Endoscopic Screening of Esophagus with Lugol's Solution in Patients with Head and Neck Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES : Second primary esophageal cancer has been reported to comprise 6-9% of head and neck cancer cases, which are frequently detected in the advanced stage. Thus, detecting esophageal cancer in the early stage is important in the prognosis of head and neck cancer. However, it is difficult to detect early lesions using the conventional endoscopy. In the current study, the feasibility of endoscopic screening using Lugol's solution was assessing for detecting early esophageal cancer in patients of head and neck cancer. SUBJECTS AND METHOD : Sixty-two patients (Group I-synchronous cancer study group) diagnosed with head and neck cancer between November, 2003 and November, 2004 were prospectively studied. Fortysix patients (Group II-metachronous cancer study group) under the follow-up care with head and neck cancer during the same period were also evaluated. The esophagus was initially observed under direct endoscopic view and then Lugol dye was sprayed at the esophagus. Any unstained area was biopsied. RESULTS : Of 34 patients (54.8%) with unstained lesions in Group I, 10 (16.1%) showed dysplasia and 4 (6.4%) had cancer. Of 21 patients (45.6%) with unstained lesions in Group II, 2 (4.3%) showed dysplasia and 5 (10.8%) had cancer. Among 9 (8.3%) second primary esophageal cancer, 6 were detected with superficial esophageal cancer while the other 3 were found to be in the advanced stage of cancer. This superficial cancer revealed nonspecific mucosal findings in the direct endoscopic view and was difficult to be visualized as a pathologic lesion; however, it revealed unstained areas when Lugol's solution was sprayed, thus could be diagnosed as cancer through biopsy of the area. CONCLUSION : Endoscopy of esophagus with Lugol's solution could be highly effective as a screening method to detect second primary esophageal cancer in patients with head and neck cancer.

Surgical Experience of Hyperthyroidism / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In the field of otolaryngology-head and neck surgery, surgical experience in hyperthyroidism is still limited with a lack of study on the subject. The author realized the necessity to study problems of early experience with the surgery. The purpose of this study is to elucidate significant prognostic factors in the surgery of Graves' disease and propose an optimum surgical method which is considered significant prognostic factors. SUBJECTS AND METHODS: Nineteen cases of Graves' disease and 4 cases of toxic nodule diagnosed and operated at the department of Endocrinology and department of Otolaryngology-Head and neck surgery of Kosin university Gospel Hospital, from November 1999 to February 2004 were retrospectively studied. To evaluate the safety of the surgery, preoperative management and postoperative complications were analyzed. The relations between postoperative thyroid function and surgical extent, lymphocytic infiltration, and TSH (Thyroid stimulating hormone) receptor binding inhibiting immunoglobulin were studied. Histological results of the postoperative thyroid tissue were also analyzed to detect any concurrent disease. RESULTS: Among the 9 cases of subtotal thyroidectomy in Graves' disease, 3 cases (33.3%) revealed postoperative hypothyrodism and 5 cases (55.6%) had normal thyroid function, while in 1 case (11.1%), hyperthyroidism recurred. There was no statistically significant relation between the degree of lymphocytic infiltration and postoperative thyroid function. Hyperthyroidism recurred 6 months postoperatively in one case with persistently elevated TSH receptor binding inhibiting immunoglobulin. No intraoperative or postoperative complication occurred in any of the cases. According to histopathologic results, 6 cases of Graves' disease were determined as diffuse thyroid hyperplasia and thyroid cancer was detected in 6 cases. CONCLUSION: This study revealed many advantages of surgical treatment in hyperthyroidism. High success rate and safe treatment without complication could be accomplished, and histologic diagnosis could be determined. Amounts of the remnant thyroid tissue and the level of TSH receptor binding inhibiting immunoglobulin seemed to be related to postoperative thyroid function. This study was performed with limited cases within a short period; thus, to preserve the remission state of postoperative thyroid function, studies on various factors affecting postoperative thyroid function are required.

Transoral CO2 Laser Resection of Laryngeal Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Early stages of laryngeal carcinoma are usually treated with three different therapeutic options: partial or total laryngectomy, radiotherapy and transoral endoscopic CO2 laser partial laryngectomy. Combined use of CO2 laser and operating microscope, initially described by Strong and Jako in 1972, has been developed to a variety of procedures by many surgeons. The aim of this study was to define when laser resection of early stage laryngeal carcinoma is indicated and to compare the results obtained by laser surgery with other therapeutic options. MATERIALS AND METHOD: A retrospective study of 50 patients (glottic carcinoma 41 cases, supraglottic carcinoma 9 cases) treated between May, 1997 and March, 2003 at Department of Otolaryngology, Head and Neck Surgery of Kosin Medical College Hospital, was performed. Glottic cancers were treated with cordectomy type I to V, according to the classification proposed by the European Laryngological Society in 2000. Supraglottic cancer was treated with partial epiglottectomy, epiglottectomy, supraglottic partial laryngectomy, supraglottic laryngectomy, and extended supraglottic laryngectomy. RESULTS: The overall survival rate at 3 years was 100% for the glottic cancer (Tis, 3; T1a, 27; T1b, 5; T2, 2; rT1a, 3; rT2, 1) and local recurrence was identified in 1 patient, thus local control rate was 97.6%. Overall survival rate at 3 years was 100 % for the supraglottic cancer (T1, 3; T2, 2; T3, 1; rT2, 2; rT3, 1) and local control rate was 100%. CONCLUSION: Our results suggest that transoral endoscopic laser resection is a cost-effective procedure with good oncologic results and has acceptable functional results in early laryngeal carcinoma.

Analysis of RET Gene Point Mutation in a Family with Familial Medullary Thyroid Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hereditary medullary thyroid carcinoma is presented as a part of MEN2A (65-75%) or MEN2B, but can also be inherited alone, which is called familial medullary thyroid carcinoma. The author sought to detect point mutations of the RET proto-oncogene using the molecular genetic method on the family line of the familial medullary thyroid carcinoma, which is identified by the family history of an index patient, and to investigate the presence of point mutation carriers among the family members. SUBJECTS AND METHOD: DNA was extracted from the peripheral blood leukocyte of 5 patients who were assumed to have sporadic medullary thyroid carcinoma and 1 patient who was an index of a family line assumed to contain hereditary medullary thyroid carcinoma according to the family history. The PCR amplification of exons, 10, 11, 13, 14, 15, 16 was then carried out, and we investigated point mutations of the RET proto-oncogene using a DNA sequence analyzer. After identifying point mutation of the familial medullary carcinoma with them, the same investigation was carried out with their family. RESULTS: We identified point mutation of TGC (Cys)->CGC (Arg) at codon 618 of the RET proto-oncogene exon 10, using the automatic DNA sequence analyzing method on the index patient and detected the same point mutation with 4 of the 9 family members. Among them, the index patient and her mother who had biochemical and clinical symptoms underwent a total thyroidectomy and neck dissection and are now being followed up ; operations are scheduled for two other members later on. CONCLUSION: With the genetic analysis of RET proto-oncogene, we expect to overcome the limitations of the calcitonin stimulation test and that more complete approach through early diagnosis would be possible by carrying out the screening test for point mutation in patients with the hereditary medullary thyroid carcinoma.