Sex Differences in Attitudes Toward Marriage and Childbearing Based on the Assumption of Being BRCA1/2 Mutation Carriers Among Young People / 한국유방암학회지

Purpose@#This study investigated changes in attitudes toward marriage and childbearing assuming a BRCA1/2 mutation carrier status among healthy, unmarried individuals in Korea. @*Methods@#A nationally representative sample of healthy, unmarried individuals aged 20–39 years was surveyed. A questionnaire on marriage and childbearing intentions was administered to the participants before and after providing them with information on BRCA1/2 mutation carriers’ breast and ovarian cancer risks and their autosomal dominant inheritance pattern. The participants were asked about their attitudes toward childbearing through preimplantation genetic diagnosis (PGD). @*Results@#Of the participants who initially wanted to marry, the assumption that they or their partners had BRCA1/2 mutation caused 25.3% to no longer want to get married and 36.2% to change their attitude from wanting to bear children to no longer wanting them. Females were more likely than males to change their attitudes toward marriage and childbearing. The participants who had negative attitudes toward genetic testing were more likely to change their attitudes regarding marriage and childbearing than those who were favorable toward both disclosure and testing. More than 50% of the participants who did not want children were willing to bear children through PGD when it was assumed that they were BRCA mutation carriers. @*Conclusion@#On the assumption of being carriers, general, young, and healthy females were more likely than males to negatively change their attitudes toward marriage and childbearing. Public education on the implications of living with mutation carriers and reproductive options may be required.

Attitudes toward Risk-Reducing Mastectomy and Risk-Reducing Salpingo-oophorectomy among Young, Unmarried, Healthy Women in Korea / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#This study investigated the attitudes toward risk-reducing mastectomy (RRM) and risk-reducing salpingo-oophorectomy (RRSO) as cancer prevention options for BRCA1/2 carriers in healthy, young, unmarried Korean women. @*Materials and Methods@#A nationally representative sample of 600 women, aged 20-39 years, completed a questionnaire on sociodemographic variables, preference for genetic testing, and intention to undergo risk-reducing surgeries after receiving information on the cancer risk of BRCA1/2 mutations and benefits of risk-reducing surgeries. @*Results@#A total of 54.7% and 57.7% had the intention to undergo RRM and RRSO, respectively, on the assumption that they were BRCA1/2 carriers. Older age and no intention to undergo genetic testing were associated with a reduced likelihood of undergoing RRM (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.14 to 0.61 for age 35-39 years and OR, 0.35; 95% CI, 0.20 to 0.62 for no intention for genetic testing) and RRSO (OR, 0.39; 95% CI, 0.19 to 0.79 for age 35-39 years and OR, 0.30; 95% CI, 0.17 to 0.53 for no intention for genetic testing). Women who chose to be single were likely to undergo risk-reducing surgeries (OR, 1.67; 95% CI, 1.07 to 2.60 for RRM and OR, 1.56; 95% CI, 1.00 to 2.44 for RRSO). @*Conclusion@#More than 50% of healthy, unmarried, young Korean women were inclined to undergo prophylactic surgeries if they were BRCA1/2 mutation carriers. Further studies on decision-making process for cancer prevention in individuals at high risk for cancer need to be conducted.

A Case Report for Myopericarditis after BNT162b2 COVID-19 mRNA Vaccination in a Korean Young Male

Mass vaccination with the Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine (BNT162b2) in Korea has resulted in many reported adverse effects. These side effects are the object of much scrutiny in the medical community. We report the case of a 29-year-old male who was diagnosed with myopericarditis after his second dose of Pfizer-BioNTech COVID-19 vaccine. This patient is the second recognized case of Pfizer-BioNTech COVID-19 vaccine induced myopericarditis in Korea and the first to have recovered from it. He originally presented with chest discomfort and exertional chest pain. Lab tests revealed elevated cardiac marker levels and echocardiographic findings displayed minimal pericardial effusion, prompting diagnosis as myopericarditis. We decided on two weeks of outpatient treatment with non-steroidal anti-inflammatory drugs (NSAIDs) due to the patient's mild symptoms and his occupation in the military. When this proved insufficient, we shifted to combination therapy with low dose corticosteroids and NSAIDs. After two weeks of treatment, the patient's symptoms and pericardial effusion had improved, and he was recovered completely 37 days after the onset.

A Case Report for Myopericarditis after BNT162b2 COVID-19 mRNA Vaccination in a Korean Young Male

Mass vaccination with the Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine (BNT162b2) in Korea has resulted in many reported adverse effects. These side effects are the object of much scrutiny in the medical community. We report the case of a 29-year-old male who was diagnosed with myopericarditis after his second dose of Pfizer-BioNTech COVID-19 vaccine. This patient is the second recognized case of Pfizer-BioNTech COVID-19 vaccine induced myopericarditis in Korea and the first to have recovered from it. He originally presented with chest discomfort and exertional chest pain. Lab tests revealed elevated cardiac marker levels and echocardiographic findings displayed minimal pericardial effusion, prompting diagnosis as myopericarditis. We decided on two weeks of outpatient treatment with non-steroidal anti-inflammatory drugs (NSAIDs) due to the patient's mild symptoms and his occupation in the military. When this proved insufficient, we shifted to combination therapy with low dose corticosteroids and NSAIDs. After two weeks of treatment, the patient's symptoms and pericardial effusion had improved, and he was recovered completely 37 days after the onset.

Primary Extracranial Fibrous Meningioma of the Maxillary Sinus: A Case Report and Literature Review

Meningioma is a common neoplasm of the central nervous system; however, primary extracranial meningioma of the paranasal sinus, especially the maxillary sinus, is rare. We report a case of primary extracranial meningioma (fibrous type) of the maxillary sinus and present a literature review of the imaging features that correlate with fibrous meningioma.

Trends in Risk-Reducing Mastectomy and Risk-Reducing SalpingoOophorectomy in Korean Carriers of the BRCA1/2 Mutation / 한국유방암학회지

Purpose@#BRCA1/2 mutations are associated with risks of breast and ovarian cancer. In Korea, incidences of BRCA1/2 genetic testing and risk-reducing surgery (RRS) have increased with insurance coverage and the Angelina Jolie effect. The aim of this study was to identify trends in RRS performed in Korean women with the BRCA1/2 mutation. @*Methods@#We retrospectively reviewed the medical records of BRCA1/2 mutation carriers with (affected carriers) and without (unaffected carriers) breast cancer until August 2018 from 25 Korean Hereditary Breast Cancer (KOHBRA)-affiliated hospitals. @*Results@#The numbers of contralateral risk-reducing mastectomy (RRM) and risk-reducing bilateral salpingo-oophorectomy (RRBSO) in affected carriers have increased 5.8- and 3.6-fold, respectively, since 2013. The numbers of RRBSO in unaffected carriers has increased 8-fold since 2013. The number of institutions that perform RRS has increased gradually. The number of hospitals that perform contralateral RRM on affected carriers increased from 3 in 2012 to 11 in 2018, and that of those that perform RRBSO increased from 7 to 17. The number of hospitals that perform bilateral RRM on unaffected carriers increased from 1 in 2012 to 2 in 2018, and that of those that perform RRBSO increased from 1 to 8. However, the hospitals showed differences in the rates of RRM or RRBSO performed. @*Conclusion@#The incidence of RRS increased each year throughout the study period. However, in Korea, the rate of RRS procedures depended on the hospital.

Trends in Risk-Reducing Mastectomy and Risk-Reducing SalpingoOophorectomy in Korean Carriers of the BRCA1/2 Mutation / 한국유방암학회지

Purpose@#BRCA1/2 mutations are associated with risks of breast and ovarian cancer. In Korea, incidences of BRCA1/2 genetic testing and risk-reducing surgery (RRS) have increased with insurance coverage and the Angelina Jolie effect. The aim of this study was to identify trends in RRS performed in Korean women with the BRCA1/2 mutation. @*Methods@#We retrospectively reviewed the medical records of BRCA1/2 mutation carriers with (affected carriers) and without (unaffected carriers) breast cancer until August 2018 from 25 Korean Hereditary Breast Cancer (KOHBRA)-affiliated hospitals. @*Results@#The numbers of contralateral risk-reducing mastectomy (RRM) and risk-reducing bilateral salpingo-oophorectomy (RRBSO) in affected carriers have increased 5.8- and 3.6-fold, respectively, since 2013. The numbers of RRBSO in unaffected carriers has increased 8-fold since 2013. The number of institutions that perform RRS has increased gradually. The number of hospitals that perform contralateral RRM on affected carriers increased from 3 in 2012 to 11 in 2018, and that of those that perform RRBSO increased from 7 to 17. The number of hospitals that perform bilateral RRM on unaffected carriers increased from 1 in 2012 to 2 in 2018, and that of those that perform RRBSO increased from 1 to 8. However, the hospitals showed differences in the rates of RRM or RRBSO performed. @*Conclusion@#The incidence of RRS increased each year throughout the study period. However, in Korea, the rate of RRS procedures depended on the hospital.

Effectiveness of Polyvinyl Acetate Sheeted with Carboxymethyl Cellulose as a Packing Material after Septoplasty

BACKGROUND AND OBJECTIVES: Although polyvinyl acetate (Merocel®) has been widely used as a packing material after septoplasty, removable nasal packing can increase patient discomfort, local pain, and pressure. Furthermore, the removal of nasal packing has been described as the most uncomfortable and distressing feature associated with septoplasty. The purpose of this study was to investigate the efficacy of polyvinyl acetate with carboxymethyl cellulose sheet (Rhinocel®) nasal packing on patient subjective symptoms, degree of bleeding, hemostasis, and wound healing following septoplasty. SUBJECTS AND METHOD: Forty patients with nasal septum deviation requiring septoplasty were included. Following surgery, one nasal cavity was packed with Rhinocel® and the other one with Merocel®. Patient subjective symptoms while the packing was in situ, hemostatic properties, pain on removal, degree of bleeding on removal, duration of hemostasis after removal, postoperative wound healing, and the cost of the pack were evaluated. RESULTS: Although the two types of packing materials were equally effective in controlling postoperative bleeding after septoplasty, Rhinocel® was significantly more comfortable while in situ and less painful on removal than Merocel®, which was associated with significantly more bleeding on removal and so more time was needed to control hemorrhage. There was no significant difference in postoperative wound healing or pack cost. CONCLUSIONS: The use of Rhinocel® after septoplasty has less discomfort, greater patient satisfaction, and less bleeding on removal with no adverse reactions compared to Merocel® packing. Therefore, Rhinocel® may be a useful packing material after septoplasty.

Chronic Invasive Sinonasal Mucormycosis; A Rare Disease Entity

Mucormycosis is a rare invasive fungal infection of the nose and paranasal sinus, which often has an acute fulminant course and distinctive clinical findings. It usually occurs in diabetics or immunocompromised patients and shows rapid progression with a high mortality rate. Slow, silent progression is a highly unusual presentation of this disease. Herein, we report a case of mucormycosis with a chronic course of invasion into the hard palate and the maxillary sinus.

The Effect of Probiotics for Preventing Radiation-Induced Morphological Changes in Intestinal Mucosa of Rats

Radiation therapy is an important treatment modality for abdominal or pelvic cancer, but there is a common and serious complication such as radiation-induced enteritis. Probiotics is reported to have positive effects against radiation-induced enteropathy. In this study, morphological changes of bowel mucosa were analyzed in rats to presume the effect of probiotics on radiation-induced enteritis and its correlation with radiation dose. A total of 48 adult male Sprague-Dawley rats were randomly assigned to two groups and received a solution containing 1.0x108 colony-forming units of Lactiobacillus acidophilus or water once daily for 10 days. Each of two groups was divided into three subgroups and abdomino-pelvic area of each subgroup was irradiated with 10, 15, and 20 Gy, respectively on the seventh day of feeding the solutions. All rats were sacrificed 3 days after irradiation and the mucosal thickness and villus height of jejunum, ileum and colon were measured. The morphological parameters of the small intestine represented significant differences between two solution groups irradiated 10 or 15 Gy, except for villus height of jejunum in 15 Gy-subgroup (P=0.065). There was no significant morphometric difference between two groups irradiated with 20 Gy of radiation. Probiotics appear to be effective for the morphological shortening of small intestinal mucosa damaged by radiation less than or equal to 15 Gy.

Effect of Electromagnetic Navigated Ventriculoperitoneal Shunt Placement on Failure Rates

OBJECTIVE: To evaluate the effect of electromagnetic (EM) navigation system on ventriculoperitoneal (VP) shunt failure rate through comparing the result of standard shunt placement. METHODS: All patients undergoing VP shunt from October 2007 to September 2010 were included in this retrospective study. The first group received shunt surgery using EM navigation. The second group had catheters inserted using manual method with anatomical landmark. The relationship between proximal catheter position and shunt revision rate was evaluated using postoperative computed tomography by a 3-point scale. 1) Grade I; optimal position free-floating in cerebrospinal fluid, 2) Grade II; touching choroid or ventricular wall, 3) Grade III; tip within parenchyma. RESULTS: A total of 72 patients were participated, 27 with EM navigated shunts and 45 with standard shunts. Grade I was found in 25 patients from group 1 and 32 patients from group 2. Only 2 patients without use of navigation belonged to grade III. Proximal obstruction took place 7% in grade I, 15% in grade II and 100% in grade III. Shunt revision occurred in 11% of group 1 and 31% of group 2. Compared in terms of proximal catheter position, there was growing trend of revision rate according to increase of grade on each group. Although infection rate was similar between both groups, the result had no statistical meaning (p=0.905, chi-square test). CONCLUSION: The use of EM navigation in routine shunt surgery can eliminate poor shunt placement resulting in a dramatic reduction in failure rates.

Factors Associated with Re-excision after Breast-Conserving Surgery for Early-Stage Breast Cancer / 한국유방암학회지

PURPOSE: Re-excisions after breast-conserving surgery (BCS) for breast cancer cause delays in the adjuvant treatment, increased morbidity, and leads to poor aesthetic results. Thus, efforts to reduce the re-excision rate are essential. This study aimed to conclusively determine the re-excision rate and the factors associated with re-excision after BCS. METHODS: We retrospectively reviewed the medical records and pathological reports of 711 cases that underwent BCS for early-stage breast cancer. Univariate and multivariate analyses were performed. RESULTS: Of the 711 cases of BCS, 71 (10.0%) required re-excision. Patients in the re-excision group were younger than those in the no re-excision group. Non-palpable lesions, the presence of non-mass-like enhancement at magnetic resonance imaging, multifocality, the presence of a ductal carcinoma in situ (DCIS) component, and an infiltrative tumor border were also significantly associated with re-excision. Multivariate analysis indicated that younger age, non-palpable lesions, multifocal lesions, and the presence of a DCIS component were factors which were independently associated with re-excision. Tumors located in the lower inner quadrant had a relatively high involved resection margin rate as well as a narrow resection margin width, especially at the superior and medial margins. Lateral margins showed a tendency toward a wider resection margin width. CONCLUSION: At our institution, the rate of re-excision was low despite the lack of an intraoperative frozen section. Patients with non-palpable or multifocal tumors, a DCIS component, or those who were younger than 50 years were more likely to require re-excision after BCS. These factors should be considered when planning surgical management of early-stage breast cancer. Positive resection margin rates and margin widths differed on a directional basis based on tumor location, and these differences were considerable.

Development of a Method to Measure the Radiation Isocenter Size of Linear Accelerators and Quantitative Analysis of the Radiation Isocenter Size for Clinac 21EX Linear Accelerator / 의학물리

A method to get a size of the radiation isocenter of linear accelerators using star-shot images was presented and a computer program was developed to automate the method. Accuracy of the method was verified. The developed program was used to measure sizes of the radiation isocenters for a Clinac 21EX (Varian, USA) using data of quality assurance (QA) performed from June 2008 to December 2010. To calculated the size of radiation isocenter, positions of two points on each central ray of the star-shot image were found and the equation of the central ray was determined using the positions of two points. Using the equations of central rays the radius of the minimum circle intersecting all the central rays, which is one half of the size of radiation isocenter, was calculated. The program measured X-intercepts and y-intercepts of the central rays within errors of 0.084 mm and sizes of radiation isocenters within 0.053 mm. All the errors were less than the spatial resolution of star-shot images 0.085 mm. The radiation isocenter sizes of Clinac 21EX were 0.33+/-0.27 mm, 0.71+/-0.36 mm, 0.50+/-0.16 mm for collimator, gantry and couch respectively. During the measurement period all the measured sizes were less than 2.0 mm and within tolerance. The developed program could calculate the size of radiation isocenters and it would be helpful to routine QA.

The Factors Related to Health-related Quality of Life(HRQOL), and Correlation between Occupational Stress and HRQOL among Municipal Fire Officers in Incheon / 대한산업의학회지

OBJECTIVES: This study was performed to investigate the factors related to HRQOL, and a correlation between occupational stress and HRQOL among municipal fire officers. METHODS: In November 2005, 341 male municipal fire officers submitted to the following tests: A general questionnaire, a medical questionnaire, the Korean Occupational Stress Scale Short Form(KOSSSF), and the SmithKline Beecham quality of life scale (SBQOL). RESULTS: Back pain (OR=3.54, 95% C.I.=1.81-6.93) and occupational stress (OR=6.33, 95% C.I.=3.12-12.83) were significantly related to poor HRQOL scores among municipal fire officers, and there is negative relationship between KOSS-SF score and SBQOL score. Logistic regression analysis indicated that the medium occupational stress group (OR=2.21, 95% C.I.=1.04-4.71) and the high occupational stress group (OR=6.33, 95% C.I.=3.12-12.83) were more significantly associated with poor HRQOL than low occupational stress group. CONCLUSIONS: Among municipal fire officers, back pain and occupational stress were found to be related to their HRQOL. Based on this study, we suggest that the management of back pain and occupational stress are instrumental to improving the HRQOL among municipal fire officers.

Analysis of the Influence of Diagnosis Related Variables on the Accuracy of Initial Diagnosis in Patients with Acute Abdominal Pain Seen at the Emergency Center

BACKGROUND: Abdominal pain is a common complaint seen at emergency centers. Various diseases can cause abdomin al pain making it difficult to make a correct diagnosis. In the elderly, however, the consequences of an incorrect or delayed diagnosis can be more critical. We investigated the accuracy of initial diagnoses in the emergency center and analyzed the associations among medical factors including age. METHODS: We compared the ICD 10 codes of initial diagnoses to the codes of final diagnoses, defined the 'degree of agreement' using a 5 point scale, and classified patients into 'high degree of agreement' or 'low degree of agreement' groups. According to the severity of illness, we classified patients as 'admission' or 'out patient follow up'. According to their illness, we classified them as 'surgical' or 'medical'. According to age, we classified them as 'elderly' or 'adult'. Finally, we analyzed the statistical significance of each association. RESULTS: Overall, admitted patients and surgical diagnoses had higher degrees of agreement. 'Elderly' patients had no significant difference in 'degree of agreement' from 'adult' patients. CONCLUSION: Among patients presenting with acute abdominal pain to the emergency center, the degree of agreement between initial diagnosis and final diagnosis is dependent on the diagnostic characteristics of the disease, and not on the age of the patients. Further studies on the diagnostic accuracy of individual diseases are needed. Additional diagnosis associated variables, for example comorbidity and prognosis, needs to be studied regarding relationship to diagnostic accuracy.

A Comparison of KOSHA's Cardiovascular Disease Risk Assessment and the Predicted 10-year Risk of Cardiovascular Disease Developed by Jee for a Male Workers at a Wallpaper and Floor Covering Manufacturer / 대한산업의학회지

OBJECTIVES: This study was conducted to evaluate the relationship between KOSHA's cardiovascular disease risk assessment and the predicted 10-year risk of cardiovascular disease developed by Jee. SUBJECTS AND METHODS: Data were obtained from a structured questionnaire survey and medical examination of 509 male workers aged 30-59 years employed at a wallpaper and floor covering workplace in May 2008. We calculated KOSHA's cardiovascular disease risk assessment and Jee's predicted 10-year risk of cardiovascular disease. A high risk of cardiovascular disease was defined as the upper 10th percentile of Jee's predicted 10-year risk of cardiovascular disease. Statistical analysis was conducted using the Wilcoxon rank sum test, Kruskal Wallis test and a logistic regression model. RESULTS: Jee's predicted 10-year risk of cardiovascular disease significantly increased as KOSHA's cardiovascular disease risk increased. Logistic regression analysis indicated that the group with 3 or more cardiovascular disease risk factors according to KOSHA's model was more likely to experience cardiovascular disease within 10 years(OR=34.4, 95% C.I.=4.4-267.2). CONCLUSIONS: KOSHA's cardiovascular disease risk assessment was fairly well associated with Jee's predicted 10-year risk of cardiovascular disease and was believed to be a practical and convenient method of preventing cardiovascular disease at the workplace.

A Comparison of KOSHA's Cardiovascular Disease Risk Assessment and the Predicted 10-year Risk of Cardiovascular Disease Developed by Jee for a Male Workers at a Wallpaper and Floor Covering Manufacturer / 대한산업의학회지

OBJECTIVES: This study was conducted to evaluate the relationship between KOSHA's cardiovascular disease risk assessment and the predicted 10-year risk of cardiovascular disease developed by Jee. SUBJECTS AND METHODS: Data were obtained from a structured questionnaire survey and medical examination of 509 male workers aged 30-59 years employed at a wallpaper and floor covering workplace in May 2008. We calculated KOSHA's cardiovascular disease risk assessment and Jee's predicted 10-year risk of cardiovascular disease. A high risk of cardiovascular disease was defined as the upper 10th percentile of Jee's predicted 10-year risk of cardiovascular disease. Statistical analysis was conducted using the Wilcoxon rank sum test, Kruskal Wallis test and a logistic regression model. RESULTS: Jee's predicted 10-year risk of cardiovascular disease significantly increased as KOSHA's cardiovascular disease risk increased. Logistic regression analysis indicated that the group with 3 or more cardiovascular disease risk factors according to KOSHA's model was more likely to experience cardiovascular disease within 10 years(OR=34.4, 95% C.I.=4.4-267.2). CONCLUSIONS: KOSHA's cardiovascular disease risk assessment was fairly well associated with Jee's predicted 10-year risk of cardiovascular disease and was believed to be a practical and convenient method of preventing cardiovascular disease at the workplace.

An OSCE Assessment of Fourth-year Medical Students as A Comprehensive Evaluation of Medical Skills Before Graduation / 한국의학교육

BACKGROUND: Experiences on Objective Structured Clinical Examination(OSCE) for student assessment are limited in medical colleges in Korea. The purposes of this study were to develop an OSCE to fourth-year medical students after completion of all clerkships at Hanyang University Medical College. METHODS: The OSCE was a 8-station examination, with each station taking five minutes. We conducted two parallel OSCEs simultaneously by duplication. We checked each stage of the process in the development of OSCEs with recording of diary. We analysed validity and costs of the OSCE. We got feedback from all participants by questionnaires. RESULTS: Of the total 102 fourth-year students, only 74 persons(72.5%) were evaluated. The rate of pass was 63.5%. Cronbach alpha of the OSCE was 0.14. The scores were different between sites according to stations, especially in items related to attitude and physical. The total OSCE score was not significantly different either between duplication sites or among groups. OSCE scores didn't relate to those of both multiple choice tests and entrance exam for internship. Our use of only a few SP's contributed to relatively low cost of $85 per examinee. Both students and faculty were satisfied with the examination, and felt that the material tested was relevant and appropriate for primary care. The OSCE process served to identify weakness in the curriculum and/or teaching methods, and thus could serve as a mechanism to improve educational effectiveness. CONCLUSIONS: Problems of validity and reliability were detected in the developing process of the OSCE. It appeared financially feasible. Setting appropriate goal, optimum number of station, training of evaluators, development of good checklist, and enthusiastic support of the school's administartion were all needed more to success of such a program.

A Case of Simple Intratesticular Cyst / 대한비뇨기과학회지

Simple cyst of the testis is a rare lesion. Clinically, testicular simple cyst may be difficult to differentiate from a cystic neoplasm. We report a simple intratesticular cyst which was found incidentally as a nontender, enlarged mass in the testicle of an eight- month- old infant. It was diagnosed by preoperative ultrasonography and operative finding and the patient underwent an organ-preserving operation.