PURPOSE: Systematic educational programs and genetic counseling certification courses for hereditary breast/ovarian cancer (HBOC) have not yet been introduced in Korea. We provided and evaluated the effects of genetic counseling education on Korean healthcare providers' knowledge, awareness, and counseling skills for patients at high risk of HBOC. METHODS: A 3-day educational program was conducted for healthcare providers who were interested in genetic counseling for patients at high risk of HBOC. Participants who completed a knowledge test and satisfaction questionnaire were included in the present sample. Pre-post comparisons were conducted to determine the effects of the intervention. RESULTS: Significant differences between preprogram and postprogram knowledge scores were observed (p=0.002). Awareness (p<0.001) and confidence (p<0.001) regarding genetic counseling significantly increased after the training. Doctors and participants with fewer years of work experience performed well on the knowledge test. Previous educational experience was correlated with increased confidence in knowledge and counseling skills. CONCLUSION: Genetic counseling education regarding HBOC improved knowledge and awareness of HBOC and enhanced confidence in the counseling process. The effects varied according to occupation and participants' previous education. The implementation of systematic educational programs that consider participant characteristics may improve the effects of such interventions.
Breast ; Breast Neoplasms ; Certification ; Counseling ; Delivery of Health Care ; Genetic Counseling ; Health Personnel ; Humans ; Korea ; Neoplastic Syndromes, Hereditary ; Occupations ; Surveys and Questionnaires

BACKGROUND: Thyroid function depends on ethnic and environmental factors. North Korean refugees have the same genetic background as South Koreans, but they have been exposed to different environments. This study examines the prevalence and pattern of thyroid disorders in North Korean women living in South Korea, focusing on subclinical hypothyroidism (SCH). METHODS: The intended sample was a total of 327 North Korean women residing in Seoul. Health questionnaires and medical examinations, including serum thyrotropin (thyroid stimulating hormone, TSH), free thyroxine, and thyroid autoantibodies, were conducted. RESULTS: The prevalence of SCH was 9.4%. In logistic regression analysis, smoking, menopause, length of stay in South Korea, body mass index, history of thyroid disease, and metabolic syndrome were not associated with the risk of SCH. Whereas, the positivity of autoantibodies were associated with a high risk for SCH (odds ratio [OR], 4.840; 95% confidence interval [CI], 1.80-13.017; P = 0.002), and age was associated with a low risk for SCH (OR, 0.94; 95% CI, 0.888-0.994; P = 0.031). The serum TSH levels also decreased with increasing age, and in particular, there was significant difference between 30-39 years, and over 60 years (2.33 +/- 1.51 microIU/mL vs. 1.54 +/- 0.73 microIU/mL, P = 0.028). CONCLUSION: In North Korean women, the positivity of autoantibodies was associated with a high risk for SCH. But interestingly, a younger age was associated with a high risk for SCH. Considering that they suffered from severe famine at the period of growth, and this led to malnutrition, their thyroid dysfunction might be associated with the peculiar environment that they experienced.
Autoantibodies ; Body Mass Index ; Female ; Humans ; Hypothyroidism ; Length of Stay ; Logistic Models ; Malnutrition ; Menopause ; Prevalence ; Refugees ; Republic of Korea ; Smoke ; Smoking ; Starvation ; Thyroid Diseases ; Thyroid Gland ; Thyrotropin ; Thyroxine ; Surveys and Questionnaires

Intra-operative parathyroid hormone (IOPTH) assay is a useful tool to confirm complete excision of all hyper-functioning parathyroid gland tissue. In this report, we describe a case with successful localization of distant metastasis in a patient with parathyroid carcinoma using the IOPTH assay. A 53-year-old man presented to our clinic with a serum calcium level of 11.8 mg/dL and an intact PTH level of 233.3 pg/mL. He had been treated for parathyroid carcinoma eleven years ago. Two suspected metastatic lesions were detected on the chest computed tomography. Due to the vastly different surgical field necessary to excise each lesion, we preferentially removed only one lesion and we monitored the other remaining suspected lesion without resection via IOPTH assay. Six months later, the patient's serum calcium and intact PTH levels remained within their normal ranges. To the best of our knowledge, this is the first case to effectively utilize IOPTH assay for the management of metastatic parathyroid carcinoma.
Calcium ; Humans ; Middle Aged ; Neoplasm Metastasis ; Parathyroid Glands ; Parathyroid Hormone ; Parathyroid Neoplasms ; Reference Values ; Thorax

PURPOSE: The safety of radiation therapy after breast reconstruction using transverse rectus abdominis myocutaneous(TRAM) flap is still being debated, and few studies exist on the outcome of irradiation after immediate TRAM breast reconstruction. Some authors presented satisfactory outcomes after adjuvant radiation therapy on reconstructed breast with pedicled TRAM flap, while others reported significant post radiation changes of the flap. Effect of radiation therapy on TRAM flap was evaluated to see whether adjuvant radiation therapy was tolerable. METHODS: 1000 immediate TRAM breast reconstruction was done by a single surgeon from July, 2001 to December, 2009. Among them 105 patients required adjuvant radiation therapy because of advanced disease or locoregional recurrence. Fat necrosis, radiation fibrosis, mastectomy skin flap necrosis, need for secondary touch up procedures, patient satisfaction were evaluated. RESULTS: The incidence of fat necrosis was 10.5% and significant radiation fibrosis occurred in only one patient. Delayed wound problem did not occur during or after irradiation. Secondary touch-up procedures were performed in 12.3%, the most common being fat graft(8.6%). Average patient satisfaction score was 8.62/10, which was not significantly different from the authors' previous report involving all the TRAM patients(8.50). CONCLUSION: Radiation therapy did not increase the complication rate significantly. Aesthetic result was affected but was tolerated in most cases. The fear of adjuvant radiation is not a negative factor in selecting immediate breast reconstruction with TRAM flap.
Breast ; Breast Neoplasms ; Fat Necrosis ; Female ; Humans ; Incidence ; Mammaplasty ; Mastectomy ; Necrosis ; Patient Satisfaction ; Radiation Pneumonitis ; Rectus Abdominis ; Recurrence ; Skin

Malignant duodenocolic fistula is a rare complication of colon cancer, and this usually develops as the right-side colon cancer or colonic hepatic flexure cancer infiltrates into the second portion of the duodenum. Six Korean cases of this malignancy have been previously reported on. The patients usually complain of watery diarrhea, feculant vomiting and weight loss that can be attributed to the altered normal flora. Barium enema has been the diagnostic procedure of choice to demonstrate the fistulous tract, but with the technical development of gastroendoscopy, the primary procedure is also changing. Curative resection is not possible in many cases. Palliative ileotransverse colostomy with gastrodjejunostomy is performed to relieve symptoms, but it cannot completely prevent the vomiting or diarrhea. We herein present a case of malignant duodenocolic fistula in a patient who had been suffering from indigestion, loose stool and feculant vomiting for one year. This case was diagnosed by endoscopy and the patient underwent a palliative operation.
Barium ; Colon ; Colonic Neoplasms ; Colostomy ; Diarrhea ; Duodenum ; Dyspepsia ; Endoscopy ; Enema ; Fistula ; Humans ; Stress, Psychological ; Vomiting ; Weight Loss

PURPOSE: Histone deacetylase inhibitors (HDACIs) induce accumulation of acetylated histones in nucleosomes, which lead to reactivate gene expression and inhibit the growth and survival of tumor cells. This study evaluated the efficacy of HDACIs in breast cancer cells in comparison with other established drug regimens. METHODS: Drug responses of tumor samples from mastectomy specimens of 78 breast cancer patients were evaluated using the histoculture drug response assay (HDRA). Tumor inhibition rates (IRs) of established drug regimens such as doxorubicin, cyclophosphamide, doxorubicin with cyclophosphamide (AC), paclitaxel, docetaxel and doxorubicin with docetaxel (AT), as well as those of three HDACIs (SAHA, PXD101, and a novel compound CG-2) were evaluate. RESULTS: The percentages of chemosensitive tumors (chemoresponsiveness) were 26.9-60.3% with established regimens and 61.5-73.1% with HDACIs when the cutoff value for inhibition rate was set at 30%. Breast cancer cells appeared to be more chemoresponsive to HDACIs than to established drug regimens. Chemoresponsiveness to AT was the highest among the established drug regimens. A combination regimen offered higher activity than did a single drug (doxorubicin vs AT; p<0.001). HER2/Neu-overexpressing breast cancers were chemosensitive to SAHA and AT (p=0.031 and 0.04, respectively). CONCLUSION: Our findings show that breast cancer cells were sensitive to HDACIs, with therapeutic efficacies comparable to those of established drug regimens. Specific biological markers such as HER2/Neu could be assessed for effectiveness as HDACIs chemosensitivity markers in further clinical trials.
Biomarkers ; Breast ; Breast Neoplasms ; Cyclophosphamide ; Doxorubicin ; Gene Expression ; Histone Deacetylase Inhibitors ; Histone Deacetylases ; Histones ; Humans ; Hydroxamic Acids ; Mastectomy ; Nucleosomes ; Paclitaxel ; Sulfonamides ; Taxoids

PURPOSE: We designed a pig to canine liver xenotransplantation model to study the diverse immunologic and hemodynamic consequences that follow xenotransplantation and hyperacute rejection. METHODS: The animals were divided into two groups: the cobra venom factor and Gadolinium chloride treatment group (CVF+Gd group) (3 cases) and the control group (3 cases). The donor pig's whole liver was harvested, and then the harvested pig's whole liver was transplanted into a dog after the dog underwent left hepatectomy. After reperfusion of the graft, blood samples were taken 20, 40 and 60 minutes after reperfusion, and the liver, lung and kidney tissues were taken 1 hour after reperfusion. RESULTS: In the control group, the grafts showed a patchy hypoperfused liver surface and it felt rubbery solid compared to the CVF+Gd group. The serum total protein, albumin, fibrinogen and platelets decreased abruptly and there were no significant differences between the two groups. The serum PT, PTT and FDP were increased in both groups and the CVF+Gd group showed a more obtuse slope than the control group. We could not find any intravascular pathologic changes on the microscopic findings of the graft. Only scant intravascular fibrin deposition was found. Hepatocellular vacuolization and sinusoidal dilatation were also found. There were patches of necrosis without any zonal distribution, intrasinusoidal neutrophil sequestration and interstitial hemorrhage. These findings were milder in the CVF+Gd group. CONCLUSION: The pig to canine partial auxiliary liver xenotransplantation model is feasible and it is a good model before starting to perform pig to primate liver xenotransplantation. In the CVF+Gd group, pathologic findings like patch hepatocyte necrosis etc. were less severe. As there were no corresponding vascular pathologic findings, these findings are not the direct effect of CVF and gadolinium treatment, and so other factors like Ischemia- reperfusion injury should be considered.
Animals ; Blood Platelets ; Cobra Venoms ; Complement System Proteins ; Dilatation ; Dogs ; Fibrin ; Fibrinogen ; Fluconazole ; Formycins ; Gadolinium ; Hemodynamics ; Hemorrhage ; Hepatectomy ; Hepatocytes ; Humans ; Kidney ; Kupffer Cells ; Liver ; Lung ; Necrosis ; Neutrophils ; Primates ; Rejection (Psychology) ; Reperfusion ; Reperfusion Injury ; Ribonucleotides ; Tissue Donors ; Transplantation, Heterologous ; Transplants

PURPOSE: Published Early Breast Cancer Trialists' Collaborative Group overview results have been the beneficial effects of tamoxifen and ovarian ablation for pre and perimenopausal women with node negative breast cancer. Chemotherapy and Luteinizing Hormone Releasing Hormone (LHRH) agonists (medical ovarian ablation) have been shown to be effective adjuvant therapies for early stage breast cancer in several clinical trials however, the efficacy and tolerance of LHRH agonists in Korean breast cancer patients has not been evaluated. METHODS: Three thousand one hundred fifty breast cancer patients were treated at Asan Medical Center between January 2003 and December 2005. We selected 185 patients with node negative early breast cancer who were endocrine responsive (more than intermediate intensity), with a tumor size more than 1 cm, and who were reluctant to undergo chemotherapy due to the side effects. They received LHRH agonists (Zoladex(R) 3.6 mg) every 28 days with tamoxifen for two years. We prospectively evaluated mammography, chest PA, and physical examination every six months and evaluated the side effects and quality of life. RESULTS: The mean age was 43.5 yr, and the mean tumor size was 1.62 cm. One hundred sixty-two patients had Stage I, and 23 Stage II disease. The incidence of severe menopausal symptoms was 24.1%, but these symptoms were reported to be "tolerable" during the two year follow-up. Quality of life and physical activity were essentially unchanged. The median follow-up duration was 18 months, and there was no local recurrence or distant metastases during the study. CONCLUSION: Adjuvant therapy with LHRH agonists is safe and tolerable, and may be an alternative to chemotherapy for pre-and perimenopausal women with hormone responsive early breast cancer who are reluctant to undergo chemotherpy.
Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Drug Therapy ; Female ; Follow-Up Studies ; Gonadotropin-Releasing Hormone ; Humans ; Incidence ; Mammography ; Motor Activity ; Neoplasm Metastasis ; Physical Examination ; Prospective Studies ; Quality of Life ; Recurrence ; Tamoxifen ; Thorax

BACKGROUND: Atrial fibrillation (AF) is the most common cause of embolic cerebral infarction. This study was performed to determine new risk factors and the mechanism underlying thromboembolism (TE) in patients with AF. METHODS: 192 patients (M:F=137:55, 61+/-11 years) with AF were randomly selected and divided into a TE (n=95) and non-TE group (n=97). Another 71 patients with AF (M:F=38:33, 55+/-14) were studied for endothelial function by measuring the level of von Willebrand factor (vWF; factor 8 related antigen), inflammation by WBC, ESR, and high sensitive CRP and coagulation system by fibrinogen, fibrinogen degradation product and fibrin d-dimer; the results were compared with 25 patients with normal sinus rhythm. RESULTS: The TE group was older than non-TE group. Hypertension (HTN), diabetes mellitus (DM), hypercholesterolemia, smoking and fine AF (AF wave amplitude <1 mm) were more frequent in the TE group. Mitral valvular disease, an ejection fraction <40% and dilated cardiomyopathy were more frequent in the TE group and the left atrial (LA) dimension was greater in the TE group. The use of anticoagulants, an angiotensin-II receptor blocker and statins were less frequently observed in the TE group. The vWF-factor 8 related antigen was higher in patients with advanced age, LV dysfunction, HTN, DM, mitral stenosis and positively correlated with age, LA dimension, LV end-diastolic and end-systolic dimension, ejection fraction, NYHA class and AF duration. The fibrinogen level was positively correlated with age, NYHA class, LA dimension and d-dimer with NYHA class. Markers for inflammation or coagulation were not significantly different in the atrial fibrillation and the sinus rhythm group. CONCLUSIONS: No use of an angiotensin-II receptor blocker or statin and fine AF may be new risk factors for TE in patients with AF. The TE risk factors are thought to increase TE by impairing endothelial function.
Anticoagulants ; Atrial Fibrillation* ; Cardiomyopathy, Dilated ; Cerebral Infarction ; Diabetes Mellitus ; Fibrin ; Fibrinogen ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypercholesterolemia ; Hypertension ; Inflammation ; Mitral Valve Stenosis ; Risk Factors* ; Smoke ; Smoking ; Thromboembolism ; von Willebrand Factor

BACKGROUND AND OBJECTIVES: It is well established that tonsillar squamous cell carcinoma has high probability to be disseminated to the neck. An ipsilateral neck treatment is mandatory during initial treatment stages of II-IV tonsillar carcinomas. However, no consensus exists as to whether an elective contralateral neck management should be performed. SUBJECTS AND METHOD: A retrospective analysis was performed on 43 N1-3 tonsillar cancer patients with contralateral negative necks who were treated between 1992 to 2002. All patients had a contralateral elective neck dissection. Surgical treatment was followed by postoperative radiotherapy in 33 patients. The follow-up period ranged from 2 to 120 months (mean, 38 months). The Kaplan-Meier method and log-rank test were used to calculate the disease-specific survival rates and prognostic significance of contralateral occult lymph node metastasis. RESULTS: Clinically occult, but pathologically positive contralateral lymph nodes were found in 16% (7 of 43). In cases of ipsilateral N (+) neck, contralateral occult lymph node metastases developed in 21% (7 of 33) and there was no incidence of that in the cases of ipsilateral N0 necks. Based on the clinical stages of the tumor, 5% (1 of 22) of the cases metastatically involved ymph nodes in the T2 tumors, 36% (5 of 14) in the T3, and 25% (1 of 4) in the T4. T1 tumors (3 cases) had no pathologically positive lymph nodes (T1+T2 vs T3+T4, p<.05). Patients with no evidence of contralateral nodal cancer had significantly improved disease-specific free survival rates over patients with any pathologically positive nodes (5 year disease specific survival rate, 92% vs 28%, p=<.05). CONCLUSION: The risk of contralateral occult neck involvement in above T3 staged tonsillar squamous cell carcinomas with unilateral metastases was high and patients who presented with contralateral metastatic neck have worse prognosis than those who are staged as N0. Therefore, we advocate a routine bilateral neck dissection in tonsillar squamous cell carcinoma patients with unilateral node metastases.
Carcinoma, Squamous Cell* ; Consensus ; Follow-Up Studies ; Humans ; Incidence ; Lymph Nodes ; Lymphatic Metastasis ; Neck Dissection ; Neck* ; Neoplasm Metastasis ; Prognosis ; Radiotherapy ; Retrospective Studies ; Survival Rate ; Tonsillar Neoplasms