악하선문 타석의 치료:악하선관 조대술을 이용한 구강내 접근법

정한신,백정환,손영익,정규환,이동경,김준호,이현종 대한이비인후과학회 2005 대한이비인후과학회지 두경부외과학 Vol.48 No.8

Background and Objectives:The excision of submandibular gland (SMG) has been commonly used for the treatment of calculi in the hilum of SMG, since intraoral removal of the hilar stone has the potential risk of lingual nerve injury and the poor surgical field. However, it would leave loss of remained gland function and external scars after the excision. Therefore, the authors modified the intraoral retrieval techniques as the marsupialization of the Whartons duct up to the calculi in the hilum. This study reports our clinical experience with the modified intraoral retrieval technique and the advantages of this modality for calculi in the hilum of SMG. Subjects and Method:SMG excision and intraoral removal with marsupialization (IRM) were used from 1994 through 2003 to treat 9 and 16 cases of calculi in the hilum of SMG, respectively. We analyzed the characteristic findings of calculi, surgical morbidities and complications by comparing two different treatment groups. Results:The mean diameter of the calculi was 6.1 mm in patients with SMG excision and 7.8 mm in patients with IRM. The success rate of extraction by IRM of calculi in the hilum were 86.7%. The surgical complications were similar in both groups. The proportion of palpable calculi were significantly increased in the IRM group (92.9% vs 22.2%). We failed to remove the stone by IRM from patients, and stones were impalpable intraorally preoperatively. Conclusion:IRM is an excellent alternative method for the removal of palpable calculi located in the hilum of SMG. Furthermore, it would preserve the salivary gland function without external scarsand with acceptable surgical complications and morbidities.

결핵성 경부 림프절염의 임상경과 및 치료원칙

정한신,강제형,김상우,송재훈,백정환,손영익 대한이비인후과학회 2003 대한이비인후과학회지 두경부외과학 Vol.46 No.5

Background and Objectives: (TCL) is not an uncommon inflammatory disorder. Yet, the management strategy of TCL is controversial and there are no clear answers for when, how and to whom surgical intervention should be applied. This study aimed to analyze the eficacy of antituberculous chemotherapy (AC) and surgical treatment to provide the guidelines of surgical intervention. Materials and Method:A retrospective chart review was carried out for 153 patients with TCL who were treated between Jan. 1998 and Jun. 2001 at Samsung Medical Center, Seoul, Korea. AC ory to the medical management. Treatment results of AC and indications of the surgical intervention were analyzed. Results:AC, as a sole treatment modality, was successful in most (83.7%) of the patients while combined surgical intervention was neded for 16.3%. Overall cure rate (remnant mass size ≤5 mm) was 96.3%. Surgery was provided for the TCL showing progresion even after the initiation of AC or not responding to AC within 3 months. The necrotic lymph node les than 4 cm in its size did rupture or overt draining sinus, surgical intervention shortened the duration of treatment required for the wound healing. Conclusion:Most of TCL can be effectively controled with AC alone. It would be reasonable to reserve surgical interventions for the TCL with 1) abscess greater than 4 cm in its size, 2) absces not rapidly responding to AC regardles of its size, 3) draining skin wound, and 4) non-necrotic nodes with poor response to AC over 3 months. Gross total removal of TCL would be prefered for shortening the duration of wound care to drainage procedures including curettage, incision and drainage or simple dresing.(Korean J Otolaryngol 2003 ;46 :419-25)

‘모델 영화’(실존인물 영화)와 표현의 자유 - 특히 명예훼손과 관련하여 -

정한신 한국스포츠엔터테인먼트법학회 2006 스포츠와 법 Vol.9 No.-

실존 인물을 모델로 하여 그에 관한 사실에 허구를 가미하여 제작한 영화를 ‘모델 영화’라고 한다. 그러나 모델 영화는 그 소재가 된 실존 인물과 그 유족들의 명예 등 인격권을 침해할 가능성도 있다. 예술·표현의 자유가 중요한 헌법적 가치이기는 하지만 타인의 인격권을 침해하여서는 안 되고, 양자는 조화를 이루어야 한다. 따라서 본 논문은 모델 영화를 통한 예술·표현이 어떤 경우에 인격권(특히 명예권)을 침해하게 되는지를 규명하고, 그 판단기준을 확립하는 것을 주된 목표로 하였다. 또한 모델 영화에 대한 상영금지가처분이 예술·표현의 자유를 사전적으로 제한하는 검열에 해당하는 것은 아닌지의 문제도 검토하였다. 첫째, 관객이 모델 영화 속에서 실존 인물을 연상할 때 그 인물의 인격권이 침해될 수 있다. 그러나 영화제작자가 실존 인물에서 모티브를 얻었지만 전혀 다른 인물을 창출한 경우나, 관객들이 실존 인물을 연상할 수 없도록 조작한 때에는 인격권 침해가 문제되지 않는다. 둘째, 死者의 인격권은 인정되나, 모델 영화가 死者의 인격권을 침해했다는 이유로 손해배상 청구를 할 수는 없다. 그러나 유족의 명예를 침해하거나 유족의 경애 추모의 정을 침해한 경우에는 손해배상을 청구할 수 있다. 한편 死者에 관한 사실은 시간의 경과에 따라 역사적 사실로 이행해 가므로, 死者의 명예가 중대하게 훼손된 경우에만 명예훼손을 인정해야 한다. 셋째, 명예훼손의 성립 요건 중 ‘사실의 적시’는 영화의 전체적 흐름, 대사의 의미, 장면 연결방법 등과 작품의 예술적 가치, 모델이 된 사람을 비방하려는 의도의 존부 등을 종합적으로 판단해야 한다. 특히 창작에 의한 예술적 승화도와 절연장치를 고려하여야 한다. 아울러 역사적 사실에 대한 다양한 해석의 여지가 존재한다면 표현의 자유가 보다 옹호된다고 보아야 한다. 넷째, 형법 제310조는 허구성, 예술성, 상업성을 특징으로 하는 영화에 그대로 적용하기 어렵지만, 영화의 장르와 내용, 목적 등을 고려하여 그 적용가능성이 있다. 또한 ‘공공성’ 판단에 있어서 공인 이론이나 현실적 악의 이론을 부분적으로 수용하여 공적 인물의 공적 사안에 관한 것인 때에는 표현의 자유를 더욱 보장하여야 한다. ‘진실성’은 중요 부분의 객관적 사실과의 합치를 의미하고 다소 과장된 표현도 허용된다. ‘상당성’ 판단시 영화는 표현행위의 신속성이 요청되지 않고 진실확인을 위한 충분한 여유가 있기 때문에 영화의 내용이 객관적이고 합리적인 자료나 근거에 의해 뒷받침되도록 요구된다는 점을 고려해야 한다. 한편, 모델 영화의 상영금지가처분은 검열은 아니나 실질적으로 검열과 비슷한 기능을 하기 때문에 매우 제한적으로 이루어져야 한다. 즉 인격적 가치의 사후구제가 실효성을 거두기 어렵고, 인격권이 중대하게 훼손되는 경우에 한하여 엄격하게 인정되어야 한다. 'Model Film' is a fiction based on the true stories of real person. But it can violate the personal right like reputation of the real person and his or her bereaved family. Freedom of expression is very important constitutional value, but it should not violate the personal right of another person. Freedom of expression and the personal right should be harmonized. Therefore the purpose of this essay is establishing useful standards of judgement whether the expressions of a model film which is protected by freedom of expression violate the personal right. And I examined whether the ruling to ban films by injunction is a censorship that is the prior restraint of the freedom of expression. First, the personal right of real person in model film can be violated when the audience is able to know who the person is by the film. But when the film maker gained the motives by the real person's story, but could create a totally new character, or could make the audience recognize the character in film is not the real person, there is no infringement of personal right. Second, the personal right of a dead person is recognized. But the bereaved family cannot claim damages for the infringement of personal right of a dead person by model film. But when a model film injured the bereaved family's honor or memorial feelings to the real person, the family can claim damages. And the facts about dead person are gradually incorporated into history, so the defamation should be recognized when the damaging of the dead person's reputation is a severe infringement. Third, the 'presentation of facts', one of the essential conditions of defamation should be judged by the developments of story, the meanings of lines, the methods of scene shifts, the artistic value of work, the intention of abuse and so on. Especially the artistic sublimation by creative work and the equipment in film breaking off connection with the real person should be considered. And the room for interpretation about historical facts in a film provides more protection to freedom of expression. Fourth, the Article 310 of Korea Penal Code cannot be directly applied to film which has fictional, artistic, and commercial features, but it can be applied by considering the genre, contents, and purpose of the film. And public figure theory or actual malice theory can be partly adopted, so the freedom of expression should be more protected when a case is about public concerns of public figure. 'True fact' of the Article 310 means the correspondence with objective fact in important part, so more or less exaggerated expression is approved. 'Considerable reason' can be more strictly judged in model film cases, because the film is not required speediness of expression and has enough time to confirm the true fact. So the contents of model film should be supported by objective and reasonable sources. The ruling to ban films by injunction is not a censorship that is the prior restraint of the freedom of expression, but in fact it functions like a censorship. So it should be made very strictly, only when the remedy after the fact is difficult to recover damages effectively and the personal right is very severely infringed.

두경부 영역 동정맥 기형의 진단과 치료

정한신,최종윤,이현종,김태욱,김민범,소윤경,손영익,백정환,이병붕,변홍식 대한이비인후과학회 2005 대한이비인후과학회지 두경부외과학 Vol.48 No.9

Background and Objectives:Arteriovenous malformation is a vascular malformation with fast-flow shunt from the artery to the vein. Extracranial arteriovenous malformation in the head and neck (HNAVM) is so rare that there have been no systematical reports related to it in Korea. Authors aimed to suggest the treatment protocols for HNAVM through retrospective analysis. Subjects and Method:We reviewed retrospectively the medical records of 19 patients with extracranial HNAVM, who had been diagnosed and treated between 1995 and 2001. Mean follow-up duration was 27.3 months. The mean age at detection was 13.2 years old. The cheek was the most frequently suffered site. We used MRI, angiography, and 99mTechnetium (Tc) RBC scintigraphy for the diagnosis and follow-up of HNAVM. For the treatment, ethanol sclerotherapy, excision, and embolization were adopted alone or in variable combination. Results:Angiography was confirmative of the diagnosis and MRI was excellent in evaluating the extent of the disease. Ethanol sclerotherapy was used as the first line of treatment for 11 cases. For others, surgical excision combined with embolization was used as the first line of treatment for 7 patients and the second choice for 6 patients. 99mTc RBC scintigraphy was useful in quantifying the response after treatment. Fifteen out of 19 patients finally achieved 75% or more reduction in their size of lesions. There were 5 permanent complications from the total of 37 procedures. Conclusion:For those cases of HNAVM that had the nidus accessible via the percutaneous route, ethanol sclerotherapy worked as the firstline treatment . For other HNAVM cases, surgical excision with embolization might be the best choice of treatment.

모델 영화 (실존인물 영화)와 표현의 자유 - 특히 명예훼손과 관련하여 -

정한신 한국스포츠엔터테인먼트법학회 2006 한국스포츠엔터테인먼트법학회 학술대회자료집 Vol.2006 No.-

안와주위 악성 종양의 림프절 전이 양상 및 수술적 치료

정한신,정용기,이혁준,정만기,손영익,백정환 대한이비인후과학회 2004 대한이비인후과학회지 두경부외과학 Vol.47 No.1

타액관 암종의 임상양상 및 치료결과

정한신,이현석,이혁준,고영혜,백정환,손영익 대한이비인후과학회 2003 대한이비인후과학회지 두경부외과학 Vol.46 No.4

Background and Objectives:Salivary duct carcinoma (SDC) is a rare but highly malignant tumor of the salivary glands. Authors aimed to assess the current treatment outcome and to estimate the prognostic factors in the patients with SDC. Materials and Methods:We reviewed the medical records of 11 patients with SDC, who were treated between Jan. 1995 and Jun. 2002 at the Department of Otolaryngology, Samsung Medical Center. Follow-up duration ranged from 10 to 76 months with a mean of 29.6. Results:The parotid glands were more frequently involved (9 patients) than the submandibular glands (2 patients). Most patients were diagnosed to have an advanced stage of the disease. Curative surgical resections and/or postoperative radiation were the mainstay of the treatment. The adjusted 3-year survival rate was 64.9% and the disease-free 3-year survival rate was 34.1%. Four patients died of the disease at a mean interval of 22 months after the initial diagnosis. Presentation with the facial nerve paralysis, positive surgical resection margins and pathological vascular invasion had a tendency to result in poor survivals. Treatment failures due to distant metastasis were common (54.5%). Conclusion:We reconfirmed the aggressive clinical natures of SDC;frequent distant metastasis and poor survival rates. These findings strongly suggest that additional treatment modalities such as an adjunctive systemic treatment need to be considered in the patients with SDC especially when they have high risk factors or an advanced disease, which need further investigation. (Korean J Otolaryngol 2003;46:318-23)

Combined 18F-FDG PET/CT Imaging for the Initial Evaluation of Glottic Cancer

정한신,백정환,정만기,손영익,홍상덕,복권효 대한이비인후과학회 2008 Clinical and Experimental Otorhinolaryngology Vol.1 No.1

Objectives. The primary aim of this study was to determine whether 18F-FDG-PET/CT (PET/CT) scans provide additional diagnostic information in addition to the direct laryngoscopic examination (L/E) and contrast-enhanced CT (CT) in patients with glottic cancer during the initial evaluation. Methods. Fifty-five consecutive patients with glottic cancer of the larynx that had L/E, CT and PET/CT were enrolled. The diagnostic value of each modality was compared for their accuracy in predicting the extent of the primary tumors on sub-site based analysis and the final tumor staging. The reference standards were either the surgical pathology findings or clinical/radiological follow-up outcome. Changes in patient care based on PET/CT results were compared with the treatment decisions based on L/E with CT. Results. For primary tumor sub-site based analysis, the sensitivity was significantly higher for L/E (92.8%) than for PET/ CT (79.4%, P=0.028). The comparisons between L/E vs. CT and CT vs. PET/CT did not reach statistical significance. As an initial tumor-staging method the L/E had a diagnostic accuracy of 76.4%, compared to 61.8% for CT and 41.8% for PET/CT. The L/E and CT were better than the PET/CT (P=0.0009 and 0.049) for the initial TNM staging. PET/CT scanning changed the clinical decision-making based on the L/E with CT results in 12.7% of cases, of whom 5.5% had no additional PET/CT related benefit. Conclusion. The results of this study showed that PET/CT imaging added no clinical information benefit compared to the L/E and CT for the initial evaluation of patients with glottic cancer. Objectives. The primary aim of this study was to determine whether 18F-FDG-PET/CT (PET/CT) scans provide additional diagnostic information in addition to the direct laryngoscopic examination (L/E) and contrast-enhanced CT (CT) in patients with glottic cancer during the initial evaluation. Methods. Fifty-five consecutive patients with glottic cancer of the larynx that had L/E, CT and PET/CT were enrolled. The diagnostic value of each modality was compared for their accuracy in predicting the extent of the primary tumors on sub-site based analysis and the final tumor staging. The reference standards were either the surgical pathology findings or clinical/radiological follow-up outcome. Changes in patient care based on PET/CT results were compared with the treatment decisions based on L/E with CT. Results. For primary tumor sub-site based analysis, the sensitivity was significantly higher for L/E (92.8%) than for PET/ CT (79.4%, P=0.028). The comparisons between L/E vs. CT and CT vs. PET/CT did not reach statistical significance. As an initial tumor-staging method the L/E had a diagnostic accuracy of 76.4%, compared to 61.8% for CT and 41.8% for PET/CT. The L/E and CT were better than the PET/CT (P=0.0009 and 0.049) for the initial TNM staging. PET/CT scanning changed the clinical decision-making based on the L/E with CT results in 12.7% of cases, of whom 5.5% had no additional PET/CT related benefit. Conclusion. The results of this study showed that PET/CT imaging added no clinical information benefit compared to the L/E and CT for the initial evaluation of patients with glottic cancer.

한국인 비증후군성 감각신경성 난청 환자에서 미토콘드리아 유전자 점 돌연변이의 빈도

정한신,임문정,장선오,김종선,오승하 대한이비인후과학회 2004 대한이비인후과학회지 두경부외과학 Vol.47 No.3

Background and Objectives:Mitochondrial point mutations have been shown to be responsible for syndromic and non-syndromic hearing impairment. Among these mitochondrial point mutations, 1555 A→G, 3243 A→G, and 7445 A→G mutations are detected more frequently in sensorineural hearing loss (SNHL)of these thre mitochondrial mutations among the non-syndromic SNHL population in Korea. Subjects and Method:To determine the frequency of thre mitochondrial point mutation 1555 A→G, 3243 A→G, and 7445 A→G, we examined 129 unrelated SNHL outpatients using restriction fragment length polymorphism. And to confirm these point mutations, we analyzed mitochondrial DNA with point mutations by direct sequence analysis. Results:The frequency of mitochondrial gene mutation in the unrelated sensorineural hearing impaired patients in the Korean population was 1555 A→G:2.3% (3/129), 3243 A→G:0.7% (1/129), 7445 A→G:0% (0/129). Conclusion:These results regarding Koreans are similar to those of Japanese. Each member in a family with 1555 A→G mitochondrial point mutation had variable hearing levels (different phenotype) in spite of the same mitochondrial point mutation. The pathogenesis of these mitochondrial point mutations in hearing should be further of these point mutations.

전외측대퇴 유리피판술을 이용한 두경부 영역 결손의 재건

정한신,이현종,백정환,김태욱,손영익,문구현,이혁준 대한이비인후과학회 2005 대한이비인후과학회지 두경부외과학 Vol.48 No.2