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구용철,황치상,고승현,이원상 대한이비인후과학회 2012 대한이비인후과학회지 두경부외과학 Vol.55 No.6
Cerebral Salt Wasting Syndrome (CSWS) is defined as the development of extracellular volume depletion due to a dysfunction of the renal sodium transport system. Differentiation of CSWS from the Symdrome of Inappropriate Secretion of Antidiuretic Hormone in patients with intracranial disease is difficult because both syndromes include hyponatremia and concentrated urine with natriuresis. However, distinguishing between these two syndromes is very important because the treatment options differ. We report a 41 year-old Asian woman who presented initially with hyponatremia, and was finally diagnosed with CSWS after an operation for an acoustic neuroma. Based on this case, we discuss a possible mechanism and disclose insights about differential diagnosis thereof.
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구용철,황치상,김기정,최홍식,Koo, Yong-Cheol,Hwang, Chi-Sang,Kim, Gi-Jeong,Choi, Hong-Shik 대한후두음성언어의학회 2011 대한후두음성언어의학회지 Vol.22 No.2
Malignant fibrous histiocytoma is one of the rare types of larynx tumor. The most common sites of the tumor are limbs, trunk, and retroperitoneal space, but tumor localization within head and neck are very rare. It is built of histiocytes, fibroblasts and multinuclear giant cells. A diagnosis of the tumor includes microscopic and immunohistologic examination with identification of specific tissue markers and intermediate filaments of proteins. This disease has been treated by several methods combining radical surgery, radiotherapy, and chemotherapy, but the prognosis is poor. We present 74-year-old Asian man with dysphonia for 2 years. The tumor of the larynx was examined on laryngoscopy. The radical surgery rendered the final pathological diagnosis, confirmed histologically and immunohistochemically as malignant fibrous histiocytoma. This tumor was treated with laser cordectomy followed by radiotherapy. 3.5 year's observation of the patient didn't either show any signs of recurrence or dysphonia.
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성문상 부분 후두절제술의 종양학적 및 기능적 결과: 18년간의 경험
박도양,구용철,홍재민,김원식,고윤우,최은창 대한이비인후과학회 2012 대한이비인후과학회지 두경부외과학 Vol.55 No.5
Background and Objectives Supraglottic partial laryngectomy (SPL), which provides the removal of selected tumors involving the upper structure of the glottis, shows equivalent oncologic outcome when compared to total laryngectomy with functional preservation. We report our 18-year experience of applying supraglottic partial laryngectomy in the Yonsei Head and Neck Cancer Clinic. Subjects and Method We retrospectively reviewed the charts of 78 patients who underwent SPL. We divided the patients into two groups, the early and the recent, and performed Kaplan-Meier survival analysis and χ2-test on the groups. The post-operative functional outcome was assessed. Results The 3-year-disease-specific survival rate of the early and recent period was 87% and 84.6%, respectively. Decannulation and tolerability of an oral diet was possible in 93% and 95% of the earlier group, and 95% and 98% in the recent group, respectively. There was no statistically significant difference in survival rate, recurrence pattern, decannulation and tolerability of oral diet between the two groups. Conclusion We achieved a satisfactory survival rate through SPL. In addition, almost all patients could be decannulated and eventually tolerated an oral diet. Our results confirm that SPL is an oncologically & functionally sound procedure for selected supraglottic tumors.
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황치상,김창훈,김유석,구용철,이동원 대한비과학회 2012 Journal of rhinology Vol.19 No.1
Metastasis of hepatocellular carcinoma (HCC) in the nasal septum is an extremely rare condition. The proper management and the role of surgical intervention are still controversial and there is no evidence-based guideline for this specific condition. The authors of the present study report a case of HCC with sinonasal metastasis, managed by surgery to relieve nasal obstruction and frequent epistaxis. Complete removal of the tumor via endoscopic surgery was performed and the pathology was reported to be consistent with metastatic HCC. No additional treatment modality was considered for the septal lesion. During the 8-month postoperative period, the patient remained alive and satisfied with comfortable nasal breathing. The present case report stresses the importance of interdisciplinary collaboration. Proper consultation between surgeon and oncologist may lead to improved quality of life, even when the patient is in the terminal stage of HCC.
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수술 후 잔존한 연소성 비인강 혈관섬유종에 감마나이프 수술로 치료한 1예
설정훈,김창훈,현동우,구용철 대한비과학회 2012 Journal of rhinology Vol.19 No.2
Juvenile nasophayngeal angiofibroma (JNA) is a histologically benign but highly vascular, agressively expansile lesion that occurs exclusively in prepubescent or pubescent males. Traditional treatmemt strategy of JNA has included open surgical approaches for majority of tumors. However, radiosurgery has been rarely applied for juvenile nasopharyngeal angiofibroma (JNA) and cumulative reports are lacking. The authors report a case of successful treatment of postoperative residual JNA with gamma knife radiosurgery.
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홍현준,고윤우,김원식,이소윤,신유섭,구용철,박윤아,최은창 연세대학교의과대학 2011 Yonsei medical journal Vol.52 No.4
Purpose: To examine the feasibility of endoscopic thyroidectomy (ET) via an axillo-breast approach without gas insufflation for large thyroid tumors and micropapillary carcinomas. Materials and Methods: The patients in the benign group were separated into groups 1 (n=95, <4 cm in tumor diameter) and 2 (n=37, ≥4 cm in tumor diameter). Also, 57 patients in the micropapillary carcinoma group underwent an endoscopic hemithyroidectomy (HT) (group 3) and were compared with 60 patients who received conventional open HT (group 4). Postoperative functional outcome, local complications, surgical outcomes, and pathological outcomes were compared between the groups. Results: In the benign group, there was no significant difference in mean operating time, hospital stay, or overall perioperative complications between the two groups. In the micropapillary carcinoma group, mean operating time and hospital stay in group 3 were significantly longer than in group 4 (p=0.015 and p≤0.001). The overall perioperative complications did not differ significantly between the groups. The postoperative cosmetic result was better in groups 1-3 (endo group) than in group 4 (open group). Conclusion: ET via a gasless axillo-breast approach seems to be a safe procedure even for benign thyroid lesions ≥4 cm and micropapillary carcinomas. Although it has the advantage of better cosmetic results over open thyroidectomy, there is room for improvement in terms of lessening its invasiveness and shortening the operative time.
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