BACKGROUND: The purpose of this study was to ascertain the prevalence of vitamin D deficiency and risk factors associated with mortality in patients > or =50-year-of-age with hip fractures. METHODS: A total of 489 patients > or =50-year-of-age who sustained a hip fracture from January 2010 to October 2014 were followed-up for a minimum of 1 year. Clinical and radiological outcomes were evaluated including prevalence of vitamin D deficiency. Crude mortality rates were calculated, and the effects of different risk factors on mortality were assessed. RESULTS: Vitamin D deficiency was present in 76.5% of cases (n=237). The prevalence of vitamin D insufficiency was 12.3%, and only 11.2% of patients had normal vitamin D levels. Accumulated mortality was 11% (54 patients) at 1 year. A univariate analysis showed that vitamin D deficiency (P=0.012), age (P<0.001), BMI (P<0.001), type of management (P<0.001), American Society of Anesthesiologists (ASA) score (P=0.009), pre-fracture ambulatory status (P<0.001), and osteoporosis (P<0.001) were associated with mortality. A multivariate analysis performed using a Cox proportional hazards model demonstrated that ASA score (P=0.001) and pre-fracture ambulatory status (P=0.011) were independently associated with mortality after hip fracture. CONCLUSIONS: We did not find a relationship between serum 25-hydroxy-vitamin D levels and mortality after hip fracture, although we observed a high prevalence of vitamin D deficiency and a significant association with mortality in the univariate analysis.
Hip Fractures ; Hip* ; Humans ; Mortality* ; Multivariate Analysis ; Osteoporosis ; Prevalence ; Proportional Hazards Models ; Risk Factors* ; Vitamin D Deficiency* ; Vitamin D* ; Vitamins*

In this article, The author's name and Table 1 should be corrected.

BACKGROUND: Extramammary Paget's disease (EMPD) is an uncommon but distinctive tumor. Definitive diagnosis requires biopsy of the lesion and immunohistochemical staining. Immunohistochemical study using anti-cytokeratin monoclonal antibodies may be helpful for differentiating EMPD from other similar skin lesions and primary EMPD from pagetoid spread of underlying regional internal malignancy (secondary EMPD). OBJECTIVE: The purpose of this study was to identify clinical findings, histopathologic features and immunohistochemical characteristics of EMPD. METHODS: The twelve cases diagnosed as EMPD at our institution over ten years were included. Clinical records and pathology slides of the patients were reviewed retrospectively. Immunohistochemical stains for CK7, CK20, CEA, EMA, PSA, GCDFP15 and mucin stains such as PAS, d-PAS, alcian blue (pH 2.5) were done using paraffin blocks. RESULTS: 1. In most cases, EMPD developed on the scrotum of senile male patients. 2. In the pathologic findings, Paget cells were observed from the epidermis only in 2 cases, from the epidermis and intradermal skin appendages in 7 cases and from the dermis in 3 cases. 3. In all cases except for the single case associated with a transitional cell carcinoma of the urinary bladder, there were histochemical findings of alcian blue-, PAS- and immunohistochemical findings of CK7+, CK20-, CEA+, EMA+. 4. In the single case associated with transitional cell carcinoma of the urinary bladder, there were histochemical findings of alcian blue-, PAS- and immunohistochemical findings of CK7+, CK20+, CEA-, EMA-. CONCLUSION: The combination of CK7 and CK20 demonstrates these to be useful markers in distinguising primary EMPD from a pagetoid spread of extracutaneous malignancies. Namely, immunophenotypes other than CK7+/CK20- in Paget cells suggest underlying regional internal malignancy.
Male ; Humans ; Biopsy

BACKGROUND: Osteoporosis treatment following hip fracture is well known to not enough. We previously performed intervention study for orthopaedic surgeon's education and reported twofold increase in osteoporosis detection and treatment rate observed between 2005 and 2007. This follow-up observational study was conducted to find out the rate in which a diagnostic workup and treatment for osteoporosis were done in patients with hip fracture. METHODS: Medical records and radiographs in patients who were older than 50 years and diagnosed as having femoral neck or intertrochanteric fractures at 8 hospitals in Jeju island, South Korea from 2008 to 2011 were reviewed. The numbers of patients who were studied with bone densitometry and who were treated for osteoporosis after the diagnosis of hip fracture were analyzed. RESULTS: Nine hundred forty five hip fractures (201 in 2008, 257 in 2009, 265 in 2010, and 304 in 2011) occurred in 191 men and 754 women during the study periods. The mean age of the patients was 79.7 years. The mean rate of osteoporosis detection using dual energy X-ray absorptiometry was 36.4% (344/945 hips) (ranged from 24.2% in 2009 to 40.5% in 2011). The mean initiation rate of osteoporosis treatment was 23.1% (218/945 hips) (ranged from 20% in 2009 to 29% in 2008). CONCLUSIONS: Detection and treatment rate of osteoporosis following hip fracture during follow-up periods was still not enough. Additional intervention studies are required to further improvement of osteoporosis treatment rates after hip fracture.
Absorptiometry, Photon ; Bone Density Conservation Agents ; Cohort Studies* ; Clinical Trial ; Densitometry ; Diagnosis ; Education ; Female ; Femur Neck ; Follow-Up Studies ; Hip ; Hip Fractures* ; Humans ; Korea ; Male ; Medical Records ; Observational Study ; Osteoporosis*

Primary adrenal lymphoma is extremely rare. We describe a case of non-Hodgkin's lymphoma of diffuse large B-cell type with right adrenal involvement. The patient received chemotherapy and external irradiation and achieved complete remission of the disease. We describe the case of primary adrenal lymphoma with a review of the literature on this unusual neoplasm. Primary adrenal lymphoma should be included in the differential diagnosis of adrenal mass.
Adrenal Gland Neoplasms/*diagnosis/therapy ; Human ; Lymphoma, Large-Cell/*diagnosis/therapy ; Male ; Middle Aged ; Treatment Outcome

Background: This prospective randomized controlled study aimed to determine the effects of abdominal massage on constipation management in elderly patients with hip fractures. Methods: From August 2017 to December 2018, patients aged above 65 years with hip fractures (n = 88) were randomly assigned to a massage group that received a bowel massage (n = 48) or a control group that did not receive a bowel massage (n = 40). Patients in the bowel massage group received a bowel massage from a trained caregiver after breakfast at approximately 9:00 AM for an hour. On admission, 5 days after surgery, and on the day of discharge, the patient’s normal and actual defecation pattern, stool consistency, and any problems with defecation were assessed through a structured interview. The questionnaire comprising the Bristol Stool Scale, patient assessment of constipation, time to defecation, medication for defecations, failure to defecate, cause of admission, admission period, and date of surgery were recorded. Statistical analyses were performed 5 days after surgery and on the day of discharge. Results: The mean age of the study cohort was 81.4 years (range, 65–99 years). The number of constipation remedies was significantly lower in the massage group than in the control group on postoperative day (POD) 5 and at discharge (9 vs. 15, p = 0.049 and 6 vs. 11, p = 0.039, respectively). The number of defecation failures was significantly lower in the massage group than in the control group (10 vs. 17, p = 0.028) on POD 5. However, the number of defecation failures at discharge was not significantly different between the two groups ( p = 0.131). The development of postoperative ileus ( p = 0.271) and length of hospital stay ( p = 0.576) were not different between the groups. Conclusions The number of constipation remedies was significantly lower in the massage group than in the control group on POD 5 and discharge, and the number of defecation failures was significantly lower in the massage group than in the control group on POD 5. Therefore, abdominal massage may be considered as an independent nursing initiative for constipation management.

Acquired hypophosphatemic rickets, or osteomalacia, requires the recognition of the typical clinical and radiological features of osteomalacia in association with hypophosphatemia, which is caused by the decrease in intestinal absorption or impaired renal tubular phosphate reabsorption. The latter form may either be hereditary or acquired. Acquired hypophosphatemic osteomalacia includes oncogenic osteomalacia, neurofibromatosis, fibrous dysplasia, renal tubular acidosis and sporadic nonfamilial hypophosphatemic osteomalacia. A 33-year-old man presented with bone pain, progressive severe muscle weakness and a height loss of more than 10 cm over a 5 year period. The familiy history was negative for bone disease or other renal tubular defects. He was found to have hypophosphatemia, impaired phosphate reabsorption, normocalcemia, normal vitamin D metabolite levels, normal PTH and elevated alkaline phophatase. A bone biopsy showed thickened unmineralized osteoid compared to pelvic bone in control cases. Clinical symptoms, such as bone pain and muscle weakness, were improved after supplementation of oral phosphorus and calcitriol, although the serum phosphorus level did not normalize.
Acidosis, Renal Tubular ; Adult ; Biopsy ; Bone Diseases ; Calcitriol ; Humans ; Hypophosphatemia ; Intestinal Absorption ; Muscle Weakness ; Neurofibromatoses ; Osteomalacia* ; Pelvic Bones ; Phosphorus ; Rickets, Hypophosphatemic ; Vitamin D