Previously, we reported the concept of a cloud-based telemedicine platform for patients with intracerebral hemorrhage (ICH) at local emergency rooms in rural and medically underserved areas in Gangwon state by combining artificial intelligence and remote consultation with a neurosurgeon. Developing a telemedicine ICH treatment protocol exclusively for doctors with less ICH expertise working in emergency rooms should be part of establishing this system. Difficulties arise in providing appropriate early treatment for ICH in rural and underserved areas before the patient is transferred to a nearby hub hospital with stroke specialists. This has been an unmet medical need for decade. The available reporting ICH guidelines are realistically possible in university hospitals with a well-equipped infrastructure. However, it is very difficult for doctors inexperienced with ICH treatment to appropriately select and deliver ICH treatment based on the guidelines. To address these issues, we developed an ICH telemedicine protocol. Neurosurgeons from four university hospitals in Gangwon state first wrote the guidelines, and professors with extensive ICH expertise across the country revised them. Guidelines and recommendations for ICH management were described as simply as possible to allow more doctors to use them easily. We hope that our effort in developing the telemedicine protocols will ultimately improve the quality of ICH treatment in local emergency rooms in rural and underserved areas in Gangwon state.

Objective: 177 Lutetium [Lu] Ludotadipep is a novel prostate-specific membrane antigen targeting therapeutic agent with an albumin motif added to increase uptake in the tumors. We assessed the biodistribution and dosimetry of [ 177 Lu]Ludotadipep in patients with metastatic castration-resistant prostate cancer (mCRPC). Materials and Methods: Data from 25 patients (median age, 73 years; range, 60–90) with mCRPC from a phase I study with activity escalation design of single administration of [ 177 Lu]Ludotadipep (1.85, 2.78, 3.70, 4.63, and 5.55 GBq) were assessed. Activity in the salivary glands, lungs, liver, kidneys, and spleen was estimated from whole-body scan and abdominal SPECT/CT images acquired at 2, 24, 48, 72, and 168 h after administration of [ 177 Lu]Ludotadipep. Red marrow activity was calculated from blood samples obtained at 3, 10, 30, 60, and 180 min, and at 24, 48, and 72 h after administration. Organand tumor-based absorbed dose calculations were performed using IDAC-Dose 2.1. Results: Absorbed dose coefficient (mean ± standard deviation) of normal organs was 1.17 ± 0.81 Gy/GBq for salivary glands, 0.05 ± 0.02 Gy/GBq for lungs, 0.14 ± 0.06 Gy/GBq for liver, 0.77 ± 0.28 Gy/GBq for kidneys, 0.12 ± 0.06 Gy/GBq for spleen, and 0.07 ± 0.02 Gy/GBq for red marrow. The absorbed dose coefficient of the tumors was 10.43 ± 7.77 Gy/GBq. Conclusion [ 177 Lu]Ludotadipep is expected to be safe at the dose of 3.7 GBq times 6 cycles planned for a phase II clinical trial with kidneys and bone marrow being the critical organs, and shows a high tumor absorbed dose.

The gastrointestinal tract is the most common extranodal site for lymphomas, and mucosa-associated lymphoid tissue lymphoma is the second most common histological lymphoma subtype. However, primary esophageal mucosa-associated lymphoid tissue lymphomas are extremely rare. Few such cases are documented, and the reports demonstrate inconsistent diagnostic and therapeutic strategies. Herein, a 54-year-old man was referred to our hospital for treatment of dysphagia. Esophagogastroduodenoscopy revealed a large, horseshoe-shaped subepithelial mass in the upper esophagus. Endoscopic ultrasonography and computed tomography revealed that the mass was well-demarcated and confined to the muscularis mucosa, with no abnormalities in other organs or lymph nodes. The mass was presumptively diagnosed as benign, and the patient underwent endoscopic mucosal dissection for pathological confirmation and symptom relief. Pathological examination of the dissection specimen revealed that it was a primary esophageal mucosa-associated lymphoid tissue lymphoma. As the patient had an elevated immunoglobulin G level and Helicobacter pylori infection, we administered adjuvant eradication therapy. The patient remains under surveillance and is free of lymphoma recurrence 36 months postoperatively. This case report demonstrates that endoscopic resection and H. pylori eradication are effective treatment strategies for early-stage esophageal mucosa-associated lymphoid tissue lymphoma.

Background: The effects of far-infrared radiation (FIR) on the treatment of rotator cuff diseases remains unknown. We evaluated the safety and efficacy of FIR after arthroscopic rotator cuff repair with regard to postoperative pain and healing. Methods: This prospective randomized comparative study included 38 patients who underwent arthroscopic rotator cuff repair due to a medium-sized tear. Patients were randomly divided into the FIR or control group (n = 19 per group). In the FIR group, FIR with an FIR radiator started 1 week postoperatively for 30 minutes per session twice daily. It lasted until abduction brace weaning at 5 weeks postoperatively. We assessed pain using a pain visual analogue scale (pVAS) and measured the range of motion (ROM) of the shoulder at 5 weeks, and 3 and 6 months, postoperatively. The anatomical outcome was evaluated using magnetic resonance imaging at 6 months postoperatively. Results: At 5 weeks postoperatively, the average pVAS score was lower in the FIR group than in the control group (1.5 ± 0.8 vs. 2.7 ± 1.7; P = 0.019). At 3 months postoperatively, the average forward flexion was higher in the FIR group (151.6° ± 15.3° vs. 132.9° ± 27.8°;P = 0.045), but there was no significant difference at 6 months postoperatively. There was no significant difference in healing failure between the groups (P = 0.999). Conclusions FIR after arthroscopic rotator cuff repair could be an effective and safe procedure to reduce postoperative pain, thereby facilitating rehabilitation and better ROM in the early postoperative period.

PURPOSE: Triple-positive breast cancer is defined by estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) positivity. Several systemic breast cancer therapies target hormonal and HER2 responsiveness. We compared clinical outcomes of triple-positive disease with those of HER2-enriched and luminal HER2-negative disease and investigated the clinical efficacy of anti-HER2 therapy for triple-positive disease. METHODS: We retrospectively compared overall and recurrence-free survival among cases included in the Korean Breast Cancer Society (KBCS) and Seoul St. Mary's Hospital breast cancer registries and the therapeutic efficacy of trastuzumab for triple-positive and HER2-enriched cases. RESULTS: KBCS registry data (2006–2010; median follow-up, 76 months) indicated that patients with triple-positive breast cancer had intermediate survival between those with luminal A and HER2-enriched subtypes (p < 0.001). Trastuzumab did not improve overall survival among patients with triple-positive breast cancer (p=0.899) in contrast to the HER2-enriched subtype (p=0.018). Seoul St. Mary's Hospital registry data indicated similar recurrence-free survival outcomes (p < 0.001) and a lack of improvement with trastuzumab among patients with triple-positive breast cancer (median follow-up, 33 months; p=0.800). Multivariate analysis revealed that patients with triple-positive breast cancer had better overall survival than those with HER2-enriched disease and similar survival as those with the luminal A subtype (triple-positive: hazard ratio, 1.258, p=0.118; HER2-enriched: hazard ratio, 2.377, p < 0.001). CONCLUSION: Our findings showed that anti-HER2 therapy was less beneficial for treatment of triple-positive breast cancer than for HER2-enriched subtypes of breast cancer, and the triple-positive subtype had a distinct prognosis.
Breast Neoplasms* ; Breast* ; Estrogens ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Phenobarbital ; Prognosis ; Receptor, Epidermal Growth Factor ; Receptor, ErbB-2 ; Receptors, Estrogen ; Receptors, Progesterone ; Registries ; Retrospective Studies ; Seoul ; Trastuzumab ; Treatment Outcome

Since 2013, the Hospital-based Influenza Morbidity and Mortality (HIMM) surveillance system began a H7N9 influenza surveillance scheme for returning travelers in addition to pre-existing emergency room (ER)-based influenza-like illness (ILI) surveillance and severe acute respiratory infection (SARI) surveillance. Although limited to eastern China, avian A/H7N9 influenza virus is considered to have the highest pandemic potential among currently circulating influenza viruses. During the study period between October 1st, 2013 and April 30th, 2016, 11 cases presented with ILI within seven days of travel return. These patients visited China, Hong Kong, or neighboring Southeast Asian countries, but none of them visited a livestock market. Seasonal influenza virus (54.5%, 6 among 11) was the most common cause of ILI among returning travelers, and avian A/H7N9 influenza virus was not detected during the study period.
Asian Continental Ancestry Group ; China ; Emergency Service, Hospital ; Hong Kong ; Humans ; Influenza A Virus, H7N9 Subtype ; Influenza, Human ; Livestock ; Mortality ; Orthomyxoviridae ; Pandemics ; Seasons

Antipsychotics are the drug of choice for patients with schizophrenia, but they can induce hyperprolactinemia and growth of pituitary adenomas by blocking dopamine 2 receptors in the pituitary gland. In contrast, the medical treatment for a prolactinoma is a dopamine agonist. Therefore, managing a patient concurrently diagnosed with a prolactinoma and psychosis is challenging. We describe a patient with schizophrenia who was diagnosed with a prolactinoma. We changed his neuroleptic to quetiapine and prescribed bromocriptine for the prolactinoma. As a result, the patient was successfully treated with a dopamine agonist and antipsychotic without psychotic exacerbation. Our case suggests that dopamine agonists can be administrated to patients with schizophrenia and a prolactinoma without adversely affecting their psychopathological status.
Antipsychotic Agents ; Bromocriptine ; Dopamine ; Dopamine Agonists ; Humans ; Hyperprolactinemia ; Pituitary Gland ; Pituitary Neoplasms ; Prolactinoma ; Psychotic Disorders ; Schizophrenia ; Quetiapine Fumarate

Actinomycosis is a chronic granulomatous disease caused by the species of Actinomyces. Although it has become a rare disease in the present antibiotics era, it still needs long term antibiotic treatment and often mis- or delayed- diagnosed due to no typical sign and symptoms. Most often, it occurs in the cervicofacial region. Middle ear is not a common site for Actinomycosis, and the inner ear involvement is extremely rare. Here, we report a case of middle ear Actinomycosis involving facial nerve and lateral semicircular canal.
Actinomyces ; Actinomycosis* ; Anti-Bacterial Agents ; Ear, Inner ; Ear, Middle* ; Facial Nerve* ; Granulomatous Disease, Chronic ; Rare Diseases ; Semicircular Canals* ; Temporal Bone

BACKGROUND AND OBJECTIVES: Assessing accurate audiometry might be an important index treating patients with hearing loss. So far there have been no studies on analysis of correlations between pure tone audiometry (PTA) and auditory steady-state response (ASSR) for children in Korea. We analyzed correlations between PTA and ASSR in order to investigate the usefulness of ASSR. SUBJECTS AND METHOD: Past medical records were retrieved from the patients who visited Department of Otolaryngology at Tertiary Referral Hospital from January 2012 to December 2012 and underwent the correlation study between ASSR and PTA with a correlation analysis of frequency. The participants over the age of 15 were classified into the adult group and those below in the children group. RESULTS: There was a statistically significant correlation between the average hearing threshold of ASSR and PTA (correlation coefficient=0.934). There was a strong correlation between children and adult group, too. With the frequency range of 500, 1000, 2000, and 4000 Hz, the correlation coefficients were 0.875, 0.896, 0.915, and 0.900, respectively. The degree of hearing loss was classified by using PTA follows: below 25 dB as normal; between 26-55 dB as moderate hearing loss; above 56 dB as severe hearing loss. Correlation coefficients for the above hearing ranges were 0.527, 0.670, and 0.744, respectively. Strong correlation was found between children and adult group, too. CONCLUSION: The comparison results between the average hearing threshold of ASSR and PTA indicated that the threshold of ASSR could well reflect the results of both children and adult group.
Adult* ; Audiometry* ; Child* ; Evoked Potentials, Auditory ; Hearing ; Hearing Loss ; Humans ; Korea ; Medical Records ; Otolaryngology ; Statistics as Topic ; Tertiary Care Centers

Osteoma of the temporal bone most commonly occurs in the external ear. Osteomas in the middle ear are not common, and only 25 relevant cases (18 papers) have been reported in the English literature. With only 5 cases reported to date, osteoma of the promontory in the middle ear is rare. This study reports a case of asymptomatic osteoma of the promontory in the middle ear mimicking a congenital cholesteatoma in a 4-year-old girl.
Child, Preschool ; Cholesteatoma* ; Ear, External ; Ear, Middle ; Female ; Humans ; Osteoma* ; Temporal Bone