피판 부전증의 구제를 위한 약용거머리 치료법

백정환(Chung Hwan Baek),신준호(Juno Shin),박주현(Joo Hyun Park) 대한두경부종양학회 2000 대한두경부 종양학회지 Vol.16 No.1

The medicinal leech, Hirudo medicinalis, has been used for salvage of the venous-congested flap following reconstructive surgery, with increasing frequency during the last two decades. Medicinal leech therapy is a safe, efficacious, economical, and well-tolerated intervention. The flap salvage with leeching occurs in approximately 70% of cases, and leeches need to be used as early as possible. At the time of the bite, evacuation of blood and injection of the leech saliva products, including anticoagulants and inhibitors of platelet aggregation, maintain capillary circulation of the flap, and then venous capillary return is established across the wound by angiogenesis. One of the salivary products, hirudin, represents the first parenteral anticoagulant introduced since the discovery of heparin. We analyzed two cases in which flap salvage with leeching was attempted, and reviewed medicinal leech therapy on the basis of our experiences and literature review. This has not been documented in the head and neck surgery literature in our country.

누액선에 발생한 Adenoid Cytic Carcinoma - 증 례 보 고 -

서대희,백정환,김윤덕,하범준,박익성,남도현,박관,김종현,Seo, Dae Hee,Baek, Chung-Hwan,Kim, Yoon-Duck,Ha, Bom Joon,Park, Ik-Seong,Nam, Do-Hyun,Park, Kwan,Kim, Jong-Hyun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.8

Adenoid cystic carcinoma(ACC) is a rare malignant tumor that occurs in exocrine glands such as major and minor salivary glands, lacrimal glands, ceruminal glands. It has a tendency for delayed distant metastasis and long clinical course. ACC of the lacrimal gland is generally found in adults and is usually managed by radical orbitectomy and supplemental external beam irradiation. The authors present two cases of recurrent lacrimal gland ACC with review of the literature.

소아 후두기관협착 환자에서 single-stage 방법의 후두기관재건수술

고문희,손영익,백정환,정한신,정만기,Ko, Moon-Hee,Son, Young-Ik,Baek, Chung-Hwan,Jeong, Han-Sin,Chung, Man-Ki 대한기관식도과학회 2007 大韓氣管食道科學會誌 Vol.13 No.2

Background and Objectives: Laryngotracheal stenosis and its reconstruction in children is a highly challenging field to airway surgeons, and the way of stenting after a reconstructive surgery is still controversial. The aims of this study were to analyze the single institutional experiences of laryngotracheal reconstruction (LTR) in the pediatric patients with laryngotracheal stenosis and to compare the outcomes of single-stage LTR (SSLTR) with conventional two-stage LTR (TSLTR) in these patients. Materials and Methods: Medical records of 14 children (mean age 4.1 years) were reviewed, who received 20 LTR including 6 revisions for their moderate to severe subglottic stenosis and/or combined posterior glottic stenosis. Of these 20 LTR, tracheostoma was temporarily maintained after LTR in 12 cases (TSLTR) or not in the other 8 cases (SSLTR). Results: Overall decannulation rate of LTR that were performed before and after the year of 2003 was 40% (4/10) and 70% (7/10) respectively. Decannulation rate was 42% (5/12) in TSLTR group and 75% (6/8) in SSLTR group (P = 0.197). Mean interval to decannulation after LTR was 9.8 months and 7.2 days in TSLTR and SSLTR groups respectively (P = 0.004). A number of additional touch-up procedures that were required after LTR was 4 in TSLTR and 2.7 in SSLTR group (P = 0.238). Major complication rate was similar in both groups (33% in TSLTR and 38% in SSLTR, P = 0.910). Conclusion: A laryngotracheal reconstruction in children is a technically demanding procedure and its outcome is largely dependent on the surgeon's experience. Albeit there was a tendency that SSLTR ofters a higher decannulation rate, less additional touch-up procedures and similar complication rates, a shorter interval to decannulation after LTR was the only advantage that was confirmed as statistically significant in this study.

구강내 재건을 위한 안면 동맥 근점막 피판의 다양한 적용법

손영익(Young-Ik Son),백정환(Chung-Hwan Baek),정한신(Han-Sin Jeong),조재근(Jae Keun Cho),류광희(Gwanghui Ryu) 대한두경부종양학회 2013 대한두경부 종양학회지 Vol.29 No.2

Background:The purpose of this study is to review our experience with the variable applications of the facial artery muscolomucosal(FAMM) flap for oral cavity reconstruction following treatment for head and neck malig-nancies. Methods:We performed retrospect medical record review from January 2012 to June 2013. This flap technique was applied in 3 patients to reconstruct the defects of oral cavity induced by treatment for head and neck malignancies. Results:The defects and fibrosis occurred due to variable causes related to previous treat-ment for head and neck malignancies such as tumor resection and chemoradiation. Two patient suffered from defect on hard and soft palate and one patient suffered from trismus related to fibrotic scar band. We performed oral cavity reconstruction using FAMM flap even though these all patients had history of neck dissection surgery or radiation therapy. Conclusion:FAMM flap is an ideal option for reconstruction following treatment not only for primary tumor resection but also for defects induced by variable causes. Preoperative radiation and neck dis-section surgery, which are previously considered as some challenges, are no longer contraindication in our cases.

The Clinical Applicability of Transoral Transpharyngeal Approach to the Craniovertebral Junction Lesions

조태구,박관,조양선,백정환,남도현,김종수,홍승철,신형진,어환,김종현,Cho, Tae Goo,Park, Kwan,Cho, Yang-Sun,Baek, Chung-Hwan,Nam, Do Hyun,Kim, Jong Soo,Hong, Seung-Chyul,Shin, Hyung Jin,Eoh, Whan,Kim, Jong Hyun The Korean Neurosurgical Society 2000 Journal of Korean neurosurgical society Vol.29 No.3

목 적 : 경구적 접근법은 두개 경추이행부의 병소에 대한 유용한 접근방법이나 신경외과 의사에게는 비교적 친숙하지 않은 해부학적 구조물과 뇌척수액 누출로 인한 뇌막염의 위험성으로 인하여 많이 사용되지 않고 있다. 본원 신경외과에서는 다양한 두개 경추이행부의 병변에 대한 경구적 접근법을 시행하였으며, 수술 방법에 따른 결과 및 이의 적응증에 대해 발표하고자 한다. 방 법 : 1996년 9월부터 1999년 4월까지 총 8예의 환자에서 경구적 접근법을 시행하였다. 3명의 환자에서 선천성 기형에 의한 두개저 함입이 있었고, 2명에서는 외상성 치상돌기 골절, 2명에서는 외상성 환축추탈구, 1명에서는 비인두부위 가양성 종양을 동반하였다. 5명의 환자에서 전방 접근법 시행후 후방 골유합술을 시행하였다. 결 과 : 환자 전 예에서 양호한 결과를 보였으며 수술전 사지의 부진마비가 있었던 환자에서는 시간이 경과 함에 따라 신경학적 호전을 보였으며, 골유합술을 시행하였던 5예에서 성공적인 골유합이 관찰되었고, 연구개를 절개하였던 환자 4명중 1명이 창상 열개를 보여 재수술로 상처 치유가 가능하였다. 뇌척수액 누수는 한 예에서도 발생하지 않았다. 결 론 : 경구적 접근법은 두개 경추 이행부의 병소에 대한 유용한 접근법으로 사용될 수 있을 것으로 생각된다. Objective : Although transoral transpharyngeal approach is a very useful method for the lesions of craniovertebral junction, it is not frequently used because of anatomical unfamilarity, risk of cerebrospinal fluid(CSF) leakage, and resultant postoperative meningitis. To evaluate the usefulness of transoral transpharyngeal approach for various lesions of craniovertebral junction, clinical characteristics and the results of this approach are investigated. Methods : Transoral transpharyngeal approaches were performed in eight cases between 1996 and 1999. Among them, there were three basilar invaginations due to congenital anomalies, two odontoid type I fractures, two atlantoaxial dislocations, and one pseudotumor. Surgical methods included five cases of anterior decompression and posterior fusion, two anterior approaches for decompression and one transoral approach for biopsy. Results : This procedure allowed immediate clinical improvement in all cases. In seven patients with preoperative motor deficit showed a progressive neurological improvement. The follow-up plain x-rays demonstrated successful bony fusion in all patients. Only one patient suffered from postoperative wound dehiscence, but she completely recovered after wound revision. There was no complication of postoperative CSF leakages. Conclusions : Transoral transpharyngeal approach for the ventral lesions of craniovertebral junction, can be used as a relatively simple and effective method.

상악동 편평세포암종에 대한 상악절제술의 치료 결과

정한신(Han Sin Jeong),손영익(Young Ik Son),정만기(Man ki Chung),민진영(Jin Young Min),오재원(Jae Won Oh),홍상덕(Sang Duk Hong),이현석(Hyun Seok Lee),백정환(Chung Hwan Baek) 대한두경부종양학회 2006 대한두경부 종양학회지 Vol.22 No.1

Background and Objectives: Maxillectomy is the mainstay of treatment for malignant tumors of the maxillary sinus(MS). Nevertheless, few have been reported on the surgical outcomes of maxillectomy for malignant tumors of MS in Korean literature. Based on our clinical experience, the authors aimed to present the treatment outcomes of maxillectomy for squamous cell carcinomas(SCC) of MS. Subjects and Methods: We reviewed the medical records of 26 cases of maxillectomies with see of MS, who were treated from 1995 to 2004 at Samsung Medical Center. Most patients(73.1%) were locally advanced stage(T3 or T4a) at initial presentation. Total maxillectomy was performed in 18 cases, which is the most frequent procedure(69.2%). We analyzed the treatment outcomes of see of MS and several variables includeing tumor stage and resection margin to identify predictors for treatment failure after maxillectomy. Follow-up duration ranged from 7 to 89 months with a mean of 33 months. Results: Treatment failure occurred in 7 cases(26.9%), among which 3 were salvaged. Three of 26 maxillectomies(11.5%) showed the positive or close(less than 5mm) resection margin in their posterior resection sites; however it did not coincide with the site of recurrence after radiation therapy. Among patients who had been followed up for more than 6 months, disease-free 3 year survival rate was 100.0% in T1 and T2, 76.2% in T3, 60% in T4a, and 69.6% in total. Conclusion: Even though most of see of MS were detected at locally advanced stage, maxillectomy with or without postoperative radiation therapy for resectable MS see(T1-T4a) provided the acceptable treatment outcome(70%, 3Y disease-free survival rate).

안와내용제거술 후 유리피판을 이용한 안와재건술

이선주 ( Sun Joo Lee ) , 남도현 ( Do Hyun Nam ) , 백정환 ( Chung Hwan Baek ) , 하범준 ( Bom Joon Ha ) , 김윤덕 ( Yoon Duck Kim ) 대한안과학회 2003 대한안과학회지 Vol.44 No.3

경부 낭종의 형태로 발현한 전이암 2례

장병찬(Byung Suk Ha),하병석(Byung Chan Chang),백정환(Chung Hwan Baek),손영익(Young Ik Son) 대한두경부종양학회 1997 대한두경부 종양학회지 Vol.13 No.2

Metastatic cancer presenting as a cervical cyst is uncommon, and often misdiagnosed as branchial cleft cyst. Authors experienced two cases which presented clinically with features of branchial cleft cyst, but were subsequently found to be metastatic cancer. Radiologic examination and fine needle aspiration biopsy proved to be non-diagnostic, and pathologic findings after surgical excision showed metastatic cancer. Further evaluation and examination were made to find out the primary focus, which revealed tonsillar squamous cell cancer and thyroid papillary cancer in each case. When cervical cysts are noted in aged patients, it is mandatory to rule out metastatic cancer until it is proven otherwise. Surgical excision and pathologic diagnosis should be always accompanied to make correct diagnosis and further treatment.

처음 진단된 두경부 선양낭성암종에서 18F-FDG PET/CT: 임상상 및 병리소견과의 상관성

이지영 ( Ji Young Lee ),최준영 ( Joon Young Choi ),고영혜 ( Young Hyeh Ko ),백정환 ( Chung Hwan Baek ),손영익 ( Young Ik Son ),조숙경 ( Suk Kyong Cho ),천미주 ( Mi Ju Cheon ),이경한 ( Kyung Han Lee ),김병태 ( Byung Tae Kim ) 대한핵의학회 2009 핵의학 분자영상 Vol.43 No.5

목적: 처음 진단된 두경부 선양낭성암종의 18F-FDG PET/CT의 영상소견을 선양낭성암종의 병리적 소견, 병기 결정, 가장 흔한 두경부암인 편평세포암종의 18F-FDG 섭취양상, 예후와 상관 지어 알아보았다. 대상 및 방법: 두경부 선양낭성암종으로 처음 진단되어 18F-FDG PET/CT를 시행한 16명의 환자가 대상이었다. PET/CT의 병기 결정 능력을 알아보고, 두경부 선양낭성암종의 SUVmax를 원발종양의 조직학적 아형(고형 대 관상형/사상형상), 병변의 크기와 일치하는 두경부 편평세포암종의 SUVmax, 무병생존율과 비교하였다. 결과: 16명의 환자들 중, 관상형 또는 사상형을 가진 군은 10명이었고 나머지 6명은 고형을 가진 군이었다. 고형 선양낭성암종의 SUVmax는 관상형 또는 사상형 선양낭성암종 보다 유의하게 높았다(6.7±3.2 vs. 4.2±0.9, p=0.03). 18F-FDG PET/CT로 기존 영상법에서 발견하지 못한 원격 전이를 18.7%의 환자에서 발견하여, 치료방침 변경에 기여하였다. 선양낭성암종의 SUVmax는 병변 크기가 같은 편평세포암종과 비교해 보았을 때 유의하게 낮았다(5.1±2.4 vs. 13.6±6.0, p<0.001). 조직학적 아형에 따른 무병생존율은 통계적으로 유의한 차이를 보이지 않았다. 반면에, 원발종양의 SUVmax가 6.0 이상인 환자들의 무병생존율은 SUVmax가 6.0 미만인 환자들보다 유의하게 낮았다(p=0.002). 결론: 두경부 선양낭성암종의 18F-FDG 섭취양상은 조직학적 아형과 무병생존율과 유의한 관계가 있다. 18F-FDG PET/CT는 기존 영상법에서 발견하지 못한 원격전이 진단에 유용한 것으로 보인다. 사상형상 또는 관상형 선양낭성암종의 18F-FDG 섭취는 낮을 수 있어, 선양낭성암종이 의심되지 않은 환자들의 PET 영상 판독에 주의가 필요하다. Purpose: We evaluated 18F-FDG PET/CT findings in initially diagnosed adenoid cystic carcinoma (ACC) of the head and neck in association with pathological subtype, staging, uptake comparison with squamous cell carcinoma (SqCC) and prognosis. Materials and Methods: The subjects were 16 patients with initially diagnosed ACC of head and neck who underwent pretreatment 18F-FDG PET/CT. Histological subtype (solid pattern vs. tubular/cribriform pattern), SUVmax of size-matched SqCC of the head and neck as control group, disease-free survival (DFS) were compared with the SUVmax of ACC of the head and neck. Results: Of total 16 patients, 6 had solid pattern and the remaining 10 had tubular/cribriform pattern. The SUVmax were significantly higher in solid pattern group than in tubular/cribriform pattern group (6.7±3.2 vs. 4.2±0.9, p=0.03). PET/CT found unexpected distant metastasis in 18.7% of patients (3/16) and changed the therapeutic plan in those patients. The SUVmax of ACC was significantly lower than that of size-matched SqCC (5.1±2.4 vs. 13.6±6.0, p<0.001). DFS was not significantly different according to the histological subtype. In contrast, patients with high 18F-FDG uptake (SUVmax≥6.0) had significantly shorter DFS than those with low 18F-FDG uptake (SUVmax<6.0). Conclusion: 18F-FDG uptake of ACC of the head and neck is significantly associated with histological subtype and DFS. 18F-FDG PET/CT may be useful for detecting unexpected metastasis. Since 18F-FDG uptake of tubular/cribriform ACC compared with SqCC is relatively low, it is necessary to interpret PET images carefully in patients without alleged ACC. (Nucl Med Mol Imaging 2009;43(5):395-401)

방사선 치료 중인 두경부 종양 환자를 대상으로 메게이스 내복 현탁액 경구투여 후 유효성 및 안전성에 관한 다기관, 공개, 관측연구

최은창(Eun Chang Choi),주형로(Hyung Ro Chu),주영훈(Young Hoon Joo),정필상(Phil Sang Chung),정성민(Sung Min Chung),정광윤(Kwang Yoon Jung),이용섭(Yong Seop Lee),이강대(Kang Dae Lee),봉정표(Jung Pyo Bong),백정환(Chung Hwan Baek),박영학 대한두경부종양학회 2008 대한두경부 종양학회지 Vol.24 No.1

Background and Purpose :Nausea, vomiting and weight loss are common problems that are encountered in the course of cancer patient treatment who are receiving radiotherapy. In this study, we are aiming to analyze the effect of megestrol acetate on quality of life of head and neck cancer patients receiving radiotherapy, resulting from improvement of weight loss, appetite and nutritional status via multicenter, open-labeled, observational clinical trial. Material and Methods :A total of 270 patients from 10 medical institutes who are receiving radiotherapy or who have completed radiotherapy within 3 months, between February 2007 and February 2008, were selected as candidates for the study. Megestrol acetate suspension(megace) was given to the subjectives once a week for 4 weeks with the amount of 20ml(megestrol 800mg). Measurement of weight and questionnaire surveys were carried out three times: at the start of the study, 4 weeks after the start of the medication, and 4 weeks after the end of the medication, respectively. Results :The group who has received megace had a total number of 199, and control group was 70. The group who have received megace showed mean weight loss of 1kg in 8 weeks, compared with the weight loss of 5.5kg in control group, which showed that the medication was effective in reducing the amount of weight loss(P=0.027). The group who received megace had a tendency to report a reduced rate of decrease in the score of appetite, nausea and vomiting, and QOL score, but it did not have statistical significance(P〉0.05). Conclusion :Megestrol acetate have reduced the degree of weight loss significantly, and it has a tendency to reduce the rate of decrease in appetite, aggravation of nausea and vomiting, and quality of life.