A New 'Y' Shape Partial Laryngectomy for Supraglottic Carcinoma with Anterior Commissure Invasion or Encroachment / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Supraglottic partial laryngectomy (SPL) is contraindicated when lower margin of the tumor invades the anterior commissure or encroaches on it. Those cases are usually treated with supracricoid laryngectomy or near- total or total laryngectomy. But all these procedures have to sacrifice innocent true vocal cords, not because of oncological concerns but because of reconstruction concerns. We designed a new Y-shape partial laryngectomy with preserving vocal cords for this particular situation. PATIENTS AND METHODS: Thyrotomy consists of two incisions, upper and lower. The upper incision was made oblique from superior cornu down to the anterior commissure. When this incision was made 5 mm lateral to the midline, it went down to the inferior border of thyroid cartilage. This modification enables resection enbloc anterior commissure region with SPI. specimen. At closure, both ends of the true cord is anchored to the thyrotomy margin. Each lamina is connected with one miniplate with 6 holes. Then the closure is reinforced with elevated thyroid perichondrium and strap muscles. RESULTS: Two patients were treated with this type of surgery. Both had negative surgical margins. In the postoperative period, no specific complications were noted. Roth of them could decannulate and swallow without aspiration on the 20th day following the surgery. They retained their voices from the true vocal cords. CONCLUSION: This new partial laryngectomy technique could apply to supraglottic carcinoma cases with anterior commissure invasion or encroachment without sacrificing true cords. This procedure provides satisfactory swallowing and postoperative phonatoty function even with resection of the supraglottic structure.

Effectiveness of Cupulolith Repositioning Maneuver in the Treatment of Lateral Semicircular Canal Cupulolithiasis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There is still a controversy surrounding lesion side differentiation and treatment of the lateral canal cupulolithiasis. The purpose of this study is to understand side differentiation, and study the treatment of this disease through analyses of clinical features, electronystagmographic (ENG) results, treatment maneuvers and its effectiveness. MATERIALS AND METHODS: Twenty three patients who showed ageotropic direction-changing horizontal positional nystagmus were included in this study. A supine head turning test was performed to induce positional nystagmus. Clinical findings and typical features of the nystagmus were recorded. Neurologic examinations, ENG tests, and MRI (6 cases) were checked to exclude the possibility of any central lesions. Cupulolith Repositioning Maneuver (CuRM) was applied on the patients and these patients were instructed to keep the healthy side at the lateral decubitus position while sleeping. RESULTS: The nystagmus had a short latency, no fatigability, and persistency in character. In one patient, nystagmus was resolved spontaneously, so we could not decide the lesion side. However, seventeen out of 22 patients showed significant differences between the intensity of each side nystagmus, and all of them showed stronger nystagmus when the head was rotated to the unaffected side. In five patients who showed no significant difference between the intensity of each side nystagmus, two cases showed same results and three cases showed opposite results. Typical nystagmus and spinning sensation in the supine head-turning test had completely subsided after physical therapy. CONCLUSION: In the cupulolithiasis of lateral semicircular canal, ageotropic nystagmus was stronger when the pathological ear was at the uppermost position, and this excitatory nystagmus beat to the lesion side. But, if there was no significant difference between the intensity of each side nystagmus, associated canal paresis, other types of BPPV, past history of acute vestibuloneuritis, and Meniere's disease, etc. might be helpful to localize the lesion side. CuRM and post- treatment lateral decubitus position kept during the night (while sleeping on the day of treatment) were effective in treating the cupulolithiasis of lateral semicircular canal.

Epithelial-Myoepithelial Carcinoma of the Lung: one case report / 대한흉부외과학회지

Epithelial-myoepithelial carcinoma is a rate low-grade malignant salivary neoplasm that usually occurs in the parotid gland but can also arise in minor salivary glands. We report a case of a primary epithelial-myoepithelial carcinoma of the lung neoplasm. The patient was 48-year-old women who presented with dry cough of 1 month duration. A right middle lobe endobronchial lesion was identified bronchoscopically. The bilobectomy of RML & RLL was performed, the pathologic result was epithelial-myoepithelial carcinoma.

Rapidly Grown Huge Mediastinal Benign Teratoma: one case report / 대한흉부외과학회지

The benign teratoma is usually slow growing tumor, but we expirienced a case of primary huge mediastinal benign teratoma that had grown very rapidly, maximally during 3 years. The 14-year-old female patient was admitted to our hospital because of abnormal chest X-ray that showed 10x10cm sized well definded mass with multiple calcificactions. but the mass was not present in chest X-ray perfomed on 3 years prior to admission. Under the diagnosis of teratoma, complete surgical resection was done by the left thoracotomy. The result of pathology was benign teratoma.

Mesenchymal Cystic Hamartoma of the Lung: 1 Case Report / 대한흉부외과학회지

Mesenchymal cystic hamartoma of the lung is quite rare lesion which has an unknown prevalence, firstly described in 1986. It is characterized by multiple nodules and variable sized cysts in both lung field. The nodules of immature mesenchymal cells gradually enlarge and become cysts which are lined with normal or metaplastic respiratory epithelium and have the cambium layer of primitive mesenchymal cells. Main symptoms are hemoptysis, recurrent pneumothorax, and hemothorax. It is known to benign tumor, but has possibility of malignant degeneration. In gross findings in opertive field, multiple and variable-sized cystic lesions and nodules were observed. The cysts were lined with normal respiratory epithelium and had the cambium layer of primitive mesenchymal cell. Gross and microscopic findings were compatible with mesenchymal cystic hamartoma. We report a case of mesenchymal cystic hamartoma in a 27-year-old woman who had recurrent pneumothorax and hemoptysis.

Effect of Retinoic Acid on the Differentiation and Lysozyme Expression in Human Airway Epithelial Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Retinoic acid (RA)-deprived cultures of normal human tracheobronchial epithelial (NHTBE) cells became squamous metaplastic, failed to produce mucin and instead secreted or released large amounts of lysozyme (LZ). The purpose of this study was to elucidate the relationship between RA-deficiency induced squamous metaplasia and increased LZ as a function of time. MATERIALS AND METHOD:The change of lysozyme protein and lysozyme mRNA was investigated over time in cultures using passage-2 normal human tracheobronchial epithelial (NHTBE) cells and passage-2 normal human keratinocytes (NHK). The amount of lysozyme and mucin was measured with dot blot, message of lysozyme with RT-PCR, and cornifin mRNA with Northern blot. RESULTS: Lysozyme message levels were consistently higher in RA-sufficient than RA-deficient cultures. Intracellular and extracellular LZ increased to a peak on the day 16 and thereafter decreased in the RA-deficient cultures. LZ gene expression in the RA-deficient cultures was barely detectable on the day 7 but was clearly expressed between days 10 and 14, but thereafter message levels decreased markedly. On day 12, large numbers of cells began to exfoliate in the RA-deficient cultures. Extracellular LZ appeared simultaneously at the apical surface, presumably released from the exfoliated cells, which contained high concentrations of LZ. Intracellular LZ levels were more than 11 fold less in NHK cells compared to NHTBE cells. CONCLUSION: This study suggests that cellular accumulation of lysozyme protein is a unique feature of metaplastic squamous differentiation. Further studies are needed to find out what mechanisms are involved.