Background and Objectives: Among various emerging catheter-based treatments for severe tricuspid regurgitation (TR), the spacer device can reduce the regurgitation orifice without manipulating the valve leaflet. However, its clinical application has been hampered by traumatic anchoring to the myocardium and the coaxial alignment of the balloon resulting in insufficient TR reduction. This study aimed to evaluate the early-stage safety, technical feasibility, and preliminary efficacy of the novel atraumatic vertical spacer in patients with isolated severe TR. Methods: All procedures were guided by fluoroscopy and transthoracic echocardiography.The maximum device placement time with an inflated balloon was 24 hours. Changes in the amount of TR, right ventricular function, and patient hemodynamics were measured during balloon deployment. Results: A total of 7 patients (median age 74), underwent successful device implantation without procedure-related complications. During balloon inflation (median 25 minutes), there were no symptoms or signs indicative of TR intolerance. TR was reduced by 1 grade or greater in all patients, with 2 patients exhibiting a reduction of 3 grades, from torrential TR to a moderate degree. Mild TR after balloon inflation was achieved in 3 patients with baseline severe TR. The TR reduction observed during initial balloon deployment was sustained during the subsequent balloon maintenance period. Conclusions The Pivot-balloon procedure was safe, technically feasible, and effective in reducing TR in patients with severe TR. No periprocedural complications or adverse cardiovascular events were reported during device placement with TR reduction observed in all patients. However, longer-term follow-up is needed to confirm safety and treatment effect.

Background and Objectives: Among various emerging catheter-based treatments for severe tricuspid regurgitation (TR), the spacer device can reduce the regurgitation orifice without manipulating the valve leaflet. However, its clinical application has been hampered by traumatic anchoring to the myocardium and the coaxial alignment of the balloon resulting in insufficient TR reduction. This study aimed to evaluate the early-stage safety, technical feasibility, and preliminary efficacy of the novel atraumatic vertical spacer in patients with isolated severe TR. Methods: All procedures were guided by fluoroscopy and transthoracic echocardiography.The maximum device placement time with an inflated balloon was 24 hours. Changes in the amount of TR, right ventricular function, and patient hemodynamics were measured during balloon deployment. Results: A total of 7 patients (median age 74), underwent successful device implantation without procedure-related complications. During balloon inflation (median 25 minutes), there were no symptoms or signs indicative of TR intolerance. TR was reduced by 1 grade or greater in all patients, with 2 patients exhibiting a reduction of 3 grades, from torrential TR to a moderate degree. Mild TR after balloon inflation was achieved in 3 patients with baseline severe TR. The TR reduction observed during initial balloon deployment was sustained during the subsequent balloon maintenance period. Conclusions The Pivot-balloon procedure was safe, technically feasible, and effective in reducing TR in patients with severe TR. No periprocedural complications or adverse cardiovascular events were reported during device placement with TR reduction observed in all patients. However, longer-term follow-up is needed to confirm safety and treatment effect.

Background and Objectives: Among various emerging catheter-based treatments for severe tricuspid regurgitation (TR), the spacer device can reduce the regurgitation orifice without manipulating the valve leaflet. However, its clinical application has been hampered by traumatic anchoring to the myocardium and the coaxial alignment of the balloon resulting in insufficient TR reduction. This study aimed to evaluate the early-stage safety, technical feasibility, and preliminary efficacy of the novel atraumatic vertical spacer in patients with isolated severe TR. Methods: All procedures were guided by fluoroscopy and transthoracic echocardiography.The maximum device placement time with an inflated balloon was 24 hours. Changes in the amount of TR, right ventricular function, and patient hemodynamics were measured during balloon deployment. Results: A total of 7 patients (median age 74), underwent successful device implantation without procedure-related complications. During balloon inflation (median 25 minutes), there were no symptoms or signs indicative of TR intolerance. TR was reduced by 1 grade or greater in all patients, with 2 patients exhibiting a reduction of 3 grades, from torrential TR to a moderate degree. Mild TR after balloon inflation was achieved in 3 patients with baseline severe TR. The TR reduction observed during initial balloon deployment was sustained during the subsequent balloon maintenance period. Conclusions The Pivot-balloon procedure was safe, technically feasible, and effective in reducing TR in patients with severe TR. No periprocedural complications or adverse cardiovascular events were reported during device placement with TR reduction observed in all patients. However, longer-term follow-up is needed to confirm safety and treatment effect.

Background and Objectives: Among various emerging catheter-based treatments for severe tricuspid regurgitation (TR), the spacer device can reduce the regurgitation orifice without manipulating the valve leaflet. However, its clinical application has been hampered by traumatic anchoring to the myocardium and the coaxial alignment of the balloon resulting in insufficient TR reduction. This study aimed to evaluate the early-stage safety, technical feasibility, and preliminary efficacy of the novel atraumatic vertical spacer in patients with isolated severe TR. Methods: All procedures were guided by fluoroscopy and transthoracic echocardiography.The maximum device placement time with an inflated balloon was 24 hours. Changes in the amount of TR, right ventricular function, and patient hemodynamics were measured during balloon deployment. Results: A total of 7 patients (median age 74), underwent successful device implantation without procedure-related complications. During balloon inflation (median 25 minutes), there were no symptoms or signs indicative of TR intolerance. TR was reduced by 1 grade or greater in all patients, with 2 patients exhibiting a reduction of 3 grades, from torrential TR to a moderate degree. Mild TR after balloon inflation was achieved in 3 patients with baseline severe TR. The TR reduction observed during initial balloon deployment was sustained during the subsequent balloon maintenance period. Conclusions The Pivot-balloon procedure was safe, technically feasible, and effective in reducing TR in patients with severe TR. No periprocedural complications or adverse cardiovascular events were reported during device placement with TR reduction observed in all patients. However, longer-term follow-up is needed to confirm safety and treatment effect.

Background: Atherogenic dyslipidemia, which is frequently associated with type 2 diabetes (T2D) and insulin resistance, contributes to the development of vascular complications. Statin therapy is the primary approach to dyslipidemia management in T2D, however, the role of non-statin therapy remains unclear. Ezetimibe reduces cholesterol burden by inhibiting intestinal cholesterol absorption. Fibrates lower triglyceride levels and increase high-density lipoprotein cholesterol (HDL-C) levels via peroxisome proliferator- activated receptor alpha agonism. Therefore, when combined, these drugs effectively lower non-HDL-C levels. Despite this, few clinical trials have specifically targeted non-HDL-C, and the efficacy of triple combination therapies, including statins, ezetimibe, and fibrates, has yet to be determined. Methods: This is a multicenter, prospective, randomized, open-label, active-comparator controlled trial involving 3,958 eligible participants with T2D, cardiovascular risk factors, and elevated non-HDL-C (≥100 mg/dL). Participants, already on moderate-intensity statins, will be randomly assigned to either Ezefeno (ezetimibe/fenofibrate) addition or statin dose-escalation. The primary end point is the development of a composite of major adverse cardiovascular and diabetic microvascular events over 48 months. Conclusion This trial aims to assess whether combining statins, ezetimibe, and fenofibrate is as effective as, or possibly superior to, statin monotherapy intensification in lowering cardiovascular and microvascular disease risk for patients with T2D. This could propose a novel therapeutic approach for managing dyslipidemia in T2D.

Celiomesenteric trunk is a rare anomaly, and its co-occurrence with an aneurysm is even more unusual. We present a case of celiomesenteric trunk with a concurrent hepatic arterial aneurysm, both of which were found incidentally on screening abdominal ultrasonography.
Abdomen ; Aneurysm ; Hepatic Artery ; Mass Screening

BACKGROUND: Patients with diabetic nephropathy (DN) and coronary artery disease (CAD) represent a subset of patients with high cardiovascular morbidity and mortality. The optimal revascularization strategy using either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains controversial. The purpose of this study was to compare the clinical outcomes of PCI to CABG in DN patients with CAD. METHODS: The clinical and angiographic records of DN patients with CAD who underwent either CABG (n=52) or PCI (n=48) were retrospectively analyzed. RESULTS: The baseline characteristics were similar in the two groups except for the severity of the CAD. At 30 days, the death rate (PCI: 2.1% vs. CABG: 9.6%, p=0.21) and major adverse cardiac events (MACE) rate (PCI: 2.1 % vs. CABG: 9.6%, p=0.21) were similar in comparisons between the PCI and CABG groups. At three years, the death rate (PCI: 18.8% vs. CABG: 19.2%, p=0.94) was similar between the PCI and CABG groups but the MACE rate (PCI: 47.9% vs. CABG: 21.2%, p=0.006) was higher in the PCI group compared to the CABG group. In addition, the repeat revascularization rate was higher in the PCI group compared to the CABG group (PCI: 12.5% vs. CABG: 1.9%, p=0.046). CONCLUSIONS: The CABG procedure was associated with a lower incidence of MACE and repeat revascularization for up to three years of follow-up in DN patients with CAD. However, the overall survival rate was similar in the CABG and PCI groups. Therefore, CABG may be superior to PCI with regard to MACE and repeat revascularization.
Aged ; *Angioplasty, Transluminal, Percutaneous Coronary/adverse effects ; *Coronary Artery Bypass/adverse effects ; Coronary Artery Disease/complications/surgery/*therapy ; *Diabetic Nephropathies/complications ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Severity of Illness Index ; Survival Analysis ; Treatment Outcome

Pagetoid reticulosis(PR) is a rare lymphoproliferative disorder that has been divided into the localized and disseminated type. There has been ongoing debate about the nature of PR. Some authors have regarded PR as a variant of mycosis fungoides(MF). However recent reported cases suggest that PR may represent a spectrum of lymphoproliferative disorders that may not be related to MF. We report a case of a 65-year-old woman who had an erythematous plaque on the anterior chest, buttock and lower extremities for 2 years. Histologically there was dense infiltrate of predominantly CD8-/CD30+ atypical mononuclear cells in the epidermis that produce a pagetoid appearance. We believe this is the first reported case of disseminated pagetoid reticulosis in the Korean literature.
Aged ; Buttocks ; Epidermis ; Female ; Humans ; Lower Extremity ; Lymphoproliferative Disorders ; Pagetoid Reticulosis* ; Thorax

BACKGROUND: Differential diagnosis of keratoacanthoma(KA) from squamous cell carcinoma(SCC) is often difficult, especially when SCC has KA-like features(KA-like SCC). A number of recent studies have been attempted to separate these two entities with the use of immunohistochemical stains. But the results were inconsistent and the studies with KA-like SCC are rarely reported. OBJECTIVES: The purpose of this study was to examine the expression patterns of p53 protein and Ki-67 antigen on KA and KA-like SCC using immunohistochemical staining method and to evaluate the usefulness of this method in distinguishing each other. METHODS: We performed immunoperoxidase staining(LSAB technique) using monoclonal antibody to p53 protein(PAb1801) and Ki-67 antigen(MIB1) on the formalin-fixed, paraffin-embedded biopsy specimens obtained from 12 patients with KA, 8 patient with KA-like SCC, and 10 patients with well-differentiated SCC. RESULTS: The results were as follows; 1) There was a significant difference in the p53 expression between KA(25%) and SCC group (KA-like SCC=88%, SCC=100%). 2) Mean Ki-67 labeling index was slightly higher for SCC group(KA-like SCC=30.72%, SCC= 31.23%) than for KA(25.30%), but this difference was not statistically significant. 3) In Ki-67 expression, KA showed more pheriperal basal pattern(91%), whereas SCC group showed more diffuse pattern(77%). CONCLUSION: Our results suggest that KA and SCC are distinct entities of different nature and that these immunohistochemical staining methods can be useful methods in differentiating KA-like SCC from KA.
Biopsy ; Carcinoma, Squamous Cell* ; Coloring Agents ; Diagnosis, Differential ; Humans ; Keratoacanthoma* ; Ki-67 Antigen*

BACKGROUND: Differential diagnosis of keratoacanthoma(KA) from squamous cell carcinoma(SCC) is often difficult, especially when SCC has KA-like features(KA-like SCC). A number of recent studies have been attempted to separate these two entities with the use of immunohistochemical stains. But the results were inconsistent and the studies with KA-like SCC are rarely reported. OBJECTIVES: The purpose of this study was to examine the expression patterns of p53 protein and Ki-67 antigen on KA and KA-like SCC using immunohistochemical staining method and to evaluate the usefulness of this method in distinguishing each other. METHODS: We performed immunoperoxidase staining(LSAB technique) using monoclonal antibody to p53 protein(PAb1801) and Ki-67 antigen(MIB1) on the formalin-fixed, paraffin-embedded biopsy specimens obtained from 12 patients with KA, 8 patient with KA-like SCC, and 10 patients with well-differentiated SCC. RESULTS: The results were as follows; 1) There was a significant difference in the p53 expression between KA(25%) and SCC group (KA-like SCC=88%, SCC=100%). 2) Mean Ki-67 labeling index was slightly higher for SCC group(KA-like SCC=30.72%, SCC= 31.23%) than for KA(25.30%), but this difference was not statistically significant. 3) In Ki-67 expression, KA showed more pheriperal basal pattern(91%), whereas SCC group showed more diffuse pattern(77%). CONCLUSION: Our results suggest that KA and SCC are distinct entities of different nature and that these immunohistochemical staining methods can be useful methods in differentiating KA-like SCC from KA.
Biopsy ; Carcinoma, Squamous Cell* ; Coloring Agents ; Diagnosis, Differential ; Humans ; Keratoacanthoma* ; Ki-67 Antigen*