OBJECTIVES: Electronic detailing (e-detailing), the use of electronic devices to facilitate sales presentations to physicians, has been adopted and expanded in the pharmaceutical industry. To maximize the potential outcome of e-detailing, it is important to understand medical representatives (MRs)' behavior and attitude to e-detailing. This study investigates how information technology devices such as laptop computers and tablet PCs are utilized in pharmaceutical marketing, and it analyzes the factors influencing MRs' intention to use devices. METHODS: This study has adopted and modified the theory of Roger's diffusion of innovation model and the technology acceptance model. To test the model empirically, a questionnaire survey was conducted with 221 MRs who were working in three multinational or eleven domestic pharmaceutical companies in Korea. RESULTS: Overall, 28% and 35% of MRs experienced using laptop computers and tablet PCs in pharmaceutical marketing, respectively. However, the rates were different across different groups of MRs, categorized by age, education level, position, and career. The results showed that MRs' intention to use information technology devices was significantly influenced by perceived usefulness in general. Perceived ease of use, organizational and individual innovativeness, and several MR characteristics were also found to have significant impacts. CONCLUSIONS: This study provides timely information about e-detailing devices to marketing managers and policy makers in the pharmaceutical industry for successful marketing strategy development by understanding the needs of MRs' intention to use information technology. Further in-depth study should be conducted to understand obstacles and limitations and to improve the strategies for better marketing tools.
Administrative Personnel ; Commerce ; Diffusion of Innovation ; Drug Industry ; Education ; Humans ; Intention* ; Korea ; Marketing*

Thyroid ultrasonography (US) plays a key role in the diagnosis and management of thyroid-related diseases. The aim of this article was to illustrate various pitfalls that can occur in utilizing thyroid US and techniques to prevent them. In this article, we present cases demonstrating the common pitfalls associated with US equipment, performance, normal thyroid structures, misinterpretations, and surrounding structures. Knowledge of these areas is essential to avoid misdiagnosis or improper disease management.
Adult ; Artifacts ; Diagnostic Errors/*prevention & control ; Female ; Humans ; Male ; Middle Aged ; Thyroid Diseases/*ultrasonography ; Thyroid Gland/anatomy & histology/*ultrasonography ; Ultrasonography/instrumentation

Phyllodes tumors of the breast are rare, accounting for 0.3-0.5% of breast neoplasms. The tumors are divided into benign, borderline and malignant lesions according to the histological features. Phyllodes tumors are commonly recurrent, so wide local excision is considered as the only curable treatment. Therefore, an accurate pre-operative diagnosis can reduce recurrence after treatment. On ultrasonography, benign phyllodes tumors are generally seen as well circumscribed, oval shaped, hypoechoic or isoechoic masses, and occasionally, internal clefts or cystic portions are visible. Borderline or malignant phyllodes tumors tend to be larger and more highly categorized than benign tumors. Most phyllodes tumors present as a palpable mass, which usually require sonographic evaluation with a core biopsy; however, the reported diagnostic accuracy is approximately 60 percent, due to limitations of the histological features. Thus, a follow-up ultrasonographic evaluation is essential after a core biopsy and a phyllodes tumor should be considered in cases of growth occurring after a benign biopsy.
Accounting ; Biopsy ; Breast ; Breast Neoplasms ; Follow-Up Studies ; Phyllodes Tumor ; Recurrence

PURPOSE: To investigate and compare inter-observer variability and diagnostic performance of thyroid ultrasound (US) between a faculty member and observing residents. MATERIALS AND METHODS: From October 2007 to June 2009, 18 residents underwent training in thyroid US section. Group 1 included 8 residents that were trained for the first time and group 2 included 10 residents that were trained for the second time. US features of nodules were recoded according to the composition, echogenicity, margin, calcifications, shape, and final assessment by a faculty member and residents, respectively. Following a discussion, a faculty member performed fine needle aspiration. Then, the inter-observer variability and diagnostic performance between a faculty member and residents were investigated and compared for US. RESULTS: In group 1, agreement for composition in resident 1, calcification for residents 5 and 6, and shape for resident 4 were slight, moderate, moderate, and moderate, respectively. In group 2, agreement for composition in residents 1 and 10 were moderate. Substantial or greater agreement was observed more frequently in group 2 than 1. The diagnostic performances for both the faculty and residents were high and not statistically different. CONCLUSION: Agreement for US features between a faculty and residents as well as diagnostic performance were high. Moreover, diagnostic performance of residents that underwent training a second time of training was higher than residents that underwent training only once.
Biopsy, Fine-Needle ; Observer Variation ; Thyroid Gland

PURPOSE: The efficacy of stenting for the right-side colonic malignant obstruction is unknown. The purpose of this study was to evaluate the safety and feasibility of self-expandable metallic stent insertion for the right-side colonic malignant obstruction and its clinical benefits. METHODS: We retrospectively reviewed clinical data from 460 patients who underwent right hemicolectomy for right-side colon cancer from January 2006 to January 2014 at Korea University Anam Hospital. Twenty four patients who developed malignant obstruction in the right -side colon were identified and analyzed. RESULTS: Self-expandable metallic stent insertion was attempted in 14 patients, and initial technical success was achieved in 13 patients (92.9%). No immediate stent-related complications were reported. Complete relief of obstruction was achieved in all of the 13 patients. Eleven patients who failed stenting underwent emergency operation. All of the 13 patients with stent underwent laparoscopic surgery and only one case was converted to open. Only three patients in the emergency group underwent laparoscopic surgery but one was converted. Operative time and number of retrieved lymph nodes did not differ between the two groups. Postoperative hospital stay (9.8+/-3.2 in stent group vs. 16.3+/-10.9 days in emergency group, p=0.082) tended to be shorter in the stent group. Estimated blood loss (38.5+/-138.7 in stent group vs. 381.8+/-411.9 in emergency group, p=0.010) and duration for resuming diet (3.2+/-2.2 in stent group vs. 6.6+/-7.0 days in emergency group, p=0.017) were significantly better in the stent group. CONCLUSION: Self-expandable metallic stent appears to be safe and feasible in the right-side colonic malignant obstruction. It facilitates minimally invasive surgery and may result in better short-term surgical outcome.
Colon* ; Colonic Neoplasms ; Diet ; Emergencies ; Humans ; Korea ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Operative Time ; Retrospective Studies ; Stents* ; Surgical Procedures, Minimally Invasive

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has led to significant global casualties. This study examines the postoperative impact of COVID-19 on patients who underwent gastrointestinal surgery, considering their heightened vulnerability to infections and increased morbidity and mortality risk. Methods: This retrospective observational study was conducted at a tertiary center and patients who underwent gastrointestinal surgery between January 2022 and February 2023 were included. Postoperative COVID-19 infection was defined as the detection of severe acute respiratory syndrome coronavirus 2 RNA by RT-PCR within 14 days after surgery. Propensity score matching was performed including age, sex, American Society of Anesthesiology physical status classification, and emergency operation between the COVID-19-negative (–) and -positive (+) groups. Results: Following 1:2 propensity score matching, 21 COVID-19(+) and 42 COVID-19(–) patients were included in the study. In the COVID-19(+) group, the postoperative complication rate was significantly higher (52.4% vs. 23.8%, P = 0.023).Mechanical ventilator requirement, intensive care unit (ICU) admission, and readmission rate did not significantly differ between the 2 groups. The median length of ICU (19 days vs. 4 days, P < 0.001) and hospital stay (18 vs. 8 days, P = 0.015) were significantly longer in the COVID-19(+) group. Patients with COVID-19 had a 2.4 times higher relative risk (RR) of major complications than patients without COVID-19 (RR, 2.37; 95% confidence interval, 1.254–4.467; P = 0.015). Conclusion COVID-19 infection during the postoperative period in gastrointestinal surgery may have adverse outcomes which may increase the risk of major complications. Preoperative COVID-19 screening and protocols for COVID-19 prevention in surgical patients should be maintained.

PURPOSE: To evaluate the effectiveness of transcatheter arterial embolization(TAE) and the relationshipbetween therapeutic effect and prognostic factors after this procedure. MATERIALS AND METHODS: Fifty-fivepatients with hemoptysis caused by pulmonary tuberculosis(TB) underwent TAE. We reviewed medical records of thehistory and activity of pulmonary TB, and the extent of treatment, and assessed plain chest PA for the extent oflesions ; we also evaluated the angiographic findings of embolized arteries, and embolic agents. The initialsuccess rate, as shown by immediate response, and recurrence during follow-up, were then observed. Using theChi-square test, differences in these findings were analysed. RESULTS: Immediate control of hemoptysis wasachieved in 46 of 55 patients(84%); 24 of 46(52.2%), experienced recurrence. Initial failure and partial responserates were higher in patients with active pulmonary TB(p<0.05) than in those in whom the condition was inactive.The recurrence rate was higher among those who had had pulmonary TB for between one and ten years (p<0.05). Therewas, however, no significant correlation between therapeutic effect and the extent of anti-TB treatment, theextent of lesions seen on plain chest PA, angiographic findings, embolized arteries, and embolic agents. CONCLUSION: The initial success rate of TAE was 84% and the recurrence rate was as high as 52.2%. Both activityand duration of pulmonary TB were prognostic factors in immediate response and recurrence.
Arteries ; Bronchial Arteries ; Follow-Up Studies ; Hemoptysis* ; Humans ; Medical Records ; Recurrence ; Thorax ; Tuberculosis, Pulmonary*

PURPOSE: To evaluate the frequency and imaging findings of various ventriculo-peritoneal shunt-relatedcomplications in pediatric patients with hydrocephalus. MATERIALS AND METHODS: We retrospectively reviewed 246plain radiographs, three shuntograms, 53 ultrasounds, 133 CT scans, and 24 MR images obtained before and after theventriculo-peritoneal shunt procedure in 33 pediatric patients with hydrocephalus. Using preoperative images, theetiology of the hydrocephalus was assessed. Changes in the size and shape of the ventricles, the location andcontinuity of shunt apparatus, and the presence of any abnormal enhancement, hemorrhage, edema or tissue loss, orother findings of complications, were analyzed on postoperative images; the frequency and imaging findings ofshunt-related complications such as shunt malfunction, infection, hemorrhage or isolated ventricle, andcomplications caused by overdrainage, were thus evaluated. The frequency of such complications was analyzedaccording to the etiology of the hydrocephalus, and in addition, medical records were reviewed and correlated withimaging findings. RESULTS: In 18 of the 33 patients(54%), a total of 31 complications was detected. These werepresent in four of five cases (80%) of hydrocephalus caused by meningitis and ventriculitis, seven of twelve (58%)intraventricular hemorrhage, two of four (50%) unknown cases, three of nine (33%) congenital malformations, one oftwo (50%) tumors, and one (100%) congenital infection. Shunt malfunction was most common(n=15), and wasaccompanied by findings of enlarged ventricles, periventricular and peritubal edema, and abnormal location of theshunt tube. Symptoms and signs of increased intracranial pressure were also noted. Subdural hemorrhage andinfection were present infour cases each;findings of infection were enhancement of the ventricular wall, meninges,and parenchyma, as well as sonographically noted intraventricular septation and increased ventricular wall echo.Isolated lateral ventricle (n=4) or 4th ventricle (n=1) was persistently distended in spite of the presence of ashunt tube within the other ventricle. Collapsed ventricles, thick calvarium, and symptoms of increasedintracranial pressure were helpful in the diagnosis of slit ventricle syndrome(n=1). Immediate postoperativeintraventricular and parenchymal hemorrhage were noted in one case each. CONCLUSION: Shunt-related complicationswere found on postoperative images in 54% of pediatric patients with hydrocephalus; the frequency was highest incases of hydrocephalus caused by infection. Shunt malfunction occurred most frequently and each complication hadvarious imaging findings. For the diagnosis of post-operative shunt-related complication, continuous follow-upstudies are therefore necessary.
Child* ; Diagnosis ; Edema ; Hematoma, Subdural ; Hemorrhage ; Humans ; Hydrocephalus* ; Infant* ; Intracranial Pressure ; Lateral Ventricles ; Medical Records ; Meningitis ; Retrospective Studies ; Skull ; Tomography, X-Ray Computed ; Ultrasonography

PURPOSE: To evaluate the frequency and imaging findings of various ventriculo-peritoneal shunt-relatedcomplications in pediatric patients with hydrocephalus. MATERIALS AND METHODS: We retrospectively reviewed 246plain radiographs, three shuntograms, 53 ultrasounds, 133 CT scans, and 24 MR images obtained before and after theventriculo-peritoneal shunt procedure in 33 pediatric patients with hydrocephalus. Using preoperative images, theetiology of the hydrocephalus was assessed. Changes in the size and shape of the ventricles, the location andcontinuity of shunt apparatus, and the presence of any abnormal enhancement, hemorrhage, edema or tissue loss, orother findings of complications, were analyzed on postoperative images; the frequency and imaging findings ofshunt-related complications such as shunt malfunction, infection, hemorrhage or isolated ventricle, andcomplications caused by overdrainage, were thus evaluated. The frequency of such complications was analyzedaccording to the etiology of the hydrocephalus, and in addition, medical records were reviewed and correlated withimaging findings. RESULTS: In 18 of the 33 patients(54%), a total of 31 complications was detected. These werepresent in four of five cases (80%) of hydrocephalus caused by meningitis and ventriculitis, seven of twelve (58%)intraventricular hemorrhage, two of four (50%) unknown cases, three of nine (33%) congenital malformations, one oftwo (50%) tumors, and one (100%) congenital infection. Shunt malfunction was most common(n=15), and wasaccompanied by findings of enlarged ventricles, periventricular and peritubal edema, and abnormal location of theshunt tube. Symptoms and signs of increased intracranial pressure were also noted. Subdural hemorrhage andinfection were present infour cases each;findings of infection were enhancement of the ventricular wall, meninges,and parenchyma, as well as sonographically noted intraventricular septation and increased ventricular wall echo.Isolated lateral ventricle (n=4) or 4th ventricle (n=1) was persistently distended in spite of the presence of ashunt tube within the other ventricle. Collapsed ventricles, thick calvarium, and symptoms of increasedintracranial pressure were helpful in the diagnosis of slit ventricle syndrome(n=1). Immediate postoperativeintraventricular and parenchymal hemorrhage were noted in one case each. CONCLUSION: Shunt-related complicationswere found on postoperative images in 54% of pediatric patients with hydrocephalus; the frequency was highest incases of hydrocephalus caused by infection. Shunt malfunction occurred most frequently and each complication hadvarious imaging findings. For the diagnosis of post-operative shunt-related complication, continuous follow-upstudies are therefore necessary.
Child* ; Diagnosis ; Edema ; Hematoma, Subdural ; Hemorrhage ; Humans ; Hydrocephalus* ; Infant* ; Intracranial Pressure ; Lateral Ventricles ; Medical Records ; Meningitis ; Retrospective Studies ; Skull ; Tomography, X-Ray Computed ; Ultrasonography

Mutation in HNF1B, the hepatocyte nuclear factor-1beta (HNF-1beta) gene, results in maturity-onset diabetes of the young (MODY) 5, which is characterized by gradual impairment of insulin secretion. However, the functional role of HNF-1beta in insulin secretion and glucose metabolism is not fully understood. We identified a family with early-onset diabetes that fulfilled the criteria of MODY. Sanger sequencing revealed that a heterozygous P159L (CCT to CTT in codon 159 in the DNA-binding domain) mutation in HNF1B was segregated according to the affected status. To investigate the functional consequences of this HNF1B mutation, we generated a P159L HNF1B construct. The wild-type and mutant HNF1B constructs were transfected into COS-7 cells in the presence of the promoter sequence of human glucose transporter type 2 (GLUT2). The luciferase reporter assay revealed that P159L HNF1B had decreased transcriptional activity compared to wild-type (p < 0.05). Electrophoretic mobility shift assay showed reduced DNA binding activity of P159L HNF1B. In the MIN6 pancreatic beta-cell line, overexpression of the P159L mutant was significantly associated with decreased mRNA levels of GLUT2 compared to wild-type (p < 0.05). However, INS expression was not different between the wild-type and mutant HNF1B constructs. These findings suggests that the impaired insulin secretion in this family with the P159L HNF1B mutation may be related to altered GLUT2 expression in beta-cells rather than decreased insulin gene expression. In conclusion, we have identified a Korean family with an HNF1B mutation and characterized its effect on the pathogenesis of diabetes.
Animals ; Codon ; COS Cells ; Diabetes Mellitus, Type 2* ; DNA ; Electrophoretic Mobility Shift Assay ; Gene Expression ; Glucose ; Glucose Transporter Type 2 ; Hepatocyte Nuclear Factor 1-beta ; Humans ; Insulin ; Luciferases ; Metabolism ; Point Mutation ; RNA, Messenger