인후두역류의 약물치료

주형로,Chu, Hyung-Ro 대한후두음성언어의학회 2007 대한후두음성언어의학회지 Vol.18 No.2

Otolaryngological manifestations of acid reflux include a wide range of pharyngeal and laryngeal symptoms ; and the constellation of symptoms has been called laryngopharyngeal reflux (LPR). In the absence of definite diagnostic criteria, LPR disease remains a subjective entity. A diagnosis of LPR is usually based on response of symptoms to empirical treatment. Investigative modalities such as pH monitoring and, more recently, impedance studies are generally reserved for treatment failures. LPR usually requires more aggressive and prolonged treatment to achieve regression of both symptoms and laryngeal findings. The suppression of gastric acid and secretion with anti-secretary agents has been the mainstay of medical treatment for patients with acid-related disorders. The suppression of gastric acid secretion achieved with Hz-receptor antagonist $(H_2RA)$ has proved suboptimal for relief of reflux symptoms. The rapid development of tolerance and rebound acid hypersecretion after the with-drawal of $H_2RA$ limit their clinical use. Proton pump inhibitors (PPI) have been proved to be very effective for suppressing intragastric acidity, but the optimal dose and duration is unknown. Current evidence indicates that pharmacologic intervention should include, at a minimum, a 3 month trial of twice daily PPI. Symptoms of LPR improve over 2 months of therapy. The physical findings of LPR resolve more slowly than the symptoms and this continues through out at least 6 months of treatment. For most patients with LPR, twice daily dosing with a PPI is usually recommended for an initial treatment for a period of no less than 6 months treatment, and lifetime treatment may be required.

외측경부 종물로 나타난 어류골편이물 1례

주형로,고원혁,최동준,김일우,박일석,김범규,김용복,Chu, Hyung-Ro,Ko, Weon-Hyoug,Choi, Dong-Joon,Kim, Il-Woo,Kim, Beom-Gyu,Park, Il-Seok,Kim, Yong-Bok 대한기관식도과학회 2007 大韓氣管食道科學會誌 Vol.13 No.2

The case report of migrating ingested fish bone presenting as an unresolving inflamed neck mass is rare. The diagnosis must be suspected in a patient with an unresolving inflamed cutaneous lesion, especially one with a punctum, the tenderness of the lesion elicited on swallowing and the presence of a palpable subcutaneous neck mass. In such a patient, a history of recent foreign body ingestion must be actively sought. An accurate early diagnosis of this easily treatable condition is desirable because it could avert unnecessary delays, inconveniences, anxiety, costs, and surgery. The authors experienced a case of lateral neck mass resulting from the migration of a fish bone which was successfully removed by surgical exploration and made a report with a review of literature.

수직후두부분절제술 및 점막 피판과 지방 이식을 통한 성대 재건술 후의 음성분석

주형로,최인자,김진환,안회영,노영수,Chu, Hyung-Ro,Choi, In-Ja,Kim, Jin-Hwan,Ahn, Hwoe-Young,Rho, Young-Soo 대한후두음성언어의학회 2007 대한후두음성언어의학회지 Vol.18 No.2

Background and Objectives: The goals of laryngeal reconstruction have been prevention of aspiration, production of a functional voice, and maintenance of an adequate airway for decannulation. It is generally believed that the reconstruction of the glottic region after vertical partial laryngectomy (VPL) can improve laryngeal function. The objective of this study is to evaluate of voice function after VPL with mucosal flap and fat graft reconstruction. Materials and Methods: From 1994 to 2006, 13 patients, who had been treated with VPL with mucosal flap and fat graft reconstruction. The voice characteristics, acoustic, aerodynamic parameter were measured in 13 patients after vertical partial laryngectomy with mucosal flap and fat graft reconstruction. Acoustic analysis was carried out using Computerized Speech Lab (CSL) and aerodynamic analysis were carried out using Aerophon II,3 months and 12 months after surgery. Results: The GRBAS scale, jitter, shimmer, NHR were improved as time goes on after surgery. But, maximum phonation time was shortened after surgery and there is no significant differences between before and after surgery in mean flow rate. Conclusion: The voice function of the mucosal flap and fat graft reconstruction after VPL were satisfactory. This can be an excellent reconstruction method after vertical partial laryngectomy.

갑상선암종의 후인두림프절 전이

주형로 ( Hyung Ro Chu ),배우진 ( Woo Jin Bae ),이동진 ( Dong Jin Lee ),고은석 ( Eun Seok Koh ),노영수 ( Young Soo Rho ) 대한갑상선학회 2008 International Journal of Thyroidology Vol.1 No.1

Background and Objectives: Metastasis of the retropharyngeal lymph nodes (RPLNs) in thyroid cancer is rare. It is almost impossible to detect metastasis of the RPLNs by palpation or inspection. Images such as CT, MRI or PET/CT can be used for preoperative evaluation of RPLNs but the effectiveness of these radiologic diagnoses in detecting the PRLNs metastasis in thyroid cancer has not been reported. Our study goal is to identify the effectiveness of radiologic diagnosis by comparing preoperative radiologic findings with histopathologic results. We also tried to find clinical factors which are associated with RPLNs metastasis in thyroid cancer. Materials and Methods: We reviewed all patients who underwent resection of RPLN group because of thyroid cancer metastasis at our institution between 2003 and 2007. Total 6 patients were included in this study. All patients underwent retropharyngeal lymph node dissection and got histopathologic interpretation of the RPLNs. We compared the preoperative radiologic findings with postoperative histopathologic results. Results: Metastatic retropharyngeal nodes were successfully resected via transcervical approach in all patients. Metastasis to the RPLN group was confirmed hisotpathologically in all 6 patients (positive predictive value 100%). All 6 patients had multiple cervical lymph node metastases and among them, 5 patients had extrathyroid extension of primary tumor. Conclusion: Preoperative positive finding in radiologic studies such as CT, MRI and PET/CT perfectly predicted RPLN metastasis of thyroid cancer in this study. If patients with thyroid cancer have cervical lymph node metastasis, previous neck dissection history, or extrathyroidal extension, we have to keep the chance of RPLN metastasis in mind. Because of the high possibility of RPLN metastastis in cases of positive radiologic finding, we recommend the adding of RPLN dissection in these patients.

편도암의 수술적용 형태에 따른 치료효과

주형로(Hyung Ro Chu),한승훈(Seung Hoon Han),권기환(Kee Hwan Kwon),정광윤(Kwang Yoon Jung),최건(Geon Choi),최종욱(Jong Ouck Choi) 대한두경부종양학회 1999 대한두경부 종양학회지 Vol.15 No.1

Objectives: The treatment for squamous cell carcinoma of the tonsil remains controversial. Surgery or radiation therapy alone is effective in treating early tonsil cancer, but results with single treatment modality in advanced disease have been disappointing. We retrospectively analyzed 37 patients with advanced squamous cell carcinoma of the tonsil for two treatment modalities in an effort to identify more efficacious therapeutic options. Materials and Methods: From 1990 through 1997, 37 patients who were treated primarily with surgery, were retrospectively sudied. The patients were grouped into two groups according to the method of treatment, extended tonsillectomy followed by irradiation and/or postradiation neck dissection(Group I) and a combination of composite resection and postoperative radiation(Group II). Results: The three year disease-tree survival in patients with stage IV lesions was 59.09% for the Group I patients, and 56.25% for the Group II patients. This difference was not statistically significant(p=0.775). The primary tumor recurrence rate in Group I was 16.7% in contrast to 23.1% for Group II. The local recurrence rate in the neck was 16.7% for the Group I patients and 23.1% for the Group II patients. There was no significant difference in the frequency of recurrences in the primary or neck in the patients treated with extended tonsillectomy or composite resection(p=0.639). Fistula formation and aspiration occurred in four patients after composite resection. Additionally, there were three trismus, one soft tissue necrosis, and one velopharyngeal insufficiency. Major complications were not observed in the patients treated with extended tonsillectomy and irradiation: velopharyngeal insufficiency was observed in eight patients and soft tissue necrosis in two patients. Conclusion: Extended tonsillectomy followed by irradiation may be an effective therapy with low morbidity in selected patients with tonsil cancer.

두경부편평세포암종에서 Gleevec의 효과

주형로(Hyung Ro Chu),Robert A Weisman 대한두경부종양학회 2005 대한두경부 종양학회지 Vol.21 No.2

Purpose: The serine/threonine kinase Akt was described to inhibit apoptosis in cancer. This study was to examine the effect of Gleevec on head and neck squamous cell carcinoma(HNSCC) through the mechanism of Akt. Experimental Design: Gleevec was introduced into the HNSCC cell lines UMSCC10B, HN12 and HN30 in a range of concentrations. Cell viability was assessed by clonogenic survival analysis. Targets of Gleevec(PDGFR, c-Kit, and c-Abl) were evaluated by Western blot. HNSCC tissue samples were stained for PDGFR, c-Kit and phosphorylated Akt. Akt phosphorylation following Gleevec treatment was assessed using Western blot. Akt siRNA was used to as the positive control. Results: Colony forming efficiency decreased with an increase in concentration of Gleevec. Expressions of PDGFR, c-Kit, and c-Abl were observed in HNSCC cells. Immunohistochemistry confirmed high expression of PDGFR, c-Kit, and p-Akt in human HNSCC tissues. Akt kinase activity was significantly inhibited with increasing concentration of Gleevec in HNSCC cells, and near complete dephosphorylation of Akt was observed at 6μM of Gleevec in the UMSCC10B and HN30 cell lines. Conclusions: Gleevec at clinically comparable concentrations caused a dose dependant decrease in HNSCC survival. The decreased cell survival was related to the inhibition of Akt kinase activity and dephosphorylation of Akt. Akt signaling pathway may be a relevant target for Gleevec in treating HNSCC.

편도 편평세포암종의 뇌전이 1례

주형로(Hyung Ro Chu) 대한두경부종양학회 1999 대한두경부 종양학회지 Vol.15 No.2

두경부 영역에서 발생하는 악성종양은 원격전이가 흔하지 않으나 최근 들어 국소전이에 대한 치료효과가 향상됨에 따라 원격전이가 재발과 사망의 주된 원인이 되고 있다. 원격전이중 뇌전이는 빈도는 적으나 이환시 높은 사망률을 보이므로 뇌전이를 의심하는 증상이 있을 때는 조기발견을 위한 적극적인 진단적 접근과 이에 대한 적절한 치료가 중요하다. 본 증례와 같이 고식적 수술후 국소전이에 대한 조절이 잘 되고 있는 환자에서 지속적인 두통 및 체중감소 등의 증상이 나타나는 경우 뇌전이를 의심하여 적절한 진단 방법을 통한 조기 진단과 치료가 중요하다고 생각된다. Distant metastases of head and neck cancer have become an increasingly common cause of death as local and regional control has improved. The most frequent metastatic sites of head and neck cancer are the lung, liver, bone and kidney; but metastases to the gastrointestinal tract, brain and heart have also been reported. We report a recent case of a 37-year-old male patient with squamous cell carcinoma of the tonsil who had undergone composite operation with left radical neck dissection and postoperative radiotherapy. The patient presented three years later, cachexic and complaining of severe deep seated headache. Radiologic evaluation revealed a cystic mass with peripheral enhancement in left temporal lobe that was proven to be metastatic cancer by burrhole exploration. However, in spite of various modalities, the patient expired.

갑상선 유두상암의 핵산분석

주형로(Hyung Ro Chu),정도광(Do Kwang Jung),우정수(Jeong Su Woo),최종욱(Jong Ouck Choi),김인선(In Sun Kim) 대한두경부종양학회 1994 대한두경부 종양학회지 Vol.10 No.2

The indolent course of most thyroid papillary carcinomas, even the presence of regional lymph node metastasis, make them unique among human malignant head and neck cancers. Age, sex, extracapsular invasion and anaplastic change are known to be correlated with prognosis. The purpose of this study is to clarify the significance of DNA content analysis as a prognostic factor. Twenty five thyroid papillary carcinomas were possible to be examined by flow cytometric analysis using fresh surgical specimens and three nodular hyperplasias and seven follicular adenomas were included as control group. The results were as follows: 1) All of twenty five thyroid papillary carcinomas showed diploidy. 2) S-phase fraction was 1.94±2.77 in normal control group and 2.60±2.66 in papillary carcinoma group. The proliferation index was 8.44±3.89 in normal control and 7.70±3.63 in papillary carcinoma group with even low value. 3) Age, sex, extracapsular spread and lymph node metastasis showed no significant difference. In conclusion, low proliferative activity of thyroid papillary carcinomas are thought to be related with good prognosis.

갑상선 종물로 오인된 Killian-Jamieson 게실 1예

주형로(Hyung Ro Chu),이종선(Jong Sun Lee),한동혁(Dong Hyuk Han),진재원(Jae Won Jin) 대한두경부종양학회 2006 대한두경부 종양학회지 Vol.22 No.1

Killian-Jamieson and Zenker diverticula are both rare pharyngoesophageal diverticula. Both are outpouching of the mucosal and submucosal layers of the esophageal wall, which protrude through a mucosal gap at the level of the pharyngoesophageal esophagus. When these diverticula are large enough, they can be in proximity to the thyroid gland and may mimic a thyroid nodule. We report a case in which a diverticulum was filled with dietary residue and thus simulated a thyroid cyst on CT scan. And it was finally diagnosed as a Killian-Jamieson diverticulum by the surgery.

KTP-532 레이저를 이용한 후두미세음성수술의 임상적 적용 결과

최종욱,주형로,정광윤,Choi, Jong-Ouck,Chu, Hyung-Ro,Jung, Kwang-Yoon 대한미세수술학회 1993 Archives of reconstructive microsurgery Vol.2 No.1

Recently, conservative and bloodless operative procedures have been focused, so that endoscopic laser have been used. However application of endoscopic laser surgery for laryngeal lesion is capable for followings: (1)capability of delivery through an operating microscope, (2) vaporization of ultraspot. $CO_2$ laser which has been used, has limitations for voice improvement because of 700 micron beam spot. KTP-532 laser which is capable of delivery through an operating microscope vapore 200 micron ultraspot has developed and applied to microlaryngeal surgery. We have experienced 60 cases who were contracted with hoarseness(53 cases of benign lesions vocal nodule 13, vocal polyp 13, bilateral diffuse polyposis of vocal cords 11, intracordal cyst 8, vocal papilloma 5, laryngocele 1, laryngeal stenosis 2 and 7 cases of malignant lesions : laryngeal carcinoma stage I and II) since 1991. We operated them with KTP-532 Laserscope(3 Watt/0.05 sec., pulsed or continuous. San Jose, Calif, USA). Forty eigh cases(90.6%) of 53 bengin laryngeal lesions and 4 cases(57.1%) of malignant lesions were significantly improved in their voices. There were a few complications and technical problems, but laser surgery alone had a limitation to eradicate the disease.