구강 혹은 인두피부루의 동시재건을 위한 양면 대흉근피판술

임영창(Young Chang Lim),손은진(Eun Jin Son),신우철(Woo Chul Shin),김상철(Sang Cheol Kim),이욱진(Wook Jin Lee),최은창(Eun Chang Choi) 대한두경부종양학회 2003 대한두경부 종양학회지 Vol.19 No.1

본 증례에서 처럼 구강과 피부 또는 인두와 피부의 복합 결손은 내측 점막재건 및 피부의 외측부분을 함께 재건해야 하는데, 저자들이 사용한 진도서형의 양면 대흉근 피판이 아주 유용한 방법으로, 수술시간도 짧고 피판의 혈관경도 믿을 수 있어 대단히 안전한 피판으로 사료된다. Background and Objectives: Oro-and pharyngocutaneous fistula after irradiation can lead to extensive wound necrosis and fetal complication such as carotid rutpure. So, there is a need to clean and cover the wound rapidly in these compromised patients. Pectoralis major myocutaneous (PMMC) flap has been presented for reconstruction of complex defects in these irradiated patients. We applied the double paddle PMMC flap for the simultaneous reconstruction of above complex defects and evaluated the it's clinical efficacy. Material and Methods: Retrospective chart review of three cases of simultaneous head and neck reconstruction after irradiation with double paddle PMMC. All patients received prior radiotherpy before development of complications. The double paddle PMMC flap was used for mucosal lining of the oral cavity and epithelial lining of external skin in 2 cases, for mucosal lining of the pharynx and epithelial lining of external skin in 1 case. Results: Considerable complications such as major flap necrosis or fistula did not occur in any of the cases, and simultaneous reconstruction was achieved in all cases without reoperations. Conclusion: Many extended defects such as oro-and pharyngocutaneous fistula involving cover and lining about the head and neck after irradiation can be rehabilitated by the double paddle pectoralis major myocutaneous flap.

방사선치료 실패 후의 수직부분후두절제술은 안전한가?

임영창(Young Chang Lim),임정택(Jeong Taek Lim),강주완(Joo Wan Kang),최현승(Hyun Seung Choi),송미현(Mee Hyun Song),김민범(Min Byum Kim),최은창(Eun Chang Choi) 대한두경부종양학회 2003 대한두경부 종양학회지 Vol.19 No.1

Objectives: Radiotherapy is an effective treatment in the initial management of T1 glottic carcinoma, but local recurrent or residual tumor growth is found in approximately 10% of the patients. Even in recurrence or residual tumor, in highly selected cases, conservation surgery with preservation of a portion of the larynx is feasible. So we investigated the efficacy of salvage vertical partial laryngectomy for recurrent glottic carcinoma after irradiation. Material and Methods: Retrospectively we reviewed a consecutive series of 10 patients treated by conservative vertical partial laryngectomy of the larynx for radiation-failure, recurrent T1 glottic squamous cell carcinoma treated at Severance Hospital from 1994 to 2002. Results: Local recurrence developed in 4 patients (40%). Two patient was salvaged by further totallaryngectomy. Successful salvage was achieved finally in 8 (80%) of the 10 patients. There was no operative mortality. Postoperative perichondritis was developed in two patients. One was resolved by conservative treatment, but the other has underwent the total laryngectomy. Conclusion: A vertical partial laryngectomy in case of recurrent glottic carcinoma after a course of irridation should be the therapy of choice when stringent criteria are observed.

Overexpression of EFGR as Prognostic Factor and Effect of EGF in the Progression of Hypopharyngeal Cancer

Young Chang Lim(임영창),Eun Chang Choi(최은창),Yoon Tae Kim(김윤태),Jang Hee Kim(김장희),Hye Sook Hwang(황혜숙),Sung Un Kang(강성운),Jae Won Chang(장재원),Yoo Seob Shin(신유섭),Chul-Ho Kim(김철호) 대한두경부종양학회 2013 대한두경부 종양학회지 Vol.29 No.1

연구배경 및 목적 표피성장인자수용체(EGFR)는 HER2/neu(erbB2), HER3(erbB3), HER4(erbB4)를 포함하는 receptor tyrosine kinase의 erbB 그룹에 속하는 수용체이다. 표피성장인자수용체의 과발현은 다양한 종류의 암, 특히 두경부편평세포암에서 예후를 악화시킨다고 알려져 있다. 이에 저자들은 하인두편평세포암에서 표피성장인자수용체의 발현 및 분포를 확인하고, 하인두암에서 표피성장인자(EGF)가 암세포의 증식과 침습에 미치는 영향에 대해 알아보고자 하였다. 대상 및 방법 57명의 하인두편평세포암 환자의 조직에서 표피성장인자수용체의 발현을 면역화학적염색을 통해 확인하고, 이에 대해 임상병리학적 요인과 생존율에 대한 분석을 시행하고, 일부 환자의 정상 및 암조직에서 Western blot을 시행하였다. 하인두편평세포암 세포주인 FaDu에서 proliferative assay, colony dispersion, wound healing assay, invasion assay를 시행하여, 하인두암의 진행에서 표피성장인자의 역할에 대하여 분석하였다. 또한 RT-PCR과 Zymography를 통하여 Matrix metalloproteinase(MMP)-2, 9의 발현을 확인하였다. 결 과 63.2%의 하인두편평세포암 조직에서 표피성장인자수용체의 발현이 확인되었다. 표피성장인자수용체의 발현은 정상조직에서 비하여 하인두암 조직에서 유의하게 증가되어 있었으며, 병리학적 병기( p=0.022)가 올라갈수록 유의 하게 증가하였으나, 증례수의 제한으로 생존율에서는 통계적 유의성을 얻지는 못했다( p=0.053). in vitro 의 결과로 표피성장인자를 FaDu 세포주에 처리하였을 때, FaDu 세포주의 증식이 유의하게 증가되었으며( p<0.05), Transwell invasion chamber상 침습의 증가가 확인되었다( p<0.05). RT-PCR과 zymogram 실험상 표피성장인자처리시 FaDu세포주의 MMP-2, 9이 발현이 증가되고 활성화되는 것이 확인하였다. 결 론 본 연구에서 표피성장인자수용체의 과발현이 하인두암의 예후 인자로서의 가능성을 확인하였고, 표피성장인자가 하인두편평세포암의 증식과 침습에 관여하는 것을 확인하였다.

Overexpression of EFGR as Prognostic Factor and Effect of EGF in the Progression of Hypopharyngeal Cancer

임영창,최은창,김윤태,김장희,황혜숙,강성운,장재원,신유섭,김철호,Lim, Young Chang,Choi, Eun Chang,Kim, Yoon Tae,Kim, Jang Hee,Hwang, Hye Sook,Kang, Sung Un,Chang, Jae Won,Shin, Yoo Seob,Kim, Chul-Ho The Korean Society for Head and Neck Oncology 2013 대한두경부 종양학회지 Vol.29 No.1

연구배경 및 목적 표피성장인자수용체(EGFR)는 HER2/neu(erbB2), HER3(erbB3), HER4(erbB4)를 포함하는 receptor tyrosine ki-nase의 erbB 그룹에 속하는 수용체이다. 표피성장인자수용체의 과발현은 다양한 종류의 암, 특히 두경부편평세포암에서 예후를 악화시킨다고 알려져 있다. 이에 저자들은 하인두편평세포암에서 표피성장인자수용체의 발현 및 분포를 확인하고, 하인두암에서 표피성장인자(EGF)가 암세포의 증식과 침습에 미치는 영향에 대해 알아보고자 하였다. 대상 및 방법 57명의 하인두편평세포암 환자의 조직에서 표피성장인자수용체의 발현을 면역화학적염색을 통해 확인하고, 이에 대해 임상병리학적 요인과 생존율에 대한 분석을 시행하고, 일부 환자의 정상 및 암조직에서 Western blot을 시행하였다. 하인두편평세포암 세포주인 FaDu에서 proliferative assay, colony dispersion, wound healing assay, invasion assay를 시행하여, 하인두암의 진행에서 표피성장인자의 역할에 대하여 분석하였다. 또한 RT-PCR과 Zymography를 통하여 Matrix metalloproteinase(MMP)-2, 9의 발현을 확인하였다. 결 과 63.2%의 하인두편평세포암 조직에서 표피성장인자수용체의 발현이 확인되었다. 표피성장인자수용체의 발현은 정상조직에서 비하여 하인두암 조직에서 유의하게 증가되어 있었으며, 병리학적 병기(p=0.022)가 올라갈수록 유의하게 증가하였으나, 증례수의 제한으로 생존율에서는 통계적 유의성을 얻지는 못했다(p=0.053). in vitro의 결과로 표피성장인자를 FaDu 세포주에 처리하였을 때, FaDu 세포주의 증식이 유의하게 증가되었으며(p<0.05), Transwell invasion chamber상 침습의 증가가 확인되었다(p<0.05). RT-PCR과 zymogram 실험상 표피성장인자처리시 FaDu 세포주의 MMP-2, 9이 발현이 증가되고 활성화되는 것이 확인하였다. 결 론 본 연구에서 표피성장인자수용체의 과발현이 하인두암의 예후 인자로서의 가능성을 확인하였고, 표피성장인자가 하인두편평세포암의 증식과 침습에 관여하는 것을 확인하였다.

두경부 편평세포암에서 HMGI(Y), p53, Ki-67의 발현과 임상인자와의 상관 관계

노영수(Young Soo Rho),박준영(Jun Young Park),박일석(Il Seok Park),임영창(Young Chang Lim),문성호(Sung Ho Moon),김성동(Sung Dong Kim),황준식(Joon Sik Hwang),김덕환(Duk Hwan Kim) 대한두경부종양학회 2002 대한두경부 종양학회지 Vol.18 No.1

Objectives: Expression of HMGI(Y), a nucleoprotein that binds to A/T rich sequences in the minor groove of the DNA helix, is observed in neoplastically transformed cells but not in normal cells. We have analyzed HMGI(Y), p53 expression and Ki-67 labelling index in squamous cell carcinomas of the head and neck, and evaluated its clinicopathologic significance. Materials and Methods: 40 cases of squamous cell carcinoma of the head and neck were entered on the study of immunohistochemical stains for HMGI(Y), p53 and Ki-67. We analyzed the relationship between HMGI(Y), p53, Ki-67 expression and age, sex, primary tumor site, stage, survival rate, recurrence. Results: HMGI(Y) expression evidenced by immunohistochemical staining was observed in 35 of 40 (87.5%) squamous cell carcinoma of the head and neck. But no significant correlation was observed between HMGI(Y) expression and other clinical factors such as primary site, tumor stage, differenciation, cervical lymph node, metastasis, recurrence and immunohistochemical status of p53. The Ki-67 labelling index was significantly correlated with recurrence and HMGI(Y) expression (p<0.05). Conclusion : This results suggest the Ki-67 is a good prognostic factor and the HMGI (Y) expression plays some roles in carcinogenesis and cellular proliferation of squamous cell carcinoma of the head and neck. HMGI (Y) gene can be used as a cancer marker, the correlation between the gene expression and the prognosis of the cancer patient should be proved in the future studies.

전기화학적 염소 추출법에 의한 시멘트 모르터내의 철근 방식

남상철,임영창,조원일,조병원,전해수,윤경석,Nam Sang Cheol,Lim Young Chang,Cho Won-Il,Cho Byung Won,Chun Hai Soo,Yun Kyung Suk 한국전기화학회 2000 한국전기화학회지 Vol.3 No.1

전기화학적 염소 추출법에 의해 염분이 함유된 시멘트 모르터내의 철근의 방식효과를 고찰하였다 초기에 혼입된 염 중 약 $43\%$가 Friedel 염 형태로 시멘트 모르터내에 고정되었으며, 전기화학적 염소추출법에 의해 가용성 염소이온의 추출이 가능하였다. Fick's 2nd law에 의해 시간 및 거리에 따른 농도 profile의 예측이 가능하였으며, 이는 실제값에 근접하였다. 전기화학적 염소추출법 수행 후 부식전위는 양의 방향으로 상승하였으며, 교류 임피던스결과 부식이 억제됨을 알 수 있었다. Anti-corrosion behaviour of rebar embedded in cement mortar containing chloride ions was investigated by electrochemical chloride extraction(ECE). $43\%$ of the initial chloride ions of the cement mortar was fixed to Friedel salts and the soluble chloride ions were successfully extracted by ECE method. Concentration profiles of the chloride ions were estimated by Fick's 2nd law with time and depth, and it was close to the real value. The corrosion potential increased to anodic direction after ECE test, and the corrosion of rebar was reduced as a result of AC impedance spectroscopy.

이하선절제술시 Modified Facelift 절개의 유용성

김동영(Dong Young Kim),임영창(Young Chang Lim),최은창(Eun Chang Choi) 대한두경부종양학회 2000 대한두경부 종양학회지 Vol.16 No.1

Background and Objectives: The most commonly used incision for parotidectomy is modified Blair incision, but it has unsatisfactory cosmetic result due to long exposed scar in the neck. Therefore, we introduce an alternative approach with more acceptable scar named modified facelift incision. We report it's techniques, indications and disadvantages with our experiences. Materials and Methods: During the 1999, 15 patients were underwent parotidectomies using modified facelift incision. We studied the postoperative complications and the cosmetic results respectively. Results: There were 11 benign tumors, 3 malignant tumors, and 1 chronic inflammation. Total parotidectomy was performed in 2 malignant tumors and chronic parotitis patients. The others has superficial parotidectomy. In terms of operation field, there was no difference between classical incision and facelift incision. Partial facial nerve palsy was noted in 2 cases, who required sacrifice of branches of facial nerve because of malignant tumor invasion. There were no specific complications associated with this type of approach. Postoperative cosmetic results were satisfactory in all cases. Conclusion: Modified facelift incision provides better cosmetic result than conventional incision without narrowing of operation field. We believe that it is a safe alternative approach to all parotidectomy cases especially to women and patient with keloid skin. The only limitation of this incision is poor adaptability for combining neck dissection.

경동맥 절제술 후 재건에 사용된 복재정맥의 혈관구경 불일치를 극복하기 위한 Titanium Hemostatic Clip 봉합방법

김선호(Sun Ho Kim),임영창(Young Chang Lim),이세영(Sei Young Lee),임재열(Jae Yol Lim),최은창(Eun Chang Choi) 대한두경부종양학회 2004 대한두경부 종양학회지 Vol.20 No.2

Objectives: To completely excise a malignant tumor which invades carotid artery walls, the resection and reconstruction of the carotid artery is essentially required. In most of the cases, interposition graft using a saphenous vein has been performed, however the vessel caliber discrepancy between a common carotid artery and the saphenous vein can result in a problem on surgical technique. We have introduced and evaluated a new titanium hemoclip tailing method to overcome vessel caliber discrepancy in interposition saphenous vein graft for carotid artery resection in the treatment of head and neck cancers. Method: After carotid artery resection, the calibers of the proximal common carotid artery and the vein were compared, and an orifice of the common carotid artery was gradually reduced to a little larger than or the same size as the orifice of the vein by using the titanium hemostatic clip. Subsequently, the common carotid artery was connected to the vein through anastomosis. The same method was also applied to the distal anastomosis site. There after, the vessels were connected through the anastomosis, and a circulation was restored by releasing a vascular clamp. Then, a titanium hemostatic clip-applied redundant portion on the outside of carotid artery was sutured by the blanket edge suture method, using 6-0 Prolene. Results: We have experienced this method in two patients with recurrent squamous cell carcinoma and neuroblostoma, respectively. The interposition saphenous vein graft of these patients was found to maintain good patency on the follow up angiography after one year, and they had no specific vascular complication, such as atherosclerosis. Conclusion: This method made it possible to simply perform the interposition saphenous vein graft (ISVG) within a short time and, therefore, was very useful for shortening the duration to block circulation.

두경부 악성 종양 절제술후 요골 전완 유리피판을 이용한 재건술의 평가

김현직(Hyun Jik Kim),임영창(Young Chang Lim),송미현(Mee Hyun Song),이원재(Won Jae Lee),최은창(Eun Chang Choi) 대한두경부종양학회 2003 대한두경부 종양학회지 Vol.19 No.2

Background and Objectives: The reconstruction is very important in Head and neck cancer surgery to repair the defect created by resection of tumors, to enable successful wound healing, to restore function and to provide acceptable cosmesis. The radial forearm free flap has been the most useful reconstructive flap because it provides a moderate amount of thin, pliable, relatively hairless skin and comparatively simple to do with minimal morbidity. The aims of this study is to estimate the outcome of the reconstruction with radial forearm free flap with the several factors in 140 head and neck cancer cases in our hospital for last 10 years. Materials and Methods: Retrospective review of the records of 140 patients underwent resection of the head and neck tumors and reconstruction with a radial forearm free flap from 1993 to 2003. The age, sex of the patients, Primary site, the complication of donor and recipient site, flap survival rate, median time to start diet, patient subjective symtoms about swallowing and articulating and the fact of revision reconstructive surgery were analyzed. Results: In primary pathologic site, 56 cases were oral cavity cancers, 44 cases, oropharyngeal cancers and 22 cases, hypopharyngeal cancers. Flap survival rate was 93.6% (13 leases). On donor site, wound dehiscence, hematoma, sensory change and infection were noted and on recipient site, most common complication were fistula and wound dehiscence. The complication rate of recipient's site was 19.1 % and donor site, 3.5%. In 118 cases (84.3%), the patients could take all kinds of food. Swallowing difficulty were noted in 22 cases 05.7%). In 5 cases, there was articulation difficulty but most of patients except patients having total laryngectomy (18 cases) couldn't have any difficulty in articulation and speaking. Conclusion: We conclude that the radial forearm free flap is the most appropriate reconstructive material for treating the defect in head and neck reconstruction.

하악골을 침범한 점액표피양 암종에서 하악 일부를 보전한 변형적 하악 절제술 치험 1예

황준식(Joon Sik Hwang),임영창(Young Chang Lim),김진환(Jin Hwan Kim),박일석(Il Suk Park),노영수(Young Su Rho) 대한두경부종양학회 2002 대한두경부 종양학회지 Vol.18 No.2

The segmental mandibulectomy should be performed, if mandiblie invasion is suspected clinically and radiologically. And if tumor is located to mandible very closely or when microinvasion to mandible is suspected, marginal mandibulectomy is recommended. But in segmental mandibulectomy, reconstruction is difficult and cosmetic problem remains. In this case, we performed modified segmental resection of mandible, preserving the inferior margin of mandible, and maintains the continuity of the bone, in mucoepidermoid carcinoma of parapharynx, invading mandible. We reviewed the diagnosis, pathology, and treatment, and report the case with reviews of literature.