Background and Objectives: Evidence regarding the efficacy and safety of intracardiac echocardiography (ICE) for guidance during transcatheter aortic valve replacement (TAVR) is limited. This study aimed to compare the clinical efficacy and safety of ICE versus transesophageal echocardiography (TEE) for guiding TAVR. Methods: This prospective cohort study included patients who underwent TAVR from August 18, 2015, to June 31, 2021. Eligible patients were stratified by echocardiographic modality (ICE or TEE) and anesthesia mode (monitored anesthesia care [MAC] or general anesthesia [GA]). Primary outcome was the 1-year composite of all-cause mortality, rehospitalization for cardiovascular cause, or stroke, according to the Valve Academic Research Consortium-3 (VARC-3) definition. Propensity score matching was performed, and study outcomes were analyzed for the matched cohorts. Results: Of the 359 eligible patients, 120 patients were matched for the ICE-MAC and TEEGA groups, respectively. The incidence of primary outcome was similar between matched groups (18.3% vs. 20.0%; adjusted hazard ratio, 0.94; 95% confidence interval [CI], 0.53– 1.68; p=0.843). ICE-MAC and TEE-GA also had similar incidences of moderate-to-severe paravalvular regurgitation (PVR) (4.2% vs. 5.0%; adjusted odds ratio, 0.83; 95% CI, 0.23– 2.82; p=0.758), new permanent pacemaker implantation, and VARC-3 types 2–4 bleeding. Conclusions ICE was comparable to TEE for guidance during TAVR for the composite clinical efficacy outcome, with similar incidences of moderate-to-severe PVR, new permanent pacemaker implantation, and major bleeding. These results suggest that ICE could be a safe and effective alternative echocardiographic modality to TEE for guiding TAVR.

PURPOSE: The purpose of this study was to evaluate the feasibility and usefulness of sagittal color Doppler ultrasonography (CDUS) for the diagnosis of fetal cleft lip (CL) and cleft palate (CP). METHODS: We performed targeted ultrasonography on 25 fetuses with CL and CP, taking coronal and axial images of the upper lip and maxillary alveolar arch in each case. The existence of defects in and malalignment of the alveolus on the axial image, hard palate defects on the midsagittal image, and flow-through defects on CDUS taken during fetal breathing or swallowing were assessed. We compared the ultrasonography findings with postnatal findings in all fetuses. RESULTS: Alveolar defects were detected in 16 out of 17 cases with CP and four out of eight cases with CL. Alveolar malalignment and hard palate defects were detected in 11 out of 17 cases and 14 out of 17 cases with CP, respectively, but not detected in any cases with CL. Communicating flow through the palate defect was detected in 11 out of 17 cases of CL with CP. The accuracy of detection in axial scans of an alveolar defect and malalignment was 80% and 76%, respectively. Accuracy of detection of in mid-sagittal images of hard palate defect and flow was 80% and 86%, respectively. The overall diagnostic accuracy of combined axial and sagittal images with sagittal CDUS was 92%. CONCLUSION: Sagittal CDUS of the fetal hard palate is a feasible method to directly reveal hard palate bony defects and flow through defects, which may have additional value in the differential diagnosis of fetal CL and CP.
Cleft Lip* ; Cleft Palate ; Congenital Abnormalities ; Deglutition ; Diagnosis ; Diagnosis, Differential* ; Fetus ; Lip ; Methods ; Palate* ; Palate, Hard ; Respiration ; Ultrasonography ; Ultrasonography, Doppler, Color* ; Ultrasonography, Prenatal

PURPOSE: This retrospective study evaluated the utility of shear wave elastography (SWE), Tozaki's visual pattern classification, and conventional Breast Imaging Reporting and Data System (BI-RADS) classification for differentiating between benign and malignant lesions. METHODS: Between May 2015 and July 2016, 388 patients underwent SWE and B-mode ultrasonography. The BI-RADS system was used to exclude cases with category 1–2 lesions or unbiopsied category 3 lesions. A total of 100 patients with 100 solid breast masses underwent tissue sampling (ultrasonography-guided core biopsy or vacuum-assisted biopsy) or surgical excision. The quantitative elasticity was measured for each lesion, and the imaging and histological findings were compared. RESULTS: The mean age of the patients was 51 years (range, 18–79 years). Histological examination identified 50 malignant lesions and 50 benign lesions. According to the BI-RADS classification, 20 lesions were classified as category 3, 56 as category 4, and 24 as category 5. Based on the Tozaki classification, 39 lesions were classified as pattern 1, seven as pattern 2, 23 as pattern 3, and 31 as pattern 4. If patterns 1 and 2 were assumed to be benign, and patterns 3 and 4 were assumed to be malignant, the combination of BI-RADS and SWE provided a sensitivity of 100% (50/50), a specificity of 92.0% (46/50), a positive predictive value of 92.5% (50/54), and a negative predictive value of 100% (50/50). CONCLUSION: The combination of SWE and BI-RADS was useful for evaluating breast lesions, improved the specificity of ultrasonography and may help facilitate appropriate treatment planning.
Biopsy ; Breast Neoplasms ; Breast* ; Classification ; Elasticity ; Elasticity Imaging Techniques* ; Humans ; Information Systems ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) is common in asthma patients. Proton pump inhibitor (PPI) therapy improves symptoms of asthma in some patients. The objective of this study was to investigate endoscopic findings of GERD in asthma patients and to assess the effect of gastric acid suppression with the PPIs on symptom improvement and pulmonary function. METHODS: From 105 consecutive patients with GERD symptoms during follow up for asthma, 45 patients were enrolled. Patients enrolled to this study were asked about GERD symptoms before and after treating with PPI. Endoscopic findings were described according to Los Angeles classification. The improvement of asthma symptoms and follow-up pulmonary function test were investigated after administration of PPIs. RESULTS: Esophageal symptoms such as heartburn and acid reflux were present in 25 patients (55.6%), and patients without esophageal symptoms were 20 (44.4%). The degree of endoscopic abnormality was not significantly different between groups with or without esophageal symptoms. The improvement of symptoms was seen in 44 patients (97.8%) except 1 patient after administration of PPIs. The number of patients classified to the low-dose group was 7 patients (15.6%) and that of patients classified to the standard-dose group was 38 patients (84.4%). The follow-up pulmonary function test, peak expiratory flow rate (L/sec) was improved in 3 patients (3 of 7, 42.9%) of the low-dose group, and in 24 patients (24 of 38, 63.2%) of the standard-dose group. The improvement of ventilatory function was not significantly different according to dose of PPIs. CONCLUSIONS: Treatment with PPIs is expected to improve subjective symptoms and ventilatory function in asthma patients.
Adrenergic beta-Agonists/therapeutic use ; Adult ; Aged ; Asthma/*complications/drug therapy ; Female ; Follow-Up Studies ; Gastroesophageal Reflux/complications/*drug therapy ; Gastroscopy ; Glucocorticoids/therapeutic use ; Humans ; Male ; Middle Aged ; Peak Expiratory Flow Rate ; Proton Pump Inhibitors/*therapeutic use ; Treatment Outcome

OBJECTIVE: To evaluate the clinical outcome of coil embolization for unruptured intracranial aneurysm (UIA) with oculomotor nerve palsy (ONP) compared with surgical clipping. METHODS: A total of 19 patients presented with ONP caused by UIAs between Jan 2004 and June 2008. Ten patients underwent coil embolization and nine patients surgical clipping. The following parameters were retrospectively analyzed to evaluate the differences in clinical outcome observed in both coil embolization and surgical clipping : 1) gender, 2) age, 3) location of the aneurysm, 4) duration of the symptom, and 5) degree of ONP. RESULTS: Following treatment, complete symptomatic recovery or partial relief from ONP was observed in 15 patients. Seven of the ten patients were treated by coil embolization, compared to eight of the nine patients treated by surgical clipping (p = 0.582). Patient's gender, age, location of the aneurysm, size of the aneurysm, duration of symptom, and degree of the ONP did not statistically correlate with recovery of symptoms between the two groups. No significant differences were observed in mean improvement time in either group (55 days in coil embolization and 60 days in surgical clipping). CONCLUSION: This study indicates that no significant differences were observed in the clinical outcome between coil embolization and surgical clipping techniques in the treatment of aneurysms causing ONP. Coil embolization seems to be more feasible and safe treatment modality for the relief and recovery of oculomotor nerve palsy.
Aneurysm ; Humans ; Intracranial Aneurysm ; Oculomotor Nerve ; Oculomotor Nerve Diseases ; Retrospective Studies ; Surgical Instruments

BACKGROUND/AIMS: Peptic ulcer disease (PUD) is one of the common gastrointestinal diseases, and its medical management has been developed so much that the incidence of its serious complications, such as bleeding and perforation, are declining significantly. Its prevalence in Korea is not definitely decreased, probably due to increasing proportion of elderly patients and their rising usage of non-steroidal anti-inflammatory drugs (NSAIDs) and aspirins. This study was conducted to identify the risk factors for development and recurrence of peptic ulcer disease in Korea. METHODS: From 2003 to 2008, upper gastrointestinal endoscopy and detailed personal questionnaires were performed for patients who visited Department of Gastroenterology at Seoul National University Bundang Hospital. In total, 475 PUD patients and 335 non-ulcer dyspepsia patients were included. The results of questionnaires and repeated upper gastrointestinal endoscopy at initial diagnosis time and follow-up periods were analyzed. RESULTS: Multivariable analysis showed that male, H. pylori infection, NSAIDs use and smoking were risk factors for the development of PUD. The use of proton pump inhibitors (PPIs) and H2 receptor antagonists has significantly reduced the risk of PUD in patients who had taken NSAIDs and/or aspirins. H. pylori infection was found as the only risk factor for the recurrence of PUD. CONCLUSIONS: For the old patients who are taking drugs, such as NSAIDs and aspirins, concomitant use of PPIs or H2 receptor antagonists should be considered to protect from the development of PUD. H. pylori eradication has been confirmed again to be essential for the treatment of PUD patients infected with H. pylori.
Adult ; Aged ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Aspirin/therapeutic use ; Endoscopy, Gastrointestinal ; Female ; Helicobacter Infections/complications/drug therapy ; Helicobacter pylori ; Histamine H2 Antagonists/therapeutic use ; Humans ; Male ; Middle Aged ; Peptic Ulcer/drug therapy/*etiology ; Proton Pump Inhibitors/therapeutic use ; Questionnaires ; Recurrence ; Risk Factors ; Sex Factors ; Smoking ; Stomach Ulcer/etiology

PURPOSE: To evaluate the performance of a newly-designed ultrasound (US)-guided puncture device. MATERIALS AND METHODS: A newly-designed US-guided puncture device was composed of a guide segment and an attachable segment. The guide segment allowed the needle to be placed in the plane of US view with a maximal degree of freedom, and the attachable segment was designed to attach to most convex US probes. Six operators punctured 144 targets in phantoms using either the new device (n = 72) or free-hand technique (n = 72). The number of required needle passages and the necessary procedure times were compared between the two groups. RESULTS: The number of required needle passages and the necessary procedure time were significantly reduced in five operators when the newly-designed US-guided puncture device was used (p < 0.05). CONCLUSION: A newly-designed US-guided puncture device, which allows for a maximal degree of freedom in needle placement and can attach to most convex US probes, showed good performance in our study.
Freedom ; Needles ; Punctures

Scrub typhus is a zoonotic disease, caused by Orientia tsutsugamushi, and characterized by a typical primary lesion(eschar), rash and non-specific symptoms such as fever and chills, headache, myalgia. Although it is an acute febrile illness, severe complications of this disease are very rare since the introduction of specific antibiotic therapy. The authors report two cases of scrub typhus complicating acute respiratory distress syndrome. Although appropriate diagnosis and treatment were performed, all two patients expired. They were diagnosed as scrub typhus by travel history, clinical manifestations, eschars, serologic test and polymerase chain reaction(PCR).
Chills ; Diagnosis ; Exanthema ; Fever ; Headache ; Humans ; Myalgia ; Orientia tsutsugamushi ; Respiratory Distress Syndrome, Adult* ; Scrub Typhus* ; Serologic Tests ; Zoonoses

BACKGROUND: Mallory-Weiss syndrome is a laceration of gastroesophageal junction due to abruptly increased intraabdominal pressure. Bleeding from Mallory-Weiss tears stops spontaneously within 2-3 days without specific therapy in 80-90% of cases, but in some cases, aggressive treatment is required due to massive bleeding. METHODS: Among two hundreds and fifteen cases of upper gastrointestinal bleeding from January 1997 to January 1999, twenty three cases (10.7%) were diagnosed as Mallory-Weiss syndrome by endoscopy. We assessed the site, number, coexisting diseases, precipitating factors and bleeding lesion according to the time interval after the tears. After supportive care or specific therapy, we performed follow-up endoscopy to evaluate the healing of the lesions. RESULT: The mean age was 49.1 years and male:female ratio was 4.8:1. The most common precipitating factors were nausea, vomiting and alcohol drinking. In twenty cases, coexisting diseases such as gastritis and esophageal varix were detected. As for the number of tears, one tear was the most common (69.6%), while two tears were identified in five cases and three were in two cases. Thirteen cases of the Mallory-Weiss tears were located on the gastroesophageal junction, seven cases on the lower esophagus, one case on the cardia and two cases from lower esophagus to cardia. Eighteen cases were diagnosed by endoscopy within 24 hours after bleeding, of whom fourteen cases had active bleeding. Among four cases diagnosed after 24 hours, endoscopic finding revealed active bleeding in two cases and blood clots in the other two cases. We treated thirteen cases with supportive care, one case with hypertonic saline injection and nine cases who had active bleeding or deep and long tears with endoscopic band ligation. One or two weeks later, we performed follow-up endoscopy, and no bleeding was detected in all cases. CONCLUSION: We diagnosed twenty three cases of Mallory-Weiss syndrome by endoscopy and treated all cases with supportive care or endoscopic band ligation successfully.
Alcohol Drinking ; Cardia ; Diagnosis* ; Endoscopy ; Esophageal and Gastric Varices ; Esophagogastric Junction ; Esophagus ; Follow-Up Studies ; Gastritis ; Hemorrhage ; Lacerations ; Ligation ; Mallory-Weiss Syndrome* ; Nausea ; Precipitating Factors ; Vomiting

Cryptococcal meningitis is rare but, often fatal complication of systemic lupus erythematosus(SLE). It is difficult to differentiate cryptococcal meningitis from neuropsychiatric lupus due to similarity of clinical symptoms and laboratory findings of cerebrospinal fluid(CSF). Earlier diagnosis and effective antifungal therapy improve the prognosis of cryptococcal meningitis in SLE patients. We report a case of cryptococcal meningitis in a patients with SLE who had been medicated with low dose steroid.
Diagnosis ; Humans ; Lupus Erythematosus, Systemic* ; Meningitis, Cryptococcal* ; Prognosis