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저자들은 좌측 전경부 종물을 주소로 내원한 9세 여아에서 발생한 갑상선수질암종을 갑상선 전절제술 및 술후 방사성요드로 치료한 경험을 보고하는 바이다. Medullary thyroid carcinoma constitutes about 5-10% of all thyroid malignancies, but rare in children. It has frequent association with multiple endocrine neoplasia(MEN) and frequent familial occurrence. They are derived from parafollicular cells of thyroid glands and produce calcitonin. They are capable of local invasion, spread to regional lymph nodes, or distant metastases. Histopathologically, the lesions are characterized by sheets of non-follicular cells surrounded by deposits of hyaline amyloid. Aggressive surgical intervention is recommended due to the propensity of medullary thyroid carcinoma for local microvascular invasion, late recurrence and metastasis. A total thyroidectomy is generally recommended because of the high incidence of bilaterality. Recently, authors experienced a case of medullary carcinoma in child. We report this case with review of the literatures.
Vocal folds injury from vocal abuse is important topics of phonosurgery. Recent advances in diagnostic equipment, phonosurgery and speech analysis equipment have provided a lot of Information about fine movement of the vocal folds. However, predicting the reaction of the vocal folds to phonatory trauma remains difficult. The vocal folds need to withstand great vibratory and shearing stress and anchoring fibers of basement membrane Bone play a role in maintaining structural integrity of histologically different epidermis and superficial layer of lamina propria(cover of vocal folds). The purpose of this study is to demonstrate the changes of anchoring fibers in vocal polyp using transmission electron microscope. Various defects were observed : a irregular thickening of basement membrane, a near absence of normal anchoring fiber, a lot of electron dense material in superficial layer of lamina propria, a destruction of hemidesmosome and many vesicles carrying electron dense material In basal keratinocyte. These observations were suggestive of a hyperactivity of basal keratinocyte of vocal folds epithelium in response to vibratory stress.
A retrospective review of clinical records of 34 cases with polypoid vocal folds who underwent endolaryngeal microsurgery was carried out. The results were followings; 1) The incidence was high in elder age group(mean age : 53.7 years old). 2) Bilateral lesions were much more frequent than unilateral ones(67.6% vs. 32.4%). 3) Nine out of 34 patients had associated local pathologies and nine out of 34 patients had associated systemic pathologies. 4) Smoking appeared to be the most dominant predisposing factor(76.5%). 5) Maximal phonation time was decreased in 10 cases out of 14 cases(71.4%) and phonation quotient was increased in 9 cases out of 14 cases(64.3%). 6) All the cases were treated with sucking technique and the voice quality was improved in 32 cases(94.1%) The average duration for voice improvement was 2.8 months.
정광윤,전병선,고상현,권기환,권순영,권중근,김동영,김상철,김성완,김영모,김영호,김윤환,김장묵,Jung, K.W.,Jun, B.S.,Ko, S.H.,Kwon, K.H.,Kwon, S.Y.,Kwon, J.K.,Kim,, D.Y.,Kim,, S.C.,Kim,, S.W.,Kim,, Y.M.,Kim,, Y.H.,Kim,, Y.H.,Kim,, J.M. 대한기관식도과학회 2004 大韓氣管食道科學會誌 Vol.10 No.2
Background and objective : Rabeprazole is a new generation proton pump inhibitor, which has a rapid onset after first dose, predictable efficacy in all patients regardless of CYP2C19 genotype status, and less nocturnal acid breakthrough. The aim of the study is to investigate clinical efficacy and safety of rabeprazole sodium (Pariet 10mg qd)when administered once daily to patients with laryngopharyngeal reflux(LPR) disease. Methods : Among the patients who had visited the Department of Otolaryngology, those with LPR symptoms, had undergone laryngoscopy. Symptoms and endoscopic laryngeal sings were recorded initially, at 1 month, 2 months, 3 months, and more than 3 months, All patients were evaluated for clinical efficacy on the basis of symptom scores, reflux finding score(RFS), and side effects. Results : In general, most symptom scores and RFS improved over the time. Efficacy of the Pariet on LPR-related symptoms were $63.2\%,\;77.5\%,\;78.7\%,\;and\;90.9\%$ before 4 weeks, 4 to 8 weeks, 8 to 12 weeks, and after 12 weeks respectively. Efficacy on the RFS were $61.8\%,\;78.4\%,\;82.9\%,\;and\;85.5\%$ before 4 weeks, 4 to 8 weeks, 8 to 12 weeks, and after 12 weeks respectively. Pariet was well tolerated and was associated with few drug-related side effects. Conclusion Because of its efficacy and safety, Pariet may prove to be an alternative to currently available proton pump inhibitors.
Bowing of the vocal cords may be due to aging. atrophy. bilateral superior laryngeal nerve paralysis. injudicious vocal cord surgery, of an idiopathic cause. The bowing usually produces a dysphonia characterized by breathiness due to air escape : however, it can produce aphonia. This report reviews vocal function after surgical correction of bowing of the vocal cords for diagnosis and management. The vocal function of 13 patients with sulcus vocalis and 12 patients with vocal cord atrophy was evaluated with the use of a test battery of multidimensional evaluation items. The voice was improved postoperatively in most patients. The voice improvement was reflected objectively in maximum phonation time, mean air flow rate during phonation, stroboscopic findings. sound pressure level range and fundamental frequency range of phonation, and results of acoustic analyses of tape-recorded voice. The vocal function after surgical correction of the sulcus vocalis and vocal cord atrophy was improved postoperatively in most patient, but the results were not satisfactory.