Nutcracker syndrome is caused by the compression of the left renal vein between the abdominal aorta and the superior mesenteric artery. The use of Doppler ultrasonography to diagnose this condition is challenging due to the dynamic nature of the nutcracker phenomenon and the variability of its symptoms, which can fluctuate with changes in patient posture and respiration. This review emphasizes the critical role of Doppler ultrasonography in identifying and managing nutcracker syndrome. It also explores the various subtypes of the nutcracker phenomenon and discusses how Doppler ultrasonography can improve patient outcomes by enabling management strategies that are informed by dynamic assessments of left renal vein compression.

Nutcracker syndrome is caused by the compression of the left renal vein between the abdominal aorta and the superior mesenteric artery. The use of Doppler ultrasonography to diagnose this condition is challenging due to the dynamic nature of the nutcracker phenomenon and the variability of its symptoms, which can fluctuate with changes in patient posture and respiration. This review emphasizes the critical role of Doppler ultrasonography in identifying and managing nutcracker syndrome. It also explores the various subtypes of the nutcracker phenomenon and discusses how Doppler ultrasonography can improve patient outcomes by enabling management strategies that are informed by dynamic assessments of left renal vein compression.

Nutcracker syndrome is caused by the compression of the left renal vein between the abdominal aorta and the superior mesenteric artery. The use of Doppler ultrasonography to diagnose this condition is challenging due to the dynamic nature of the nutcracker phenomenon and the variability of its symptoms, which can fluctuate with changes in patient posture and respiration. This review emphasizes the critical role of Doppler ultrasonography in identifying and managing nutcracker syndrome. It also explores the various subtypes of the nutcracker phenomenon and discusses how Doppler ultrasonography can improve patient outcomes by enabling management strategies that are informed by dynamic assessments of left renal vein compression.

Nutcracker syndrome is caused by the compression of the left renal vein between the abdominal aorta and the superior mesenteric artery. The use of Doppler ultrasonography to diagnose this condition is challenging due to the dynamic nature of the nutcracker phenomenon and the variability of its symptoms, which can fluctuate with changes in patient posture and respiration. This review emphasizes the critical role of Doppler ultrasonography in identifying and managing nutcracker syndrome. It also explores the various subtypes of the nutcracker phenomenon and discusses how Doppler ultrasonography can improve patient outcomes by enabling management strategies that are informed by dynamic assessments of left renal vein compression.

Nutcracker syndrome is caused by the compression of the left renal vein between the abdominal aorta and the superior mesenteric artery. The use of Doppler ultrasonography to diagnose this condition is challenging due to the dynamic nature of the nutcracker phenomenon and the variability of its symptoms, which can fluctuate with changes in patient posture and respiration. This review emphasizes the critical role of Doppler ultrasonography in identifying and managing nutcracker syndrome. It also explores the various subtypes of the nutcracker phenomenon and discusses how Doppler ultrasonography can improve patient outcomes by enabling management strategies that are informed by dynamic assessments of left renal vein compression.

Background/Aims: Recently, patients with pancreatic cancer (PC) who underwent resection have exhibited improved survival outcomes, but comprehensive analysis is limited. We analyzed the trends of contributing factors. Methods: Data of patients with resected PC were retrospectively collected from the Korean Health Insurance Review and Assessment Service (HIRA) database and separately at our institution. Cox regression analysis was conducted with the data from our institution a survival prediction score was calculated using the β coefficients. Results: Comparison between the periods 2013–2015 (n=3,255) and 2016–2018 (n=3,698) revealed a difference in the median overall survival (25.9 months vs not reached, p<0.001) when analyzed with the HIRA database which was similar to our single-center data (2013–2015 [n=119] vs 2016–2018 [n=148], 20.9 months vs 32.2 months, p=0.003). Multivariable analyses revealed six factors significantly associated with better OS, and the scores were as follows: age >70 years, 1; elevated carbohydrate antigen 19-9 at diagnosis, 1; R1 resection, 1; stage N1 and N2, 1 and 3, respectively; no adjuvant treatment, 2; FOLFIRINOX or gemcitabine plus nab-paclitaxel after recurrence, 4; and other chemotherapy or supportive care only after recurrence, 5. The rate of R0 resection (69.7% vs 80.4%), use of adjuvant treatment (63.0% vs 74.3%), and utilization of FOLFIRINOX or gemcitabine plus nab-paclitaxel (25.2% vs 47.3%) as palliative chemotherapeutic regimen, all increased between the two time periods, resulting in decreased total survival prediction score (mean: 7.32 vs 6.18, p=0.004). Conclusions Strict selection of surgical candidates, more use of adjuvant treatment, and adoption of the latest combination regimens for palliative chemotherapy after recurrence were identified as factors of recent improvement.

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: This study aimed to develop a model for predicting pathologic extracapsular extension (ECE) and seminal vesicle invasion (SVI) while integrating magnetic resonance imaging-based T-staging (cTMRI, cT1c-cT3b). Materials and Methods: A total of 1,915 who underwent radical prostatectomy between 2006-2016 met the inclusion/exclusion criteria. We performed a multivariate logistic regression analysis as well as Bayesian network (BN) modeling based on possible confounding factors. The BN model was internally validated using 5-fold validation. Results: According to the multivariate logistic regression analysis, initial prostate-specific antigen (iPSA) (β=0.050, p < 0.001), percentage of positive biopsy cores (PPC) (β=0.033, p < 0.001), both lobe involvement on biopsy (β=0.359, p=0.009), Gleason score (β=0.358, p < 0.001), and cTMRI (β=0.259, p < 0.001) were significant factors for ECE. For SVI, iPSA (β=0.037, p < 0.001), PPC (β=0.024, p < 0.001), Gleason score (β=0.753, p < 0.001), and cTMRI (β=0.507, p < 0.001) showed statistical significance. BN models to predict ECE and SVI were also successfully established. The overall area under the receiver operating characteristic curve (AUC)/accuracy of the BN models were 0.76/73.0% and 0.88/89.6% for ECE and SVI, respectively. According to internal comparison between the BN model and Roach formula, BN model had improved AUC values for predicting ECE (0.76 vs. 0.74, p=0.060) and SVI (0.88 vs. 0.84, p < 0.001). Conclusion Two models to predict pathologic ECE and SVI integrating cTMRI were established and installed on a separate website for public access to guide radiation oncologists.

Purpose: This study aimed to evaluate the association of redundant nerve roots of the cauda equina (RNRCEs) with the degree and duration of symptoms in patients with lumbar spinal canal stenosis. Materials and Methods: Between January 2017 and December 2018, 224 patients demonstrating central canal stenosis on lumbar spine MRI were included. Various imaging findings associated with spinal canal stenosis were investigated, as were the presence, level, type, and length of RNRCEs, and the presence of nerve root swelling. Clinically, the degree of symptoms and symptom changes after treatment were investigated. Multinomial logistic regression was used for statistical analysis. Results: RNRCEs were present in 142 patients (63.4%). Most RNRCEs were observed above the level of stenosis (47.3%). RNRCE was associated with the number of stenoses and symptom duration (p < 0.05). The presence, level, type, and length of RNRCE and nerve root swelling significantly affected the severity of symptoms (p < 0.05). The type of treatment influenced symptom changes (p < 0.05). Conclusion The recognition and assessment of RNRCEs on spinal MRI are clinically important because the presence, level, type, and length of a RNRCE may be associated with the degree of symptoms and help predict the clinical outcome according to treatment methods.