Rapid Eye Movement와 연관된 폐쇄성 수면무호흡증의 수면다원검사와 임상적 특징

은영규,이영찬,권기환,조중생,김성완 대한이비인후과학회 2009 대한이비인후과학회지 두경부외과학 Vol.52 No.1

Background and Objectives:To evaluate the clinical and polysomnographic features of rapid eye movement (REM)-related obstructive sleep apnea (OSA). Subjects and Method:185 consecutive OSA patients were classified as having REM and non- REM OSA. Subjective symptoms, anthropometric and polysomnographic characteristics between REM OSAS and non-REM OSAS patients were compared. Results:Thirty-eight of the 185 patients (20.5%) were classified as REM OSA, and 147 patients (79.5%) were classified as non-REM OSA. Ninety five percent of the REM OSA patients belonged to the mild or moderate OSA group. The dominant occurrence of apnea and hypopnea in REM sleep did notseem to affect subjective symptoms and daytime sleepiness. Anthropometric and polysomnographic features did not help to differentiate REM OSA from non-REM OSA. Conclusion:REM OSA may not be a separate and specific disease entity of OSA.

갑상선 결절에서 세침흡인검사: Bethesda Classification의 임상적 적용

은영규,류은웅,신일호,권기환 대한이비인후과학회 2010 대한이비인후과학회지 두경부외과학 Vol.53 No.7

Background and Objectives To evaluate the usefulness of fine needle aspiration (FNA) for thyroid nodule using the new Bethesda classification. Subjects and Method Patient cytology data were reviewed by retrospective search of thyroid FNA. Cytologic diagnoses were classified as unsatisfactory, benign/negative for malignancy,indeterminate (ID), follicular neoplasm (FN), suspicious for malignancy (SM), and positive for malignancy (PM) according to the proposing of The National Cancer Institute. We analyzed the follow-up FNA diagnoses and the cytologic-histologic correlations. Results Of 1983 patients, 16.8% was classified as unsatisfactory, 73.6% as benign, 1.1% as ID,0.4% as FN, 1.4% as SM, and 6.8% as PM. After the cytologic follow-up, the groups designated as unsatisafactory (80.2%) and ID (50%) mainly showed significant change in diagnosis. Two hundred fifty patients had surgical follow-up. Sensitivity, specificity, and accuracy, positive predictive values and negative predictive values for malignancy of thyroid were 87.6%, 97.2%, 91%,98.3% and 81.2%, respectively. The cytologic-histologic diagnostic discrepancy rate was 13.6%. Conclusion FNA for thyroid nodule using the new Bethesda classification was an accurate and sensitive method for the diagnosis of thyroid nodule, and can provide useful information for the management of thyroid nodule. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:436-40

A Polymorphism (rs1801018, Thr7Thr) of BCL2 is Associated with Papillary Thyroid Cancer in Korean Population

은영규,홍일기,김수강,박현경,권삼,정대한,권기환 대한이비인후과학회 2011 Clinical and Experimental Otorhinolaryngology Vol.4 No.3

Objectives. Among the apoptosis signals, B-cell CLL/lymphoma 2 (BCL2) is a well-known regulator of apoptosis with antiapoptotic properties. We investigated here whether single nucleotide polymorphisms (SNPs) of the BCL2 were associated with host susceptibility of papillary thyroid cancer (PTC) occurrence and clinicopathologic parameters. Methods. Ninety-two PTC patients and 222 control subjects were recruited. One promoter SNP (rs2279115, -938A/C) and one synonymous SNP (rs1801018, Thr7Thr) in the BCL2 gene were selected and genotyped using direct sequencing. Multiple logistic regression models were performed to evaluate odds ratios, 95% confidence intervals, and P-values. Results. rs1801018 of the BCL2 gene was not associated with the development of PTC. In the clinicopathologic features,rs1801018 SNP was associated with the number and location. The G allele frequency of rs1801018 in PTC patients with multifocality (13.3%) was about four-fold higher than that in PTC patients with unifocality (3.4%). The G allele frequency of rs1801018 in PTC patients with both lobes (15.4%) was increased by about five-fold, compared to PTC patients with one lobe (3.2%). Conclusion. The results suggest that synonymous SNP rs1801018 and the G allele of the BCL2 gene may be associated with the multifocality and bilaterality of PTC in Korean population.

알레르기 소아의 아데노이드에서 IgE 항체와 항체조절인자

은영규,여승근,정훈,정대한,김명구,변재용,박문서,차창일 대한이비인후과학회 2009 대한이비인후과학회지 두경부외과학 Vol.52 No.7

Background and Objectives Immunoglobulin E (IgE) production in adenoid has been debated and the role of adenoid in development of allergy remains largely unknown. To examine the production of local IgE in adenoid involved with IgE-mediated sensitization, we evaluated IgE production and the expression of the transcription factor B cell leukemia/lymphoma-6 (BCL-6) and B lymphocyte inducer of maturation program 1 (Blimp-1) in adenoids. Subjects and Method Ten children with allergic rhinitis (AR) and ten children without any history of AR were enrolled. Immunohistochemical studies of adenoid for IgE, BCL-6 and Blimp-1 were performed. Results IgE was stained mainly in the germinal center and submucosal area and the staining scores of antibody to IgE did not differ signigicantly between children with AR and control. BCL- 6 was mainly stained in mucosa and germinal center and Blimp-1 in mucosa. The scores of antibody to BCL-6 and Blimp-1 in children with AR and control did not show significant differences. Conclusion We found that allergic rhinitis was not involved in the production of IgE nor the expression of the transcription factor BCL-6 and Blimp-1 in adenoid.

전체 호흡장애지수와 앙와위 호흡장애지수의 주관적 증상과의 연관성 비교

은영규,이건희,조중생,김성완,권기환 대한비과학회 2008 Journal of rhinology Vol.15 No.2

Background and Objectives:The aggravating effect of the supine body position on breathing abnormalities during sleep appears to be due to the effect of gravity on the upper airway. All patients have a higher supine RDI (respiratory disturbance index) than total RDI. The body position during sleep may be the cause of night-to-night variability in the results of the polysomnography (PSG). The aim of this study is to compare the correlation of subjective symptoms with supine RDI and total RDI. Materials and Method:One hundred and twenty nine patients who visited for snoring and/or apnea, excessive daytime sleepiness were included in the study. All patients underwent full night PSG and were administered 10 cm visual analogue scale (VAS) for 14 symtoms and Epworth sleepiness scale (ESS). Supine RDI, lateral RDI and total RDI were measured in PSG. Patients were divided to positional patients (PP) and non-positional patients (NPP). Results:Fifty of 97 obstructive sleep apnea patients (51.5%) were divided into PP group and 47 patients (48.5%) were divided into NPP group. Several symptoms had correlation with supine RDI and total RDI. In correlated symptoms, total RDI had higher correlation coefficient than supine RDI in both PP group and NPP group. Conclusions:Our results suggest that total RDI may reflect patient’s subjective symptoms. Background and Objectives:The aggravating effect of the supine body position on breathing abnormalities during sleep appears to be due to the effect of gravity on the upper airway. All patients have a higher supine RDI (respiratory disturbance index) than total RDI. The body position during sleep may be the cause of night-to-night variability in the results of the polysomnography (PSG). The aim of this study is to compare the correlation of subjective symptoms with supine RDI and total RDI. Materials and Method:One hundred and twenty nine patients who visited for snoring and/or apnea, excessive daytime sleepiness were included in the study. All patients underwent full night PSG and were administered 10 cm visual analogue scale (VAS) for 14 symtoms and Epworth sleepiness scale (ESS). Supine RDI, lateral RDI and total RDI were measured in PSG. Patients were divided to positional patients (PP) and non-positional patients (NPP). Results:Fifty of 97 obstructive sleep apnea patients (51.5%) were divided into PP group and 47 patients (48.5%) were divided into NPP group. Several symptoms had correlation with supine RDI and total RDI. In correlated symptoms, total RDI had higher correlation coefficient than supine RDI in both PP group and NPP group. Conclusions:Our results suggest that total RDI may reflect patient’s subjective symptoms.

한국의 도시지역에서 바퀴벌레 항원에 의한 알레르기비염:감작률과 진단

은영규,김성완,이인영,조중생 대한이비인후과학회 2004 대한이비인후과학회지 두경부외과학 Vol.47 No.8

Background and Objectives:Recently persistent type and mixed sensitization of allergic rhinitis are on the rise. We have frequently experienced patients sensitized to cockroach in allergic skin test (AST). There was a report that cockroach was prevalent in each house within Seoul metropolitan area. The aim of this study is to investigate the prevalence of patients sensitized to cockroach and to compare AST positivity to cockroach with multiple allergosorbent chemiluminescent asay (MAST-CLA) result. Subjects and Method:Alergic skin test with 5 comon inhalant alergens was performed in 180 patients who had visited Alergic Clinic of Kyung-Hee University Hospital from Jan. 2003 to Jul. 2003. Among them, MAST-CLA was performed itized patients with negative result in MAST. Results:54 patients (30% ) were AST positive to cockroach among 180 patients had allergic rhinitis. Concomitant ofending antigen were D. farinae (63% ), House dust (33.3%), Candida (13% ), Aspergillus (9.3%). on MAST. Minor bands of cockroach antigen in Western blot were detected in 6 of 10 patients who were sensitized to cockroach in AST but not to MAST. Conclusion:We suggest that cockroach should be considered as an important antigen in allergic rhinitis. It should be neded for the diagnosis of cockroach allergic rhinitis that MAST sensitivity is increased.

Follicular Dendritic Cell Sarcoma of the Tonsil

은영규,김성완,권기환 연세대학교의과대학 2010 Yonsei medical journal Vol.51 No.4

Follicular dendritic cell sarcoma (FDCS) is unusual, and those with an extranodal origin in the head and neck region are extremely rare. To date, no cases of tumors featuring the characteristics of follicular dendritic cells were reported in Korea. We report a new case of FDCS of the tonsils in a 65-year-old man. A diagnostic tonsillectomy was performed. Based on histopathologic and immunohistochemical findings, the patient was diagnosed with FDCS. Adjuvant radiotherapy was performed due to a high mitotic count. The patient survived with a 2-year disease free period. The differential diagnosis of a tonsillar mass must include FDCS. In cases in which FDCS is suspected on histopathologic examination, an immunohistochemical study is essential for the diagnosis.

알레르기비염 환자를 대상으로 시행한 면역치료의 부작용

은영규,김성완,여승근,김명구,조중생 대한이비인후과학회 2005 대한이비인후과학회지 두경부외과학 Vol.48 No.6

Background and Objectives:It has become increasingly clear that immunotherapy with a specific aeroallergen extract is an effectivetreatment for allergic rhinitis. The fear of side reactions has led to strict regulation preventing a more widespread use ofspecific immunotherapy. The aim of this study is to investigate incidence of local and systemic side reactions in patients who receivedimmunotherapy. Subjects and Method:Subjects were 139 patients with perennial allergic rhinitis. All patients with allergicrhinitis were diagnosed by history and positive allergic skin test or MAST. All patients received injections of Dermatophagoidesfarinae or cockroach extracts. Retrospective study was conducted to investigate the incidence of local and systemic side reactions.Results:Ninety-nine patients (71.2%) experienced more than a side reaction. Eighty-seven patients (62.6%) experienced localside reactions and 41 patients (29.5%) experienced systemic reactions. The frequency of side reaction in each age group wasdifferent but not statistically significant. The side reactions were developed in 66.8% of patients during buildup phase and in 42.4%of patients during maintenance phase. All patients who experienced systemic reactions were recovered after appropriate managements.Conclusion:Immunotherapy is a relatively safe treatment for allergic rhinitis patients in spite of frequent reaction rate,because most of reactions are local reactions and patients with systemic reactions are treated completely.

폐쇄성 수면무호흡증과 상기도저항증후군의 임상적 특징 비교

은영규,김성완,이건희,조중생 대한이비인후과학회 2006 대한이비인후과학회지 두경부외과학 Vol.49 No.9

Background and Objectives:Most of the patients with upper airway resistance syndrome (UARS) remain undiagnosed and areleft untreated because of the disagreement with diagnostic criteria of obstructive sleep apnea syndrome (OSAS). The aim of thisstudy is to help understanding UARS through evaluating differences of polysomnographic findings and subjective symptoms betweenUARS and OSAS. Subjects and Method:One hundred nineteen patients, who visited for snoring and/or apnea, excessivedaytime sleepiness, were included. All patients underwent full night polysomnography (PSG) and performed tests on the 10cm visual analogue scale (VAS) for 14 symptoms and Epworth sleepiness scale (ESS). PSG results and VAS score were comparedbetween UARS group and OSAS group. Results:Among 119 patients, 4 patients had simple snoring, 19 patients had UARS and96 patients had OSAS. Patients with UARS were younger and had lower BMI than OSAS. Apnea index, hypopnea index, respiratorydisturbance index, arousal index, portion of slow wave sleep, mean and lowest oxygen saturation were more severe in patientswith OSAS than UARS. But subjective symptoms and ESS were similar in both groups. Conclusion:Although significantdifferences were found in PSG results in patients with UARS and OSAS, complaints and symptoms were similar in both groups. Wesuggest that diagnosis and treatment for sleep-disordered breathing should not be based solely upon the presence of apnea/hypopnea.We also suggest that more consideration should be given to UARS diagnosis and treatment. (Korean J Otolaryngol 2006;49:908-11)

성대 백반증 진단에 있어서 I-Scan Image-Enhanced 내시경의 유용성

이영찬,은영규,박일석 대한후두음성언어의학회 2018 대한후두음성언어의학회지 Vol.29 No.2

Background and Objectives:Detection of vascular abnormalities in vocal cord (VC) leukoplakia is important for the diagnosis of neoplastic change of the mucosa. The aim of this study was to investigate the value of i-scan in the differential diagnosis of VC leukoplakia based on visualization of abnormal vascular features. Material and Methods:Fifty-two patients with leukoplakia were enrolled in the study. Images of their larynx obtained using conventional white light endoscopy and an i-scan-enhanced endoscopy (Pentax DEFINA EPK-3000 Video Processors, with Pentax VNLJ10) were reviewed. The microvascular features of the lesions and vascular changes were analyzed and the results were compared with the histopathologic diagnosis. Results:Among the 52 leukoplakia patients, 7 (13.5%) patients had squamous hyperplasia, 10 (19.3%) mild dysplasia, 2 (3.8%) moderate dysplasia, 14 (26.9%) severe dysplasia, 4 (7.7%) carcinoma in situ, and 15 (28.8%) invasive squamous cell carcinoma on histopathologic examination. Using i-scan-enhanced endoscopy, abnormal vascular change with neoplastic neoangiogenesis was detected in most cases of malignant VC lesion [severe dysplasia : 9/14 (64.3%), carcinoma in situ: 2/4 (50.0%), and invasive squamous cell carcinoma : 11/15 (73.4%)]. Conclusion:i-scan-enhanced endoscopy is a useful optical technique for the diagnosis of VC leukoplakia. Our results suggest that i-scan may be a promising diagnostic tool in the early detection of laryngeal cancer.