발살바 법 이후에 발생한 자발적 갑상선 출혈

성의숙,김민식,김동조,이진춘 대한이비인후과학회 부산,울산,경남 지부회 2017 임상이비인후과 Vol.28 No.1

Spontaneous thyroid hemorrhage is a rare cause of acute neck swelling. But it is self-limiting in most cases. Symptoms of thyroid hemorrhage are often subtle or not present on initial exam. But it can be rapidly expanding hematoma resulting in airway compromise. We have reported the case who a 21-year old healthy young woman with slowly expanding thyroid hemorrhage without trauma history. There were mild dyspena and swelling of the neck gradually increased. So she underwent hemithyroidectomy for definitive treatment. There had not been reported in the literature regarding spontaneous thyroid hemorrhage in a young healthy female patient with valasalva maneuver. Decision making is based on the patients’s vital signs, symptoms, and the findings on a contrast enhanced computered tomography of the neck.

항응고제와 항혈소판제 복용 환자에서의 비출혈

성의숙,김태헌,조석현,김경래,박철원,정진혁 대한이비인후과학회 2012 대한이비인후과학회지 두경부외과학 Vol.55 No.5

Background and Objectives Epistaxis can be caused or exacerbated by anticoagulant and antiplatelet medication. The use of these medications has been increasing markedly in Korea over the recent years due to it becoming an aging society. This retrospective study assessed the proportion of patients taking anticoagulant and antiplatelet in epistaxis patients and monitored differences in patients’ clinical courses. Subjects and Method A retrospective chart review was performed for consecutive patients referred to the ENT department with epistaxis from the emergency room over a one-year period. Results One hundred eighty eight patients presented to the emergency room with epistaxis, representing 0.6% of all emergency attendances. Of these patients, 143 (76%) were referred to the ENT department: of these referred to us, 24% had been taking anticoagulant or antiplatelet medication. There were 5 taking Warfarin, 32 Aspirin, 3 Clopidogrel, and six more than one medication simultaneously. Patients that were taking these medications were older and had higher prevalent rate of hypertension. There was no difference in the bleeding site, the recurrence rate, hospitalization and duration of in-patient stay, and method of treatment between groups. Conclusion Patients with epistaxis in ENT emergency taking anticoagulant and antiplatelet medication have been increasing recently, so an understanding of the action of such medication may enable health care personnels to provide more effective management of these patients.

측경부 종괴로 표현된 기관지원성 낭종 1례

성의숙,지용배,김경래,박찬금,태경,Sung, Eui Suk,Ji, Yong Bae,Kim, Kyung Rae,Park, Chan Kum,Tae, Kyung 대한기관식도과학회 2011 大韓氣管食道科學會誌 Vol.17 No.2

A bronchogenic cyst is an uncommon benign congenital anomaly of the primitive ventral forgut which was generally encountered within the mediastinum and detected in pediatric patients. It is rarely detected in adult population as a lateral neck mass. We have recently experienced one case of bronchogenic cyst as a left lateral neck mass in a 49-year-old male. He complaints of a $2{\times}1$ cm sized, soft, non tender, and movable mass on the low lateral neck. The surgical excision of mass was performed and the final histopathologic diagnosis was a bronchogenic cyst. Here, we report this case with the review of literatures.

갑상선 수술을 위한 새로운 수술 중 신경감시시스템의개발

성의숙,이병주 대한갑상선학회 2018 International Journal of Thyroidology Vol.11 No.2

It is very important to identify recurrent laryngeal nerve (RLN) and prevent RLN injury during thyroid surgery. The intraoperative neuromonitoring (IONM) for the prevention of RLN injury is a useful method because it can identify the location and status of RLN and predict postoperative vocal cord function easily. The IONM consists of a stimulating side that applies electrical stimulation to the nerve and a recording side that measures the surface electromyography (EMG) of the vocal cord muscle through electrode endotracheal tube. The nerve stimulator and surgical dissector are separate instruments. So, during IONM for the prevention of the RLN injury in conventional, endoscopic, or robotic thyroid surgery, repeated exchanging between surgical instruments and the nerve stimulator is inconvenient and time consuming. On the recording side, the accuracy of the electrode endotracheal tube which measures the EMG of the vocalis muscle can be affected by contact with between electrode and vocal fold and position change of patient. We would like to introduce recent several researches to overcome the current limitations of IONM.

상후두신경의 외측분지와 수술 중 신경 감시 방법

성의숙,이진춘 대한이비인후과학회 부산,울산,경남 지부회 2018 임상이비인후과 Vol.29 No.2

Development of a Novel Intraoperative Neuromonitoring System Using an Accelerometer Sensor in Thyroid Surgery: A Porcine Model Study

성의숙,이진춘,신성찬,권현근,나한슬,박다희,최성욱,노정훈,이병주 대한이비인후과학회 2019 Clinical and Experimental Otorhinolaryngology Vol.12 No.4

Objectives. The sensitivity and positive predictive value of widely used intraoperative neuromonitoring (IONM) using electromyography (EMG) of the vocalis muscle in thyroid surgery are controversial. Thus, we developed a novel IONM system with an accelerometer sensor that uses the piezoelectric effect instead of EMG to detect laryngeal twitching. The objective of this study was to evaluate the feasibility and safety of this novel IONM system during thyroid surgery in a porcine model. Methods. We developed an accelerometer sensor that uses the piezoelectric effect to measure laryngeal twitching in three dimensions. This novel accelerometer sensor was placed in the anterior neck skin (transcutaneous) or postcricoid area. Stimulus thresholds, amplitude, and latency of laryngeal twitching measured using the accelerometer sensor were compared to those measured through EMG of the vocalis muscle. Results. The amplitudes of the accelerometer sensor at the anterior neck and postcricoid area were significantly lower than those of EMG because of differences in the measurement method used to evaluate laryngeal movement. However, no significant differences in stimulus thresholds between the EMG endotracheal tube and transcutaneous or postcricoid accelerometer sensors were observed. Conclusion. Accelerometer sensors located at the anterior neck or postcricoid area were able to identify laryngeal twitching. The stimulus intensity measured with these sensors was equivalent to that from conventional vocalis EMG. Our novel IONM system with an accelerometer sensor that checks changes in surface acceleration can be an alternative to EMG of the vocalis muscle for IONM in the future.

Development of a Novel Intraoperative Neuromonitoring System Using a Surface Pressure Sensor to Detect Muscle Movement: A Rabbit Model Study

성의숙,이진춘,신성찬,권현근,김민식,김동주,노정훈,이병주 대한이비인후과학회 2019 Clinical and Experimental Otorhinolaryngology Vol.12 No.2

Objectives. False-negative or false-positive responses in intraoperative neuromonitoring (IONM) using electromyography (EMG) in thyroid surgery pose a challenge. Therefore, we developed a novel IONM system that uses a surface pressure sensor instead of EMG to detect muscle twitching. This study aimed to investigate the feasibility and safety of a new IONM system using a piezo-electric surface pressure sensor in an experimental animal model. Methods. We developed the surface pressure sensor by modifying a commercial piezo-electric sensor. We evaluated the stimulus thresholds to detect muscle movement, as well as the amplitude and latency of the EMG and surface pressure sensor in six sciatic nerves of three rabbits, according to the stimulus intensity. Results. The surface pressure sensor detected the muscle movements in response to a 0.1 mA stimulation of all six sciatic nerves. There were no differences in the thresholds of stimulus intensity between the surface pressure sensor and EMG recordings to detect muscle movements. Conclusion. It is possible to measure the change in surface pressure by using a piezo-electric surface pressure sensor instead of EMG to detect muscle movement induced by nerve stimulation. The application of IONM using a piezo-electric surface pressure sensor during surgery is noninvasive, safe, and feasible. Measuring muscle twitching to identify the state of the nerves using the novel IONM system can be an alternative to recording of EMG responses.

Application of Novel Intraoperative Neuromonitoring System Using an Endotracheal Tube With Pressure Sensor During Thyroid Surgery: A Porcine Model Study

성의숙,신성찬,권현근,김지아,박다희,최성욱,김상훈,이진춘,노정훈,이병주 대한이비인후과학회 2020 Clinical and Experimental Otorhinolaryngology Vol.13 No.3

Objectives. The loss of signal during intraoperative neuromonitoring (IONM) using electromyography (EMG) in thyroidectomy is one of the biggest problems. We have developed a novel IONM system with an endotracheal tube (ETT) with an attached pressure sensor instead of EMG to detect laryngeal twitching. The aim of the present study was to investigate the feasibility and reliability of this novel IONM system using an ETT with pressure sensor during thyroidectomy in a porcine model. Methods. We developed an ETT-attached pressure sensor that uses the piezoelectric effect to measure laryngeal muscle twitching. Stimulus thresholds, amplitude, and latency of laryngeal twitching evaluated using the pressure sensor were compared to those measured using transcartilage needle EMG. The measured amplitude changes by EMG and the pressure sensor during recurrent laryngeal nerve (RLN) traction injury were compared. Results. No significant differences in stimulus threshold intensity between EMG and the pressure sensor were observed. The EMG amplitude detected at 0.3 mA, increased with increasing stimulus intensity. When the stimulus was more than 1.0 mA, the amplitude showed a plateau. In a RLN traction injury experiment, the EMG amplitude did not recover even 20 minutes after stopping RLN traction. However, the pressure sensor showed a mostly recovery. Conclusion. The change in amplitude due to stimulation of the pressure sensor showed a pattern similar to EMG. Pressure sensors can be feasibly and reliably used for RLN traction injury prediction, RLN identification, and preservation through the detection of laryngeal muscle twitching. Our novel IONM system that uses an ETT with an attached pressure sensor to measure the change of surface pressure can be an alternative to EMG in the future.

부갑상선 기능 항진증에서 병변의 영상학적 진단과 위치 탐색 방법의 비교 연구

성의숙,지용배,최윤영,김지영,박정선,이영준,태경 대한이비인후과학회 2012 대한이비인후과학회지 두경부외과학 Vol.55 No.9

Background and Objectives Accurate preoperative localization of abnormal parathyroid gland is essential for successful parathyroidectomy. The aim of this study was to evaluate the accuracy of a localization test for hyperparathyroidism including ultrasonography (US), computed tomography (CT) and 99mTc-sestamibi scan. Subjects and Method We studied 47 patients with hyperparathyroidism who underwent parathyroidectomy from January 2003 through December 2010, retrospectively. 99mTc-sestamibi scan, US and CT were carried out as a preoperative localization test and their accuracy were analyzed according to the size, location and pathology of parathyroid lesions. Results The accuracy of 99mTc-sestamibi scan, US and CT were 93%, 77% and 65%, respectively. The accuracy of 99mTc-sestamibi scan and CT combined was 94% and US and CT 73%. The accuracy of combination of US and 99mTc-sestamibi scan was 96%, which was not different depending on size, location and pathology of parathyroid lesions. Conclusion The combination of 99mTc-sestamibi scan and US is the most effective method for preoperative detection and the localization of hyperparathyroidism.

Application of an Intraoperative Neuromonitoring System Using a Surface Pressure Sensor in Parotid Surgery: A Rabbit Model Study

성의숙,권현근,신성찬,전영일,이정우,박다희,최성욱,김화빈,박혜진,이진춘,노정훈,이병주 대한이비인후과학회 2021 Clinical and Experimental Otorhinolaryngology Vol.14 No.1

Objectives. Facial nerve monitoring (FNM) can be used to identify the facial nerve, to obtain information regarding its course, and to evaluate its status during parotidectomy. However, there has been disagreement regarding the efficacy of FNM in reducing the incidence of facial nerve palsy during parotid surgery. Therefore, instead of using electromyography (EMG) to identify the location and state of the facial nerve, we applied an intraoperative neuromonitoring (IONM) system using a surface pressure sensor to detect facial muscle twitching. The objective of this study was to investigate the feasibility of using the IONM system with a surface pressure sensor to detect facial muscle twitching during parotidectomy. Methods. We evaluated the stimulus thresholds for the detection of muscle twitching in the orbicularis oris and orbicularis oculi, as well as the amplitude and latency of EMG and the surface pressure sensor in 13 facial nerves of seven rabbits, using the same stimulus intensity. Results. The surface pressure sensor detected muscle twitching in the orbicularis oris and orbicularis oculi in response to a stimulation of 0.1 mA in all 13 facial nerves. The stimulus threshold did not differ between the surface pressure sensor and EMG. Conclusion. The application of IONM using a surface pressure sensor during parotidectomy is noninvasive, reliable, and feasible. Therefore, the IONM system with a surface pressure sensor to measure facial muscle twitching may be an alternative to EMG for verifying the status of the facial nerve.