Background: Spine-hip discordance (SHD) increases fracture risk. However, its prevalence and clinical implications have not been investigated in patients with hip fractures. This study determined the prevalence and association of SHD with mortality and investigated the cause of SHD in patients with hip fractures. Methods: This study included patients admitted for fragility hip fractures between 2011 and 2020. All patients underwent dual energy X-ray absorptiometry and anteroposterior and lateral views of the lumbosacral spine during admission. Data on demographics, diagnosis, American Society of Anesthesiologists score, and mortality were collected. A T-score difference of more than 1.5 between L1-4 and the femur neck was considered discordant, and 3 groups (lumbar low [LL] discordance, no discordance [ND], and femur neck low [FL] discordance) were compared. In the discordance group, lumbar radiographs were reviewed to determine the cause of discordance. Results: Among 1,220 eligible patients, 130 were excluded due to patient refusal or bilateral hip implantation; therefore, this study included 1,090 patients (271 male and 819 female). The prevalence of LL, ND, and FL was 4.4%, 66.4% and 29.2% in men and 3.9%, 76.1%, and 20.0% women. Mortality was not associated with discordance. The most common causes of discordance were physiological in the LL group and pathological in the FL group for both sexes. Conclusions Patients with hip fractures showed lower rates of ND and higher rates of FL compared to the general population. True discordance should be carefully judged for pathological and artifact reasons. The clinical implications of SHD require further investigation.

Background: Dual energy X-ray absorptiometry (DXA) has evolved from pencil-beam (PB) to narrow fan-beam (FB) densitometers. We performed a meta-analysis of the available observational studies to determine how different modes of DXA affect bone mineral density (BMD) measurements. Methods: A total of 1,233 patients (808 women) from 14 cohort studies were included. We evaluated the differences in BMD according to the DXA mode: PB and FB. Additionally, we evaluated the differences in BMD between the 2 types of FB mode: FB (Prodigy) and the most recent FB (iDXA). Pairwise meta-analysis was performed, and weighted mean differences (WMD) were calculated for (total lumbar, total hip, and total body). Results: No significant difference was observed in total lumbar (pooled WMD, -0.013; P=0.152) and total hip BMD (pooled WMD, -0.01; P=0.889), between PB and FB. However, total body BMD was significantly lower in the PB compared to the FB group (pooled WMD, -0.014; P=0.024). No significant difference was observed in lumbar BMD (pooled WMD, -0.006; P=0.567), total hip (pooled WMD, -0.002; P=0.821), and total body (pooled WMD, 0.015; P=0.109), between Prodigy and iDXA. Conclusions The results of this study warrant the recommendation that correction equations should not be used when comparing BMD from different modes. Further research is still needed to highlight the ways in which differences between DXA systems can be minimized.

Primary central nervous system lymphoma is a rare form of extranodal non-Hodgkin lymphoma, and primary T-cell lymphoma of the cauda equina is extremely rare. We describe a case involving a 56-year-old female who presented with low back pain and radiating leg pain for 4 months. MRI of the lumbar spine revealed an elongated, multinodular intradural lesion of approximately 10 cm from the L4 body to the S2 body level with iso-signal intensity on T1-weighted imaging, heterogeneous iso- and high-signal intensity on T2-weighted imaging, and a heterogeneous intense enhancement on gadolinium contrast-enhanced T1-weighted imaging. A peripheral T-cell lymphoma of the cauda equina was diagnosed on the basis of immunohistochemical and T-cell receptor gamma gene rearrangement analysis after intradural biopsy of the mass.

PURPOSE: To identify the differential MRI findings between myxoid tumors and benign peripheral nerve sheath tumors (BPNSTs) in the musculoskeletal system. MATERIALS AND METHODS: The study participants included a total of 35 consecutive patients who underwent MRI between September 2011 and December 2013. The patients were pathologically diagnosed with myxoid tumors (22 patients) or BPNSTs (13 patients). Evaluation was done by two radiologists, based on the following characteristics: size, margin, degree of signal intensity (SI) on T2-weighted images (T2WI), homogeneity of SI on T2WI, enhancement pattern, enhancement homogeneity, presence of cystic portion, internal fat component, presence of fat split sign, presence of target sign, presence of continuation with adjacent neurovascular bundle, and presence of surrounding halo. RESULTS: Large size, high SI on T2WI, heterogeneous enhancement, and internal fat component were commonly observed in myxoid tumors, while homogenous enhancement, fat split sign, target sign were common in BPNSTs. The differences were statistically significant (P < 0.05). Other findings, such as margin, homogeneity of SI on T2WI, enhancement pattern (peripheral or solid), internal cystic portion, continuation with neurovascular bundle, and surrounding halo, did not show significant difference between myxoid tumors and BPNSTs (P > 0.05). CONCLUSION: In the differential diagnosis of myxoid tumors and BPNSTs involving the musculoskeletal system, several MRI findings such as degree of SI on T2WI, enhancement homogeneity, internal fat component, fat split sign, and target sign, may be helpful in establishing the diagnosis.
Diagnosis ; Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging* ; Musculoskeletal System* ; Nerve Sheath Neoplasms* ; Peripheral Nerves*

No abstract available.
Intestinal Volvulus* ; Pregnancy*

BACKGROUND: Korean regression models for spirometric reference values are different from those of Americans. Using spirometry results of Korean adults, goodness-of-fits of the Korean and the USA Caucasian regression models for forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were compared. METHODS: The number of study participants was 2,360 (1,124 males and 1,236 females). Spirometry was performed under the guidelines of the American Thoracic Society and the European Respiratory Society. After excluding unsuitable participants, spirometric data for 729 individuals (105 males and 624 females) was included in the statistical analysis. The estimated FVC and FEV1 values were compared with those measured. Goodness-of-fits for Korean and USA Caucasian models were compared using an F-test. RESULTS: In males, the expected values of FVC and FEV1 using the Korean model were 12.5% and 5.7% greater than those measured, respectively. The corresponding values for the USA Caucasian model were 3.5% and 0.6%. In females, the difference in FVC and FEV1 were 13.5% and 7.7% for the Korean model, and 6.3% and 0.4% for the USA model, respectively. Goodness-of-fit for the Korean model regarding FVC was not good to the study population, but the Korean regression model for FEV1, and the USA Caucasian models for FVC and FEV1 showed good fits to the measured data. CONCLUSION: These results suggest that the USA Caucasian model correlates better to the measured data than the Korean model. Using reference values derived from the Korean model can lead to an overestimation regarding the prevalence of abnormal lung function.
Adult ; Female ; Forced Expiratory Volume ; Humans ; Lung ; Male ; Prevalence ; Reference Values ; Spirometry ; Vital Capacity

For implant treatment there must be sufficient bone to house the implant body. At least 5mm wide residual bone is needed and usually a 6mm width is preferred by clinicians. However, surgeons sometimes find patients with a narrow ridge, which makes it difficult to place an implant. Therefore, many clinicians perform bone graft or a ridge splitting technique to overcome these poor conditions. The time and cost can be reduced using the ridge splitting technique with immediate implant placement. Recently, many studies reported reliable consequences of ridge splitting technique. This paper reports a successful of implant placement with a ridge splitting technique in a very thin alveolar ridge.
Alveolar Process ; Humans ; Hypogonadism ; Mitochondrial Diseases ; Ophthalmoplegia ; Transplants

PURPOSE: Missing cervical pathology after injury may lead to disability and influence long-term survival. Controversies continue to evolve concerning the initial screening methods used to predict cervical spine injury. Through a retrospective chart review, we attempted to analyze and propose factors predictive of cervical trauma. METHODS: Of all the patients who had visited the Emergency Department of Korea University, from January 2009 to December 2009, a retrospective review of the clinical records of the 217 patients who had undergone cervical spine computed tomography was done. We investigated whether we could predict the need for cervical spine computed tomography shortly after presentation in trauma patients by comparing the group with fractures and group without fractures and by finding risk factors showing significant differences between the two groups that might be used as guides in decision making. RESULTS: Of the 217 subjects who underwent cervical spine computed tomography scans, 33 were identified with fractures of the cervical spine while 184 were not. The most common mechanisms of trauma, in order, for those with fractures were falls, followed by traffic accidents. We found that the injury severity score, multiple injuries, a high-energy injury mechanism, neurologic deficit, and pain and tenderness of the cervical spine showed statistically significant differences between the two groups. CONCLUSION: Fractures of the cervical spine that are not observed with simple radiography occur with a relatively high frequency in trauma patients. Consideration should be given to the risk factors for cervical spine fracture, and if pertinent, cervical spine computed tomography should be performed with speed for early diagnosis of cervical spine fractures.
Accidents, Traffic ; Early Diagnosis ; Emergencies ; Humans ; Injury Severity Score ; Korea ; Mass Screening ; Multiple Trauma ; Neurologic Manifestations ; Retrospective Studies ; Risk Factors ; Spine

Humans ; Jaw ; Mandible ; Periodontal Ligament ; Transplants

PURPOSE: To evaluate the reliability of Singh index (SI) values, determined on image software processed digital radiographs in elderly patients with proximal femoral fractures, with respect to its value as a simple and inexpensive method to evaluate osteoporosis in acute trauma situations. MATERIALS AND METHODS: The authors retrospectively reviewed 210 patients (98 femur neck fractures, 112 intertrochanter fractures) treated between March 2005 and March 2009. Preoperative digital radiographs of each patient were assessed by four observers to determine SI values. The reliability of SI was expressed in terms of intraobserver and interobserver agreements in pairs using Fleiss's overall Kappa, Stuart's tau-c index, and Kendall's coefficiency of concordance. RESULTS: Fleiss's overall kappa values for intraobserver agreement ranged from 0.278 to 0.586 (mean, 0.452) and did not reach good reliability overall. Fleiss's overall kappa values for interobserver agreement ranged from 0.120 to 0.241 (mean, 0.180), and thus, did not reach acceptable reliability. CONCLUSION: The result suggest that the image adjustment tools provided by digital radiography cannot improve the usefulness of SI as a simple and inexpensive method of assessing the osteoporosis. Therefore, the reliability of SI good enough to be used for clinical and research work is questionable.
Aged ; Femoral Fractures ; Femoral Neck Fractures ; Hip ; Humans ; Osteoporosis ; Radiographic Image Enhancement ; Retrospective Studies