Atypical femoral fractures after anti-osteoporotic medication: a Korean multicenter study.

PURPOSE: Increasing numbers of atypical femoral fractures have been reported among long-term bisphosphonate users. We evaluated clinical characteristics of atypical femoral fractures throughout Korean multicenter studies. METHODS: We retrospectively analysed the bone mineral density, prodromal symptoms before femoral fracture, and medication history of osteoporosis in 76 cases of atypical femoral fracture. RESULTS: The mean age of cases was 71.4 ± 8.8 (range, 43-89) years old. The mean follow-up period after the fracture operation was 24.5 ± 12.9 (range, 12-79) months. BMI was 23.2 ± 3.0 on average. The mean BMD of femur was -1.9 ± 1.4 (range, -4.8 to 1.3). Prodromal symptoms including thigh pain before femoral fracture appeared in 22 (28.9 %) of 76 patients. All patients included in the study used bisphosphonate. The duration of taking bisphosphonate before fracture was 36.8 ± 50.8 (one-204 months) months. Fifty-seven (75 %) of 76 patients were taking the medication for more than three years. Delayed union occurred in 43 (56.5 %) of 76 patients. Delayed union was defined as a fractured bone that did not completely heal within six months of injury. The group of having taken anti-osteoporotic medication for more than three years showed relatively longer union period compared to that for a shorter period medication group (4.8 ± 2.5 months vs 9.3 ± 3.7 months, p = 0.017). The delayed union developed in 43 (56.5 %) of 76 patients and showed a significantly higher incidence in the group with long-term therapy (five/43 vs 38/43, p = 0.021). The bilateral femoral fractures developed in 23 (30.2 %) of 76 patients and showed a high incidence in the group medicated more than three years (two/23 vs 21/23, p = 0.039). CONCLUSIONS: The longer bisphosphonates are used, the more the cases of delayed union and the more frequent the development of bilateral fractures following unilateral fractures. With regard to the delayed union, the methods of the acceleration of fracture healing may be beneficial in atypical femoral fracture patients who had been receiving long-term bisphosphonates therapy. Careful observation is required for contra-lateral femurs due to a high incidence of bilateral atypical femoral fractures.

Comparison of the Oncologic Outcomes of Transanal Excision and Conventional Radical Surgery in Patients with Pathologic Stage I Rectal Cancer.

UNLABELLED: METHODOLOGY/AIMS: This study was conducted to compare the oncologic outcomes of transanal excision and radical resection in pathologic stage I rectal cancer. Ninety-six consecutive patients with stage I rectal cancer treated surgically between January 2000 and December 2009 were enrolled. Thirty-one patients underwent full-thickness transanal excision (TAE) and 65 patients underwent conventional radical resection (RR) (45 low anterior resections and 20 abdominoperineal resections). RESULTS: For all 96 study subjects, median follow up was 58.0 months. Patients in the TAE group had smaller tumors and less advanced preoperative stages than patients in the RR group. By multivariate analysis in all study subjects, the presence of lymphovascular invasion (P = 0.014) and a positive resection margin (P = 0.028) were significantly associated with local recurrence free survival, and lymphovascular invasion (P = 0.039) and a positive resection margin (P < 0.001) were significantly associated with disease free survival. CONCLUSION: In patients with pathologic stage I rectal cancer, lymphovascular invasion and a positive resection margin were found to be independent risk factors of recurrence. Furthermore, local excision was found to have an adverse effect on disease free survival rate as compared with radical surgery.

A polymorphism (G894T) in eNOS increases the risk of coronary atherosclerosis rather than intracranial atherosclerosis in Koreans.

OBJECTIVES: The aim of this study was to investigate whether genetic variations in the eNOS gene were associated with intracranial and extracranial atherosclerosis in Koreans. MATERIALS AND METHODS: We analyzed data on 282 consecutive Korean patients with atherosclerosis in intracranial (ICAS) or extracranial vessels, and compared with 300 healthy individuals. The eNOS gene polymorphism was analyzed by PCR and direct sequencing. RESULTS: All genetic variants were single nucleotide polymorphism, two in the coding sequence (C774T and G894T) and one in intron 6. The frequency of the G894T polymorphism was significantly higher in the coronary atherosclerosis group than in the control group, but its presence did not correlate with other clinical risk factors. There was no significant difference in genotype and allele frequencies between coronary atherosclerosis and ICAS. CONCLUSION: The G894T polymorphism in the eNOS gene might influence coronary atherosclerosis rather than ICAS in Koreans.