코골이 클리닉을 방문한 환자들의 폐쇄성 수면무호흡증 인식도

이소진,이진성,신홍범,조상용,이재서,정도언,Lee, So-Jin,Lee, Jin-Seong,Shin, Hong-Beum,Cho, Sang-Yong,Rhee, Chae-Seo,Jeong, Do-Un 대한수면의학회 2011 수면·정신생리 Vol.18 No.2

목 적 : 폐쇄성 수면무호흡증은 흔하고 심각한 질환이므로 적극적인 진단과 치료가 필요하다. 본 연구에서는 이미 증상이 있어 코골이 클리닉을 방문한 환자들의 코골이와 수면무호흡증에 대한 인식 정도를 조사하고자 하였다. 방 법 : 서울대학교병원 이비인후과 코골이 클리닉을 방문한 179명(남자 135명, 여자 44명)의 환자를 대상으로 설문 조사를 시행하였다. 설문지를 통해 클리닉을 방문한 이유, 수면무호흡증과 코골이 치료법, 검사 방법, 관련 증상 및 합병증에 대한 지식을 파악하였다. 결 과 : 환자들의 평균 연령은 $45.2{\pm}14.5$세였고 체질량지수의 평균값은 $24.8{\pm}3.4$였다. 환자들의 89.4%이 폐쇄성 수면무호흡증에 대해 들어보았다고 대답했으며, 주로 텔레비전과 라디오와 같은 대중매체(58.1%)를 통해 정보를 접했다고 했다. 코골이와 폐쇄성 수면무호흡증이 밀접한 관련이 있다는 것은 60.3%가 알고 있었고, 59.8%는 치료방침을 정하기 위해 야간 수면다원검사가 필요함을 알고 있었다. 코골이 치료 방법으로는 수술(67%)을 가장 많이 알고 있었다. 코골이 치료를 선택할 때 의사의 권고에 따르겠다는 사람들이 55.9%로 가장 많았으나 양압술을 선택한 사람은 아무도 없었다. 양압술 치료에 대해 들어본 사람들은 전체의 12.3%였고, 폐쇄성 수면무호흡증의 치료로 양압술을 선택한 사람은 아무도 없었다. 환자들 중에서 폐쇄성 수면무호흡증이 고혈압과 관련되어 있다는 것을 아는 사람들은 34.6%, 당뇨와 관련이 있다는 것을 아는 사람들은 12.8%였다. 결 론 : 이미 증상이 있어 코골이 클리닉을 방문한 사람들조차 폐쇄성 수면무호흡증의 위험성과 적절한 치료 방법에 대해 잘 알고 있지 못했다. 환자와 일반인들을 대상으로 폐쇄성 수면무호흡증에 대해 교육하고 홍보하는 것이 향후 질환의 진단율을 높이고 적절한 치료로 연결하며 연관 질환을 예방하는 것에 중요할 것이다. Objective: OSAS (obstructive sleep apnea syndrome) is a common disorder and its consequences are often serious. It is important to detect the disorder early in the course for proper treatment. This study is to grasp the snoring clinic visitors' knowledge level of OSAS. Method: One hundred and seventy-nine visitors at the of snoring clinic of Seoul National University Hospital were surveyed by questionnaire about reasons of visit and knowledge of treatment methods of snoring and OSAS, diagnostic method, OSAS-related symptoms, and complications. Results: Most of the respondents (89.4%) "have already heard about OSAS" and the major sources of information was the mass media (58.1%) such as television and radio. More than half (60.3%) were aware that snoring is closely related to OSAS. More than half (59.8%) recognized that a nocturnal polysomnograpy was necessary for proper diagnosis. Two thirds (67%) of the respondents noted surgery as a treatment for snoring. More than half (55.9%) answered that they would follow the doctor's advice on the treatment choice. Only 12.3% of respondents "have heard about nCPAP". No one chose nCPAP (nasal continuous positive airway pressure) as a treatment for either snoring or OSAS. About one third (34.6%) of the respondents were aware that OSAS is related to hypertension. Only 12.8% noted that OSAS is related to diabetes mellitus. Conclusion: Visitors at the snoring clinic were found to have substantially limited knowledge of health risks and proper treatments of OSAS. We suggest that it is crucially important to educate patients and offer easy-to-understand information on snoring and OSAS. We predict that provision of educaiton and information to patients and general public will faciliate the diagnosis and treatment of snoring and OSAS and reduce the related disorders such as hypertension, stroke, and diabetes mellitus.

후두 악성종양에 대한 내시경적 레이저 수술의 적용

김광현(Kwang Hyun Kim),성명훈()Myung Whun Sung,이효정(Hyo Jeong Lee),이동욱(Dong Wook Lee),박범정(Bum Jung Park),성원진(Weon Jin Seong),민양기(Yang Gi Min),이철희(Chul Hee Lee),이재서(Chae Seo Rhee),이상준(Sang Jun Lee),노종열(Jong L 대한두경부종양학회 2002 대한두경부 종양학회지 Vol.18 No.1

Background and Objectives: To determine if laser endoscopic microsurgery is a reliable and appropriate approach in the treatment of laryngeal carcinomas. Materials and Methods: Retrospective study of 62 patients treated with CO2 laser from June 1988 to November 2000 at Seoul National University Hospital for laryngeal squamous cell carcinoma. All patients were treated with curative intention. Fifty three untreated patients with laryngeal carcinoma (39 glottic and 14 supraglottic carcinoma patients) had primary carbon dioxide laser microsurgery. Nine radiation failure patients were treated. Postoperative radiotheray was done for 17 patients. Neck dissection was performed simultaneously for 4 supraglottic cases with cervical nodal metastasis. Mean follow-up duration was 40 months. Results: In primary laser surgery group, distribution of tumors (American Joint Committee on Cancer, 1997) were 38 cases with Tl, 13 cases with T2, 2 cases with T3. Cure rate was 88.7%(47/53) and local control rate was 92.5%(49/53). Larynx was preserved in 94%(50/53) of patients. The overall 5-year survival rate(Kaplan-Meier) was 81.5%. In radiation failure group, 56% of patients were recurred after laser surgery. Conclusion: Laser surgery could be a better treatment modality for early laryngeal cancers and selected advanced cases. Additional radiation therapy should be considered if resection margin is not satisfactory.

경부 림프절 종대로 발현한 원발 부위 불명의 전이암

김태용(Tae Yong Kim),조요한(Yo Han Joh),김진수(Jin Su Kim),홍용상(Yong Sang Hong),이근욱(Keun Wook Lee),윤탁(Tak Yun),송은기(Eun Ki Song),나임일(Im Il Na),신현춘(Hyun Chun Shin),김동완(Dong Wan Kim),이재서(Chae Seo RLee),성명훈(Myung W 대한두경부종양학회 2004 대한두경부 종양학회지 Vol.20 No.2

Background: About 3% of all cancer patients suffer from cancer of unknown primary origin. Generally, carcinoma of unknown primary (CUP) carries a grave prognosis, but primary tumor presented to the neck is exception to this. The aims of study are to determine the role of chemotherapy and to find the prognostic factors in unknown primary tumor presented to the neck. Method and Material: Eighty-four patients were diagnosed with unknown primary tumor presented to the neck between January 1996 and June 2002. Among 84 patients, 43 patients (52%) received chemotherapy, radiation or surgery were performed in 20 patients (23%), 21 patients (25%) had no treatment. Results: The response rates to chemotherapy were 87.5% in CUP only localized to the neck and 44.0% in CUP systemically involved (p=0.012). A median follow-up duration was 6.4 years and overall median survival time was 9 months. The median overall survival time of patients treated with chemotherapy were 17 months and that of patients who received surgery or radiation were 20 months (p=0.3548). The important prognostic factors were performance status and the number of involved organ. Conclusion: The prognosis of patients with CUP presented to the neck is more favorable than that of patients with CUP of other localization. The effectiveness of chemotherapy for CUP only localized to the neck was similar to that of surgery or radiation. The important prognostic factors were performance status and the number of involved organ.

Postoperative Radiotherapy for Parotid Gland Malignancy

Keun-Yong Eom(엄근용),Hong-Gyun Wu(우홍균),Jae-Sung Kim(김재성),Charn Il Park(박찬일),In-Ah Kim(김인아),Kwang Hyun Kim(김광현),Chae Seo Lee(이재서) 대한방사선종양학회 2005 Radiation Oncology Journal Vol.23 No.3

목 적: 귀밑샘 악성종양의 수술 후 방사선 치료 성적 및 예후인자를 분석하였다. 대상 및 방법: 1980년부터 2002년까지 130명의 귀밑샘 악성 종양 환자가 서울대병원 방사선 종양학과 데이터베이스에 등록되었고 이 중 수술 후 방사선 치료를 받은 72명의 환자에 대하여 후향적 분석을 실시하였다. 남자는 42명, 여자는 30명이었고, 나이의 중앙값은 46.5세였다. 점액표피양암종이 가장 흔한 조직학적 유형이었다. 병기에 따라서는 I, I, III, IV 병기에 각각 6, 23, 23, 20명이 해당되었다. 수술 부위의 방사선 조사량의 중앙값은 60 Gy였고, 일회 조사량의 중앙값은 1.8 Gy였다. 결 과: 5년 전체 생존율 및 10년 전체 생존율은 각각 85%와 76%였다. 5년 국소제어율은 85%였고 6년이 지나면서 변화가 없었다. 다변량분석을 하였을 때, 성별, 조직학적 유형이 생존율과 통계적 유의성이 있었다. 나이, 안면신경마비증상, 병기(T 병기, N병기, 병기)는 생존율과 관련된 통계적 유의성이 없었다. 국소제어율의 경우, 림프절 전이 및 절제연 침범여부가 의미있는 예후인자였다. 조직학적 유형, 종양의 크기, 신경침윤여부 및 수술의 종류는 국소제어율의 예후인자가 아니었다. 결 론: 귀밑샘 악성종양에서 수술 후 방사선치료의 우수한 성적을 확인하였다. 성별 및 조직학적 유형이 생존율에 대한 의미있는 예후인자였고, 림프절 전이 및 절제연의 침윤이 있는 경우 국소제어율이 불량했다. Purpose: The aim of this study was to evaluate the clinical results of postoperative radiotherapy for parotid gland malignancy, and determine prognostic factors for locoregional control and survival. Materials and Methods: Between 1980 and 2002, 130 patients with parotid malignancy were registered in the database of the Department of Radiation Oncology, Seoul National University Hospital. The subjects of this analysis were the 72 of these 130 patients who underwent postoperative irradiation. There were 42 males and 30 females, with a median age of 46.5 years. The most common histological type was a mucoepidermoid carcinoma. There were 6, 23, 23 and 20 patients in Stages I, II, III and IV, respectively. The median dose to the tumor bed was 60 Gy, with a median fraction size of 1.8 Gy. Results: The overall 5 and 10 year survival rates were 85 and 76%, respectively. The five-year locoregional control rate was 85%, which reached a plateau phase after 6 years. Sex and histological type were found to be statistically significant for overall survival from a multivariate analysis. No other factors, including age, facial nerve palsy and stage, were related to overall survival. For locoregional control, nodal involvement and positive resection margin were associated with poor local control. Histological type, tumor size, perineural invasion and type of surgery were not significant for locoregional control. Conclusion: A high survival rate of parotid gland malignancies, with surgery and postoperative radiotherapy, was confirmed. Sex and histological type were significant prognostic factors for overall survival. Nodal involvement and a positive resection margin were associated with poor locoregional control.

만성 부비동염 환자에서 임상증상 및 전산화단층촬영 소견에 의한 부비동 내시경수술의 술후 결과분석

민양기,정하원,이재서,이종우,박석원 釜算慶南耳鼻咽喉科學會 1993 임상이비인후과 Vol.4 No.1

만성 부비동염에서 섬모운동과 전산화 단층촬영에서의 상악동 점막비후의 상관관계

민양기,전상준,이재서,이철회,이강수,윤자복,이원진,박광석 대한이비인후과학회 1999 대한이비인후과학회지 두경부외과학 Vol.42 No.7