후두 발적에 대한 컴퓨터 평가 시스템의 신뢰도 연구

문병재,남순열,김상윤,최승호,Moon, Byoung-Jae,Nam, Soon-Yuhl,Kim, Sang-Yoon,Choi, Seung-Ho 대한후두음성언어의학회 2005 대한후두음성언어의학회지 Vol.16 No.1

Background and Objectives : While considerable progress has been made in enhancing the quality of laryngoscopy and image processing, the evaluation of laryngeal erythema is still based on the clinician's judgement. The purpose of this study is to quantitatively measure the degree of erythema and to examine the relationship with clinical grading. Materials and Methods : Color images of larynx from 100 subjects were captured from video-documented examinations of laryngoscopy. The amount of erythema within the digitized larynx image was quantified using software developed and was compared with a grading system (0 to 3 scale) based on visual inspection by 4 experienced clinicians. The results were compared by deriving Kappa, Kendall and Spearman statistic. Results : There was high intra-observer(R=0.402-0.755) and inter-observer correlation (R=0.789). Among parameters, the red composite value had most remarkable agreement with clinical grading(R=0.827). Conclusion : The result suggest that the computer based analysis of laryngeal erythema can provide quantiative data on degree of erythema and the basis for further development of an expert system.

비/비인강 비호즈킨 림프종의 임상양상과 예후 인자

박순서(Soon Seo Park),서철원(Cheol won Suh),박종범(Jong Beom Park),박지운(Ji Woon Park),임소덕(Soo Duk Lim),허주령(Joo ryung Huh),남순열(Soon Yuhl Nam),김상윤(Sang Yoon Kim),이호규,장혜숙(Hye sook Chang),김태원(Tae Won Kim),이제환(Je Hw 대한두경부종양학회 1999 대한두경부 종양학회지 Vol.15 No.2

Objectives: To study the clinical features of the primary nasal/nasopharyngeal non-Hodgkin's lymphomas and to evaluate the implication of immunophenotyping as a prognostic factor. Patients and Methods: From January 1990 to December 1997,41 patients(median age, 41 years) of primary nasal/nasopharyngeal non-Hodgkin's lymphoma were studied. The clinical records and paraffin-embedded tissue blocks were reviewed retrospectively. The histologic features, immunophenotypic findings(pan-T, pan-B, CD3, CD56) and Epstein-Barr virus in situ hybridizatios were examined. The prognostic factors for clinical outcome were evaluated in these patients. According to Ann-Arbor system, there were 30 patiets(73%) with stage IE, 4(10%) with stage IIE, 3(7%) with stage IIIE, 4(10%) with stage IVE lymphoma. Among the patients with stage IE/IIE, 4 patients received local radiation alone, 4 received chemotherapy alone, 25 received combination chemotherapy and radiotherapy and 1 refused treatment. The patients with stage IIIE/IVE were given combination chemotherapy and radiotherapy. Results: Immunophenotyping were performed in 40 patients and staining results were as follows: 3(7%) patients with B cell, 17(42%) with T cell, 18(44%) with NK/T cell(CD56 positive), and two patients with unclassifiable result. Epstein-Barr(EB) virus in situ hybridization were performed in 28 patients and 23(82%) patients had positive EBV-encoded RNAs(EBERs). 21(55%) patients achieved a complete remission. There was no difference in complete remission between radiation alone and combination therapy. With median follow-up of 30 months, 5-years disease free survival of complete responders was 60% and 5-years overall survival rate was 36%. Multivariate analysis showed that better overall survival was related with absence of B symptoms, ECOG performance ≤1 and non-NK cells. Conclusion: Most of all cases were positive for EBER. Since NK/T phenotype carried the worst prognosis, analysis for CD56 expression should be done. Further prospective studies were warranted to evaluate the role of chemotherapy in stage IE/IIE.

타액선 종양의 병리조직학적 분류

이시형,남순열,최승호,김범규,김상윤,Lee, Si-Hyung,Nam, Soon-Yuhl,Choi, Seung-Ho,Kim, Beom-Gyu,Kim, Sang-Yoon 대한기관식도과학회 2002 大韓氣管食道科學會誌 Vol.8 No.2

Background and Objectives : Salivary gland neoplasms are unique because of their infrequency, inconsistent classification, and highly variable biologic behavior. The aim of this study is to analysis the histopathologic classification of salivary glnad neoplasm and to suggest a guideline of management. Materials and Methods : The medical records of 310 patients with salivary gland neoplasm who treated at Asan medical center between 1992 and 2001 were analyzed retrospectively. Among the 310 patients, 138 patients were male and 172 patients were female. Mean age was 50.5 years. Results : Benign salivary neoplasms were 213 cases. They consisted of 153 cases (71.8%) of parotid tumor, 41 cases (19.2%) of submandibular gland tumor and 19 cases (8.9%) of minor salivary gland tumor. Pleomorphic adenoma was the most common benign neoplasm. Malignant salivary neoplasms were 97 cases. They consisted of 45 cases (46.4%) of parotid tumor, 26 cases(26.8%) of minor salivary gland tumor, 24 cases(24.7%) of submandibular gland tumor and 2 cases(2.1%) of sublingual gland tumor. Adenoid cystic carcinoma was the most common malignant neoplasm. Conclusions : The most commonly involved gland was parotid (64%) and the most frequent tumor was pleomorphic adenoma (52%). Although the majority of minor salivary gland neoplasms are malignant, three of parotid tumors are benign.

조기 성문암에서 레이저 수술과 방사선 치료 후 음성기능 비교

이종철,이윤세,남순열,Lee, Jong-Cheol,Lee, Yoon-Se,Nam, Soon-Yuhl 대한후두음성언어의학회 2008 대한후두음성언어의학회지 Vol.19 No.1

The early glottic cancers are traditionally treated by radiotherapy or endoscopic surgery. The excellent effectiveness of both treatment modalities for local control, larynx preservation, and disease specific death is similar. Therefore, functional voice outcome after treatment is one of the most important factors in the choice of treatment for early glottic cancer. To assess the functional outcomes and compare the voice quality in patients with early glottic cancer treated with curative intent with radiotherapy or laser cordectomy, we performed literature review. Most studies showed that the voice quality after radiation therapy is slightly better than that after laser cordectomy. Subanalysis according to types of laser cordectomy, however, indicates that voice quality depends on type of laser cordectomy. Especially, type I or type II laser cordectomy might be superior to other types of laser cordectomy and radiation therapy. We conclude that the laser cordectomy is a good surgical alternative for properly selected early glottic cancer including professional voice users.

양성성대질환에서의 발성시작유형에 관한 연구

김성태,안철민,남순열,Kim, Seong-Tae,Ahn, Cheol-Min,Nam, Soon-Yuhl 대한후두음성언어의학회 2009 대한후두음성언어의학회지 Vol.20 No.2

Background and Objectives: Benign vocal fold lesions have shown various voice onset types on phonation, however, they have not been documented yet. We studied to know the relationships between benign vocal fold lesions and voice onset types. Materials and Method: 114 subjects were evaluated by using videokymographic examinations. The subjects were classified into three types: normal, contact, and open types according to the patterns of voice onset types on phonation. Benign vocal fold lesions were investigated and voice onset types were compared between normal and disease groups. Voice parameters were obtained from and compared in all subjects to assess acoustic and aerodynamic factors. Results: The normal type among onset types were more than contact type or open type in both normal and disease groups. Disease group showed many contact and open types when. compared with normal group. Vocal nodule and vocal polyp were showed many normal and contact types, however, sulcus vocalis was almost showed open type among voice onset groups. The values of mean flow rate (MFR) of contact type were significantly higher compared to normal type in disease group (p<0.05). Shimmer of contact type was higher than normal type in diseasegroup, but the difference was not significant (p=0.057). Conclusion: Benign vocal fold lesions were related to the various types of voice onset. The various types of voice onset should be considered when benign vocal fold lesions were examined.

Prediction of Regional Metastasis by the Expression of Lymphangiogenic Factors in Micropapillary Thyroid Carcinoma

이성부,최승호,남순열,조경자,김상윤,Lee, Sung-Bu,Choi, Seung-Ho,Nam, Soon-Yuhl,Cho, Kyung-Ja,Kim, Sang-Yoon The Korean Society for Head and Neck Oncology 2011 대한두경부 종양학회지 Vol.27 No.1

서 론 : 미세갑상선유두상암종 환자에서 불필요한 예방적 중앙 림프절절제술을 피하기 위해서 림프절 전이를 수술 전에 예측하는 수단이 필요하다. 림프관 생성 및 성장의 조절에 VEGF-C/D, VEGFR-3 pathway, podoplain이 관여된다는 사실이 밝혀져 있다. 림프관 생성 및 성장과 관련된 인자인 VEGF-C/D, podoplanin에 대한 면역조직화학염색과 반정량적 분석을 통해 미세갑상선유두상암종에서 림프절전이와의 관련성을 확인하고자 하였다. 대상 및 방법 : 2006년 9월부터 2008년 6월까지 본원에서 미세갑상선유두상암종으로 진단받고 1인 술자에 의해 갑상선 전 절제술 및 예방적 중앙 림프절절제술을 받은 104명의 환자 중 중앙 림프절 전이가 있었던 환자와 없었던 환자를 각각 25명씩 무작위로 선별하여 종양부위에 면역화학염색을 실시하여 림프관생성인자의 발현 정도를 비교하였다. 결 과 : 대상군 50예 중 VEGF-C/D는 50예(100%) 모두 발현이 되었고 podoplanin은 33예(66%)에서 발현이 되었다. 그 중 VEGF-C는 10예(20%)에서 약한 양성, 37예(74%)에서 중등도 양성, 3예(6%)에서 강한 양성소견을 보였고 VEGF-D는 9예(18%)에서 약한 양성, 37예(74%)에서 중등도 양성, 4예(8%)에서 강한 양성소견을 보였다. 중앙 림프절 전이 음성 환자 군과 양성 환자 군으로 분류하였을 때 VEGF-C/D의 발현율의 차이는 p-value가 각각 0.48, 1.00으로 통계적으로 유의한 차이를 보이지 않았다. 50예 전체를 대상으로 하여 종양의 개수, 최대크기, 검출된 전체 림프절의 수, 양성 림프절의 수, 주변조직 침범여부에 따른 VEGF-C/D의 발현도 통계적으로 유의한 차이를 보이지 않았다. Podoplanin의 경우 염색 여부에 따라 양성군과 음성군으로 나누어 분석하였을 때 종양의 개수, 최대크기, 검출된 림프절의 수, 양성 림프절의 수, 주변조직 침범여부도 통계적으로 유의한 차이를 보이지 않았다. 결 론 : VEGF-C/D는 대상군 전체(100%)에서 발현이 되었고 podoplanin은 66%에서 발현이 되었다. 림프관 생성인자로 알려진 VEGF-C/D및 podoplanin이 미세갑상선유두상암종에서 많이 발현이 되는 것으로 보아 위 인자들이 림프절 전이를 일으키는 인자 중 하나로 생각된다. 하지만 미세갑상선유두상암종에서 중앙 림프절 전이를 예측할 수 있는 인자로 부적합 한 것으로 생각되며 향후 더 많은 증례를 통해 관련성 여부에 대한 연구가 필요하고 또 다른 인자의 관련성에 대해서 연구가 필요하겠다.

정상 구강 점막 소견의 구강 통증 환자의 진단 및 치료

김태수,김상윤,남순열,노종렬,최승호,Kim, Tae-Su,Kim, Sang-Yoon,Nam, Soon-Yuhl,Roh, Jong-Lyel,Choi, Seung-Ho 대한기관식도과학회 2008 大韓氣管食道科學會誌 Vol.14 No.1

Objectives : Oral pain without identifiable oral mucosa lesion is probably multifactorial origin, which include burning mouth syndrome (BMS), oral candidiasis and so on. The aim of this study was to analyze the characteristics of oral pain without identifiable oral mucosa lesion and to evaluate treatment outcome of those patients. Materials and Methods : We reviewed 50 patients without identifiable oral mucosa lesion who were complaint of oral pain. The patients were analyzed according tothe sites, associated symptoms, laboratory tests and fungus culture. The questionnaire included questions on their current diseases, smoking and alcoholic history, psychological factors, and symptoms. Results : The average age of patients was 60 years old. The most frequently involved site was tongue (92%), followed by palate, lower lip, oropharynx, and gingiva. 60% of the patients has psychological disorder as self reported. Culture for Candida was positive in 36% of patients and serum zinc deficiency was present in 60% of patients. Serum iron, vitamin B12, hemoglobin, folic acid deficiency were present in 6-2% of patients. Seventeen patients (65%) with BMS and twelve patients (66%) with oral candidiasis were improved after treatment. Conclusion : We recommend oral candida culture to oral pain patients without oral mucosa lesion. Zinc supplementation of zinc depletion patients may be helpful whereas other laboratory tests have no diagnostic values.

일측성 성대 마비의 치료 원칙

한주희,한명월,남순열,Han, Ju-Hee,Han, Myung-Woul,Nam, Soon-Yuhl 대한후두음성언어의학회 2009 대한후두음성언어의학회지 Vol.20 No.2

Vocal fold paralysis continues to be a dominant topic in laryngology. This review article discusses the management principle of patients suffering from unilateral vocal fold paralysis. There are currently some main methods ; voice therapy ; injection laryngoplasty ; laryngeal framework surgery ; reinnervation procedures.

최장발성폐기능저하를 동반한 일측성 성대마비 환자에서의 S/Z Ratio와 최장 발성시간(Maximum Phonation Time)의 유용성 비교

박준표,정고은,강병철,김성태,남순열,김상윤,노종렬,최승호,Park, Joon Pyo,Jeong, Go-Eun,Kang, Byung Chul,Kim, Seong-Tae,Nam, Soon Yuhl,Kim, Sang-Yoon,Roh, Jong-Lyel,Choi, Seung-Ho 대한후두음성언어의학회 2012 대한후두음성언어의학회지 Vol.23 No.2

Background and Objectives : MPT is directly related to degree of glottal closure. So it is widely used in the assessment of glottal closure with unilateral vocal fold paralysis. But MPT could be influenced not only by glottal closure but also by pulmonary function. So MPT might not reflect glottal closure in UVFP with decreased pulmonary function. The purpose of the study is to evaluate usefulness of MPT and ratio of /s/ time to /z/ time before and after injection laryngoplasty in UVCP with decreased pulmonary function. Materials and Methods : This study involved 34 patients with unilateral vocal fold paralysis : with decreased pulmonary function in group A (n=15) : with normal pulmonary function in group B (n=19). All patients underwent injection laryngoplasty. Paramters of perceptual analysis, acoustic analysis, aerodynamic analysis, videostroboscopy were compared between two groups. Results : Breathness and asthenic scale, G scale of perceptual analysis were significantly improved in both groups. Glottal gap index were significantly decreased after injection in both groups. In aerodynamic analysis, MPT was improved after injection laryngoplasty in both groups, but S/Z ratio was improved only in group B. In correlation analysis, /s/ time was not correlated with pulmonary function. Conclusion : S/Z ratio reflects neither the pulmonary function nor the glottal clousure properly. MPT is more useful indicator than S/Z ratio to evaluate vocal fold paralysis even with decreased pulmonary function.

구강내 접근을 이용한 악하선 타석의 제거

이성부,이종철,최승호,김상윤,남순열,Lee, Sung-Bu,Lee, Jong-Cheol,Choi, Seung-Ho,Kim, Sang-Yoon,Nam, Soon-Yuhl 대한기관식도과학회 2008 大韓氣管食道科學會誌 Vol.14 No.1

Background and Objectives : Traditionally, the excision of submandibular gland (SMG) has been commonly used for treatment of calculi in the proximal duct or gland parenchyma. Over the last 10 years several new minimally invasive techniques including lithotripsy, sialendoscope were introduced in the treatment of sialolithiasis. But these have some limitation on large, infected calculi. The aim of this study is to assess the intraoral treatment of submadibular stones. Subjects and Method : The records of one hundred and seventy-three patients who underwent intraoral removal of submadibular sialolithiasis between June 1, 1989 and July 31, 2006 were retrospectively reviewed. Results : Stone location was distal to the edge of the mylohyoid muscle in 127 patients and proximal to gland in 48 patients (mean size of sialoliths, 7.1mm [range 3.0-25mm]). The complete removal of stones was observed in 170 (97.1%) patients regardless of size and location. Recurrence of lithiasis was found in 8 patients (then treated with intraoral removal in 5 patientsand resection of SMG (submandibular glands) in 3 patients). Acalculous sialadenitis in 9 patients (5.1%) and cyst formation in 2 patients (1.1%) was found. But no evidence of postoperative complications including hemorrhage, fistula, damage to lingual nerve were found. Conclusion : The intraoral removal of submandibular stone is useful in preservation of submandiblar function and effective in palpable stones regardless of location, size.