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정유삼 대한비과학회 2009 Journal of rhinology Vol.16 No.2
Obstructive sleep apnea has a close relationship with the anatomical characteristics of the upper airway. But we should consider that obstructive sleep apnea always occurs only when the patients are asleep. Diminishing of neural signal to pharyngeal dilator muscles during the sleep state has a great role in the pathogenesis of obstructive sleep apnea. Narrowing of the upper airway could be due to aging, abnormality of craniofacial skeleton, obesity, narrowing of nasal cavity, adhesive force of mucosa, gravity, sleep, vibratory trauma of upper airway when snoring, compliance of pharyngeal dilator muscle, and apnea threshold according to blood carbon dioxide concentration. Understanding of these possible causes may help to develop treatment modality for obstructive sleep apnea and to introduce individual treatment. Obstructive sleep apnea has a close relationship with the anatomical characteristics of the upper airway. But we should consider that obstructive sleep apnea always occurs only when the patients are asleep. Diminishing of neural signal to pharyngeal dilator muscles during the sleep state has a great role in the pathogenesis of obstructive sleep apnea. Narrowing of the upper airway could be due to aging, abnormality of craniofacial skeleton, obesity, narrowing of nasal cavity, adhesive force of mucosa, gravity, sleep, vibratory trauma of upper airway when snoring, compliance of pharyngeal dilator muscle, and apnea threshold according to blood carbon dioxide concentration. Understanding of these possible causes may help to develop treatment modality for obstructive sleep apnea and to introduce individual treatment.
Gender Differences of Polysomnographic Findings in Snoring Patients
정유삼,장용주,이봉재,이상암,최세준,강우석,이시형 대한비과학회 2004 Journal of rhinology Vol.11 No.1
Snoring was considered as a problem limited to male. This study was performed to evaluate the possible differences betweenfemale and male patients who have snoring problems. A polysomnography was performed at the Asan Medical Center fromJan.1989 to May.2003 on 145 female and 1065male patients who had complained of snoring at the Asan Medical Center. Multivariate model techniques were used. For female patients, RDI was correlated with BMI (correlation coefficient [r]=0.342, p<0.001). In male patients, RDI was correlated with BMI (r=0.332, p<0.001) as well. In female patients, there was asignificant correlation between age and RDI (r=0.355, p<0.001) In male patients, the correlation was not significant betweenage and RDI (r=-0.010, p=0.745). In conclusion, both male and female snoring patients have more severe apnea with obesity. In female patients, apnea is more severe with aging but in male patients, there was no correlation between apnea and age.
편측 비공을 통한 비강내 경접형동접근법을 이용한 뇌하수체 종양 수술
정유삼,이윤식,이봉재,김창진,Albert L. Rhoton 대한이비인후과학회 2007 대한이비인후과학회지 두경부외과학 Vol.50 No.7
Background and Objectives:Transseptal TSA (transsphenoidal approach) has advantages of wide exposure, good operative view, and use of two hands, but has disadvantages of external nasal scar, posibility of external nasal deformity and severe nasal pain. And endoscopic TSA can reduce nasal morbidity, but operator cant use two hands with the endoscope and it also has endoscopic TSA. Subjects and Method:We reviewed 112 patients who had been operated with this method from Mar, 2001 to Sep, 2003. Details of surgical technique of this approach are presented. We investigated the operative time, hospital periods, and complications. Results:The mean operative time was 95 minutes. Nasal packings were removed on the first postoperative day in 106 cases, and on second postoperative days in 6 cases. The mean postoperative hospital stay was 3.2 days. During the fo-low-up periods (6- 24 months, mean 13.5 months) (4 cases), nasal septal deviation (2 cases), epistaxis (1 case), nasal septal perforation (1 case), CSF leakage (1 case), hypopituitarism (3 cases), and diabetes insipidus (4 cases). Meningitis, external nasal deformity, external scar, paresthesia or sinusitis were not noticed. Con-clusion:Using endonasal TSA, we could operate easily with two hands, obtaining a good operative view and short operation (Korean J Otorhinolaryngol-Head Neck Surg 2007 ;50 :590-5)
코골이 및 폐쇄성 수면무호흡증에서 비중격 수술 전후의 수면다원화검사 결과분석
정유삼,황수훈,김선태,박정수,차흥억,김동영 대한이비인후과학회 2002 대한이비인후과학회지 두경부외과학 Vol.45 No.11
Background and Objectives:Nasal obstruction is comon in patients with snoring and obstructive sleep apnea (OSA). A y colapse at the pharyngeal level. We tried to assess the efficacy of the septal surgery on snoring and OSA by using portable polysomnography (PSG). Materials and Method:We reviewed 21 patients who had nasal obstruction and snoring. Septal surgery was performed. Each patient was assesed by pre and postoperative PSG. We measured respiratory distres index (RDI), apnea index (AI), oxygen saturation index (OSI)PSG, clinical nasal obstruction and deviated nasal septum by examination. Results:After septal surgery, RDI decreased from 39 to 29 (p=0.0001). AI decreased from 19 to 16 (p=0.0209). OSI decreased from 48 to 32 (p=0.0001). The duration of the snoring decreased from 44% to 39% (p=0.1595). Snoring and OSA were completely relieved in 4 patients (19% ) who didnt Conclusion: Snoring and OSA can be corrected merely by the septal correction in some patient. And secondary surgery (uvulopalatoplasty) should be considered after thorough evaluation of postoperative PSG. (Korean J Otolaryngol 2002 ;45 :1081-5)
알레르기비염 환자에서 Glutathione S-Transferase P1유전자의 다형성에 관한 연구
정유삼,김선태,최진호,유정국,이은정,황규성,황유진 대한이비인후과학회 2005 대한이비인후과학회지 두경부외과학 Vol.48 No.6
Background and Objectives:Genetic factors play a role in the etiology of allergic rhinitis. The glutathione S-transferase (GSTP1)is one of the detoxifying enzymes for oxidative stress. The purpose of this study is to examine Polymorphisms of whether thereis an association between some alleles of GSTP1 genes and allergic rhinitis. Subjects and Method:Patients with allergic rhinitiswere selected on the basis of the following criteria:1) watery rhinorrhea, sneezing, nasal obstruction and/or itching for longer3months and 2) positive reaction at the allergic skin prick test for DP, DF allergen and 3) positive reaction at specific IgE RASTfor DP, DF allergen. GSTP1 gene polymorphisms in exon5 (Ile105Val) were analyzed by polymerase chain reaction (PCR) withrestriction fragment length polymorphisms (RFLP) in 149 patients with allergic rhinitis and 156 healthy control subjects.Results:In allergic rhinitis, Ile105/Ile105 were 106 cases (71.1%), Ile105/Val105 were 42 cases (28.2%), Val105/Val105 were 1case (0.7%) and in normal controls, Ile105/Ile105 were 100 cases (64.1%), Ile105/Val105 were 45 cases (28.8%), Val105/Val105were 11 cases (7.1%)(p=0.004). Conclusion:Genetic polymorphism of Val105/Val105 in GSTP1 may be protective genotypesin allergic rhinitis.
정유삼 대한의사협회 2015 대한의사협회지 Vol.58 No.2
While errors in surgical site or patient identification should not occur, they are some of the most common sentinel events. These events affect not only the patient but also the surgeon and hospital. The exact incidence of surgical errors cannot be measured because measurement depends on voluntary reporting. There have been many efforts to reduce these surgical errors. For example, Universal protocol and time-out just before surgery begins have been introduced. It is also essential to mark the surgical site in a uniform manner. Despite these processes,surgical errors still happen for many reasons. One of most common root causes is communication error. It is essential to use precise communication and to speak up if something is wrong. Hospitals and surgeons should use leadership to involve their teams in a patient safety culture. Not only the system but also this patient safety culture can reduce the incidence of surgical error.
한국인 폐쇄성수면무호흡증 환자들의 자동적정 비강기도 양압기 사용의 순응도
정유삼,왕종환,김영란,장용주,이봉재 대한비과학회 2006 Journal of rhinology Vol.13 No.2
Background and Objectives:Continuous Positive Airway Pressure (CPAP) is generally effective in correcting sleep-related respiratory disturbance in Obstructive Sleep Apnea Syndrome (OSAS). But the failure to comply with this treatment poses a serious limitation to its use. The aim of this study is to investigate the state of compliance and the cause of noncompliance of auto-adjusting positive airway pressure (autoPAP) treatment in Korean OSAS patients. Materials and Methods:This study performed a survey of 45 patients who had selected the autoPAP treatment between August 2000 and May 2003. Results: Twelve of the 45 patients (26.7%) refused the autoPAP treatment immediately after the first trial due to claustrophobia. Also, twenty patients (44.4%) stopped using it within 1 month. Only 13 patients (28.9%) continued to use it for more than 1 month. Twenty seven of the 33 patients (81.8%) who had used the autoPAP complained of claustrophobia after the first trial. The major factors of low compliance were claustrophobia, restricted body position while asleep, nasal symptoms, high cost, and inadequate education of patients. Conclusion:This study shows that claustrophobia is a major cause for the noncompliance of autoPAP. It also shows that the patients are encouraged by the effectiveness of the autoPAP to use it for a longer period. Therefore, we should focus on explaining the effects and drawbacks of autoPAP, desensitization and behavioral modification.