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*

Duodenal intramural hematoma is mostly caused by blunt abdominal trauma. It is also less commonly reported as a complication of anticoagulation therapy or as a blood dyscrasia, and as a complication of diagnostic/ therapeutic endoscopy. The presentation of these patients is abdominal pain, vomiting, fever and hematochezia, and this is rarely accompanied with intestinal obstruction, severe pancreatitis and acute peritonitis as its complications. The diagnosis is made clear by performing abdominal ultrasonography and abdominal computed tomography. We reported here on one case of intramural duodenal hematoma and hemoperitoneum after performing endoscopic hemostasis in a chronic renal failure patient who was on maintenance hemodialysis.
Abdominal Pain ; Diagnosis ; Duodenum ; Endoscopy* ; Fever ; Gastrointestinal Hemorrhage ; Hematoma* ; Hemoperitoneum* ; Hemostasis, Endoscopic ; Humans ; Intestinal Obstruction ; Kidney Failure, Chronic* ; Pancreatitis ; Peritonitis ; Renal Dialysis ; Ultrasonography ; Vomiting

Endoscopic Variceal Ligation(EVL) was developed as an alternative to endoscopic injection sclerotherapy(EIS) for decreasing of complication rate. This new technique involves placement of small elastic O-rings around the variceal channels in the distal esophagus. To evaluate the efficacy of EVL for treatment of the acute bleeding esophagea1 varices and the efficacy of prophylactic EVL, we compared EVL in 88 patients who had recently bled from esophageal varices(Group 1) and prophylactic EVL in 45 patients with large size(Grade 2 or 3 or 4) and red color sign on endoscopic finding who had not previously had upper gastrointestinal bleeding(Group 2). Also, we compared prophylactic EVL group(Group 2) and control group(Group 3) who did not performed EVL. At the time of treatment 28.4%(25/88) of patients had active bleeding. They were all treated acutely with EVL and repeated treatment for the long-term goal of variceal eradication. Initial hemostatic efficacy of EVL for acute bleeding varices was 92%(23/25). Varices were eradicated or reduced to Grade 1 in 68%(17/2S). Early mortality rate within 2 weeks was 8%(2/25). Among patients who had eradicated or reduced to Grade 1 varices by repeated EVL sessions, over a mean follow-up of 11 months there was no difference between Group 1 and Group 2 in recurrent rate(49.1%(27/63) vs. 46.8% (15/32)), rebleeding rate(10.9'Yo (6/55) vs. 9.3% (3/32)), rebleeding interval(average 75 days vs, 83.6 days). There was significant difference between prophylactic EVL group and con- trol group in bleeding rate(9.3%(3/~32) vs. 43.7%(14/32))~(p<0.05). Three patients(6.6%) died in prophylactic EVL group, two from ligation site bleeding of esophageal varix, one from hepatic failure. In conclsion, EVL is an effective method for treatment of acute bleeding esophageal varices with repeated sessions. Although prophylactic EVL can be used to prevent bleeding by eradication with lower initial morbidity are necessary because of EVL-related complications.
Esophageal and Gastric Varices* ; Esophagus ; Follow-Up Studies ; Hemorrhage* ; Humans ; Ligation* ; Liver Failure ; Mortality ; Varicose Veins

Endoscopic ultrasonography (EUS)-a combination of endoscopy a.nd ultrasonography was one of the most useful tools for diagnosis of digestive system diseases. This technique was known to be very effective in the assessment of depth of invasion in gastric cancer and in pancreatico-biliary diseases. We performed EUS in 589 patients with upper gastrointestinal and pancreatico-biliary tract lesion prior to surgery for past 22 months and examined the diagnostic accuracy of EUS, respectively. The results were compared to surgical histology in esophagus and stomach cancer,to concordance witb endoscopic retrograde cholangiopancreatography(ERCP) results for pancreaticobiliary diseases. 1) In 589 patients diagnosed with EUS, the mean age of the patients was 55.9 years with a male to female ratio of 1.7: 1. 2) Patients were divided into three groups; post-upper gastrointestinal endoscopy, post ERCP and undiagnosed with other diagnostic tools. 3) Among post-upper gastrointestinal endoscopy, 64 cases were operated due to esophageal and gastric cancer and then compared to surgical histology. After compared, EUS accuracy on depth of invasion was 78.1% and sensitivity and specificity on lymph node metastasis in gastric cancer were 76.9% and 74.3%, respectively. 4) In post-ERCP cases, EUS results were compared to ERCP results and then concordance rate was 95.4%. 5) In undiagnosed cases, EUS was performed and results were reported.
Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis* ; Digestive System Diseases ; Endoscopy ; Endoscopy, Gastrointestinal ; Endosonography ; Esophagus ; Female ; Humans ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Sensitivity and Specificity ; Stomach ; Stomach Neoplasms ; Ultrasonography* ; Upper Gastrointestinal Tract*

There is concerns about the perceived decline in the knowledge of gross anatomy of the medical students and postgraduate trainees. It is partly caused by the introduction of integrated medical curriculum and the shortage of basic medical science program and the extension of clinical clerkship consequently. There is widespread variability in the teaching style and anatomical curricular content at the medical school in Korea. Despite these changes in the anatomical education, there have been few attempts to assess the opinions of senior clinical teachers on the state of anatomical knowledge of students and the place of anatomy teaching within the curriculum. We sought the views of the clinical teachers on the adequacy of the anatomical knowledge of current students and recent graduates of 5 medical schools in Pusan and Gyeongsang-Nam do areas. Most of the clinical teachers were of the opinion that current medical students have an insufficient anatomical knowledge. They indicated the causes of decline were the clinical irrelevant anatomical teaching content and weakness of identity of anatomy by the introduction of the integrated medical education program. There was widespread support for both the concepts of spreading anatomy teaching throughout the medical course, and an optional, clinically related final year student project in the anatomy.
Busan ; Clinical Clerkship ; Curriculum ; Education ; Education, Medical ; Humans ; Korea ; Schools, Medical ; Students, Medical*

Elliptocytosis has been known to be a rare disease, especially in oriental people. Most of them are transmitted as an autosomal dominant trait but we experienced one case of transient elliptocytosis associated with acute lymphoblastic leukemia by morphologic examination of the peripheral blood and bone marrow biopsy. The results of the peripheral blood smears of the patient and his family are as follows : he showed about 50~60% of elliptocytes and anemia without hemolytic event; his family, however, showedno sign of elliptocytosis. The patient was treated for acute lymphoblastic leukemia. On follow-up check after one month, the peripheral blood showed almost normal RBC morphology. Therefore, we diagnosed this case as transient elliptocytosis associated with acute leukemia. So we report a case of transient elliptocytosis associated with acute leukemia with a brief review of the relevant literature.
Anemia ; Biopsy ; Bone Marrow ; Follow-Up Studies ; Humans ; Leukemia ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Rare Diseases

OBJECTIVES: The present study aimed to evaluate the validity of a set of self-reported questionnaires for periodontitis for estimating the prevalence of chronic adult periodontitis in the Korean population. METHODS: The questionnaire is comprised of a total of 14 questions with four summarized concepts including self-diagnosis of oral status, subjective signs related to oral health, smoking and drinking status, and use of auxiliary oral hygiene devices including scaling. The predictiveness of the measures from these self-reported questions was assessed by logistic regression modeling using receiver operating characteristic (ROC) statistics, sensitivity, and specificity. RESULTS: The sensitivity, specificity, and AUC including all questions were 0.571, 0.768, and 0.781, respectively; the sum of sensitivity and specificity was 1.34. To gain robustness, a simplified predictive model was built with six questions. Its results were 0.536, 0.817, and 0.762 for sensitivity, specificity, and AUC, respectively. The sum of sensitivity and specificity was found to be 1.35. CONCLUSIONS: The self-reported questionnaire for periodontitis showed considerable validity, but further study is required to provide optimal validity and predictability.
Area Under Curve ; Chronic Periodontitis ; Drinking ; Logistic Models ; Oral Health ; Oral Hygiene ; Periodontal Diseases ; Periodontitis* ; Prevalence ; Surveys and Questionnaires* ; ROC Curve ; Sensitivity and Specificity ; Smoke ; Smoking

Placental GnRH is one of the potential paracrine regulator of hCG secretion from the trophoblasts during pregnancy. However, this paracrine function is not clearly confirmed. The present study was designed to evaluate the possible correlation between the synthesis and cellular distribution of GnRH and GnRH -receptor in the placental villi. 6 to 40 weeks termed twenty five human placental tissues were used in this study. GnRH and GnRH -receptor mRNAs were localized in the placenta by in situ hybridization using the corresponding cRNA probes. GnRH mRNA was present in all cell types of placenta including cytotrophoblasts, syncytiotrophoblasts and stromal cells. The GnRH -receptor mRNA signals were localized in both cytotrophoblasts and syncytiotrophoblasts. The GnRH -receptor mRNA signals were also localized in some stromal cells at the full term placenta. GnRH mRNA signals were detected abundantly at 6 ~7 weeks and the intensities were remarkably increased with the following gestational ages. GnRH -receptor mRNA signals were detected at 6 ~7 weeks, peaked at 9 ~10 weeks, declined at 23 ~24 weeks and focally expressed at full term placenta. The present study demonstrates that GnRH mRNA is expressed in all cell types of the placenta, however GnRH -receptor mRNA is expressed only in the cytoptrophblasts and syncytiotrophoblasts and exhibits parallel change with the time course of hCG secretion during pregnancy. These data provide a morphological understanding that placental GnRH has a paracrine/autocrine role through its receptor from 6 ~7 weeks gestation to term placenta.
Chorionic Villi ; Gestational Age ; Gonadotropin-Releasing Hormone* ; Humans* ; In Situ Hybridization ; Placenta* ; Pregnancy ; RNA, Complementary ; RNA, Messenger* ; Stromal Cells ; Trophoblasts

A malignant fibrous histiocytoma is a malignant soft tissue neoplasm that occurs frequently in the metaphyseal ends of the long bones of adults. The lung is a common site for metastasis but it is a rare site for a primary malignant fibrous histiocytoma. Here we report a case of a primary malignant fibrous histiocytoma of the lung. The patient was a 53-year-old man who presented with a moderate amount of a left pleural effusion and an ill-defined mass in the left lower lobe on a chest radiograph and a local invasion to the left 10th and 11th rib on chest CT. Under the strong suspicion of lung cancer with a pleural invasion, a serial diagnostic thoracentesis was performed. The cytologic examination of the pleural effusion revealed no malignant cells. Consequently, a thoracoscopic pleural biopsy was performed. The histological examination revealed slender spindle cells and scattered epitheloid cells arranged in a vague storiform or a whirling pattern. Immunohistochemically, the tumor cells tested positive for vimentin and negative for cytokeratin, desmin, CD34 and PAS. These features were consistent with a malignant fibrous histiocytoma. This case is an unusual addition to the small number of published reports on a primary malignant fibrous histiocytoma of the lung.
Adult ; Biopsy ; Desmin ; Histiocytoma, Malignant Fibrous* ; Humans ; Keratins ; Lung ; Lung Neoplasms ; Middle Aged ; Neoplasm Metastasis ; Pleural Effusion ; Radiography, Thoracic ; Ribs ; Sarcoma* ; Soft Tissue Neoplasms ; Tomography, X-Ray Computed ; Vimentin

Hepatic hemangioma is the most common benign tumor of the liver. Most such hemangiomas are small, asymptomatic, and have an excellent prognosis. Giant hepatic hemangioma has been reported in the literature, but the exophytic and pedunculated forms of hepatic hemangioma are rare. A 56-year-old woman was referred to our hospital under the suspicion of having a gastric submucosal tumor. Abdominal computer tomography (CT) scans showed a pedunculated mass from the left lateral segment of the liver into the gastric fundus, exhibiting the atypical CT findings of hepatic hemangioma. We therefore decided to perform laparoscopic resection based on the symptoms, relatively large diameter, inability to exclude malignancy, and risk of rupture of the exophytic lesion. The pathology indicated it to be a cavernous hemangioma of the liver. Herein we report a case of pedunculated hepatic hemangioma mimicking a submucosal tumor of the stomach due to extrinsic compression of the gastric fundus.
Diagnosis, Differential ; Endoscopy, Digestive System ; Female ; Hemangioma/*diagnosis/pathology/surgery ; Humans ; Liver Neoplasms/*diagnosis/pathology/surgery ; Middle Aged ; Stomach Neoplasms/diagnosis ; Tomography, X-Ray Computed