metabolic disease influencing bone mineral density, were included. Age and smoking amount were negatively correlated and body weight was positively correlated with SOS. In univariate analysis, exercise, past history of fracture and dairy food intake was significantly associated with bone mineral density of men. In multiple regression analysis, body weight and dairy food intake were positively associated, but age and smoking amounts were negatively associated with bone mineral density. CONCLUSION: To increase bone mineral density of men, one should maintain adequate body weight, ingest dairy food regulary and reduce smoking amount or quit smoking.

The Effect of Prepregnancy Body Mass Index and Weight Gain during Pregnancy on Infant Birth Weight

BACKGROUND: To examine the effect of weight gain during pregnancy and prepregnancy body mass index on infant birth weight in normal term pregnancy. METHODS: We analyzed the weight data from 501 women who were in healthy singleton term pregnancy in a general hospital in Seoul from Jan. 2001 to Jun. 2001. Among the 501 women, 209 women whose data were available to calculate weight gain in every trimester were chosen. To study the effect of maternal weight gain on infant birth weight, multiple regression analysis, controlled for selected covariables, was carried out on the entire sample and on each prepregnancy weight group. RESULTS: In all the subjects both prepregnancy body mass and weight gain significantly influenced birth weight. For the lower and normal BMI, each kilogram of maternal weight gain significantly increased birth weight. CONCLUSION: These observations supports the recent evidence for the association between maternal weight gain and birth weight, but only for woman whose prepregnancy BMI are lower and normal. High maternal prepregnancy BMI did not have any influence of weight gain on birth weight.

Associated factor of prevalence of asymptomatic gallstone

BACKGROUND: Because of improvement of economic state and eating habit changes in Korea, 60-70% of gallbladder stones are cholesterol stones. As ultrasonography was used increasingly, detection of asymptomatic gallstone were increased. There has been few studies about asymptomatic gallstone in Korea. So, this study was designed to obtain associated factor of prevalence of asymptomatic gallstone. METHODS: We screened adults over 20 years who were visited the health Promotion Center in a university hospital from May 1995 to May 1999. Subjects were defined as case group(584 subjects) who were diagnosed gallstone by abdominal ultrasonogaphy by radiologist. Control group(1153 subjects) were selected by random sampling from visitors of the Health Promotion Center. Every subjects were assessed with respect to gender, age, height, weight, fasting blood glucose, serum total cholesterol, high density lipoprotein-cholesterol, triglyceride. Social-Economic state, smoking were assessed by self-administered questionnaires. Associated factor of prevalence of asymptomatic gallstone were analyzed by Chi-square test and multiple logistic regression. RESULTS: Age, BMI(Body Mass Index), fasting blood glucose were associated with gallstone by Chi-square test(P40 years old) and were associated with BMI(>25 kg/m2), fasting blood glucose. CONCLUSION: Associated factors of prevalence of asymptomatic gallstone were increased by age(>40 years old) and were associated with BMI(>25 kg/m2), fasting blood glucose, and were not different from those in West countries. further studies will be needed about associated factors according to the composition of gallstone and developing from asymptomatic gallstone to asymptomatic gallstone.

Combined effects of job strain, shift work and life style on the prevalence of sleep problems in middle aged men

BACKGROUND: There are a few studies on the effects of job strain on the prevalence of sleep problems in the foreign countries. In Korea, it has not been studied till now. In this article, the combined effects of job strain, shift work and some life style on the prevalence of sleep proplems were studied among workers in middle aged men. METHODS: 998 cases were chosen from 1109 men who visited health screening center from October to November, 1999. Sleep problems were categorized to insomnia, sleep deprivation, daytime sleepiness and snoring on the base of result of factor analysis of 11 questions. Job strain was measured by 11 questions which developed by Karasek and Theorell. All data set were analyzed using Chi square test and multiple logistic regression analysis. RESULTS: The 4 sleep proplems were analyzed by multiple logistic regression analysis in relation to job strain, shift work, occupation, obesity, sedentary life style, smoking, drinking. Insomnia was increased significantly from highest job strain group(Odds ratio (OR:2.02)) and non exercise group(OR:2.05). In these groups, daytime sleepiness was increased significantly(OR=1.92 in the highest job strain group, OR=1.72 in non exercise group). Sleep deprivation was increased in the highest job strain group(OR=2.18), managers & clerks(OR:1.67) and non exercise group(OR:1.78). Snoring was increased from BMI(Body mass index)> OR =25(OR=1.77), BMI> OR =27(OR=2.80) and non exercise group(OR:1.87). CONCLUSION: In the highest job strain group, insomnia, sleep deprivation and daytime sleepiness was increased significantly. And sedentary life style increased all sleep problems.

Clinical efficacy of the 7-Minute Screen at primary care setting

BACKGROUND: Because dementia tends to be underdiagnosed, Solomon PR developed a brief neurocognitive screening battery to identify Alzheimer's dementia. The 7-Minute Screen consists of four individual tests(orientation, memory, clock drawing, verbal fluency). It can be rapidly administered and it may be appropriately used in the primary care setting. We attempted to develop a screening tool of dementia based on the 7-Minute Screen at primary care setting in Korea. METHODS: We adapted the 7 Minute Screen to the Korean version of 7 Minute Screen(7 MS-K). 7 MS-K and MMSE-K were administered to 61 elderly people who visited the Sungbuk Public Health Center. Inter-rater reliability and test-retest reliability were evaluated. RESULTS: The 7 MS-K has a sensitivity of 92% and a specificity of 90% for cutoff point of MMSE-K 23/24. Inter-rater reliability and test-retest reliability for the entire battery was very high(both r=1). Mean time of administration was 10 minutes. CONCLUSION: 7 MS-K has a reasonable validity, reliability and can be administered in a brief period, and requires no clinical judgement and minimal training. It may be a useful tool for screening dementias in primary care setting.

CT and MR Features of the Intracranial Schwannomas

PURPOSE: To evaluate CT and MR findings of the intracranial schwannomas arising from variable cranial nerves. MATERIALS AND METHODS: The authors retrospectively analyzed CT (n=21) and MR(n=15) findings of 24 cases in 23 patients(M : 7, F : 16) who had suffered from surgically-proven intracranial schwannomas over the previous fiveyears. RESULTS: Schwannomas arose from the acoustic nerve(n=18), the trigeminal nerve(n=2), the glossopha-ryngeal-vagal-accessory nerve complex (n=2), and the olfactory nerve(n=1). Intracranial schwannomas were welldefined, lobulated and inhomogeneously or homogeneously enhancing masses on CT and MR, and were located along the course of the specific cranial nerve. Acoustic schwannomas involved both the internal auditory canal(IAC) and the cerebellopontine angle(CPA) in 14 cases, the IAC in three, and the CPA in two. Two trigeminal schwannomas involved both middle and posterior cranial fossa and were in the shape of a dumbbell. One of the two schwannomas that invelved lower cranial nerve complex(9-11th) was located in the medullary cistern and jugular foramen ; the other was located in the central posterior cranial fossa. A case of olfactory schwannoma was located in the right cribriform plate. The precontrast CT scan showed low density in 13 cases(62%), isodensity in seven(33%) and highdensity in one(5%). On postcontrast CT scan, enhancement was seen in 20 cases(95%). Of the 15 cases with MR, 12had low signal intensity on T1 weighted image and 14 had high signal intensity on T2 weighted image. MR imaging after Gd-DTPA infusion showed enhancement in 14 cases. Enhancement was inhomogeneous in 14 cases on CT and in 13 on MR. Of 24 cases, intratumoral necrosis was seen in 19, ring enhancement in five and severe cystic change inone. Other findings were intratumoral calcification(21%), hemorrhage(8%), pressure bony erosion(70.8%), midline shift(58%), peritumoral edema(29%) and hydrocephalus(33%). On MR, there was in all 15 cases a peritumoral lowsignal intensity rim on T1- and T2-weighted images and on a T1 weighted image following gadolium infusion. A caseof olfactory groove schwannoma was associated with neurofibromatosis type I and a case of bilateral acoustic schwannoma with neurofibromatosis II. CONCLUSION: Schwannomas can be easily diagnosed when a well defined, lobulated and inhomogeneously enhancing mass with intratumoral necrosis, cystic change, calcification orhemorrhage is seen along the course of a cranial nerve. Peritumoral low signal intensity rim on MR may be helpful in differentiating intracranial schwannomas from other tumors.

Radiologic Features of Posterior Fossa Hemangioblastomas: Emphasis on MR Findings

PURPOSE: To review MR findings of the posterior fossa hemangioblastomas and to evaluate diagnostic value of MRI correlated with CT and anglographic findings. MATERIALS AND METHODS: The MR findings in twelve patients with surgically proven posterior fossa hemangioblastomas including one case of von Hippel- Lindau disease were retrospectively analyzed and correlated with CT (7 patients) and anglographic findings (9 patients). RESULTS: On MRI, five hemangioblastomas were located in the cerebellar hemisphere and seven in the vermis. The masses appeared to be solid in 3 cases(25%), solid tumors with central cyst in 2 cases(17%), and cyst with mural nodules in 7 cases(58%). Abnormal tumor vessels represented by characteristic signal voids on MRI were observed in 9 cases(75%) and were not seen in 3 cases(25%) with mural nodule below 1.5cm in diameter. On pre-contrast CT, hemangioblastomas appeared poorly marginated slightly hyperdense masses in solid tumors, and hypodense cystic masses in cysts. After contrast enhancement, solid tumors were markedly enhanced, but it was difficult to differentiate hemangioblastomas from other tumors. In nine patients, anglograms demonstrated hypervascular blush corresponding to the solid component of the tumors. CONCLUSION: MRI was superior to CT in evaluating the characteristic of abnormal tumor vessels and mural nodules, delineation of tumor margin and tumor extent. Angiography was useful in the diagnosis of cystic hemangioblastomas which contain small mural nodule (less than 1.5cm in diameter) without definite vascular signal voids on MRI. MRI demonstrated solid or cystic tumor with small mural nodule and abnormal vascular signal voids in the posterior fossa should suggest hemangioblastoma.

CT and MRI Findings of Malignant Meningiomas: Comparison with Benign Meningiomas

PURPOSE: The purpose is to evaluate the CT or MRI findings to help in the differentiation between benign and malignant meningiomas. MATERIAL AND METHODS: The CT and MRI findings of 8 patients with surgically proven malignant meningioma were reviewed. Four cases of 8 malignant meningiomas and 18 cases of 27 benign lesions were studied with a 1.5T or 0.5T MRI. Radiologic analysis was focused on the heterogeneity of tumor, grade of peritumoral edema, presence of cystic degeneration and calcification, tumoral enhancement pattern, dural enhancement, and tumoral border. RESULT: Histologic types of malignant meningioma were meningotheliomatous (n=4), papillary(n=1), fibroblastic(n=l), angioblastic(n=l), and sarcomatous(n=l). Tumoral Heterogeneity was seen in 8 of 8 malignant lesions(100%) and 8 of 27 benign ones(30%). (p<0.01) Marked peritumoral edema was seen in 8 of 8 malignant lesions(100%) and 2 of 27 benign ones. (7.3%)(p<0.01) Most of malignant lesions(6 of 8 cases, 75%) showed ill defined border. Calcification was not present in malignant lesions in contrast with benign ones (14 of 27 cases, 52%). (p<0.05) No statistical significance was noted in cystic degeneration, dural tail like enhancement or tumoral enhancement pattern between malignant and benign meningiomas. MRI signal intensity of malignant meningiomas was homogeneously or heterogeneously hypointense on T1WI, heterogeneously isointense or hypointense on T2WI and heterogeneous or mixed on Gd-DTPA enhancement study. CONCLUSION: The CT or MRI findings such as heterogeneity, ill defined tumoral border, marked peritumoral edema, and absence of calcification may suggest the possibility of malignancy in meningioma.