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구강내 접근법으로 치료한 이하선관내 다발성 타석증 1예
박현우,조상재,김진평,우승훈 대한이비인후과학회 2010 대한이비인후과학회지 두경부외과학 Vol.53 No.8
Sialolithiasis is a condition characterized by the obstruction of a salivary gland or its duct due to the formation of calcareous material or sialoliths resulting in salivary ectasia and even provoking the subsequent dilation of the salivary gland or salivary duct. The most difficult cases involve sialoliths in the posterior part of the Stensen’s duct, the presence of multiple stones with stenosis of the distal part of the duct. We report on a case of Stensen’s duct abscess with multiple sialolithiasis in a 46-year-old man. The patient’s cheek was swollen, and showed no evidence of any other lesions. The patient was treated with surgical removal of stones by the intraoral approach,sialodochoplasty and antibiotics therapy. There has been no recurrence nor duct problem during the 12 months period of follow up. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:501-4
Analysis of Clinical Feature and Management of Laryngeal Fracture: Recent 22 Case Review
김진평,우승훈,조상재,손희영,박정제 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.5
Purpose: Laryngeal fracture is rare, but complications are frequent and severe. Controversy still exists in regards to its proper management. The aim of this study was to present the clinical findings and management of laryngeal fracture in Korea. Materials and Methods: We analyzed the medical records of 22 patients with laryngeal fracture at a tertiary care trauma center from 2000 to 2010 retrospectively. Results: In total, 22 patients (19 men and 3 woman) presented with laryngeal fractures caused by blunt (n=13) or penetrating (n=9) injury. Pain (68.1%), odynophagia (68.1%), hoarseness (18.1%), hemoptysis (13.6%), and subcutaneous emphysema (9%) were the common presenting symptoms and noncomminuted fracture was common. High velocity blunt trauma (mostly traffic accidents) patients had more extensive injury and poor voice outcomes. Penetrating trauma patients due to physical assault or suicide attempt demonstrated more frequently injuries on the left side. Conclusion: In driver-caused traffic accidents, where injuries in a wide area within the larynx occurred, poor voice results were seen, and these injuries required aggressive treatment. When endotracheal intubation was performed at experienced emergency centers with fiberoptic laryngoscopes, airway management was safely achieved. In addition, if the fractured laryngeal framework was corrected at appropriate times, voice results were good.
학습곡선 상승기 중 비내시경하 경비강 경접형동 뇌하수체 종양 절제술의 임상적 결과
김대우,박경범,조상재,고준석,주연희,정진명,전시영 대한이비인후과학회 2011 대한이비인후과학회지 두경부외과학 Vol.54 No.2
Background and Objectives The aim of this study was to compare endoscopic endonasal transsphenoidal hypophysectomy (EETSA) with microscopic transseptal transsphenoidal hypophysectomy (MTTSA) in terms of clinical results during an acceleration of learning curve. Subjects and Method A retrospective chart review was performed of the first 14 cases of EETSA and previous 14 cases of MTTSA. Resection results, endocrinologic outcomes, complication rates, operating time, and duration of hospital stay were investigated. A non-parametric analysis was performed to determine the significance of differences between groups. Results EETSA was performed, achieving gross total removal, based on postoperative MRI, for 12 of the 14 patients (86%) and hormonal remission for 4 of the 5 patients (80%); on the other hand, MTTSA was performed, achieving gross total removal for 9 of the 14 patients (64%) and hormonal remission for 1 of the 5 patients (20%). We found better resection results in patients who underwent EETSA than in those who did MTTSA with respect to tumors extending into suprasellar area (p<0.05). Visual improvement was achieved in all the cases with visual defect (n=5) after EETSA, whereas 4 of 6 cases (66%) were improved after MTTSA. Significant differences in complication rates, operating time and hospital stay could not be determined. All cases with CSF leakage in EETSA were successfully managed by using the nasoseptal flap. Conclusion EETSA provided better resection results than MTTSA did, especially in cases extending into the suprasellar area, showing good hormonal cure and visual improvement rates. Two approaches were comparable with respect to complications during the learning curve.
내성비내시경수술의 적응이 되는 만성 부비동염에 대한 세균학적 동정
김진용,전시영,조상재,김대우 대한이비인후과학회 부산,울산,경남 지부회 2010 임상이비인후과 Vol.21 No.2
Background and Objectives:Identification of causative organisms in the treatment of chronic rhinosinusitis (CRS) may be a critical step for a successful treatment. There is a consensus on preoperative antibiotics-presc-ription in expert-opinion guidelines, but no on postoperative. The aims of the study were to identify causative bac-terial organisms in the patients who had endoscopic sinus surgery (ESS) for CRS, and to propose a clue for appropriate postoperative antibiotics. Materials and Methods:Thirty-one patients who had at least 2-week antibiotics before taking CT and ESS were included. The exclusion criteria were, under age of 18, having DM, fungal or unilateral sinusitis. Before ESS, antral puncture was taken for sampling the secretion in the maxillary sinus, and then aerobic and anaerobic culture and antibiotic sensitivity test were performed. Results:Two cases of H. influenzae, 4 cases of E. aerogenes, 1 case of M. morganii and 2 cases of S. epidermidis were isolated. Anaerobic bacteria were not identified. The contamination rate was 5.55% and aerobic bacterial identification rate was 19.44%. All bacteria were sensitive to quinolone. Conclusions:Most of the patients, who had ESS for CRS after adequate preoperative antibiotics by guidelines, may have sterile sinuses at the time of sugery. Therefore,a prophylactic short-term antibiotics may be approprated instead of the empirical long-term antibiotics after sinus surgery. (J Clinical Otolaryngol 2010;21:221-225)
난청 동물 모델에서 신경성장인자의 청력회복에 관한 연구
김지홍,박시내,여상원,김영하,진선영,김종훈,조상재,김정현,최미영,박경호 대한이비인후과학회 2008 대한이비인후과학회지 두경부외과학 Vol.51 No.12
Sensorineural hearing loss is caused by ototoxic drugs, radiation therapy, noise exposure and trauma, etc. They make irreversible changes in cochlear hair cells and degeneration of spiral ganglion neurons. It is known that neurotrophins and other growth factors have an important role in protectingcochlear hair cells and spiral ganglion neurons. We designed this study to analyze the effect of neurotrophins and growth factors delivered to the inner ear of deafened guinea pig. Materials and Method:Healthy 15 guinea pigs with normal Preyer’s reflex were chosen, and were made deaf by infusion of kanamycin and ethacrynic acid. Myringotomy was done to both ears, normal saline injected into the left ear, and BDNF (brainderived neurotrophic factor), GDNF (glial cell derived neurotrophic factor), NT-3 (neurotrophin-3), IGF (insulin-like growth factor), EGF (epidermal growth factor), FGF (fibroblast growth factor) were injected in the right ear. Results:Statistically significant hearing gain was obtained up to 35.00±13.78 dB in the group 1 (BDNF, GDNF, NT-3 treated group), and up to 34.0± 5.47 dB in the group 2 (IGF treated group). However, no statistically significant hearing gain was observed in the group 3 (EGF, FGF treated group). Conclusion:We observed statistically important improvement of hearing threshold in the BDNF, GDNF, NT-3 treated group and IGF treated group. (Korean J Otorhinolaryngol-Head Neck Surg 2008;51:1093-8)
기니아피그 와우신경절에서 배양된 성체 신경줄기세포의 유세포분석법을 이용한 분석
김영하,김창현,박경호,박시내,최미영,홍옥기,김지홍,조상재,김정현,장기홍,여상원 대한이비인후과학회 2009 대한이비인후과학회지 두경부외과학 Vol.52 No.2
Background and Objectives:To make stem cell therapy successful as one of treatment options for sensorineural hearing loss, it is essential to culture and obtain sufficient amounts of adult neural stem cells, as well as separating them from adult auditory organs. This study was designed to investigate the proportion of cultured adult neural stem cells and its differentiated cells from guinea pig spiral ganglion. Materials and Method:The spiral ganglions from guinea pigs of 3-6 month age were obtained. The tissues were digested with 0.25 % trypsin and 10 mg/mL of DNase I, cells were then cultured with neurobasal medium (DMEM/ F12 containing B27 supplement, L-glutamin, gentamycin) and added with 20 ng/mL of epidermal growth factor and 10 ng/mL of fibroblast growth factor. After 3 passages of culture, neural stem cells and differentiated cells were analyzed with the flow cytometric method. Results:We concluded that neural stem cells were successfully cultured from spiral ganglions and these cells were in process of differentiation into neurons and Schwann cells. The results of flow cytometric analysis of cells in culture medium showed that 1.7% of cells (cell count of 24,300) expressed nestin, 3.45% polysialylated neural cell adhesion molecule, 7.19% (cell count of 66,300) neural cell adhesion molecule, and 3.57% β III tubulin. Conclusion:Though obtaining adult neural stem cells from adult spiral ganglion was successful, the cell count was small. Further studies on the subject of making proper culture medium are needed to obtain adequate amounts of adult neural stem cells.