The Change of Practice Patterns of the Hereditary Breast Cancer Management in Korea after the Korean Hereditary Breast Cancer Study

본 논문은 2010 한국유방암학회 춘계학술대회에서 구연 발표되었음.Purpose: The objective of this study was to evaluate the change in the practice patterns for managing hereditary breast and ovarian cancer (HBOC) among Korean physicians after the Korean Hereditary Breast Cancer (KOHBRA) study. Methods: The first survey was performed from July to August 2007, at the initiation of the KOHBRA study, and the follow-up survey was conducted from July to December 2009. Members of the Korean Breast Cancer Society were invited to participate in the study by e-mail. The 2009 survey was conducted with a self-administered questionnaire concerning HBOC management and was identical to the previous questionnaire. Results: According to the 2009 survey, most physicians (60.0%) tended to draw a pedigree (48.0% in 2007 survey). The rate of genetic test recommendations for patients at risk for HBOC was higher in the 2009 survey (84.0%) than that in the 2007 survey (64.0%). Physicians tended to select a BRCA genetic testing candidate more appropriately than in the previous survey (42.4% answered right in 2007 survey; 74.4% in 2009 survey). Fifteen of 25 participants (60.0%) provided genetic counseling before their patients underwent a genetic test, which was higher than that (40.0%) in the 2007 survey. According to the 2009 survey, half of the genetic counseling was being conducted by KOHBRA study research nurses; whereas most of the genetic counseling was conducted by physicians in 2007. Conclusion: The KOHBRA study has played an important role in the appropriate selection of candidates for genetic testing. However, more effort should be placed on improving the pre-test genetic counseling rate.본 연구는 보건복지부 암정복연구비의 지원을 받아 시행되었음(과제번호 0720450).Robson ME, 2010, J CLIN ONCOL, V28, P893, DOI 10.1200/JCO.2009.27.0660Han SA, 2009, J BREAST CANCER, V12, P92, DOI 10.4048/jbc.2009.12.2.92Ko SS, 2008, J SURG ONCOL, V98, P318, DOI 10.1002/jso.21110Kim KS, 2008, J BREAST CANCER, V11, P95Kim EK, 2007, J BREAST CANCER, V10, P241Chenevix-Trench G, 2007, BREAST CANCER RES, V9, DOI 10.1186/bcr1670Fisher B, 2005, J NATL CANCER I, V97, P1652, DOI 10.1093/jnci/dji372Eisen A, 2005, J CLIN ONCOL, V23, P7491, DOI 10.1200/JCO.2004.00.7138Nelson HD, 2005, ANN INTERN MED, V143, P362Green MJ, 2004, JAMA-J AM MED ASSOC, V292, P442Choi DH, 2004, J CLIN ONCOL, V22, P1638, DOI 10.1200/JCO.2004.04.179Ahn SH, 2004, J KOREAN MED SCI, V19, P269Rebbeck TR, 2004, J CLIN ONCOL, V22, P1055, DOI 10.1200/JCO.2004.04.188Antoniou A, 2003, AM J HUM GENET, V72, P1117Rebbeck TR, 2002, NEW ENGL J MED, V346, P1616KANG HC, 2002, HUM MUTAT, V20, P235Malone KE, 2000, CANCER, V88, P1393Hartmann LC, 1999, NEW ENGL J MED, V340, P77Fisher B, 1998, J NATL CANCER I, V90, P1371Ford D, 1998, AM J HUM GENET, V62, P676Parmigiani G, 1998, AM J HUM GENET, V62, P145ShattuckEidens D, 1997, JAMA-J AM MED ASSOC, V278, P1242Dinkel MK, 1997, J CLIN ONCOL, V15, P2157Claus EB, 1996, CANCER, V77, P2318WOOSTER R, 1995, NATURE, V378, P789OH JH, 1995, J KOREAN CANC ASS, V27, P1061FRIEDMAN LS, 1994, NAT GENET, V8, P399*NAT COMPR CANC NE, NCCN CLIN PRACT GUID

The Breast and Ovarian Cancer Risks in Korea Due to Inherited Mutations in BRCA1 and BRCA2: A Preliminary Report

본 논문은 2007 Global Breast Cancer Conference (GBCC)에서 포스터 발표되었음.Purpose: To estimate the cumulative risk till each age (penetrance) of breast and ovarian cancers among female family members with BRCA1 and BRCA2 mutation. Methods: Among the 61 BRCA1 mutation carriers in the 42 families and 47 BRCA2 mutation carriers in 31 families identified at 5 academic breast clinics, the probands were excluded to estimate the cumulative risk till each age of breast cancer in the Korean BRCA1 and BRCA2 carriers. Using Kaplan-Meier analyses, cumulative cancer risk estimates were determined. Results: By the age 70, the female breast cancer risk for the BRCA1 and BRCA2 mutation carriers was 72.1% (95% confidence interval [CI]=59.5% to 84.8%) and 66.3% (95% CI=41.2% to 91.5%), respectively, and the ovarian cancer risk was 24.6% (95% CI=0% to 50.3%) and 11.1% (95% CI=0% to 31.6%), respectively. The contralateral breast cancer risk at 5 years after primary breast cancer was estimated as 16.2% (95% CI=9.3% to 23.1%) for the 52 breast cancer patients with the BRCA1 mutation and 17.3% (95% CI=9.7% to 24.0%) for the 35 breast cancer patients with the BRCA2 mutation. Conclusion: The penetrance of BRCA mutations in Korea is largely consistent with the previous studies on Western populations. However, the small number of the cases, the high proportions of probands in the study subjects, the short term follow-up, and large confidence intervals are the limitations of the current study. The Korean Hereditary Breast Cancer Study (KOHBRA Study) may definitely answer this question.Kim KS, 2008, J BREAST CANCER, V11, P95Kim EK, 2007, J BREAST CANCER, V10, P241Vogl FD, 2007, FAM CANCER, V6, P63, DOI 10.1007/s10689-006-9106-8Ahn SH, 2007, CANCER LETT, V245, P90, DOI 10.1016/j.canlet.2005.12.031Schlich-Bakker KJ, 2006, PATIENT EDUC COUNS, V62, P13, DOI 10.1016/j.pec.2005.08.012Metcalfe K, 2004, J CLIN ONCOL, V22, P2328, DOI 10.1200/JCO.2004.04.033Choi DH, 2004, J CLIN ONCOL, V22, P1638, DOI 10.1200/JCO.2004.04.179King MC, 2003, SCIENCE, V302, P643Antoniou A, 2003, AM J HUM GENET, V72, P1117Kauff ND, 2003, CANCER, V97, P1601, DOI 10.1002/cncr.11225Liede A, 2002, HUM MUTAT, V20, P413, DOI 10.1002/humu.10154Brose MS, 2002, J NATL CANCER I, V94, P1365IKEDA N, 2002, J BREAST CANCER, V5, P194Eng C, 2001, J MED GENET, V38, P824Risch HA, 2001, AM J HUM GENET, V68, P700ROBSON ME, 2001, CURR PROB SURG, V38, P387Ponder BAJ, 2000, BRIT J CANCER, V83, P1301Matloff ET, 2000, J CLIN ONCOL, V18, P2484Wagner TMU, 2000, BRIT J CANCER, V82, P1249Julian-Reynier C, 2000, EUR J HUM GENET, V8, P204Schrag D, 2000, JAMA-J AM MED ASSOC, V283, P617Antoniou AC, 2000, GENET EPIDEMIOL, V18, P173Arnold N, 1999, HUM MUTAT, V14, P333Newman B, 1998, JAMA-J AM MED ASSOC, V279, P915Ford D, 1998, AM J HUM GENET, V62, P676Claus EB, 1996, CANCER, V77, P2318Nieto FJ, 1996, AM J EPIDEMIOL, V143, P1059FORD D, 1995, AM J HUM GENET, V57, P1457EASTON DF, 1995, AM J HUM GENET, V56, P265FORD D, 1994, LANCET, V343, P692KAPLAN EL, 1958, J AM STAT ASSOC, V53, P457

Anatomy of the New Energy Great Game among the United States, Russia and China in the Middle East: The US Energy Belt Building Strategy and its Origins

본 연구는 최근 중동지역에서 미국, 중국, 러시아 간에 벌어지고 있는 에너지 그레이트 게임의 개념 및 동향을 분석하고, 특히 미국의 지역 내 에너지 벨트 라인 구축 전략과 배경을 면밀히 해부하며, 중국과 러시아의 대 중동 전략에 중점을 맞추면서 중동정치혼란의 근본적인 원인을 규명하는데 초점을 맞춘다. 본 논문은 1948년 이후 발생한 여러 유형의 중동문제 근원이 19세기 말과 20세기 초 그레이트 게임(Great Game)을 벌이던 영국과 러시아 및 서방국가들이 제1차 세계대전에서 승리함에 따라 오스만투르크 제국을 해체시킨 이후, 과거 오스만투르크 영토 내 석유자원을 확보하고 이를 효과적으로 운영 관리 하기 위하여 무자비하게 혹은 인위적으로 그은 잘못된 국경선 문제에서 출발하였으며, 이러한 석유정치를 앞세운 강대국들의 힘의 균형이 중동 내 지역정치와 매우 복잡하게 얽혀서 발생한다고 주장한다. 다시 말해 중동문제에 있어서 특히 유심히 볼 대목은 서방의 강대국들과 중동 내 석유자원을 보유한 토착 정치 세력과의 이해관계 설정 방식이라는 점이다. 또한 본 연구는 중동지역의 절대강자인 미국의 에너지 벨트라인 구축의 세부적인 전략과 미국의 중국, 러시아, 이란, 이라크, 사우디아라비아를 상대로 구사하는 각종 에너지 피벗 플레이(Pivot Play)의 구체적인 전술을 면밀히 분석한다. 본 연구의 결론은 중동지역에서 미중러의 힘의 균형은 흔히 이솝 우화에 비유되곤 하는데, 중동지역에서 미국은 늑대, 러시아와 중국은 여우와 산토끼의 역할을 때에 따라 번갈아 가면서 하는데, 요점은 여우와 산토끼가 아무리 힘을 합쳐도 절대 늑대를 능가할 수 없다라는 점이다. 마지막으로 본 연구는 향후 중동문제를 인식하는 하나의 거시적이고 정형화된 틀, 즉 중동문제인식의 프리즘(Prism)을 구축하는 것을 목적으로 하며, 향후 미중러의 대 중동 행보를 예측하고 장기적인 관점에서 중동 문제에 대한 해답의 실마리를 찾고, 세계 에너지 지정학의 이해를 도모 하는 것을 연구목표로 설정한다. The main purpose of this article is to explore the anatomy of the new energy great game among three major global powers: the United States, Russia and China in the Middle East, focusing upon the US energy belt building strategy. The article seeks to discover the origins of the Middle Eastern problem which has persisted for about one century and to establish some overarching framework to access various type of the current Middle Eastern conflict. The article contends that Middle Eastern problem was caused by the careless and senseless boundary which was drawn by the major western great powers following the collapse of the Ottoman Empire at the end of the World War I. The Great Britain, France and Russia considered the Middle East as simply the piece of dessert and created strange borderlines regardless of nationalities, tribes, history and religion differences in the region. This is mainly due to the fact that western powers simply wanted to take control of the region in order to take massive oil fields and assets. Similar story also applies to the current situation in the region after the US, Russia and China replaced the Great Britain, France and the Soviet Union decades later. Perhaps the most important discussion regarding the new energy great game in the region is special relations between the three global powers and the three regional powers including Saudi Arabia, Iran and Iraq. In this regard, this article specifically investigates the US energy pivot play strategies toward Russia, China, Saudi Arabia, Iran and Iraq respectively. The study concludes that as the new energy great game can be often compared to the tale of wolf, fox and wild rabbit, it is highly unlikely that the even combining force of a fox and a wild rabbit (Russia and China either role of these two) will ever beat one single wolf (the US)

초단펄스를 이용한 전해 미세구멍 가공

Thesis (master`s)--서울대학교 대학원 :기계항공공학부,2003.Maste

Surgical Treatment of Graves' Disease

1989년 7월부터 1992년 12월까지 울산대학교 의과대학 서울중앙병원 외과에서 Graves씨병으로 수술치료를 받고 추적관찰이 가능하였던 35명의 환자를 대상으로 다음과 같은 결과를 얻어 문헌고찰과 함께 보고하는 바이다. 1) 남녀비는 1:2.9로 여자에게 호발하였으며 중간 연령은 26세로 20대 17명(48.6%), 30대 5명(14.3%)으로 20대와 10대에서 가장 호발하였다. 2) 임상증상과 이학적소견상 경부종물이 전환자에서 관찰되었으며 빈맥은 32예(91.4%), 발한은 30예(87.5%), 피로감은 22예(62.9%), 체중감소는 21예(60.0%), 안구돌출은 16예(45.7%), 진전은 14예(40.0%)였다. 3) 갑상선기능검사는 최초의 혈청 T₃의 평균치가 501.2ng/dl, T₄의 평균치가 14.7ng/dl, TSH의 평균치가 3.14uu/ml였고 수술후의 평균검사치는 T₃가 138.9ng/dl, T₄가 7.66ug/dl, THS가 5.53uu/ml로 정상범위로 회복되었다. 면역학적 검사는 thyroglobulin 항체가 48.3%, microsome 항체가 89.7%의 양성률을 보여 가장 높은 적중률을 보였다. 갑상선주사검사상 전 예에서 방사선섭취의 증가를 관찰할 수 있었다. 4) 수술적응증은 항갑상선제제요법에 반응이 좋지 않았던 예가 14예, 내과치료후 거대갑상선종이 11예로 가장 많았고 수술 전처치로는 22예(62.9%)에서 propranolol, Lugol solution, 항갑선상제제를 병합투여했으며, 13예(37.1%)에서는 Lugol solution와 항갑상선제제를 투여하였다. 5) 수술방법은 19예에서 양엽아전절제술, 15예에서 일측엽전절제술 및 반대측 아전절제술, 1예에서 일측엽전절제술 및 협절제술을 시행하였으며 잔여조직은 평균 5.6gm였고 전 예에서 회귀후두신경을 확인 보존하였다. 6) 수술후 합병증은 일시적 저칼슘협증이 6예로 가장 많았고 일시적인 목소리변성이 2예 있었다. 재수술을 요하는 출혈이나 창상감염은 없었으며 사망 역시 발생하지 않았다. 7) 수술후 정상 갑상선기능을 보인 예가 22명(62.9%)으로 가장 많았고, 잠복성 갑상선기능저하는 9명(25.7%), 갑상선기능항진은 3명(8.6%), 갑상선기능저하는 1예(2.9%)에서 발견되었다. 8) 결론적으로 Graves씨병의 수술치료는 수술전 처치의 발달과 안정된 수술수기로 인하여 치료효과가 높은 치료방법이나 수술후 갑상선기능의 가장 중요한 인자로 인정되는 잔여갑상선의 양을 신중히 고려해야 하며 수술후 정기적 추적관찰이 필수적이며 이에 따른 적절한 치료가 필요하다고 사료되는 바이다.A clinical study on Graves' disease was made to 35 patients who received operation at the department of surgery of Asan medical center from July. 1989 to Dec. 1992. The results were as follows. 1) Male to female ratio was 1:2.9 and median age at operation was 26 years with highest incidence in the second and first decade. 2) Almost all of patients had neck mass, palpitation and sweating. Other symptoms were fatigue, weight loss, exophthalmus, tremor, nervouness, irregular mentruation, headache, and dyspnea in the order of decreasing frequency. 3) In thyroid function test, initial mean value of T₃and T₄was 501.2ng/dl and 14.7ug/dl, postoperative mean value of T₃and T₄was 138.9ng/dl and 7.66 ug/dl espectively. Radioiodine uptake was increased in all cases. 4) As a preoperative preparation, antithyroid drug, Lugol solution and propranolol were given to 22 patients(62.9%) and antithyroid drug and Lugol solution were given to 13 patients(37.1%). 5) Methods of operation were bilateral subtotal thyroidectomy in 19 patents, unilateral total and contralateral subtotal lobectomy in 15 patients, and lobectomy with isthmectomy in 1 patient. The estimated average weight of remaining thyoid tissue was 5.6 grams. 6) Postoperative complications were symptomatic transient hypocalcemia in 6 cases(17.1%) and transient voice change in 2 cases(5.7%) but there was no permanent hypoparathyroidism, recurrent laryngeal nerve injury or postoperative death. 7) Follow up period was 3 to 36 months(mean 8.5 months) and there were euthyroids in 22 patients(62.9%), latent hypothroids in 9 patients(25.7%), hyperthyroids in 3 patients(8.6%), and hypothyroid in 1 patient(2.9%).A clinical study on Graves' disease was made to 35 patients who received operation at the department of surgery of Asan medical center from July. 1989 to Dec. 1992. The results were as follows. 1) Male to female ratio was 1:2.9 and median age at operation was 26 years with highest incidence in the second and first decade. 2) Almost all of patients had neck mass, palpitation and sweating. Other symptoms were fatigue, weight loss, exophthalmus, tremor, nervouness, irregular mentruation, headache, and dyspnea in the order of decreasing frequency. 3) In thyroid function test, initial mean value of T₃and T₄was 501.2ng/dl and 14.7ug/dl, postoperative mean value of T₃and T₄was 138.9ng/dl and 7.66 ug/dl espectively. Radioiodine uptake was increased in all cases. 4) As a preoperative preparation, antithyroid drug, Lugol solution and propranolol were given to 22 patients(62.9%) and antithyroid drug and Lugol solution were given to 13 patients(37.1%). 5) Methods of operation were bilateral subtotal thyroidectomy in 19 patents, unilateral total and contralateral subtotal lobectomy in 15 patients, and lobectomy with isthmectomy in 1 patient. The estimated average weight of remaining thyoid tissue was 5.6 grams. 6) Postoperative complications were symptomatic transient hypocalcemia in 6 cases(17.1%) and transient voice change in 2 cases(5.7%) but there was no permanent hypoparathyroidism, recurrent laryngeal nerve injury or postoperative death. 7) Follow up period was 3 to 36 months(mean 8.5 months) and there were euthyroids in 22 patients(62.9%), latent hypothroids in 9 patients(25.7%), hyperthyroids in 3 patients(8.6%), and hypothyroid in 1 patient(2.9%)