Endcap placement after intramedullary nailing can be cumbersome. Misplacement of the endcap which may be difficult to extract may occur. In this report, a simple Kirschner wire device with 'fish-hook' technique may ease the procedure without further violating bony or soft tissues.
Fracture Fixation, Intramedullary* ; Tibia*

PURPOSE: The purpose of this study was to evaluate the usefulness of our method, which estimated femoral stem alignment using a c-arm when the broach was inserted, for prevention of femoral stem malalignment. MATERIALS AND METHODS: A total of 103 hips were enrolled in this study. All patients underwentprimary hip arthroplasty from October 2011 to February 2013. The study was conductedretrospectively. Intraoperative estimated femoral stem alignments and final femoral stem alignments were classified into three groups. Multinomial logistic regression analysis was performed for analysis of factors (age, sex, diagnosis, body mass index, femoral stem size, osteoporosis, and proximal demur geometry) thatmight affect intraoperatively estimated femoral stem alignment. RESULTS: The distribution of intraoperative estimated femoral stem alignment was 80(78%) in the neutral group, 18(17%) in the varus group, and 5(5%) in the valgus group. The distribution of final femoral stem alignment was 100(97%) in the neutral group, 2(2%) in the varus group, and 1(1%) in the valgus group. There was no statistically significant factor affecting the intraoperatively estimated femoral stem alignment. CONCLUSION: Intraoperative estimated femoral stem alignment using a c-arm is an effective method for prevention of femoral stem malalignment.
Arthroplasty ; Body Mass Index ; Hip ; Humans ; Logistic Models ; Osteoporosis

PURPOSE: The authors evaluated the usefulness of the biochemical markers in the elderly hip fracture patients. MATERIALS AND METHODS: Eighty-two hip fractures above 65 years old were enrolled in this study. Serum level of C-telopeptide, osteocalcin, parathyroid hormone, 25-hydroxyvitamin D, calcium were checked and bone mineral density was assessed by DXA. RESULTS: 83% vitamin D deficiency and 43% calcium insufficiency were observed. There were statistically significance between C-telopeptide and osteocalcin, calcium and 25-hydroxyvitamin D, and calcium and DXA results in the Chi-Square test. Spearmann correlation coefficient results showed that there were statically significant correlations between C-telopeptide and osteocalcin, calcium and DXA results. In the multiple logistic regression analysis results, calcium had the statically significant correlations with DXA results. CONCLUSION: There was correlation between bone turnover markers and vitamin D deficiency, and calcium insufficiency was observed in the elderly hip fracture patients.
Aged* ; Biomarkers* ; Bone Density ; Calcium ; Hip Fractures ; Hip* ; Humans ; Logistic Models ; Osteocalcin ; Osteoporosis ; Parathyroid Hormone ; Vitamin D Deficiency

PURPOSE: The authors evaluated the usefulness of the biochemical markers in the elderly hip fracture patients. MATERIALS AND METHODS: Eighty-two hip fractures above 65 years old were enrolled in this study. Serum level of C-telopeptide, osteocalcin, parathyroid hormone, 25-hydroxyvitamin D, calcium were checked and bone mineral density was assessed by DXA. RESULTS: 83% vitamin D deficiency and 43% calcium insufficiency were observed. There were statistically significance between C-telopeptide and osteocalcin, calcium and 25-hydroxyvitamin D, and calcium and DXA results in the Chi-Square test. Spearmann correlation coefficient results showed that there were statically significant correlations between C-telopeptide and osteocalcin, calcium and DXA results. In the multiple logistic regression analysis results, calcium had the statically significant correlations with DXA results. CONCLUSION: There was correlation between bone turnover markers and vitamin D deficiency, and calcium insufficiency was observed in the elderly hip fracture patients.
Aged* ; Biomarkers* ; Bone Density ; Calcium ; Hip Fractures ; Hip* ; Humans ; Logistic Models ; Osteocalcin ; Osteoporosis ; Parathyroid Hormone ; Vitamin D Deficiency

Papillary thyroid carcinoma is the most prevalent type of thyroid cancer. Metastasis of this carcinoma commonly occurs in the lung and has been reported to present 5 to 30 years after the initial diagnosis of thyroid cancer. Pleural effusion can mask this metastatic spread. In patients with pleural effusion, laboratory measurement of the adenosine deaminase (ADA) level in the pleural fluid can be effective in identifying and ranking pulmonary metastasis in the differential diagnosis. A 70-year-old female patient visited our hospital with dyspnea. She presented with a considerable amount of pleural effusion. A pleural biopsy was performed and the Ziehl-Neelsen stains revealed a few acid-fast bacilli, but the ADA level in the pleural fluid was 2.4 IU/L. After drainage of the pleural effusions, we discovered pulmonary nodules by computed tomography (CT), which were later diagnosed through histologic examination as pulmonary metastasis from papillary thyroid carcinoma. We report this case.
Adenosine Deaminase ; Aged ; Biopsy ; Carcinoma ; Carcinoma, Papillary ; Coloring Agents ; Drainage ; Dyspnea ; Female ; Humans ; Lung ; Masks ; Neoplasm Metastasis ; Pleural Effusion ; Pleurisy ; Thyroid Gland ; Thyroid Neoplasms ; Tuberculosis, Pleural

OBJECTIVE: The importance of central blood pressure evaluation for cardiovascular risk stratification has been emphasized. The aim of this study is to evaluate whether brachial blood pressure obtained by the oscillometric method accurately reflects central blood pressure. METHODS: The subjects consisted of 84 consecutive patients with suspected coronary artery disease who underwent cardiac catheterization. Central blood pressure was invasively measured in the origin of the left subclavian artery by using the fluid-filled system, and at the same time, brachial blood pressure in the left upper arm was measured by the oscillometric method. RESULTS: No significant difference was found between central systolic pressure and brachial systolic pressure (144.49+/-18.84 mmHg vs. 142.44+/-14.96 mmHg, P=0.063). Bland-Altman analysis accounted for only a small bias of +2.25 mmHg, and the limits of agreement were 24.15 mmHg and -19.65 mmHg. Central diastolic pressure was significantly lower than brachial diastolic pressure (75.80+/-8.74 mmHg vs. 86.70+/-10.48 mmHg, P<0.001). Bland-Altman analysis showed a significant bias of -5.45 mmHg, and the limits of agreement were 2.83 mmHg and -13.73 mmHg. CONCLUSION: These results indicate that central systolic pressure can be directly estimated from brachial systolic pressure using the noninvasive oscillometric method and observed biases seem to remain within the practical range. However, use of the brachial diastolic pressure and pulse pressure measured by the noninvasive oscillometric method is doubtful in clinical practice because of their large biases.
Arm ; Bias (Epidemiology) ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Coronary Artery Disease ; Humans ; Oscillometry ; Subclavian Artery

Background: A fourth dose of vaccination is known to help reduce the severity and mortality rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The South Korean vaccination guidelines for the fourth dose do not include healthcare workers (HCWs) as priority candidates. We investigated the necessity of the fourth dose in South Korean HCWs based on an 8-month follow-up period after the third vaccination. Methods: Changes in the surrogate virus neutralization test (sVNT) inhibition (%) score were measured at one month, four months and eight months after the third vaccination. The sVNT values were analyzed between infected and uninfected groups, and their trajectories were compared. Results: A total of 43 HCWs were enrolled in this study. In total, 28 cases (65.1%) were confirmed to be infected with SARS-CoV-2 (presumed omicron variant), and all had mild symptoms. Meanwhile, 22 cases (78.6%) were infected within four months of the third dose (median, 97.5 days). Eight months after the third dose, the SARS-CoV-2 (presumed omicron variant)-infected group showed significantly higher sVNT inhibition than that in the uninfected group (91.3% vs. 30.7%; P < 0.001). The antibody response due to hybrid immunity, provided by a combination of infection and vaccination, was maintained at sufficient levels for more than four months. Conclusion For HCWs who had coronavirus disease 2019 infection after completing a third vaccination, a sufficient antibody response was maintained until eight months after the third dose. The recommendation of the fourth dose may not be prioritized in subjects with hybrid immunity.

Background: Allogeneic hematopoietic stem cell transplantation (HSCT) was not actively performed in elderly acute myeloid leukemia (AML) or myelodysplastic syndrome patients who are at a high-risk based on hematopoietic cell transplantation-specific comorbidity index (HCT-CI). The advent of reduced-intensity conditioning (RIC) regimens has made HSCT applicable in this population. However, the selection of appropriate conditioning is a major concern for the attending physician. The benefits of combination of treosulfan and fludarabine (Treo/Flu) have been confirmed through many clinical studies. Korean data on treosulfan-based conditioning regimen are scarce. Methods: A retrospective study was conducted to compare the clinical outcomes of allogeneic HSCT using RIC between 13 patients receiving Treo/Flu and 39 receiving busulfan/ fludarabine (Bu/Flu). Results: In terms of conditioning-related complications, the frequency of ≥ grade 2 nausea or vomiting was significantly lower and the duration of symptoms was shorter in the Treo/ Flu group than in the Bu/Flu group. The incidence of ≥ grade 2 mucositis tended to be lower in the Treo/Flu group. In the analysis of transplant outcomes, all events of acute graft versus host disease (GVHD) and ≥ grade 2 acute GVHD occurred more frequently in the Treo/ Flu group. The frequency of Epstein-Barr virus reactivation was significantly higher in the Treo/Flu group (53.8% vs. 23.1%, P = 0.037). Non-relapse mortality (NRM) at 12 months was higher in the Treo/Flu group (30.8% vs. 7.7%, P = 0.035). Significant prognostic factors included disease type, especially secondary AML, disease status and high-risk based on HCT-CI, ≥ grade 2 acute GVHD, and cases requiring ≥ 2 immunosuppressive drugs for treating acute GVHD. In the comparison of survival outcomes according to conditioning regimen, the Bu/Flu group seemed to show better results than the Treo/Flu group (60% vs.46.2%, P = 0.092 for overall survival; 56.4% vs. 38.5%, P = 0.193 for relapse-free survival). In additional analysis for only HCT-CI high-risk groups, there was no difference in transplant outcomes except that the Treo/Flu group tended to have a higher NRM within one year after transplantation. Survival outcomes of both groups were similar. Conclusion This study suggests that Treo/Flu conditioning may be an alternative to Bu/Flu regimen in elderly patients with high-risk who are not suitable for standard conditioning.

PURPOSE: Data on the efficacy of olanzapine in patients receiving moderately emetogenic chemotherapy (MEC) are limited. This study aimed to evaluate and compare the efficacy of olanzapine versus placebo in controlling nausea and vomiting in patients receiving MEC. MATERIALS AND METHODS: We conducted a randomized, double-blind, placebo-controlled study to determine whether olanzapine can reduce the frequency of chemotherapy-induced nausea and vomiting (CINV) and improve the quality of life (QOL) in patients receiving palonosetron and dexamethasone as prophylaxis for MEC-induced nausea and vomiting. The primary end point was complete response for the acute phase (0-24 hours after chemotherapy). The secondary end points were complete response for the delayed (24-120 hours) and overall phase (0-120 hours), proportion of significant nausea (visual analogue scale ≥ 25 mm), use ofrescue medications, and effect on QOL. RESULTS: Fifty-six patients were randomized to the olanzapine (n=29) and placebo (n=27) groups. Complete response rates were not significantly different between the olanzapine and placebo groups in the acute (96.5% vs. 88.0%, p=0.326), delayed (69.0% vs. 48.0%, p=0.118), and overall phases (69.0% vs. 48.0%, p=0.118). However, the percentage of patients with significant nausea (17.2% vs. 44.0%, p=0.032) and the use of rescue medications (0.03±0.19 vs. 1.88±2.88, p=0.002) were lower in the olanzapine group than in the placebo. Furthermore, the olanzapine group demonstrated better QOL (p=0.015). CONCLUSION: Olanzapine combined with palonosetron and dexamethasone significantly improved QOL and vomiting control among previously untreated patients receiving MEC, although the efficacy was limited to the reduction of the frequency of CINV.
Antiemetics ; Dexamethasone ; Drug Therapy* ; Humans ; Nausea* ; Quality of Life ; Vomiting*

Background: Although the primary vaccine coverage rate for coronavirus disease 2019 (COVID-19) in South Korea has exceeded 80%, the coronavirus continues to spread, with reports of a rapid decline in vaccine effectiveness. South Korea is administering booster shots despite concerns about the effectiveness of the existing vaccine. Methods: Neutralizing antibody inhibition scores were evaluated in two cohorts after the booster dose. For the first cohort, neutralizing activity against the wild-type, delta, and omicron variants after the booster dose was evaluated. For the second cohort, we assessed the difference in neutralizing activity between the omicron infected and uninfected groups after booster vaccination. We also compared the effectiveness and adverse events (AEs) between homologous and heterologous booster doses for BNT162b2 or ChAdOx1 vaccines. Results: A total of 105 healthcare workers (HCWs) that were additionally vaccinated with BNT162b2 at Soonchunhyang University Bucheon Hospital were enrolled in this study.Significantly higher surrogate virus neutralization test (sVNT) inhibition (%) was observed for the wild-type and delta variants compared to sVNT (%) for the omicron after the booster dose (97%, 98% vs. 75%; P < 0.001). No significant difference in the neutralizing antibody inhibition score was found between variants in the BNT/BNT/BNT group (n = 48) and the ChA/ChA/BNT group (n = 57). Total AEs were not significantly different between the ChA/ ChA/BNT group (85.96%) and the BNT/BNT group (95.83%; P = 0.11). In the second cohort with 58 HCWs, markedly higher sVNT inhibition to omicron was observed in the omicroninfected group (95.13%) compared to the uninfected group (mean of 48.44%; P < 0.001) after four months of the booster dose. In 41 HCWs (39.0%) infected with the omicron variant, no difference in immunogenicity, AEs, or effectiveness between homogeneous and heterogeneous boosters was observed. Conclusion Booster vaccination with BNT162b2 was significantly less effective for the neutralizing antibody responses to omicron variant compared to the wild-type or delta variant in healthy population. Humoral immunogenicity was sustained significantly high after 4 months of booster vaccine in the infected population after booster vaccination.Further studies are needed to understand the characteristics of immunogenicity in these populations.