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)

수면 의학과 공중 위생

정유삼 대한이비인후과학회 2009 대한이비인후과학회지 두경부외과학 Vol.52 No.9

Sleep and public health has close relationship. Life in modern society makes human sleep deprived state. Sleep deprivation could induce cognitive deficits, heart diseases, glucose metabolic disorders, and decrease quality of life. Moreover, shift worker should work in mismatched circadian rhythm environment. Errors due to sleep deprivation, mismatched circadian rhythm, and various sleep disorders including sleep apnea could be tremendous hazard to public. By understanding sleep physiology, we can prevent sleep deprivation induced accidents and health problems. Sleep specialists have role of education and detection of patients with sleep disorders.

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)

폐쇄성 수면무호흡증의 발병기전

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.

수면의학의 소개

정유삼,문병재 대한이비인후과학회 부산,울산,경남 지부회 2011 임상이비인후과 Vol.22 No.2

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.

비주피판 접근법을 통한 탈구된 비중격 교정방법

정유삼,이석기,장용주,이봉재 대한이비인후과학회 2003 대한이비인후과학회지 두경부외과학 Vol.46 No.8

Background and Objectives:Sepatal deviation with caudal septal dislocation is difficult to corect using the clasic septoplasty spine. We report the techniques and results. Materials and Method:Eighteen men with the caudal septal dislocation from anterior nasal spine were operated using the columella flap approach. The study was conducted in a retrospective fashion focusing on preoperative status, operative results and complications. Results:The operation time was in the average of 30 minutes. All patients except one showed improvement in nasal obstruction. Dislocation and deviation was corected in all patients. The scar at Conclusion:Columellar flap approach in septoplasty can be used in patients with caudal septal dislocation. (Korean J Otolaryngol 2003 ;46 :665-8)

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.

정확한 시술부위 확인과 타임아웃

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.

자기 공명 영상에서 우연히 발견된 부비동 이상 소견의 유병률 및 임상적 의의

정유삼 대한비과학회 2007 Journal of rhinology Vol.14 No.1