플라톤과 부끄러움의 정치학

학위논문 (석사)-- 서울대학교 대학원 : 정치외교학부, 2015. 8. 유홍림.This thesis aims to explore the political meaning of shame from Platos conception of shame. Shame is a complex phenomenon composed of emotion, cognition, and sociality. It is also a phenomenon with ambivalent character, for shame can lead a person to interact in a proper manner, while it can also compel a person to withdraw from discussion and social participation. Among the ancient Greek literature that portrays the Greek culture which was especially sensitive to shame, Platos dialogues manifest the political meaning of shame. Plato, utilizing shame as a leitmotif in his dialogues, displays the complex and ambivalent character of shame. Therefore, by reconstructing Platos conception of shame from a comprehensive analysis of the Platonic corpus, this thesis illuminates the political meaning of shame in Plato, and the political implication of shame in our political life. Based on the two manners that Plato employs to display shame, this study examines Platos dialogues in three stages. Plato, on the one hand, portrays shame as a subject of his characters discussion. On the other hand, he presents shame as a psychological experience of his characters. To reconstruct Platos conception of shame, this thesis first explores the complex nature of shame, which is illustrated in the texts where shame appears as a subject of conversation. Second stage is designed to investigate diverse dramatic manifestations of shame, which are demonstrated in the texts where the characters experience shame. Then, with the analyses from the previous two stages, the third stage is to examine the function of shame in relation to its connection with virtues. From the analyses, this study finds the following points. First, it is shown in Platos conception of shame that he was aware of its complex and ambivalent character. In the texts where i) the quasi-definition of shame, ii) the location of shame in tripartite soul, and iii) the origin of shame are discussed about by the characters, Platos descriptions illustrate the emotional, cognitive, and social aspects of shame. Moreover, the location of shame in the spirited part of the soul explains that the contrasting effects of shame depend on which of the two parts, the rational or the appetitive, shame associates with. Second, through diverse manifestations of shame, Plato shows that shame experience, if properly formed, can bring a certain change in a person. By distinguishing three types of shame according to the three critical factors of shame experience, this study examines the proper condition of shame experience. Third, Platos descriptions of the relationships between shame and the four virtues show that the change shame brings to a person is, in specific, the cultivation of the virtues in oneself. In conclusion, the political meaning of shame in Plato is that shame functions in civic education as a catalyst for nurturing the civic virtues. Guiding a person to a better way of life by fostering civic virtues, Platos conception of shame plays a significant role in his soul-craft and state-craft. Furthermore, as shame provides a certain kind of practical knowledge, which education by texts cannot cover, Platos conception of shame offers the political implications of shame in our political life, too.Chapter I. Introduction: Why Does Shame Matter Now? 1 Chapter II. The Complex Nature of Shame 21 1. Quasi-Definition of Shame: Euthyphro, Laws 22 2. The Place of Shame in Tripartite Soul: Republic, Phaedrus 29 3. The Origin of Shame: Protagoras, Symposium 35 Chapter III. Dramatic Manifestations of Shame 39 1. First Type: Avoiding Shame 42 2. Second Type: Confronting Shame 56 3. Third type: Socratic Shame 64 Chapter IV. Shame and Virtue 72 1. Shame and Justice 72 2. Shame and Temperance 75 3. Shame and Courage 78 4. Shame and Wisdom 82 Chapter V. Conclusion: The Political Implications of Shame 85 Bibliography 95 Abstract (Korean) 107Maste

데카르트의 꿈의 논증과 정합성을 기반으로 한 그 탈출시도에 관하여

너무나도 생생한, 그래서 깨고 난 뒤에 실제로 심장이 빨라졌거나 땀을 흘렸던 꿈의 경험은 그리 어렵지 않게 찾아 볼 수 있다. 때로는 꿈속의 일이 마치 실제 겪은 일처럼 또렷하게 기억에 남는 경우도 있다. 심지어 장자의 호접지몽에서는 내가 나비인 것이 꿈인지 사람인 것이 꿈인지가 혼동되기도 한다. 이런 사례들을 보면 꿈속에서 우리의 감각은 우리에게 사실만을 전달해주기보다 거짓을 전달해주는 듯하다. 데카르트는 꿈의 이런 특성에서 착상을 얻어 꿈의 논증'을 제시했다. 이는 확고 불변한 최초의 토대를 찾아 새로운 체계를 세우고자 한『성찰』에서 감각경험의 원리를 무너뜨리는 논증으로 사용된다. 이 글에서는 꿈의 논증의 내용을 살펴보고, 논증의 결과 무너진 감각경험의 원리를 데카르트가 어떻게 재정립하는지, 또 얼마나 잘 재정립하는지 살펴보고자 한다. 우선 논증의 내용 분석에 있어서는 논증에서 의심의 대상이 되는 믿음들 및 논증결과 살아남은 믿음들이 무엇인지를 중심으로 살펴볼 것이다. 이후 데카르트가 꿈의 논 증으로부터 벗어날 수 있는 근거로서 제6성찰에서 제시한 방법이 무엇인지 확인할 것이다. 마지막으로는 그것이 얼마나 좋은 해결책인지 검토하고 나름대로의 평가를 내려 보고자 한다. 기본 분석 문헌은 데카르트의『성찰』(이현복 역, 서울 : 문예출판사, 1997)로 한다

Papillary Thyroid Microcarcinoma: Clinicopathologic Characteristics and Treatment Strategy

Purpose: The clinical importance of papillary microcarcinoma (PTMC) is debatable. Because PTMC is being diagnosed with increasing frequency, it is important to describe the clinical and histological characteristics that confer aggressive behavior to this cancer. This study was carried out to evaluate the clinical and histological characteristics of PTMC and to determine an appropriate treatment strategy for such cases. Methods: From Jan. 2000 to Dec. 2005, 1,255 patients with small papillary carcinoma, which measured less than 2.0 cm in its greater dimension, underwent total thyroidectomy at our institution. Among these patients, 633 (50.4%) had a thyorid carcinoma less than or equal to 1 cm in diameter (Group A). The clinicopathologic features and treatment outcome of these patients were evaluated and compared with the remaining 622 cases (49.6%) (Group B). Results: For the patients with PTMC (Group A), there were 70 men and 563 women with a median age of 44 years (range; 12∼86). During a mean follow-up of 32.5⁑18.2 months, 6 patients (0.9%) developed locoregional recurrences and 3 patients (0.5%) showed distant metastases. There was no disease-related mortality in both groups. The disease of group B was more likely to show extracapsular invasion (P＜0.001), invasion to adjacent structures (P＜0.001), and lateral neck node metastasis (P＜0.001) than that of group A. However, there were no significant differences in multifocality (P=0.189), bilaterality (P=0.203), the locoregional recurrence rate (P=0.065) and the distant metastasis rate (P=0.325) between the two groups. On multivariate analysis, locoregional recurrent disease was associated with central lymph node metastases (P=0.033) and lateral neck node metastases (P=0.022). Conclusion: Despite PTMC having less aggressive clinicopathologic parameters as compared with clinical cancer (＞1 cm), some PTMCs show aggressive clinical behavior and locoregional recurrence. The treatment of PTMC should be individualized based on its tumor risk profiles and the clinical presentations. Moreover, performing close follow-up is essential, especially for those patients who present with cervicolateral lymph node metastases.ope

Surgical Treatment of Tertiary Hyperparathyroidism after Renal Transplantation

Purpose: Tertiary hyperparathyroidism (tHPT) means a persistent secondary hyperparathyroidism even after successful renal transplantation. Parathyroidectomy (PTX) is an efficient way to treat tHPT. In this study, we reviewed our single center Experience of PTX in regard to postoperative outcomes and analyzed any differences by the types of surgery. Methods: Among 2,589 recipients who underwent renal allograft between April. 1979 and Dec. 2006, 11 patients (0.4%) were identified to have tHPT and underwent PTX. Levels of intact parathyroid hormone (iPTH) and serum calcium were measured before and after PTX to evaluate therapeutic effect, and serum-creatinine and GFR using the Modification of Diet in Renal Disease (MDRD) equation to investigate any effect to graft function. Results: One patient showed persistent hyperparathyroidism and hypercalcemia after subtotal PTX. We experienced 10 successful PTXs in which 2 total PTX with autotransplantations, 4 subtotal PTXs and 4 limited PTXs. Level of iPTH and serum calcium were at normal range after PTX. Serum creatinine increased and estimated GFR decreased after PTX. Total PTX with autotransplantation showed a tendency of more decrease in the values of iPTH, and GFR after PTX than Subtotal PTX. Conclusion: PTX can cure tHPT-specific symptoms and sign by the recovery of hypercalcemia but may carry the risk of deterioration of kidney graft function. Subtotal PTX rather than total PTX might be recommended in the surgical treatment of tHPT to prevent any risk of kidney graft deterioration.ope

Surgical Aspects of Subacute Thyroiditis

Purpose: Subacute thyroiditis (SAT) is an uncommon, self- lemiting inflammatory disorder. If clinicians cannot rule out thyroid cancer in SAT patients with a thyroid nodule, surgical management can be considered. This study was performed to review the clinical characteristics of patients who were treated surgically for SAT presenting with thyroid nodule. Methods: We retrospectively reviewed the clinical features of 14 cases who underwent an operation for SAT with a thyroid nodule between January 1986 and May 2006 at our institution. Results: There were 3 male and 11 female patients, with a mean age of 47 years. All patients underwent surgical management prior to 1998. Twelve patients had thyroidal pain, 6 had viral prodromal symptoms, and 5 had hyperthyroidisms. Preoperative erythrocyte sedimentation rates (ESRs) (n=4) were elevated in 3 patients. Decreased uptake of radioiodine was reported in all 6 patients for whom scans were performed (n=6). Fine needle aspiration biopsy (FNAB) was performed in 4. In this study, the operative indications were clinically indeterminate thyroid nodule (n=14); lobectomy in 8, lobectomy with partial thyroidectomy in 2, lobectomy with near total thyroidectomy in 2, and bilateral total thyroidectomy in 2. Hoarseness occurred in one patient. Conclusion: SAT is usually managed clinically, but patients presenting with an indeterminate thyroid nodule will require surgical management even though they may have more benign characteristics. Most surgeons have to wait for the results of frozen biopsy because limited resectioning can be performed if the results are benign.ope

Follicular Thyroid Carcinoma: Clinicopathologic Features, Prognostic Factors, and Treatment Strategy

Purpose: Follicular thyroid carcinoma (FTC) is a relatively rare form of thyroid carcinoma that often presents at a more advanced stage of disease with a higher incidence of distant metastases because of its propensity for vascular invasion. However, FTC and papillary thyroid carcinoma (PTC) have similar prognoses when they are matched for age and stage. Therefore, this study was conducted to evaluate the useful prognostic factors and determine the optimal management of FTC. Methods: This study was conducted on 216 patients with FTC who underwent thyroidectomy at our institutions between April 1986 and August 2006. The patients included 174 women and 42 men with a mean age of 41 (4∼87) years, and patients underwent follow-up evaluation for a mean period of 114 (6∼253) months. The potential risk factors for treatment outcome were calculated using multivariate analysis, and the prognostic accuracy of UICC/AJCC pTNM staging, AMES, AGES, MACIS, and Degroot classification for predicting survival were compared. Results: During the follow-up period, 13 (6.0%) patients developed locoregional recurrences and 8 patients (3.7%) showed distant metastases. In addition, cause specific mortality was seen in 8 patients (3.7%). The overall survival and cause-specific survival (CSS) rates at 10 years were 95.4% and 89.3%, respectively, and these cases were accurately predicted by the AMES and pTNM staging systems. The Cox proportional hazards revealed that gender (P=0.015), angioinvasion (P=0.013), invasion to adjacent structure (P=0.003), widely invasive carcinoma (P=0.028), and distant metastases at the time of presentation (P＜0.001) were independent prognostic factors for survival. Conclusion: The extent of surgery in cases of FTC should be individualized based on the clinicopathologic findings; Conservative surgery should be adequate for cases of minimally invasive FTC without angioinvasion, however total or near-total thyroidectomy should be conducted in cases of widely invasive and minimally invasive FTC with angioinvasionope

Soft Tissue Implantation of Thyroid Adenomatous Hyperplasia after Endoscopic Thyroid Surgery：Report of a Case

Soft tissue implantation of thyroid tissue is a very rare event. Needle tract implantation of thyroid carcinoma after fine-needle aspiration (FNA) biopsy has been occasionally reported, but implantation of benign thyroid tumor tissue is extremely rare. Rupture of thyroid tissues during surgery or trauma may cause the thyroid tissue to be implanted and result in multiple palpable nodules in soft tissue of the neck. Several reports have shown the possibility of implantation of normal or hyperplastic thyroid tissues in soft tissue. We herein report a case of implantation of adenomatous hyperplastic tissue in the neck along the trochar and previous operation site after endoscopic thyroid surgery, which was successfully treated by complete excision.ope

A Case of Recurrent Papillary Thyroid Carcinoma with Adrenal Metastasis

Adrenal metastasis from papillary thyroid carcinoma is extremely rare. We present herein a patient with adrenal metastases from recurrent papillary carcinoma of the thyroid. A 54 year-old woman had received a total thyroidectomy and postoperative radioactive iodine therapy for locally advanced papillary thyroid carcinoma. One year after initial surgery, distant metastases to multiple organs including right cervical lymph nodes, left upper lung, left 2nd and 3rd ribs, 2nd thoracic vertebra and left adrenal gland were found by 18-FDG-PET-CT whole body scan. She underwent right modified neck dissection, partial resection of left 2nd and 3rd ribs, posterior arch of 2nd thoracic vertebra, left upper lobectomy of lung, and left adrenalectomy. On histologic examination, metastases to the left adrenal gland and cervical lymph nodes were papillary thyroid carcinomas, while other metastatic sites turned out to be anaplastic thyroid carcinomas. Despite aggressive surgery and postoperative adjuvant therapy, her general clinical conditions were getting worse day by day due to regrowing of the anaplastic thyroid carcinomas. To our knowledge, this is the first case reported in Korea.ope

Hypocalcemia after Total Thyroidectomy: Incidence and Risk Factors

Purpose: Postoperative hypocalcemia is a common complication of thyroidectomy. This study evaluated the incidence and risk factors for postoperative hypocalcemia after total thyroidectomy. Methods: There were 196 consecutive patients undergoing total thyroidectomy for thyroid cancer between September 2004 and February 2005 who were enrolled in this study. Patients were divided into two groups, those remaining normocalcemic (Group I) and those who had hypocalcemia requiring treatment (Group II). Group II was subdivided into a transient hypocalcemic group (Group IIA) and a permanent hypocalcemic group (Group IIB). All groups were compared with regard to age, gender, histology, coexisting disease, T stage, bilateral lesions, primary total thyroidectomy versus secondary completion thyroidectomy, extent of lymph node dissection, and autotransplantation of the parathyroid gland. Results: Among all patients, 139 (71%) were in Group I, 54 (27.5%) in Group IIA and 3 (1.5%) in Group IIB. On the multivariate analysis for risk factors compared between Group I and Group II, the T4 stage was the most significant for the development of postoperative hypocalcemia. On the univariate analysis comparing factors between Group IIA and Group IIB, the T4 stage and a complete thyroidectomy were significantly related to the development of permanent hypocalcemia. Conclusion: The results of this study showed that the incidence of transient hypocalcemia, after total thyroidectomy, was 27.5%, while permanent hypocalcemia was detected in 1.5% of cases. The parathyroid glands should be preserved more carefully to avoid postoperative hypocalcemia in patients with high risk factors including T4 tumors and complete thyroidectomy proceduresope

Robot-assisted Endoscopic Thyroid Surgery for Thyroid Cancer; Initial Experience of Consecutive 100 Patients

Background and Objectives: Various surgical procedures have been performed using surgical robot in recent years and most reports proved that application of robotic technology for surgery is technically feasible and safe. The aim of this study is to introduce our technique of robot-assisted endoscopic thyroid surgery and demonstrate its utility in the surgical management of thyroid cancer. Materials and Methods: From October 4th 2007 through March 14th 2008, 100 patients with papillary thyroid cancer underwent robot-assisted endoscopic surgeries using a gasless trans-axillary approach. This novel robotic surgical approach allowed adequate endoscopic access for thyroid surgeries. All the procedures were completed successfully using the da Vinci surgical system (Intuitive Surgical, Sunnyvale, California, USA). We used four robotic arms with this system; a 12 mm telescope and three 5 mm instruments. The 3-dimensional magnified visualization obtained by the dual-channel endoscope and tremor-free instruments controlled by robot system helped surgeon do sharp and precise endoscopic dissection. Results: We performed 84 less-than total and 16 total thyroidectomies with ipsilateral central compartment node dissection. Mean operation times was 136.5 min. (range 79∼267 min.) in which the actual time for thyroidectomy with lymphadenectomy (console time) was 60.0 min. (range 25∼157 min). The average number of lymph nodes resected was 5.3 (range 1 to 28). There was no serious complication. Most patients could go home within 3 days after surgery. Conclusion: Our technique of robotic-assisted endoscopic thyroid surgery using a gasless trans-axillary approach is feasible, safe and promising for the selected patients with thyroid cancer. We suggest application of robotic technology for endsocopic thyroid surgeries could overcome the limitations of conventional endoscopic surgeries in the surgical management of thyroid cancer.ope