• Archives of Reconstructive Microsurgery
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• 제10권1호
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• pp.28-33
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• 2001

The numbers of breast cancer are increasing in Korea and the needs for breast reconstruction are also parallel with cancer frequency. The purpose of the study is to define the different state and condition between the delayed reconstruction and the immediate reconstruction of breasts and to suggest how to get more satisfactory outcome. The study included 22 patients who underwent delayed breast reconstruction using transverse rectus abdominis myocutaneous(TRAM) free flap from December, 1990 to January, 2001. Their ages ranged from 28 years to 58 years. We have used internal mammary artery and vein as a recipient vessel in 13 patients because of fibrosis and severe scarring in the axillary region and thoracodorsal artery and vein in 9 patients. When we used internal mammary artery with recipient vessel, we would use contralateral deep inferior epigastric artery with donor vessel. We obtained satisfactory result without any flap loss, and most patients satisfied with shape and volume of reconstructed breast. We found that delayed breast reconstruction have some differences compared with immediate breast reconstruction. First, we remove fibrotic and scar tissue as much as possible to achieve satisfactory shape of breast. Second, we plan preoperative design in standing position to obtain symmetrical recreation of inframammary fold. Third, we use internal mammary vessel in many cases with recipient vessel for microvascular anastomosis. Fourth, patients with delayed breast reconstruction feel more satisfaction than patients with immediate breast reconstruction do. Finally, economic burden is much higher in the delayed case than in the immediate case because of no coverage with insurance.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.619-625
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• 2010

Purpose: Trapdoor orbital blowout fracture is most common in orbital blowout fracture. Various materials have been used to reconstruct orbital floor blowout fracture. Absorbable alloplastic implants are needed because of disadvantages of nonabsorbable alloplastic materials and donor morbidity of autogenous tissue. The aim of the study is to evaluate usefulness of absorbable mesh plate as a reconstructive material for orbital blowout fractures. Methods: From December 2008 to October 2009, 18 trapdoor orbital floor blowout fracture patients were treated using elevator fixation, depressor fixation, or elevatordepressor fixation techniques with absorbable mesh plates and screw, depending on degree of orbital floor reduction, because absorbable mesh plates are less rigid than titanium plates and other artificial substitutes. Results: Among 18 patients, 5 elevator fixation, 4 depressor fixation, and 9 elevator and depressor fixation technique were performed. In all patients, postoperative computed tomographic (CT) scan showed complete reduction of orbital contents and orbital floor, and no displacement of bony fragment and mesh plate. Mean follow-up was 10 months. There were no significant intraoperative or postoperative complications. Conclusion: Three different techniques depending on the degree of orbital floor reduction are useful for open reduction and internal fixation of trapdoor orbital floor blowout fracture with absorbable mesh plates.

• Parasites, Hosts and Diseases
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• 제51권5호
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• pp.545-549
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• 2013

A 12-year-old spayed female mixed-bred dog presented with nasal bleeding of 2 days duration and a skin nodule in the left flank. No abnormalities were found in coagulation profiles and blood pressure. Cytological evaluation of the nodule revealed numerous characteristic round organisms having a nucleus and a bar within macrophages and in the background, consistent with leishmaniasis. In vitro culture was unsuccessful but PCR of the nodular aspirate identified the organisms as Leishmania infantum, and the final diagnosis was canine leishmaniasis. No history of travel to endemic countries was noted. Because the dog had received a blood transfusion 2 years before the illness, serological screening tests were performed in all donor dogs of the commercial blood bank using the commercial Leishmania ELISA test kit, and there were no positive results. Additional 113 dogs with hyperglobulinemia from Seoul were also screened with the same kits but no positive results were obtained. To the best of the author's knowledge this is the first autochthonous case of canine leishmaniasis in Korea.

• Archives of Plastic Surgery
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• 제42권6호
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• pp.783-787
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• 2015

This procedure was developed for preservation of the rectus muscle components and deep inferior epigastric vessel after deep inferior epigastric perforator (DIEP) flap harvesting. A 53-year-old woman with granuloma caused by silicone injection underwent bilateral nipple-sparing mastectomies and immediate reconstruction with "mini-flow-through" DIEP flaps. The flaps were dissected based on the single largest perforator with a short segment of the lateral branch of the deep inferior epigastric vessel that was transected as a free flap for breast reconstruction. The short segments of the donor deep inferior epigastric vessel branch are primarily end-to-end anastomosed to each other. A short T-shaped pedicle mini-flow-through DIEP flap is interposed in the incised recipient's internal mammary vessels with two arterial and four concomitant venous anastomoses. Although it requires multiple vascular anastomoses and a short pedicle for the flap setting, the mini-flow-through DIEP flap provides a large pedicle caliber, enabling safer microsurgical anastomosis and well-vascularized tissue for creating a natural breast without consuming time or compromising the rectus muscle components and vascular flow of both the deep inferior epigastric and internal mammary vessels.

• IMMUNE NETWORK
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• 제1권2호
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• pp.162-169
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• 2001

Background: Nitric oxide (NO), a cytotoxic molecule is produced in various tissues including tumor cells during interleukin-2 (IL-2) therapy . Lymphokine-activated killer (LAK) cells are induced during IL-2 therapy, and have cytotoxic activity against tumor cells. The current study investigated the effects of NO synthesized in target cells or exposure of target cells to NO on the sensitivity of target cells to LAK cell cytotoxicity. Methods: Cytotoxicity was measured using 4 h chromium release assays. LAK cells which were induced by a 4 day incubation of BALB/c mouse splenocytes with IL-2 (6,000 IU/mL) were employed as effector cells. RD-995 skin tumor cells originated from a C3H/HeN mouse were employed as target cells. NO synthesis in target cells was induced by a 24 h incubation of RD-995 cells with $IFN{\gamma}$ (25 U/mL), TNF (50 U/mL) and IL-1 (20 U/mL). S-nitrosyl acetylpenicillamine (SNAP), an NO donor, was used to expose target cells to NO. $N^G$-monomethyl-L-arginine (MLA) and carboxy-PTIO were added during cytotoxicity assays to inhibit NO synthesis, and to scavenge NO produced by target cells, respectively. Results: Sensitivity of NO-producing RD-995 cells to LAK cell cytotoxicity was decreased by addition of MLA and carboxy-PTIO during cytotoxicity assays. However, the two reagents had no effect on the sensitivity of non-NO-producing RD-995 cells. Pretreatment of RD-995 target cells with SNAP increased the sensitivity in comparison with untreated cells. Conclusions: Sensitivity of target cells to LAK cell cytotoxicity is increased by target cell NO synthesis or exposure to NO. Further studies are needed to evaluate whether these in vitro results have relevance to in vivo phenomena.

• 대한핵의학회지
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• 제35권4호
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• pp.251-257
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• 2001

목적: 신 이식 이틀째 촬영한 Tc-99m DTPA 스캔 소견에서 나타난 이식신의 기능 저하가 이식신의 장기 생존에 영향을 미치는 지 알아보았다. 대상 및 방법: 생체 신 이식 총 64예에서 신장 스캔 소견에 따른 이식신 누적 생존율의 차이를 Kaplan-Meier법으로 분석하고, Cox proportional hazard model을 이용하여 이식신 장기 생존율 예측능을 알아보았다. Chi-square test로 두 군 간에 급성 거부반응의 빈도 차이를 보았다. 결과: 신장 스캔 비정상군의 이식신 장기 생존율이 정상군에 비하여 낮았으나 그 차이가 통계적으로 유의하지 않았다. 이식 직후 신장 스캔 소견 상 나타나는 이식신 기능저하도 이식신 장기 생존의 예후 인자가 아니었다. 단, 신장 스캔 비정상군에서 급성 거부 반응 빈도가 정상군에 비하여 유의하게 높았다. 결론: 생체 신이식 예에서 이식 직후 신장 스캔에서 이식신의 기능 저하 소견은 이식신의 장기 생존에 직접적 영향은 없으나 급성 거부 반응을 증가시켜 간접적 영향이 있을 것으로 판단된다.

• 대한한방내과학회지
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• 제21권3호
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• pp.467-475
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• 2000

The water extracts of Jagamcho-tang has been used for treatment of arrhythmia and palpitation in oriental traditional medicine. Brain is provided with blood flow by heart. Jagamcho-tang has been studied on ischemia and infarction in heart. However, little is known about the mechanism by which the water extracts of Jagamcho-tang rescues brain cells from ischemic damages. To elucidate the protective mechanism on ischemic induced cytotoxicity, the effects of Jagamcho-tang on ischemia induced cytotoxicity and generation of nitric oxide(NO) are investigated in C6 glioma cells. Jagamcho-tang induce NO in a dose dependent manner up to 2.5mg/ml in C6 glioma cells. The pretreatment of Jagamcho-tang protect sodium nitroprusside(SNP) (2mM) induced cytotoxicity. This effect of Jagamcho-tang is mimicked by treatment by pretreatment of SNP($100{\mu}M$), an exogenous NO donor. NG-monomethyl-L-arginine($N^{G}MMA$), a specific inhibitor of nitric oxide synthase (NOS), significantly blocks the protective effects of Jagamcho-tang on cell toxicity by ischemia. In addition, lipopolysaccharide(LPS) and phorhol 12 myristate 13-acetate(PMA) treatment for 72h in C6 glial cells markedly induce NO, but treatment of the cells with the water extracts of Jagamcho-tang decrease nitrite formation in a dose dependent manner. In addition, LPS and PMA treatment for 72h induce severe cell death and LDH release into medium in C6 glial cells. However treatment of the cells with the water extracts of Jagamcho-tang dose not induce significant changes compare to control cells. Furthermore, the protective effects of the water extracts of Jagamcho-tang is mimicked by treatment of $N^{G}MMA$. Taken together, I suggest that the protective effects of the water extracts of Jagamcho-tang against ischemic brain damages may be mediated by regulation of iNOS during ischemic condition.

• Tuberculosis and Respiratory Diseases
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• 제49권2호
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• pp.198-206
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• 2000

연구배경 : 골수이식후의 폐렴은 흔한 합병증이며 사망율이 높아 신속하고 정확한 원인율의 진단이 중요하며 이에 대한 기관지내시경 검사의 안전성과 유용성이 보고되고 있으나 국내에서는 이에 대한 보고가 드물었다. 저자들은 골수이식후 폐렴이 의심되는 환자를 대상으로 기관지내시경 검사를 시행하여 원인균의 동정과 임상적 특징을 조사분석하였다. 연구방법: 1997년 5월부터 2000년 4월까지 가톨릭대학교 성모병원에서 기관지내시경 검사를 시행한 골수이식후 폐렴 환자 52명을 대상으로 하였다. 총 56예에서 기관지폐포 세척액검사를 시행하여 virus 배양검사와 세균검사를 하였고 32예에서 protected specimen brush (PSB)를 이용한 정량세균 배양검사, 23예에서 경기관지 폐생검을 시행하였다. 결과 : 1) 대상환자의 평균연령은 31.3세(최소 17세에서 최고 45세)였고 남자가 37명, 여자가 15명이었다. 골수이식 방법은 혈연간 동종골수이식이 35명, 비혈 연간 동종골수이식에서는 15명, 자가 조혈포세포 이식이 2명이었다. 골수이식후 폐합병증 발생까지의 기간은 211.1 일이었으며 227일, 비혈연간 동종골수이식군에서는 169.9일, 그리고, 자가골수이식군에서는 236.5일이었다. 2) 총 56예중 33예(59%)에서 기관지폐포세척액검사로 진단이 가능했는데 cytomegalovirus와 pneumocystis carinii가 함께 발견된 폐렴이 11예(19.6%), cytomegalovirus 폐렴이 12예 (21.4%), pneumocystis carinii 폐렴이 7예(12.5%), 결핵이 2예(3.6%), $\alpha$-hemolytic streptococcus가 1예 (2.5%)에서 발견되었다. 3) 대상환자들의 X-선 소견은 대부분 전폐야를 고루 침범하는 미만성 폐침윤 병변으로 보였다. 이중 cytomegalovirus 폐렴은 주로 미세 결절성 병변을 나타냈고, pneumocystis carinii폐렴은 미만성 간유리음영을 주로 보였으며, cytomegalovirus와 pneumocystis carinii 혼합감염은 미세결절과 간유리음영이 섞여있는 모습이었다. 4) 조사대상 환자 56예종 13명 (23.2%)이 사망하였다. 사망원인은 cytomegalovirus 폐렴이 2명, pneumocytis carinii 폐렴이 2명, 두 병원균의 혼합 감염이 3명, 이식편대숙주반응이 1명, 백혈병의 진행이 1명, 원인불명의 호흡부전이 4명이었다. 5) 기관지내시경 검사에 의한 합병증은 경기관지폐생검후의 국소출혈 3예 (5.3%), 일시적인 저산소증 1예(1.7%)로 치명적인 합병증은 없었다. 결론 : 이상의 결과로 골수이식후 발생한 폐렴의 주된 원인이 cytomegalovirus와 pneumocystis carinii임을 알수 있었고, 진단에 있어 기관지폐포세척액 검사가 안전하고 유용한 방법일 것으로 생각된다.

• Journal of Chest Surgery
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• 제46권2호
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• pp.111-116
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• 2013

Background: Heart transplantation in elderly patients has raised concerns because of co-morbidities and limited life expectancy in the era of donor shortage. We examined the outcomes after heart transplantation in elderly patients. Materials and Methods: From March 1994 to December 2011, 81 patients (male:female=64:17, $49.1{\pm}14.0$ years) underwent heart transplantation. The outcomes after heart transplantation in the younger patients (<60 years; group Y, n=60) were compared with those in the elderly patients (${\geq}60$ years; group O, n=21). The follow-up duration was $51.8{\pm}62.7$ months. Results: Early mortality (${\leq}30$ days) occurred in 5.0% (3/60) and 4.8% (1/21) of groups Y and O, respectively (p>0.999). There were no differences in overall survival between the two groups (p=0.201). Freedom from rejection was higher in group O than in group Y (p=0.026). Multivariable analysis revealed that age ${\geq}60$ years was not a significant risk factor for long-term survival; postoperative renal failure was the only significant risk factor for long-term survival (p=0.011). Conclusion: Early and mid-term results of heart transplantation in elderly patients were similar to those in younger patients.

• 대한한방내과학회지
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• 제21권1호
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• pp.46-54
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• 2000

Objectives : Talmyung-san(TMS) has been used for treatment of brain diseases in Chinese traditional medicine. However, little is known about the mechanism by which TMS rescues brain cells from ischemic damages. To elucidate the protective mechanisms of TMS, we execute experiments. Methods : The effects of TMS on ischemia/reperfusion-induced cytotoxicity and generation of nitric oxide(NO) are investigated in primary neonatal myocardial cells and A7rS, aortic smooth muscle cell line. Results : Ischemia/reperfusion itself induces severe myocardial cell death in vitro. However, treatment of the cells with TMS significantly reduces both ischemia/reperfusion-induced myocardial cell death and LDH release. In addition, pretreatment of TMS before reperfusion recovers the lose of beating rates alter ischemia/reperfusion. For a while, the water extract of TMS stimulates myocardial cells to produce NO in a dose dependent manner and it protects the damage of ischemia/reperfusion-induced myocardial cells. Furthermore, the protective effects of the water extract of TMS is mimicked by treatment of sodium nitroprusside, an exogenous NO donor. NG-monomethyl-L-arginine (NGMMA), a specific inhibitor of nitric oxide synthase(NOS), significantly blocks the protective effects of TMS on the cells after ischemia/reperfusion. In addition, on ischemia the water extract of TMS induce NO in A7r5 cell. Conclusions : Taken together, we suggest that the protective effects of TMS against ischemia/reperfusion-induced myocardial damages may be mediated by NO production of myocardial and vascular smooth muscle cell during ischemic condition.