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Clinical usefulness of intraoperative parathyroid hormone monitoring for primary hyperparathyroidism
Se Hyun Paek,Su-Jin Kim,June Young Choi,Kyu Eun Lee 대한외과학회 2018 Annals of Surgical Treatment and Research(ASRT) Vol.94 No.2
Purpose: The availability of intraoperative parathyroid hormone (IOPTH) monitoring allows successful focused parathyroidectomy for primary hyperparathyroidism (pHPT). The objective of this study was to report our initial experience in IOPTH monitoring during parathyroid surgery for primary hyperparathyroidsim. Methods: Between May 2011 and February 2013, 37 patients underwent focused parathyroidectomy due to pHPT. IOPTH monitoring based on Miami criteria was used to confirm complete excision of hyperfunctioning parathyroid gland during surgery. Medical records of patients were reviewed retrospectively. Results: Preoperative mean maximal calcium level was 11.7 ± 0.9 mg/dL. Preoperative technetium (<SUP>99m</SUP>Tc) sestamibi scan and ultrasonography identified 32 of 37 (86.5%) and 29 of 37 (78.4%) of abnormal parathyroid glands, retrospectively. Results of the 2 imaging modalities were discordant for 8 cases (21.6%). The mean pre-excision PTH level was 147.2 ± 201.5 pg/mL. At 5- and 10-minute post tumor resection, PTH levels were 65.3 ± 25.4 pg/mL and 47.5 ± 24.3 pg/mL, respectively. In all cases, IOPTH levels fell by at least 50% after removing all suspected abnormal glands. All patients had a successful return to normocalcemia after surgery (mean follow-up period: 60.2 ± 15.4 months). Conclusion: Surgeon could confirm complete excision of abnormal hyperfunctioning parathyroid glands by IOPTH monitoring during surgery for pHPT. IOPTH monitoring can maximize performance of successful focused parathyroidectomy for pHPT, especially when preoperative imaging results are discordant.
Nipple-sparing mastectomy through periareolar incision with immediate reconstruction
Se Hyun Paek,Seung Eun Hong,Kyong-Je Woo,Joohyun Woo,Woosung Lim 대한외과학회 2020 Annals of Surgical Treatment and Research(ASRT) Vol.98 No.2
Purpose: Nipple-sparing mastectomy (NSM) has become increasingly popular due to improved cosmesis without compromising oncologic safety. Radial and inframammary incisions are usually used to achieve NSM, with periareolar incisions usually being avoided because of the risk to nipple-areola complex viability. In an attempt to maximize esthetic effects, we performed NSM through periareolar incision with immediate reconstruction. We report our initial experience. Methods: This case series consisted of all consecutive patients (n = 34) who underwent NSM through a periareolar incision in our institution between August 2017 and December 2018. All patients underwent NSM through periareolar incision followed by immediate reconstruction with an implant or deep inferior epigastric perforator flap. Patient demographics, tumor and treatment characteristics, and short-term postoperative outcomes were reviewed. Results: The mean patient age was 46.74 ± 6.69 years (range, 38–62 years), and the mean operation time was 96.68 ± 28.00 minutes. Indications included in situ cancer in 12 cases and invasive cancer in 22 cases. There was 1 major complication (postoperative hematoma) requiring operative reintervention. No other complications including fistula, implant exposure, or reconstruction failure was observed. At the time of writing, no case of local recurrence has been observed. Conclusion: Our initial report shows that NSM with immediate reconstruction may successfully be performed through periareolar incision. This method maximizes esthetic effects and may be an appropriate surgical option for NSM
Feasibility of sentinel lymph node dissection using Tc-99m phytate in papillary thyroid carcinoma
Se Hyun Paek,Ka Hee Yi,Su-Jin Kim,June Young Choi,Kyu Eun Lee,Young Joo Park,Do-Joon Park,Keon Wook Kang,June-Key Chung 대한외과학회 2017 Annals of Surgical Treatment and Research(ASRT) Vol.93 No.5
Purpose: Various methods of sentinel lymph node (SLN) biopsy in thyroid cancer have been introduced. Tc-99m phytate as a radiotracer has been successfully utilized for SLN biopsy in breast, cervix, and endometrial cancer. We assessed the feasibility of SLN dissection using Tc-99m phytate in papillary thyroid carcinoma (PTC). Methods: Seventeen patients with PTC were prospectively enrolled. Ultrasound-guided peritumoral injection of 55.5 MBq Tc-99m phytate in 0.25-mL normal saline was performed. Preoperative single-photon emission-computed tomography (SPECT) and intraoperative gamma-probe were used for SLN detection during operation. Results: Identification rate of SLNs was 70.6% (12 of 17) with SPECT, and 88.2% (15 of 17) with gamma-probe. Combined SPECT and gamma-probe had identification rates of 88.2% (15 of 17). Identification rates of SLNs in central LN compartments were 82.4% (14 of 17) and 41.2% (7 of 17) in lateral LN compartments. Overall sensitivity, specificity, positive predictive value, and negative predictive value of the results of SLN biopsy were 91.6%, 100%, 88.4%, and 100%, respectively. Eight patients (47.1%) had metastasis in SLNs; all patients had SLN metastasis in the central compartment and 2 patients had SLN metastasis in both the central and lateral compartments. Conclusion: Combined SPECT and gamma-probe could detect SLNs with an 88.2% identification rate in PTC. SLN biopsy using Tc-99m phytate is technically feasible. Further investigation is warranted for clinical application of Tc-99m phytate in PTC.
갑상선과 부갑상선 수술 후 발생한 오심 및 구토 연관인자들에 대한 분석
백세현 ( Se Hyun Paek ),이규언 ( Kyu Eun Lee ),배동식 ( Dong Sik Bae ),구도훈 ( Do Hoon Koo ),최준영 ( June Young Choi ),윤여규 ( Yeo Kyu Youn ) 대한임상종양학회 2011 Korean Journal of Clinical Oncology Vol.7 No.2
목적: 수술 후 발생한 오심 및 구토는 갑상선과 부갑상선 절제술을 시행받은 환자들에게 비교적 흔한 문제이다. PONV는 환자, 수술, 마취등과 관련된 다양한 인자들에 의해서 영향받는다. 이에 저자들은 갑상선과 부갑상선 수술을 시행받은 환자들을 대상으로 하여 PONV 발생율과 환자특성을 조사하는 데에 그 의의를 두고 있다. 방법: 2011년 3월 1일부터 5월 20일 사이에 서울대병원에서 갑상선 및 부갑상선 수술을 시행받은 192명의 환자 중 PONV가 발생한 22명의 환자를 대상으로 분석했다. 나이와 성별, BMI, 수술 후 조직검사결과, 수술시간 및 마취시간, 수술방법 및 마취방법들을 후향적으로 분석했다. 결과: PONV는 192명의 환자중 11.5%인 22명의 환자에서 발생하였다. 단변량분석을 시행했을때에 연령, 수술시간 및 마취시간, 수술방법 그리고 수술 후 재원일수가 통계적으로 유의하게 PONV와 연관성을 보였다. 하지만 다변량분석을 시행했을때에 위의 연관인자들 중 어느 것도 통계적으로 유의한 결과를 보이지 않았다. 결론: 본 연구에서 갑상선과 부갑상선 수술을 시행받은 환자들은 상대적으로 낮은 빈도의 PONV를 보였다. 하지만, PONV는 수술후 재원일수의 상승, 출혈위험의 증가등을 유발할 수 있으므로 PONV가 발생할 위험이 높은 환자들에 대한 관심이 필요하다. Purpose Postoperative nausea and vomiting (PONV) is a common problem in patients undergoing thyroidectomy and parathyroidectomy. PONV is influenced by various factors that involve the characteristics of the patients, surgery, and anesthesia. This study aimed to evaluate the incidence of PONV in patients undergoing thyroid and parathyroid surgery and to analyze the clinicopathological characteristics. Materials and Methods Between March 1st and May 20th 2011, 22 patients with PONV were enrolled from 192 patients who underwent elective thyroid or parathyroid surgery at Seoul National University Hospital. Clinicopathologic characteristics such as age, sex, BMI, pathology, operation/anesthesia time and methods were retrospectively reviewed. Results PONV occurred in 22 patients (11.4%) of 192 patients. Age, operation/anesthesia time, operation method and postoperative hospital stay were associated with PONV in univariate analysis. However, there were no statistically significant factors in multivariate analysis. Conclusion Patients undergoing thyroid or parathyroid surgery have a relatively low risk of developing PONV. However, we should take interest to high risk patients considering that PONV is related to longer hospital stay.
인텔 프로세서 트레이스를 이용한 제어 흐름 무결성에 대한 연구
백세현 ( Se-hyun Baek ),서지원 ( Ji-won Seo ),양명훈 ( Myong-hoon Yang ),신장섭 ( Jang-seop Shin ),백윤흥 ( Yun-heung Paek ) 한국정보처리학회 2017 한국정보처리학회 학술대회논문집 Vol.24 No.2
제어 흐름을 원래 의도와 다르게 만드는 공격을 제어 흐름 무결성을 보장하는 방법을 통해 보안성을 높여 왔다. 완벽한 보안성과 낮은 성능 저하를 만족시키기 위해 인텔 프로세서 트레이스 하드웨어를 이용한 제어 흐름 무결성을 보장하는 연구들에 대해 소개한다.
Minimum-step immuno-analysis based on continuous recycling of the capture antibody
Cho, Hyun-Kyu,Seo, Sung-Min,Cho, Il-Hoon,Paek, Sung-Ho,Kim, Dong-Hyung,Paek, Se-Hwan Royal Society of Chemistry 2011 The Analyst Vol.136 No.7
<P>Most immuno-analytical systems employ antibodies that do not readily dissociate upon binding to its partner antigen (<I>i.e.</I>, target analyte; α2-macroglobulin as a model) and, thus, either need to be disposed of after one-time use or be reused after binding has been reset. To achieve a minimum-step analysis, an antibody that is capable of <I>rapidly reversible binding</I> with high affinity to an antigen was investigated in this study. This antibody was immobilized on the surface of a label-free sensor, which was combined with microfluidic channels, to demonstrate its applicability. The antibody was successively reused without a regeneration step under physiological conditions, offered specific analysis in the serum medium, and detected the analyte at concentrations as low as 0.1 ng mL<SUP>−1</SUP>, which could further be enhanced by 100-fold. The sensor response reached 95% equilibrium after 8.3 and 14.9 min in average on each dose level for the concentration increase and decrease, respectively. The dynamic range covered a 5 logarithmic analyte concentration. Since the sampling size was in the nanolitre to millilitre range per day under the conditions used and the sensor may retain a long shelf-life, it could potentially be used in a clinical setting for long-term, on-line monitoring of diseases.</P> <P>Graphic Abstract</P><P>Model system for continuous monitoring of a protein marker. <IMG SRC='http://pubs.rsc.org/services/images/RSCpubs.ePlatform.Service.FreeContent.ImageService.svc/ImageService/image/GA?id=c0an00811g'> </P>