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.

Purpose: The purpose of this study was to identify the concordant or discordant genomic profiling between primary and matched metastatic tumors in patients with colorectal cancer (CRC) and to explore the clinical implication. Materials and Methods: Surgical samples of primary and matched metastatic tissues from 158 patients (335 samples) with CRC at Korea University Anam Hospital were evaluated using the Ion AmpliSeq Cancer Hotspot Panel. We compared genetic variants and classified them as concordant, primary-specific, and metastasis-specific variants. We used a combination of principal components analysis and clustering to find genomic groups. Kaplan-Meier curves were used to appraise survival between genomic groups. We used machine learning to confirm the correlation between genetic variants and metastatic sites. Results: A total of 282 types of deleterious non-synonymous variants were selected for analysis. Of a total of 897 variants, an average of 40% was discordant. Three genomic groups were yielded based on the genomic discrepancy patterns. Overall survival differed significantly between the genomic groups. The poorest group had the highest proportion of concordant KRAS G12V and additional metastasis-specific SMAD4. Correlation analysis between genetic variants and metastatic sites suggested that concordant KRAS mutations would have more disseminated metastases. Conclusion Driver gene mutations were mostly concordant; however, discordant or metastasis-specific mutations were present. Clinically, the concordant driver genetic changes with additional metastasis-specific variants can predict poor prognosis for patients with CRC.

BACKGROUND/AIMS: Vaccinations in patients with inflammatory bowel disease (IBD) are recommended to prevent infectious diseases. However, there are few reports of vaccination in IBD patients in Korea. The frequency of complementary and alternative medicine (CAM) use is high despite its uncertain effectiveness. This study aimed to identify the rates of vaccination and use of CAM in patients with IBD. METHODS: A total of 219 patients attended an education session for IBD patients held at Severance Hospital on March 23, 2013. We conducted a survey on vaccination and CAM use in IBD patients; 120 patients completed the questionnaire. RESULTS: The influenza vaccination rate was 44.2% and pneumococcal vaccination rate was 4.2%. Thirty-one (66%) patients were aware of the importance of vaccination. The vaccination rate was higher in patients who were aware of the importance of vaccination compared with that in patients who were unaware of the importance of vaccination (70.1% vs. 41.7%, P=0.004). The rate of CAM use was 30.0%. The most commonly used CAMs were oral products: vitamins (33.3%), red ginseng (25.0%), and probiotics (19.4%). CONCLUSIONS: Awareness of the importance of vaccination and actual vaccination rates were low in IBD patients. Despite insufficient evidence on the effectiveness of CAMs in IBD patients, many patients used CAMs. We believe that repeated education and promotion of vaccination are important. Further large-scale studies to investigate the efficacy and safety of CAMs are warranted in patients with IBD.
Communicable Diseases ; Complementary Therapies* ; Education ; Humans ; Inflammatory Bowel Diseases* ; Influenza, Human ; Korea ; Panax ; Probiotics ; Vaccination* ; Vitamins ; Surveys and Questionnaires

PURPOSE: Anaphylaxis is a medical emergency requiring immediate recognition and treatment. Despite the serious nature of these reactions, there is no universal agreement on the definition and there have been few epidemiologic studies of anaphylaxis in children. The purpose of the study is to investigate the causative agents, presenting signs and symptoms and course of disease in children suitable for established diagnostic criteria for anaphylaxis in the middle area of South Korea. METHODS: We identified potential episodes of anaphylaxis occuring between March 1994 and October 2007 from the university hospitals in the middle area of South Korea. We reviewed all patients' medical records diagnosed with anaphylaxis and other related diagnoses. From chart review, we retrospectively collected demographic and epidemiologic data. RESULTS: We identified 40 patients with anaphylaxis. Patients' ages ranged from 2 months to 17 years, with a mean age of 6.6 years. A causative agent was recognized in 84.5%. The inciting agent included foods in 26 cases (65%), medication in 7 cases (17.5%) and bee sting in 1 case (2.5%). Mucocutaneous manifestations were the most common, respiratory symptoms were in 35 patients, cardiovascular symptoms were in 8 patients, and gastrointestinal symptoms were in 5 patients. CONCLUSION: We found some cases of anaphylaxis which had misdiagnosed as urticaria or angioedema using the established diagnostic criteria. Therefore, clinicians must accurately know the criteria of anaphylaxis and make an effort to identify cases of anaphylaxis with a high suspicion. Also, we found the epidemiology, causative agents, and symptoms and treatments of anaphylaxis in the middle area of South Korea. Our data will be the basis for anaphylactic studies in South Korea.
Anaphylaxis ; Angioedema ; Bees ; Bites and Stings ; Child ; Collodion ; Emergencies ; Epidemiologic Studies ; Hospitals, University ; Humans ; Medical Records ; Republic of Korea ; Retrospective Studies ; Urticaria

Hodgkin's disease (HD) is a hematologic malignancy which shows common features regardless of race, but racial differences may be considered with certain clinical characteritcs. HD in Korea shows somewhat different characteristics when compared to cases in Western countries. We evaluated the clinical and histopathologic characteristics of HD, the outcomes of various chemotherapy regimens, and prognostic factors of HD in Korea. One hundred and five patients with initial histopathologic diagnosis of Hodgkin's disease were retrospectively reviewed 20 years after diagnosis at Yonsei University College of Medicine. Nodular sclerosis was the most common histopathogic subtype (41%) and mixed cellularity was nearly as common (40%). The overall complete remission rate (CR) was 87.6%. The disease-free survival (DFS) and overall survival (OS) rate were 79.2% and 84.8% at 5-years, 70% and 79.2% at 10- and 20-years. There were no significant differences in CR rate and DFS, but OS rates were significantly higher in m-BACOP and ABVD regimen. Univariate analysis revealed that age, B-symptom, ECOG scale, Ann Arbor stage, international prognostic index, and serum beta2-microglobulin level were significant prognostic factors for both DFS and OS. Multivariate analysis demonstrated that age, B symptoms, and ECOG scale were significant prognostic factors for OS only. In conclusion, the survival rates of HD patients in our center were superior to those of previous reports in Korea and Western countries. Considering the higher OS rate and decreased incidence of side effects, the ABVD regimen may be recommended for the initial treatment of Hodgkin's disease.
Treatment Outcome ; Remission Induction ; Prognosis ; Middle Aged ; Male ; Korea ; Humans ; Hodgkin Disease/mortality/*therapy ; Follow-Up Studies ; Female ; Disease-Free Survival ; Child, Preschool ; Child ; Antineoplastic Agents/*pharmacology ; Aged, 80 and over ; Aged ; Adult ; Adolescent

BACKGROUND: The primary mediastinal lymphoma (PML) is defined as the non-Hodgkin's lymphoma that presents primarily within the mediastinum, and primary mediastinal diffuse large B cell lymphoma (PMLBL) is defined as primary mediastinal lymphoma of which histology shows diffuse large B cell lymphoma. There is no available clinical study yet about the clinical characteristics and treatment outcome of PMLBL in Korea. Here the authors report our experience of 21 cases of PML including 11 cases of PMLBL. METHODS: The authors reviewed retrospectively medical records of 21 cases with PML from January 1992 to January 2003, and analyzed clinical characteristics, response to induction therapy, and survival. The authors subsequently performed subset analysis in 11 cases with PMLBL. Median follow-up period was 16 months (range, 4~80 months). RESULTS: Male to female ratio was 8:13 and the median age of 21 PML cases was 33.5 years. Of 21 PML cases, histology of most cases was diffuse large B cell lymphoma (11/21) and lymphoblastic lymphoma (8/21). Cell lineage was B cell in 13 cases (61.9%). Thirteen cases (62.0%) were in stage I and II. Initial induction therapy was chemotherapy alone in 19 cases, combined chemoradiotherapy in 1 case and no treatment in remaining 1 case. Response rate to initial therapy was 70% in 20 PML cases (complete response [CR] 50%, partial response 20%) with CR of 50% in 10 PMLBL. Median progression-free survival and overall survival for 11 PMLBL cases were 11 months and 16 months, respectively. CONCLUSION: Incidence of PML showed slight predominance in female and in relatively young age with median age of less than 40 years. Most patients presented with a chief complaint of superior vena cava syndrome including dyspnea. The most common histology of PML was diffuse large B cell lymphoma. PMLBL represented low complete response rate to conventional chemotherapy, low progression-free and overall survival rates compared with peripheral diffuse large B cell lymphoma by historical review.
Cell Lineage ; Chemoradiotherapy ; Disease-Free Survival ; Drug Therapy ; Dyspnea ; Female ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Lymphoma* ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin ; Male ; Mediastinum ; Medical Records ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Retrospective Studies ; Superior Vena Cava Syndrome ; Survival Rate ; Treatment Outcome*

Primary gastric lymphoma is the most common form of extralymphatic non-Hodgkin's lymphoma (NHL). Most cases are of B-cell origin and few cases of lymphoma of T-cell origin have been reported. Peripheral T cell lymphoma is a lymphoma of extrathymic origin. Expression of T-cell intracellular antigen (TIA)-1 can be detected in all cytotoxic cells, and the expression of this cytotoxic protein is associated with extranodal presentation. We report a case of primary peripheral T cell lymphoma of the stomach with cytotoxic T-cell phenotype in a 70-year-old male presenting with upper gastrointestinal bleeding.
Aged ; B-Lymphocytes ; Hemorrhage ; Humans ; Lymphoma ; Lymphoma, Non-Hodgkin ; Lymphoma, T-Cell, Peripheral* ; Male ; Phenotype* ; Stomach* ; T-Lymphocytes