595nm Pulsed Dye Laser를 이용한 수술 흉터 치료 1예

박기남(Ki Nam Park),정만기(Man Ki Chung),정한신(Han-Sin Jeong),유승재(Seung Jae Yoo),전형기(Hyung-Ki Chun),김원석(Won Seok Kim),손영익(Young-Ik Son) 대한두경부종양학회 2006 대한두경부 종양학회지 Vol.22 No.2

Pulsed dye laser(PDL) is originally designed for the treatment of vascular lesions but also effective in im-proving the quality and appearance of surgical scars. Recently, 595nm Pulsed dye laser(V-beam laser), which has the advantage of deeper tissue penetration and lesser amount of purpura, is spotlighted as a new option for the treatment of surgical scar. The authors treated a surgical scar of a female patient with V-beam laser for 3 times between 4 and 12 weeks after surgery. Subjective satisfaction was improved with visual analogue scale (VAS) and objective improvements were found in parameters of vascularity, pliability and height with Van-couver Scar Scale(VSS). We report the effectiveness of V-beam laser in surgical scar of Asian patient and plan the prospective study with larger scale.

성문에서 발생한 재발성 흉선상 방추상 상피세포 종양(Spindle Epithelial Tumor with Thymus-Like Differentiation, SETTLE) 1예

박우리,최나연,정만기,Park, Woori,Choi, Nayeon,Chung, Man Ki 대한후두음성언어의학회 2015 대한후두음성언어의학회지 Vol.26 No.2

Spindle epithelial tumor with thymus-like differentiation (SETTLE) is an extremely rare type of thyroid tumor, with spares reports on its clinical course. SETTLE is derived from branchial pouch or thymic remnants, and classified as a low grade, malignant neoplasm due to its indolent growth and tendency to develop delayed metastasis. Therefore, stringent initial workups and long-term follow-up are required to prevent misdiagnosis. We present a case of recurrent spindle epithelial tumor with thymus-like differentiation (SETTLE) in the glottis of 57 year-old male patient, who had a history of surgical excision for the SETTLE from the thyroid gland 5 years ago. Transoral CO2 laser surgery was performed to remove the glottic tumor and there was no evidence of local recurrence at 11 months postoperatively.

후두 접촉성 육아종의 치료

고문희,손영익,장전엽,소윤경,정만기,Ko, Moon-Hee,Son, Young-Ik,Jang, Jeon-Yeob,So, Yoon-Kyoung,Chung, Man-Ki 대한후두음성언어의학회 2008 대한후두음성언어의학회지 Vol.19 No.2

Background: Laryngeal contact granuloma is an inflammatory hypertrophic granulation tissue arising at around the vocal process of arytenoid cartilage. Various approaches are currently used for the treatment, but a solid guideline has not been established. Objectives: We aimed to compare the each treatment modality in the hope of suggesting a guideline for the successful management of laryngeal contact granuloma. Method: Eighty-seven treatment cases of 56 patients were analyzed. Cases having recent intubation history were excluded from the study. All patients received vocal hygiene education. Proton pump inhibitors (PPI, N = 33) or H2 receptor antagonists ($H_{2}RA$, N =26) were used as a first-line treatment. Among the non-responders to $H_{2}RA$, 11 cases received PPI as a second-line therapy. Eight cases received botulinum toxin injection and 9 cases had laryngomicrosurgical removal. Results: As an initial therapy, response rate to PPI and $H_{2}RA$ was 60.6% and 38.5% respectively, which was not statistically different (p=0.091). Response rate of PPI as the second-line therapy was 36.3% (p=0.162 when compared to that of first-line PPI therapy). Response rate of Botulinum toxin injection was 75%. All cases of surgical removal recurred in a relatively short period (mean 1.9months). Conclusion: In patients having laryngeal contact granuloma, combined therapy with vocal hygiene education and PPI medication would provide more than 60% of therapeutic response. Botulinum toxin injection is highly effective even in non-responders to antireflux therapy. The only indications of surgery are to resolve diagnostic doubt or to treat acute airway compromise.

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.

갑상선 전절제술 및 전경부 림프절 청소술 후 Fibrin Sealant 분무 여부에 따른 상처 배액량의 차이

김민범 ( Min-beom Kim ),우승훈 ( Seung Hoon Woo ),조재근 ( Jae Keun Cho ),정만기 ( Man Ki Chung ),손영익 ( Young-ik Son ) 대한갑상선학회 2008 International Journal of Thyroidology Vol.1 No.1

Background and Objectives: The authors aimed to analyze the effect of fibrin sealant spray on the amount of wound drainage in cases of total thyroidectomy (TT) and anterior compartment neck dissection (ACND). Materials and Methods: After TT and ACND, 80 adult patients were prospectively and randomly assigned into two groups; a fibrin group and a non-fibrin group. In a fibrin group, 2 ml of fibrin sealant (TissucolⓇ Duo Quick, Baxter AG, Austria) was evenly sprayed over the surgical bed of TT and ACND. In both groups, a closed suction drainage tube was placed and the amount of drainage was checked in every 8 hours until it was removed when the daily drainage amount became less than 10 ml. Results: The amount of drainage (average±standard deviation) during the first postoperative 8 hours was 43.8±15.9 ml in 40 patients of non-fibrin group and 25.0±12.6 ml in 40 patients of fibrin group, and this difference was statistically significant (p<0.001). The cumulative drainage amount for the first postoperative day reduced by 37% in fibrin group (62.0±21.3 ml) when compared to that in non-fibrin group (86.1±33.2 ml). But those at the second and third postoperative day were not statistically different between the two groups. Conclusion: These results suggest that fibrin sealant spray may help to reduce the amount of drainage in an earlier period but not to avoid placing a closed suction drain in cases of TT and ACND regardless of fibrin sealant spray since the first and second 24 hours drainage amount were larger than conventional guide for safe drain removal.

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).

소아청소년 기관 절개술의 원인과 임상 경과

서정민 ( Jung Min Suh ),이정현 ( Jung Hyun Lee ),정만기 ( Man Ki Chung ),정한신 ( Han Sin Jeong ),손영익 ( Young Ik Son ),안강모 ( Kang Mo Ahn ),이상일 ( Sang Ii Lee ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2012 소아알레르기 및 호흡기학회지 Vol.22 No.2

목적: 기관 절개술은 소아의 호흡기 관리에서 기도 유지에 도움을 주어 생명을 구하는 술기이지만 이에 따른 심각한 합병증의 위험도 있다. 본 연구에서는 국내 소아청소년 기관 절개술의 임상 양상과 결과에 대해서 알아보고자 한다. 방법: 1995년 1월부터 2010년 7월까지 삼성서울병원에서 기관 절개술을 시행한 18세 미만인 환자 153명을 대상으로 의무기록을 후향적으로 검토하여 성별, 기관 절개술을 시행한 나이, 응급 수술 여부, 원인, 기관 절개술 전 경구 기관 내 삽관 기간, 캐뉼라 발관 여부, 캐뉼라 발관까지 걸린기간, 전체 입원 기간, 기관 절개술 후 입원 기간, 기관 절개술의 합병증 그리고 퇴원, 전원, 사망한 환자 수를 조사하였다. 결과: 성문하 협착으로 기관 절개술을 받은 환자가 가장 많았다(29명, 19%). 소아청소년 기관 절개술이 시행된 중간 나이는 1.3세 (범위, 22일-17.8세)였으며 73명(47.7%)이 1세 미만이었다. 1세 미만에서는 호흡기 질환이, 1세 이상에서는 신경근육 질환이 유의하게 많았다. (P=0.013) 가장 흔한 합병증은 기도 부위 혹은 기도 누공의 육아조직 형성 (56명, 36.6%)이었다. 성공적으로 캐뉼라 발관을 한 환자는 61명(39.9%)이었으며 캐뉼라 발관까지 걸린 중앙 기간은 141일 (범위, 141 1-2,529일)이었다. 사망한 환자는 16명 (10.5%)이었으나, 기관 절개술과 직접적 관련되어 사망한 환자는 1명(0.7%)이었다. 결론: 소아청소년 기관 절개술은 비교적 안전하였다. 신경근육 질환 환자들이 호흡기 질환 환자에 비해서 기관 절개술을 시행할 때의 나이가 많았고, 캐뉼라 발관이 잘 되지 않았으며 재원 기간이 길었다. Purpose: Tracheostomy is used to aid airway management in perdiatric respiratory care. This study was designed to review causes and outcomes of pediatric tracheostomy. Methods: We performed a retrospective chart review of 153 patients, less than 18 years of age, who underwent tracheostomy between January 1995 and July 2010. Age at tracheostomy, indications, durations, complications and mortality were evaluated. Results: Subglottic stenosis (19%) was the most common indication for tracheostomy. The median age at tracheostomy was 1.3 years (range, 22 days to 17.8 years). Seventy-three (47.7%) tracheostomies were performed in children under 1 year of age. Respiratory diseases were significantly more prevalent in patients under 1 year of age, while neuromuscular disease were more frequently found in patients older than 1 year ( P=0.013). Stoma or tracheal granuloma formation (36.6%) was the most common complication of pediatric tracheostomy. Decannulation was accomplished in 61 (39.9%) patients with median cannulation time of 141 days (range, 1 to 2,529 days). Overall mortality rate was 10.5% (n=16), but only one patient (0.7%) died from tracheostomy-related complications. Conclusion: Respiratory diseases, such as subglottic stenosis and neuromuscular disease, are the main cause of pediatric tracheostomy. Although complications, like stoma or tracheal granuloma formation occur, tracheostomy in children is a safe way to aid airway management.

외이도 악성 종양 21례의 치료 경험

정종인(Jong In Jeong),조양선(Yang Sun Cho),추호석(Ho Suk Chu),홍성화(Sung Hwa Hong),정원호(Won Ho Chung),백정환(Chung Hwan Baek),정한신(Han Sin Jeong),정만기(Man Ki Chung) 대한두개저학회 2009 대한두개저학회지 Vol.4 No.1

Background and Objectives:The malignances of external auditory canal(EAC) are very rare diseases and have very poor prognosis. Numerous staging systems have been proposed to classify patients before treatment. To treat the diseases, multimodal therapy is performed. The aim of this study was to review our experiences of the treatments for the malignances of EAC, and to propose most effective treatments according to the stage. Subjects and Method:Twenty-one patients with the malignances of EAC diagnosed between November 1994 and December 2009 were analyzed. The patients were analyzed according to the Pittsburgh staging system and histopathological findings. Results:The number of patients staged as T1, T2, T3, and T4 were 4, 2, 2, and 13, respectively. Surgical treatments were performed in 13 patients using lateral temporal bone resection, subtotal temporal bone resection. Initial or postoperative radiotherapies were performed in 13 patients. After the treatment, the mean disease free survival periods of 5 patients (23.8%) who are still alive without the disease was 27.8 months, and 4 patients (19%) expired within the mean periods of 11.8 months. Conclusion:We suggest that en-bloc resection with or without radiation therapy is the best treatment for the malignancies of the external auditory canal. A positive resection margin or residual tumor should be considered as worst prognostic factor.

육종성 변화를 동반한 경부의 염증성 근섬유모세포종 1례

김한결(Han kyeol Kim),최나연(Na yeon Choi),배현식(Hyun sik Bae),박우리(Woo ri Park),정만기(Man Ki Chung) 대한두경부종양학회 2016 대한두경부 종양학회지 Vol.32 No.2

Iinflammatory myofibroblastic tumor(IMT) is a benign chronic inflammatory mass composed of proliferative myofibroblasts. It is a space occupying lesion which could potentially covert to malignant tumor. Treatment guideline of the disease has not been established due to its rarity. We demonstrate a 60-year old male who had surgical excision for IMT of the cervical esophagus. During the follow-up period, he revealed recurrent tumor which showed sarcomatous change with distant metastasis. We reported this rare case with review of the literature.

CHARGE 증후군 환자에서 호흡기 문제에 관한 분석: 단일 기관 연구

송상미 ( Sangmi Song ),박미란 ( Mi Ran Park ),김지현 ( Jihyun Kim ),최연아 ( Youn Ah Choi ),허준 ( Jinyoung Song ),강이석 ( June Huh ),정만기 ( I Seok Kang ),정한신 ( Man Ki Chung ),손영익 ( Han Sin Jeong ),안강모 ( Young Ik Son 대한천식알레르기학회 2014 Allergy Asthma & Respiratory Disease Vol.2 No.1

Purpose: CHARGE syndrome consists of multiple malformation including coloboma, heart defect, choanal atresia, growth or developmental retardation, genital anomalies, and ear anomalies. The aim of this study was to evaluate the respiratory problems in children with CHARGE syndrome. Methods: Out of 9 patients with CHARGE syndrome, medical records from 8 patients showing respiratory distress or respiratory failure were retrospectively reviewed. We investigated the causes of respiratory problems by physical examination, endoscopy, echocardiogram, computed tomography, rigid bronchoscopy, swallowing test, and 24-hour impedence monitoring. esults: Five patients required endotracheal intubation soon after birth due to bilateral choanal atresia (n=2) and congenital heart diseases (n=3). Three patients were intubated within a month because of surgery for complex heart diseases (n=2) or recurrent apnea (n=1). Tracheostomy was performed in 3 patients who showed primary or secondary subglottic stenosis. Among 8 patients who had aspiration or respiratory distress after feeding, cricopharyngeal incoordination and gastroesophageal reflux disease were found in 7 and 2 children, respectively. One patient died of aspiration during oral feeding. Conclusion: Patients with CHARGE syndrome manifest respiratory distress or failure due to various causes including congenital anomaly in the airway, cardiac anomaly, neurologic or gastrointestinal problems. Therefore, pediatricians should be alert to the respiratory symptoms and signs in CHARGE syndrome and take active intervention from the birth to improve their long-term prognosis. (Allergy Asthma Respir Dis 2014;2:70-74)