A Case of Isolated Complete Oculomotor Nerve Palsy Following Endoscopic Sinus Surgery

최나연,홍상덕,조현진,박경아 대한비과학회 2014 Journal of rhinology Vol.21 No.2

Orbital complications after endoscopic sinus surgery (ESS), such as optic nerve or medial rectus injuries, arewell known, but isolated complete oculomotor nerve palsy has never been reported. In this case, a 31-year-oldmale was transferred to our hospital after ESS. Physical examination showed complete left oculomotor nervepalsy, with a bony defect on the sellar floor, which had not fully recovered after more than 1 year. We hypoth-esized that blunt trauma could be the main cause of the oculomotor palsy. Surgeons performing ESS must keepin mind the possibility of oculomotor palsy due to blunt trauma, especially when operating around the sphenoidand posterior ethmoid sinus

Analysis of Failure Causes of Open Airway Reconstruction in Children With Combined Subglottic and Posterior Glottic Stenosis

최나연,최재혁,박주현,허유진,김희정,정만기,정한신,백정환,손영익 대한이비인후과학회 2022 대한이비인후과학회지 두경부외과학 Vol.65 No.7

Background and Objectives Airway reconstruction surgery in children is still challenging,especially in cases of combined subglottic and posterior glottic stenosis (PGS). The aimof this study was to review the underlying reasons of failure in open airway reconstructionsurgeries performed for children with combined subglottic and PGS. Subjects and Method We reviewed medical records of seven children who received morethan two open airway reconstruction surgeries to finally achieve and maintain decannulationstatus for more than one year. Twenty-two reconstructive surgeries were performed and theyconsisted of 19 laryngotracheal reconstruction (LTR), 2 cricotracheal resection with end-toendanastomosis (CTR) and one extended CTR. For each patient, the following potentialcauses of failure were evaluated; preoperative evaluation (PE), type of reconstruction (TR),single vs. double staging (SDS), type of stent (TS), and perioperative optimization (PO). Results The median age of patients at the time of surgery was 32 months (range, 4-64months). Successful decannulation was achieved after the median open surgery of three (range,2-5 times for each patient). Recognized causes of failure were as follows: 8 insufficient PE,10 inadequate TR, 3 improper SDS, 8 ill-chosen TS, and 2 inappropriate PO. Conclusion PE of dynamic airway is important, especially vocal fold mobility and tracheomalacia. Types of reconstruction should be carefully decided after full consideration of potentialcauses of failure, and adequate laryngotracheal stent is essential.

Complex Partial Seizure as a Presentation of Lemierre’s Syndrome

최나연,정유진,이길준 대한이비인후과학회 부산,울산,경남 지부회 2019 임상이비인후과 Vol.30 No.1

Lemierre’s syndrome is difficult to treat with early suspicion because of its various clinical presentations. We demonstrated unusual presentation of Lemierre’s syndrome as a complex partial seizure. A 17 year-old female had aggravated symptoms of upper respiratory infection for 2 weeks followed by complex partial seizure during one hour. Laboratory test revealed acute inflammatory state and radiologic images including computed tomography and angiography demonstrated right lateral neck inflammation with internal jugular vein occlusion. She underwent debridement of inflammatory tissue and ligation of internal jugular vein under diagnosis of Lemierre’s syndrome. Because of progression of thrombosis of distal internal jugular vein, she had anticoagulation therapy for 3 months. After that, she followed-up without any discomfort. Lemierre’s syndrome could be successfully managed by combined surgical and medical treatment. Proper treatment with early suspicion is crucial because it could present various clinical features and cause serious complications.

SysML을 이용한 STPA 기반의 위험원 분석 프로세스

최나연,이병걸 한국인터넷정보학회 2019 인터넷정보학회논문지 Vol.20 No.3

자동차, 원자력, 철도, 항공 등의 분야에서 발생하는 소프트웨어의 고장이나 사고는 바로 큰 재산 피해나 인명 피해로 연결될 수 있다. 이에 체계적이고도 효과적인 안전품질 관리의 필요성이 커지고 있으며, 최근 관련 산업 분야에서는 IEC 61508을 기반으로 안전 국제 표준이 제정되어 산업에 적용되고 있다. 국제 표준에서 명시하고 있는 안전 생명주기에 따르면 소프트웨어 안전성 품질을 확보하기 위해서는 개발 초기 단계에서 위험원 및 위험 분석(Hazard and risk analysis)을 통한 안전 요구사항을 개발하도록 권고하고 있다. 본 논문에서는 소프트웨어의 안전성 요구사항의 식별 및 정의를 위해 SysML을 활용한 STPA 기반의 위험원 분석 프로세스를 제안한다. 세부적으로는 SysML의 BDD과 IBD 다이어그램을 활용하여 기존 STPA 분석에서 활용되고 있는 제어구조도를 보다 명확하게 정의할 수 있도록 개선하였고, SD 다이어그램을 활용하여 안전 제약사항(요구사항)을 상세화할 수 있도록 하였다. 제안 방법의 적용 결과, STPA에서 누락되었던 위험원을 추가적으로 식별할 수 있었고, 위험원의 발생 시나리오도 상세하게 구체화할 수 있었다. Today’s software systems are becoming larger and more complicated, and the risk of accidents and failures have also grown larger. Software failures and accidents in industrial fields such as automobiles, nuclear power plants, railroad industries, etc. may lead to severe damage of property and human life. The safety-related international standards, such as IEC 61508 have been established and applied to industries for decades. The safety life cycle specified in the standards emphasize the activities to develop safety requirements through hazard and risk analysis in the early stage of software development. In this paper, we propose ‘Hazard Analysis Process based on STPA using SysML’ in order to ensure the safety of software at the early stage of software development. The proposed hazard analysis can be effectively performed minimizing the loss of hazard by using the BDD and the IBD of SysML to define the control structure of a system. The proposed method also improves the specification of the safety constraints(requirement) by using SD. As a result, it is possible to identify the hazard without missing and identify the hazard scenarios in detail, and safety can be sufficiently ensured in the early stage of software development.

Local Triamcinolone Injection and Oral Steroid in the Patients with Thyrohyoid Syndrome

최나연,이길준 대한이비인후과학회 2022 대한이비인후과학회지 두경부외과학 Vol.65 No.1

Background and Objectives Thyrohyoid syndrome is rare disease characterized by unilateralchronic neck pain on hyoid bone area. Currently, local triamcinolone injection was widelyused, but oral steroid treatment was rarely tried. We compared the oral steroid and triamcinoloneinjection for the thyrohyoid syndrome. Subjects and Method Patients who had unilateral pain and tenderness at thyrohyoid membranewere enrolled while excluding those with other diseases, such as gastroesophageal reflux,by physical exam and history taking. Patients were treated with oral steroid (n=15) andlocal triamcinolone injection (n=11); pain scores based on the pretreatment and post-treatmentnumeric rating scale (NRS)-11 were compared between the groups. Results Patients with thyrohyoid syndrome were comorbid with globus (42.3%), sore throat(19.2%), and radiating pain (15.4%). In the oral steroid group, posttreatment pain scores (4.0±2.2) significantly improved (p=0.001) more than pretreatment pain scores (7.7±1.2). In the triamcinoloneinjection group, posttreatment pain scores (2.3±1.7) also significantly improved(p=0.003) more than pretreatment scores (7.5±1.4). None of the patients revealed treatmentrelated complications. Pretreatment scores were not significantly different, but post-treatmentscores wre significantly better in the triamcinolone injection group than in the oral steroidgroup (p=0.047). Conclusion Oral steroid treatment could be easily performed and have significant effectsfor patients with thyrohyoid syndrome. Local triamcinolone injection was more effective thanoral steroid treatment.

Comparison of Endoscopic Tympanoplasty to Microscopic Tympanoplasty

최나연,노양섭,박우리,이정주,욱선현,최지은,정원호,조양선,홍성화,문일준 대한이비인후과학회 2017 Clinical and Experimental Otorhinolaryngology Vol.10 No.1

Objectives. This study aimed to compare the outcome of endoscopic and microscopic tympanoplasty. Methods. This was a retrospective comparative study of 73 patients (35 males and 38 females) who underwent type I tympanoplasty at Samsung Medical Center from April to December 2014. The subjects were classified into two groups; endoscopic tympanoplasty (ET, n=25), microscopic tympanoplasty (MT, n=48). Demographic data, perforation size of tympanic membrane at preoperative state, pure tone audiometric results preoperatively and 3 months postoperatively, operation time, sequential postoperative pain scale (NRS-11), and graft success rate were evaluated. Results. The perforation size of the tympanic membrane in ET and MT group was 25.3%±11.7% and 20.1%±11.9%, respectively (P=0.074). Mean operation time of MT (88.9±28.5 minutes) was longer than that of the ET (68.2±22.1 minutes) with a statistical significance (P=0.002). External auditory canal (EAC) width was shorter in the ET group than in the MT group (P=0.011). However, EAC widening was not necessary in the ET group and was performed in 33.3% of patients in the MT group. Graft success rate in the ET and MT group were 100% and 95.8%, respectively; the values were not significantly different (P=0.304). Pre- and postoperative audiometric results including bone and air conduction thresholds and air-bone gap were not significantly different between the groups. In all groups, the postoperative air-bone gap was significantly improved compared to the preoperative air-bone gap. Immediate postoperative pain was similar between the groups. However, pain of 1 day after surgery was significantly less in the ET group. Conclusion. With endoscopic system, minimal invasive tympanoplasty can be possible with similar graft success rate and less pain.

한국복지패널 자료를 이용한 아동기 공격성에 대한 경시적 자료 분석

최나연,허집,Choi, Nayeon,Huh, Jib 한국데이터정보과학회 2014 한국데이터정보과학회지 Vol.25 No.6

한국 학생들의 아동기 혹은 청소년기의 공격성에 대한 연구들은 대부분 횡단자료를 이용한 것들이다. 경시적 자료를 이용한 연구가 있지만, 반복측정된 자료들이 서로 독립이라는 가정 하에 연구되었다. 본 연구에서는 2006년부터 2012년까지 세 차례 반복측정에 의해 얻어진 한국복지패널 자료를 이용하여, 횡단자료 분석 연구의 결과인 아동 혹은 청소년의 공격성에 영향을 미치는 요인들로 알려진 학교 적응, 자아존중감, 우울 및 불안, 비행, 학교 폭력 피해 경험, 부모로부터 학대 경험과 인터넷 사용시간이 경시적 자료 분석에서도 공격성에 영향을 주는 지를 분석하고자 한다. 한국복지패널 자료의 결측치는 임의결측을 가정하고, 제한적 최우추정량을 이용한 선형혼합모형을 적합하고자 한다. Most of literatures on Korean child aggression are based on using the cross-sectional data sets. Although there is a related study with a longitudinal data set, it is assumed that the data sets measured repeatedly in the longitudinal data are mutually independent. A longitudinal data analysis for Korean child aggression is then necessary. This study is to analyze the effect of child development outcomes including academic achievement, self-esteem, depression anxiety, delinquency, victimization by peers, abuse by parents and internet using time on child aggression with Korea Welfare Panel Study data observed three times between 2006 and 2012. Since Korea Welfare Panel Study data have missing values, the missing at random is assumed. The linear mixed effect model and the restricted maximum likelihood estimation are considered.

성대 용종의 예후 인자와 음성 위생법 치료 효과 분석

최나연,김동규,이길준 대한후두음성언어의학회 2021 대한후두음성언어의학회지 Vol.32 No.1

Background and Objectives s Vocal polyp is one of the most common benign diseases of vocal fold caused by overuse of voice. Laryngeal microsurgery is the first treatment of choice for vocal polyp. However, surgery has many risks such as side effects of general anesthesia, injury of tooth and psychological burden. And we often experience reduction of vocal polyps without surgical procedure. The purpose of study is to evaluate the effect of non-surgical treatment such as vocal hygiene education and proton pump inhibitor (PPI) in patients with vocal polyp. Materials and Method We performed retrospective study for seventy-three patients of vocal polyp who treated with non-surgical modalities such as vocal hygiene education and PPI over three months. Treatment outcomes and risk factors such as age, sex, polyp size, position, symptom duration, presence of laryngopharyngeal reflux (LPR) symptoms, smoking history, voice abuse history and vocal hygiene education were evaluated by comparison between polyp size improved group and non-improved group. Results 5.5% of enrolled patients showed complete response and 23.3% showed partial response without surgery. Polyp size improved group significantly carried out more practice of vocal hygiene education treatment than the non-improved group (p=0.040). And the presence of LPR symptoms [hazard ratio (HR) 3.368, confidence interval (CI) 1.055–10.754, p=0.040] and not performing of vocal hygiene education (HR 3.664, 95% CI 1.078–12.468, p=0.038). Conclusion Vocal hygiene education can be a useful treatment option when making a decision to treat with vocal polyp.

국내 한의학 학술지에 게재된 망막과 시신경질환 관련 논문들의 경향성 분석

최나연,서형식,김태권,권강 대한한방안이비인후피부과학회 2023 한방안이비인후피부과학회지 Vol.36 No.2

Objectives : This study was designed to examine and analyze the recent trend of Korean medicine research on retinal and optic nerve diseases, which is increasing. Methods : This study examines papers related to diseases occurring in the retina and optic nerve that were published in Korean journals of Korean medicine, and analyzes the results of research so far by classifying them by year, journal, disease type and type of paper. Results : 1. Since it was first published in 1995, a total of 17 articles have been published until 2018, with 2 articles(11.1%) each in 1997, 2014 and 2018, and 1 article(5.6%) each in other years. 2. The number of searched journals was 17 paper; 4 review articles, 1 original articles, 12 case reports. 3. Distribution of journals; the percentage of Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology ranked the highest(41.2%). 4. Classification of 12 case reports into three categories; 7 retinal diseases, 3 optic nerve diseases, 2 other diseases. Conclusions : Currently, researches on retinal and optic nerve involvement in the Korean medicine journals have been conducted mainly through case reports. In the future, more clinical research and case reports are necessary to give practical application to patients. .

비전정에서 발생한 각화극세포종 1례

최나연,정승규,동헌종,김효열 대한비과학회 2013 Journal of rhinology Vol.20 No.2

Keratoacanthoma is the epidermal tumor characterized by the benign course such as rapid growth and spontaneous resolution. Rarely keratoacanthoma invades adjacent structures. Therefore, controversies have arisen about the biologic behavior whether keratoacanthoma is a benign tumor or a variant of low grade cutaneous squamous cell carcinoma. We report a case of the recurred keratoacanthoma at the nasal vestibule treated with the surgical excision and the reconstruction by local bilobed rotation flap in a 54-year old female whose final pathology was confirmed as well differentiated squamous cell carcinoma. Keratoacanthoma is the epidermal tumor characterized by the benign course such as rapid growth and spontaneous resolution. Rarely keratoacanthoma invades adjacent structures. Therefore, controversies have arisen about the biologic behavior whether keratoacanthoma is a benign tumor or a variant of low grade cutaneous squamous cell carcinoma. We report a case of the recurred keratoacanthoma at the nasal vestibule treated with the surgical excision and the reconstruction by local bilobed rotation flap in a 54-year old female whose final pathology was confirmed as well differentiated squamous cell carcinoma.