Purpose: The incidence and prognostic implications of atrial fibrillation (AF) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) are controversial, especially for Korean patients. Furthermore, the pattern of antithrombotic therapy for these patients is unknown. The present study sought to identify the impact of AF on Korean patients undergoing TAVI and demonstrate the status of antithrombotic therapy for these patients. Materials and Methods: A total of 660 patients who underwent TAVI for severe AS were recruited from the nationwide K-TAVI registry in Korea. The enrolled patients were stratified into sinus rhythm (SR) and AF groups. The primary endpoint was all-cause death at 1-year. Results: AF was recorded in 135 patients [pre-existing AF 108 (16.4%) and new-onset AF 27 (4.1%)]. The rate of all-cause death at 1 year was significantly higher in patients with AF than in those with SR [16.2% vs. 6.4%, adjusted hazard ratio (HR): 2.207, 95% confidence interval (CI): 1.182–4.120, p=0.013], regardless of the onset timing of AF. The rate of new pacemaker insertion at 1 year was also significantly higher in patients with AF than in those with SR (14.0% vs. 5.5%, adjusted HR: 3.137, 95%CI: 1.621–6.071, p=0.001).Among AF patients, substantial number of patients received the combination of multiple antithrombotic agents (77.8%), and the most common combination was that of aspirin and clopidogrel (38.1%). Conclusion AF was an independent predictor of 1-year mortality and new pacemaker insertion in Korean patients undergoing TAVI.

Medial meniscal root tears have been repaired using various methods. Arthroscopic all-inside repair using a suture anchor is one of the popular methods. However, insertion of the suture anchor into the proper position at the posterior root of the medial meniscus is technically difficult. Some methods have been reported to facilitate suture anchor insertion through a high posteromedial portal, a posterior trans-septal portal, or a medial quadriceptal portal. Nevertheless, many surgeons still have difficulty during anchor insertion. We introduce a technical tip for easy suture anchor insertion using a 25° curved guide and a soft suture anchor through a routine posteromedial portal.
Menisci, Tibial ; Surgeons ; Suture Anchors* ; Sutures* ; Tears

BACKGROUND: Hemorheologic indices are known to be related to vascular complications in variable clinical settings. However, little is known about the associations between hemorheologic parameters and acute myocardial infarction (AMI) in type 2 diabetes mellitus (T2DM). The purpose of this study was to demonstrate the changes of hemorheologic environment inside of blood using hemorheologic parameters, especially the elongation index (EI) and critical shear stress (CSS) in diabetics with versus without AMI. METHODS: A total of 195 patients with T2DM were enrolled. Patients were divided into the study group with AMI (AMI+, n = 77) and control group (AMI−, n = 118) who had no history of coronary artery disease. Hemorheologic parameters such as EI and CSS were measured and compared between the two groups. RESULTS: The EI was lower (30.44%±1.77% in AMI+ and 31.47%±1.48% in AMI−, P < 0.001) but the level of CSS was higher (316.13±108.20 mPa in AMI+ and 286.80±85.34 mPa in AMI−, P = 0.040) in the AMI+. The CSS was significantly related to the erythrocyte sedimentation rate (R² = 0.497, P < 0.001) and use of dipeptidyl peptidase-4 inhibitors (R² = 0.574, P = 0.048). CONCLUSION: Diabetics with AMI resulted in adverse hemorheologic changes with lower EI and higher CSS compared to diabetic subjects without AMI. Evaluation of the hemorheologic parameters may provide valuable supplementary information for managing patients with AMI and T2DM.
Blood Sedimentation ; Coronary Artery Disease ; Diabetes Mellitus, Type 2* ; Erythrocyte Deformability ; Hemorheology ; Humans ; Myocardial Infarction*

The affiliation no. 4 was misprinted.

Dysphagia aortica is a rare condition defined by difficulty in swallowing and is caused by extrinsic compression of the esophagus due to an ectatic, tortuous, or aneurysmatic atherosclerotic thoracic aorta. It is easy to miss the diagnosis if the clinician does not consider the possibility of dysphagia caused by a thoracic aortic aneurysm. We present the case of an 82-year-old man who developed dysphagia aortica associated with a large thoracic aortic aneurysm. Extrinsic compression of the esophagus caused by an enlarged thoracic aorta was seen on upper gastrointestinal endoscopy, barium esophagogram, and chest computed tomography. With dietary modifications, his symptoms of dysphagia gradually improved.
Aged, 80 and over ; Aorta, Thoracic ; Aortic Aneurysm, Thoracic* ; Barium ; Deglutition ; Deglutition Disorders* ; Diagnosis ; Endoscopy, Gastrointestinal ; Esophagus ; Food Habits ; Humans ; Thorax

OBJECTIVE: Left ventricular (LV) filling pressure can be estimated using echocardiographic measurements, including the ratio of transmitral early peak flow velocity to tissue Doppler mitral annular motion velocity (E/e′) during sinus rhythm. However, non-invasive echocardiographic estimation is complicated in patients with atrial fibrillation (AF). AF is associated with reduced survival in patients with heart failure with preserved LV ejection fraction (LVEF). The aim of this study was to investigate echocardiographic parameters for predicting LV filling pressure and diastolic function in chronic AF patients with preserved LVEF. METHODS: Clinical data, echocardiographic findings, and laboratory data were assessed retrospectively in 90 chronic AF patients with preserved LVEF who underwent diagnostic left-heart catheterization between January 2011 and September 2015. LV end-diastolic pressure (LVEDP) assessment and standard echocardiographic measurements were performed. RESULTS: The E/e′ ratio was significantly correlated with LVEDP (r=0.449, P < 0.001). Receiver operating characteristic analysis defined the optimal cut-off for E/e′ as 13 (sensitivity, 88%; specificity, 67%) to predict elevated LVEDP (>15 mm Hg). E (r=0.463, P < 0.001) and E/propagation velocity (Vp; r=0.471, P < 0.001) were also correlated with LVEDP. E >90 cm/sec predicted elevated LVEDP with a sensitivity of 84% and a specificity of 70%. Also, an E/Vp >1.6 predicted elevated LVEDP with a sensitivity of 80% and a specificity of 72%. CONCLUSION: E >90 cm/sec, E/e′>13 and E/Vp >1.6 were suggestive of elevated LVEDP in these patients. Therefore, E, E/e′, and E/Vp provide significant predictive value for LVEDP in chronic AF with preserved LVEF.
Atrial Fibrillation* ; Catheterization ; Catheters ; Echocardiography* ; Heart Failure ; Humans ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Stroke Volume*

BACKGROUND/AIMS: Despite improvements in surgical techniques and postoperative patient care, bile leakage can occur after hepatobiliary surgery and may lead to serious complications. The aim of this retrospective study was to evaluate the efficacy of endoscopic treatment of bile leakage after hepatobiliary surgery. METHODS: The medical records of 20 patients who underwent endoscopic retrograde cholangiopancreatography because of bile leakage after hepatobiliary surgery from August 2009 to September 2014 were reviewed retrospectively. Endoscopic treatment included insertion of an endoscopic retrograde biliary drainage stent after endoscopic sphincterotomy. RESULTS: Most cases of bile leakage presented as percutaneous bile drainage through a Jackson-Pratt bag (75%), followed by abdominal pain (20%). The sites of bile leaks were the cystic duct stump in 10 patients, intrahepatic ducts in five, liver beds in three, common hepatic duct in one, and common bile duct in one. Of the three cases of bile leakage combined with bile duct stricture, one patient had severe bile duct obstruction, and the others had mild strictures. Five cases of bile leakage also exhibited common bile duct stones. Concerning endoscopic modalities, endoscopic therapy for bile leakage was successful in 19 patients (95%). One patient experienced endoscopic failure because of an operation-induced bile duct deformity. One patient developed guidewire-induced microperforation during cannulation, which recovered with conservative treatment. One patient developed recurrent bile leakage, which required additional biliary stenting with sphincterotomy. CONCLUSIONS: The endoscopic approach should be considered a first-line modality for the diagnosis and treatment of bile leakage after hepatobiliary surgery.
Abdominal Pain ; Bile Ducts ; Bile* ; Catheterization ; Cholangiopancreatography, Endoscopic Retrograde ; Cholestasis ; Common Bile Duct ; Congenital Abnormalities ; Constriction, Pathologic ; Cystic Duct ; Diagnosis ; Drainage ; Hepatic Duct, Common ; Humans ; Liver ; Medical Records ; Patient Care ; Retrospective Studies ; Sphincterotomy, Endoscopic ; Stents

PURPOSE: The hepatic resection is the gold-standard treatment for patients with colorectal-cancer liver metastases (CLM). This study aimed to identify prognostic factors in patients with synchronous CLM who underwent a surgical curative (R0) resection with respect to the number of metastatic nodules. METHODS: Of 1,261 CLM patients treated between January 1991 and December 2010, 339 who underwent a R0 resection for synchronous CLM were included in this retrospective analysis. Patients were grouped according to the number of CLM nodules: 1-2 CLM nodules, n = 272 (group 1) and 3-8 CLM nodules, n = 67 (group 2). RESULTS: The 5-year progression-free survival (PFS) rate in group 1was better than that in group 2 (P = 0.020). The multivariate analysis identified lymph-node metastasis (N2), lymphovascular invasion (LVI), and three or more CLM nodules as independent poor prognostic factors for PFS in all patients and lymph-node metastasis (N2) and LVI as independent poor prognostic factors for patients in group 1. No independent prognostic factors were identified for patients in group 2. CLM treatment method and neoadjuvant chemotherapy were not associated with survival. CONCLUSION: Three or more metastatic nodules, lymph-node metastasis (N2), and LVI were independent poor prognostic factors for PFS in patients with synchronous CLM who underwent a R0 resection. The latter 2 factors were also independent prognostic factors for PFS in patients with less than 3 CLM nodules; however, in patients with three or more CLM nodules, the prognosis for PFS may be related only to liver metastasis.
Colorectal Neoplasms* ; Disease-Free Survival ; Drug Therapy ; Humans ; Liver* ; Methods ; Multivariate Analysis ; Neoplasm Metastasis* ; Prognosis ; Retrospective Studies

PURPOSE: p21-activated kinases (PAKs) are involved in cytoskeletal reorganization, gene transcription, cell proliferation and survival, and oncogenic transformation. Therefore, we hypothesized that PAK expression levels could predict the sensitivity of pancreatic cancer cells to gemcitabine treatment, and PAKs could be therapeutic targets. MATERIALS AND METHODS: Cell viability inhibition by gemcitabine was evaluated in human pancreatic cancer cell lines (Capan-1, Capan-2, MIA PaCa-2, PANC-1, Aspc-1, SNU-213, and SNU-410). Protein expression and mRNA of molecules was detected by immunoblot analysis and reverse transcription polymerase chain reaction. To define the function of PAK4, PAK4 was controlled using PAK4 siRNA. RESULTS: Capan-2, PANC-1, and SNU-410 cells were resistant to gemcitabine treatment. Immunoblot analysis of signaling molecules reported to indicate gemcitabine sensitivity showed higher expression of PAK4 and lower expression of human equilibrative nucleoside transporter 1 (hENT1), a well-known predictive marker for gemcitabine activity, in the resistant cell lines. Knockdown of PAK4 using siRNA induced the upregulation of hENT1. In resistant cell lines (Capan-2, PANC-1, and SNU-410), knockdown of PAK4 by siRNA resulted in restoration of sensitivity to gemcitabine. CONCLUSION: PAK4 could be a predictive marker of gemcitabine sensitivity and a potential therapeutic target to increase gemcitabine sensitivity in pancreatic cancer.
Cell Line* ; Cell Proliferation ; Cell Survival ; Equilibrative Nucleoside Transporter 1 ; Humans ; p21-Activated Kinases ; Pancreatic Neoplasms* ; Phosphotransferases* ; Polymerase Chain Reaction ; Reverse Transcription ; RNA, Messenger ; RNA, Small Interfering ; Up-Regulation

Choledochal cysts are congenital lesions involving cystic dilatation of the bile ducts. The choledochocele, the rarest type of choledochal cyst, is a cystic dilatation of the distal common bile duct that protrudes into the duodenum. There have been few reports concerning malignancy in the biliary tree associated with choledochoceles. We recently experienced a case of a choledochocele with gallbladder cancer.
Bile Ducts ; Biliary Tract ; Choledochal Cyst ; Common Bile Duct ; Dilatation ; Duodenum ; Gallbladder ; Gallbladder Neoplasms