• 수면정신생리
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• 제7권1호
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• pp.18-26
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• 2000

목적 및 방법 : 수면무호흡증 환자들에서 상기도 압력 측정법을 이용하여 수면 중 기도협착의 형태를 연구하고, 각성시와 수면 중에 실시한 상기도 CT scan의 수면무호흡 중 기도 협착 부위의 예측도를 평가하기 위하여, 11명의 수면무호흡증 환자에서 4 압력 센서 또는 2 압력 센서가 달린 도관을 상기도로 삽입하여 상기도의 압력을 측정하면서 수면다원검사를 시행하고, 이 환자들에서 각성시와 수면 중에 상기도의 다섯 곳(high-retropalatal, low-retropalatal, retroglossal, hypopharynx, esophagus)에서 cine CT를 시행한 후 각 방법에 의하여 기도 협착 부위를 진단하고, 수면 중 상기도 압력 측정 결과에 의거하여 상기도 cine CT의 정확도를 평가하였다. 결 과: 상기도 압력 측정 결과 4명(36%)만이 수면 중에 단일 형태의 기도 협착을 보였고, 나머지 7명(64%)은 여러 가지 형태의 기도 협착을 보였다. Velopharynx가 수면무호흡시에 가장 흔히 관찰되는 기도 협착 부위였다(63.6%). 그러나, 상기도 cine CT결과는 수면무호흡 중에 8명이 단일 형태의 기도 협착을 보였다(72.7%). Apneic CT에서도 Velopharynx가 가장 흔한 기도 협착 부위였다. 상기도 압력 측정법과 상기도 CT 촬영법 사이의 기도 협착 진단의 일치율은 단 5명에서만 잘 일치하였고(high-concordant), 5명은 잘 일치하지 않았으며(low-concordant), 나머지 1명은 전혀 일치하지 않았다. 결 론: 대부분의 수면무호흡증 환자는 수면 중 여러 번 발생하는 수면무호흡에서 2가지 또는 그 이상의 기도 협착 형태를 보이므로, 단 1회의 수면무호흡의 상태만을 반영하는 상기도 CT는 수면무호흡의 기도 협착 부위를 적절히 반영하지 못한다고 생각된다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제8권2호
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• pp.143-149
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• 2005

목 적: 병적 위식도 역류 환자에서 후두인두부 산도를 검사하여 후두인두부 역류와 호흡기 증상과의 상관관계를 연구하고자 하였다. 방 법: 2003년 2월부터 2004년 9월까지 잦은 구토 등 위식도 역류가 의심되는 증상이 있거나 만성 재발성 호흡기 증상이 있어 24시간 후두인두부와 식도에서 산도 검사를 실시한 39명 중 병적 위식도 역류를 보인 29명을 대상으로 하였다. 병적 위식도 역류의 기준은 95백분위수 이상 역류 지표를 병적 역 류로 정의하였고, 후두부 인두 산 역류의 기준은 식도에서 pH 4 이하로 떨어짐과 동시에 후두부 인두에서 pH가 4 이하로 떨어지는 것으로 정의하였다. 결 과: 1. 산도 검사를 실시한 39명에서 호흡기 증상이 있는 7명 중 6명(86.%), 호흡기 증상이 없는 32명 중 23명(72%)에서 병적 위식도 역류를 보였다. 2. 호흡기 증상으로는 반복되는 폐렴 2명, 크룹 1명, 후두연화증 1명, 천식 2명 등이었다. 3. 호흡기 증상을 동반한 병적 역류군에서 후두인두부와 식도의 역류 지표를 비교하면 5분 이상 지속된 역류의 횟수 제외한 역류 지수, 총 역류 횟수, 최 장 역류 시간 등에서 통계학적으로 의의있는 차이를 보였다. 4. 호흡기 증상을 동반하지 않은 병적 역류군에서 후두인두부와 식도의 모든 역류 지표들이 유의한 차이를 보였다. 5. 식도에서 호흡기 증상을 동반한 병적 역류군과 호흡기 증상을 동반하지 않은 병적 역류군의 역류지표를 비교하면 총 역류 횟수를 제외한 역류 지수, 최장 역류 시간, 5분 이상 지속된 역류의 횟수에서 통계학적 의의가 없었다. 6. 후두부 인두에서 호흡기 증상을 동반한 병적 역류군과 호흡기 증상을 동반하지 않은 병적 역류군의 역류 지표를 비교하면 모든 항목에서 통계학적 의의가 없었다. 결 론: 병적 위식도 역류 환자에서 호흡기 증상 유무와 관계없이 후두인두부의 산도 검사 결과는 통계학적 의의가 없으므로 만성 호흡기 질환에서 후두인두부 역류와의 상관관계의 규명에 후두인두부 산도 검사의 유용성에 대한 재고가 필요하다.

• 대한치과교정학회지
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• 제25권1호
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• pp.19-29
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• 1995

앵글씨 부정교합 유형에 따른 두부형태, 연구개, 혀 및 기도의 크기를 비교하고 치아안면골격과 기도의 크기와의 연관성을 알아보고자 전남대학교 병원 교정과에 내원한 12세부터 17세 사이의 여성 환자 98명을 연구대상으로 측모 두부방사선 계측사진을 촬영하여 치아안면골격과 기도에 관한 거리, 각도, 비율 및 면적에 대해 통계학적으로 분석하여 다음과 같은 결론을 얻었다. 1. 하악골체 길이, SNB, ANB, facial angle, facial convexity, A-B plane angle, Y axis to FH, SN-MP, Wits appraisal, ODI, APDI는 부정교합 유형에 따라 차이를 보였다. 2. 설골의 전후방위치는 II급 부정교합자의 설골이 다른 군에 비해 후방 위치하였으나 상하방위치는 부정교합 유형에 따라 차이를 보이지 않았다. 3. 비인두의 면적은 II급과 III급 부정교합자가 I급 부정교합자에 비해 작게 나타났으며, 인두의 총면적은 II급 부정교합자가 I급과 III급 부정교합자보다 작게 나타났다. 부정교합 유형에 따른 연구개, 혀,구인두 및 하인두의 면적에서는 차이를 보이지 않았다. 4. 하악지 고경과 하악골체 길이는 혀, 비인두, 구인두 및 인두의 면적과 순상관관계를 보였다. SNA는 혀 및 기도의 크기와 상관성을 보이지 않았으나, SNB는 하인두 및 인두의 면적과 순상관관계를 보였다. 전안면고경, 후안면고경, facial plane에 대한 상하악 중절치의 위치는 혀의 면적과 순상관관계를 보였다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권10호
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• pp.4147-4152
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• 2014

Standard therapy for advanced head and neck cancer consists of a combination of surgery and radiation. However, survival of this patient population has not improved during the past 20 years. Many different multimodality treatment schedules have been proposed, and chemotherapy is often used with the intent of organ preservation. The present study was intended to establish the efficacy of concomitant chemoradiation with a single agent carboplatin in advanced head and neck cancers.The objectives were to investigate the feasibility of concomitant administration of carboplatin, monitor acute toxicity during radiotherapy, and determine subacute side effects, such as wound healing following surgery after chemoradiotherapy. A prospective study was conducted wherein a total of 40 patients with stage III and IV squamous cell carcinomas of oral cavity, oropharynx, hypopharynx and larynx were enrolled. All patients were treated with external beam radiotherapy and weekly carboplatin area under curve (AUC of 5). Radiotherapy was given in single daily fractions of 1.8-2 grays (Gy) to a total dose of 66-72 Gy. Salvage surgery was performed for any residual or recurrent locoregional disease. Neck dissection was recommended for all patients with neck disease showing less than a complete response after chemoradiation. A total of 40 patients were enrolled of whom 32 were males and 8 were females. Highest incidence of cancer was seen in the 5th-6th decades of life with a median age of 47.7 years. Oropharyngeal tumours constituted a maximum of 21 patients followed by hypopharynx in 10, larynx in 7 and oral cavity in 2. 80% of the patients had a neck node on presentation of which 40% had N2-N3 nodal status. TNM staging revealed that 58% of patients were in stage III and 43% in stage IV. Evaluation of acute toxicity revealed that 50% had grade II mucositis, 25% grade III mucositis, 2.5% grade IV mucositis. 50% of patients had grade I skin reactions, 65% of patients had grade I thrombocytopenia, and 24% of patients had grade I anaemia. After completion of treatment 65% of patients had complete response at the primary and regional sites, and 35% of patients had a partial response of whom 23% underwent neck dissection and 5% of them underwent salvage surgery at the primary site. At the end of one year there were six deaths and four recurrences and 70% were free of disease. Concurrent chemoradiation with carboplatin provided good locoregional control for locally advanced head and neck cancers. This regimen, although toxic, is tolerable with appropriate supportive intervention. Primary site conservation is possible in many patients. Chemoradiotherapy appears to have an emerging role in the primary management of head and neck cancers.

• 대한두경부종양학회지
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• 제7권2호
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• pp.120-128
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• 1991

Reconstruction of the pharynx and cervical esophagus presents a tremendous surgical challenge to the Head and Neck Surgeon. Because life expectancy of patients with advanced carcinoma of the hypopharynx, and cervical esophagus is limited, treatment must be aimed at palliation. A variety of techiques have been proposed over the years with none proving entirely satisfactory. These techiques include prosthesis; skin graft; cervical flaps; tubed cutaneous and myocutaneous chest flaps; visceral reconstruction with stomach, colon. and jejunum; and jejunal free autografts. Many factors dictate the best method of reconstruction in any given clinical situation. The goal of the surgery is a one-stage reconstruction of swallowing function with minimal morbidity to allow as short a hospital stay as posible. Nine patients underwent the free jejunal autograft reconstruction of the pharyngoesophagus after the ablative surgery for the advanced hypopharyngeal cancer. Postoperative complications included one perioperative death, two abdominal wound dehiscences, two neck hematomas, one carotid rupture, one funtional dysphagia, one late strictures. There were no graft failure, no immediate stenosis and no fistula. An oral diet was started between days 8 and 16, with an average of 9 days and median of 8 days. Patients left the hospital between days 9 and days 38, with an average of 23.4 days and median of 23 days. This method of reconstruction is advocated as reliable palliative procedure with short-term follow-up. In conclusion, we at Korea Cancer Center Hospital are of the opinion that the free jejunal autograft offers an excellent, safe and relative easy method of the pharyngeal and cervical esophageal reconstruction with significant advantages over other techiques.

• Journal of Chest Surgery
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• 제30권1호
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• pp.48-54
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• 1997

본 인제대학교 의과대학 흉부외과학교실 서울백병 원에서는 1986년 10월부터 1995년 12월까지 부식제 의 음용으로 하인두와 식도 입구부터 심한 협착이 발생한 1 1례의 환자에서 하인두의 양배꼴동에 대용식 도를 문합하는 식도재건술을 시행하였다. 환자는 남자 7례, 여자 4례로 모두가 성인으로 연령은 21세 에서 47세까지로 평균 34세였다. 식도협착의 원인이 된 부식제는 산성이 6례: 알칼리성이 5례였다. 이들의 부식제 음용 동기는 자살 목적이 9례였 고, 사고로 인한 경우가 2례였다. 부식제의 음용후 최종적으로 식도재건술까지의 기간은 4개월에서 부 터 21년까지 였다. 식도재 건술시 이용한 대용식도는 9례에서는 우측 결장을 사용하였고, 2례는 이 전에 우측 결장을 이용한 식도재건술이 실패한 상태여서 좌측 결장을 사용하였다. 모든 환자에서 식도 절제술은 하지 않았고 결장은 흉골하로 거상하였다. 경부 문합은 환자의 머리를 똑바로 놓은 상태에서 경부에 J형태로 피부를 절개하고 흉골설골, 갑상설 골근을 절단하고 갑상연골의 연골막을 박리하여 감상연골을 역삼각형모양으로 부분절제하고 양배꼴동을 열고 결장과 단단문합하였다. 수술 직후 類觀隙\ulcorner환자는 음식물을 삼킬 때 연하곤란과 기도내로 음식물이 넘어가 고형 음식물로 삼키는 훈련이 필요하였다. 수술 후 발생한 합병증은 대용식도의 괴사가 3례가 발생하여 유리공장을 이식하였다. 3례에서는 경부 문합부위에 협착이 있어 2례에서 상부문합부위를 확장하였고 1례에서는 유착띠제거술을 시행하였으며 모두 협착이 해소되었다. 수술 후 외래 추적관찰에서 10례에서는 정상적으 로 음식물을 삼킬 수 있었고 유리공장을 사용하여 2차수술을 시행한 1례는 유리공장의 괴사로 3차수술 을 기다리고 있다.

• Radiation Oncology Journal
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• 제12권3호
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• pp.323-329
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• 1994

Purpose: In supraglottic cancer, radiation therapy is used to preserve the laryngeal function but combined surgery and radiation therapy is required in advanced stage. The authors Present the results of radiation therapy alone and combined surgery Plus Postoperative radiation therapy for supraglottic cancer. Methods and Materials: A retrospective analysis was done for 43 patients with squamous cell carcinoma of the supraglottic larynx who were treated from Feburary 1982 to December 1991, in the Department of Radiation Oncology, Korea University Hospital. Patient distribution according to the AJCC staging system was as follows: I, 3($7.0\%$); II, 7($16.3\%$); III, 17($39.5\%$); IV, 16($37.2\%$). Patients' age ranged from 30 to 72 years(median 62). Follow up durations were from 21 to 137 months(median 27). Seventeen patients($39.5\%$) were treated by radiation therapy alone with radiation doses of 6840-7380 cGy and 26 patients($60.5\%$) were treated with surgery plus postoperative irradiation with doses of 5820-6660 cGy. Results: Overall five-year survival rate for all stage was $51.8\%$, with $100\%$ for Stage I and II, $47.3\%$ for Stage III, and $29.2\%$ for Stage III. The difference of the survival rate by stage was statistically significant(p=0.0152). Five-year survival rates were $100\%$ for locally confined tumor in the supraglottic larynx, $37.5\%$ for transglottic extension, $26.7\%$ for hypopharynx extension, and only two of 5 patients with both transglottic and hypopharynx extension were alive(p=0.0033). Five-year survival rates by neck node status were as follows: $55.0\%$ for NO, $64.3\%$ for N1, $50.0\%$ for N2, and all 2 of N3 were died of disease. Overall survival rate for radiation therapy alone group was $42.8\%$, and it was $56.7\%$ for surgery plus postoperative radiation therapy group with no statistically significant difference(p=0.5215). In Stage I and II, all Patients survived. In Stage III and IV, 5-year survival rate for radiation therapy alone group was $28.5\%$ and $43.4\%$ for surgery plus postoperative irradiation group(p=0.5103). Local control rate was $58.8\%$(10/17) for radiation therapy alone group and $73.1\%$ (19/26) for surgery plus postoperative irradiation group. Three patients from surgery plus postoperative radiation therapy group developed distant metastasis in lungs. Conclusion: Treatment results of radiation therapy alone was excellent in early stage supraglottic cancer. In advanced stage, even the difference was statistically not significant, the result of postoperative radiation therapy group was superior compared with radiation therapy alone group. Since 1992, concomitant chemoradiotherapy with hyperfractionated radiotherapy is being used to improve the result of the treatment and preserve the laryngeal function in advanced stage supraglottic cancer.

• Asian Pacific Journal of Cancer Prevention
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• 제16권16호
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• pp.7045-7047
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• 2015

Background: Mean platelet volume (MPV) is a marker which has been investigated in many cancers but data for head and neck lesions are limited. We aimed to study the MPV levels in head and neck cancers as a diagnostic marker. Materials and Methods: A total of 96 head and neck cancer patients and 31 control patients who did not meet exclusion criteria were enrolled in the study. The cancer locations, the platelet and MPV levels at the first diagnosis time were collected. Results: The head and neck cancer location distribution between these patients was 2 (2.1%) buccal, 9 (9.4%) tongue, 6 (6.3) lip, 1 (1%) gingiva, 1 (1%) hypopharynx, 1 (1%) ear, 58 (60.4%) larynx, 2 (2.1%) maxilla, 2 (2.1%) nasal, 1 (1%) nasopharynx, 2 (2.1%) palatal, 3 (3.1%) primary unknown, 1 (1%) retromolar, 1 (1%) thyroid, 2 (2.1%) tonsil, and 4 (4.2%) salivary gland. MPV levels were significantly different between cancer and control group (p=0.002). The cut-off point for MPV predicting head and neck cancer is >10 fL (sensitivity=55.21, specificity=87.10). Conclusions: MPV level increase, a readily assessable parameter which does not bring extra costs can warn us regarding head and neck cancer risk.

• 대한두개안면성형외과학회지
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• 제16권3호
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• pp.105-113
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• 2015

The main challenge in pharyngoesophageal reconstruction is the restoration of swallow and speech functions. The aim of this paper is to review the reconstructive options and associated complications for patients with head and neck cancer. A literature review was performed for pharynoesophagus reconstruction after ablative surgery of head and neck cancer for studies published between January 1980 to July 2015 and listed in the PubMed database. Search queries were made using a combination of 'esophagus' and 'free flap', 'microsurgical', or 'free tissue transfer'. The search query resulted in 123 studies, of which 33 studies were full text publications that met inclusion criteria. Further review into the reference of these 33 studies resulted in 15 additional studies to be included. The pharyngoesophagus reconstruction should be individualized for each patient and clinical context. Fasciocutaneous free flap and pedicled flap are effective for partial phayngoesophageal defect. Fasciocutaneous free flap and jejunal free flap are effective for circumferential defect. Pedicled flaps remain a safe option in the context of high surgical risk patients, presence of fistula. Among free flaps, anterolateral thigh free flap and jejunal free flap were associated with superior outcomes, when compared with radial forearm free flap. Speech function is reported to be better for the fasciocutaneous free flap than for the jejunal free flap.

• Asian Pacific Journal of Cancer Prevention
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• 제15권23호
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• pp.10289-10292
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• 2015

Background: The involvement of HPV in oral and oropharyngeal carcinogenesis was first proposed in 2004, based on epithelial HPV tropism and detection of HPV genotypes in oral squamous cell carcinoma samples. While 60-70% of oropharynx tumors may be HPV-positive, only 10 to 19% of tumors of the oral cavity, larynx and hypopharynx appear to have HPV infection. The aim of the study was to evaluate HPV infection associated with oropharyngeal cancer. Materials and Methods: Seventy-eight cases were selected for p16 immunoexpression reactions, and demographic data were collected for comparisons. Results: Most patients were over 60 years old, and 64.1% were smokers. Immunohistochemistry results showed that 86.3% of cases stained positive for p16 protein. Conclusion: The oropharyngeal cancer profile at Erasto Gaertner Hospital presented a high index of smokers over 60 years as well a high number of p16+ tumors, for what we can not determinate the main etiologic factor, but can be aware of the number of patients that presented HPV infection. Since prevention is still the best way to deal with cancer disease, it is important to analyze the interaction of these two etiologic factors and how to detect lesions at an early stage.