• Journal of Chest Surgery
• /
• 제37권6호
• /
• pp.467-473
• /
• 2004

배경: 심방세동의 수술적 치료 방법인 미로술식에 있어 고주파에너지를 이용한 절제술은 전통적인 절개 및 봉합술 (cut and saw) 또는 냉동절제술(cyroablation)에 비해 술 후 동율동의로의 전환율이 낮은 것으로 알려져 있다. 이는 절제술 시 심방벽 (atrial wall)과 도자 간의 접촉이 원활하지 않아 심방의 전층에 걸쳐 고주파 에너지가 전달되지 않기 때문인 것으로 생각된다. 이에 고주파 절제시 심방과 도자간의 접촉을 원활하게 하기 위한 기구를 개발하였으며 동물실험을 통하여 그 임상적인 효과를 관찰하고자 하였다. 대상 및 방법: 60 kg 내외의 돼지 10 마리를 대상으로 하였다. 우심방이 첨부로부터 3∼4 cm 하방의 심방외벽에 고주파에너지를 가하여 우심방이가 우심방에서 완전히 분리되도록 원형의 병변 (circumferential lesions)을 만들었다. 이때 실험군(n=5)에서는 새로 고안한 기구를 이용하여 도자를 심방벽에 완전히 밀착시킨 후 고주파 에너지를 가하였으며, 대조군(n=5)에서는 이러한 기구의 사용 없이 통상적인 방법으로 에너지를 가하였다. 고주파절제술이 끝난 후 우심방이 첨부에 인공심장박동 전극을 설치하고 심박동을 유발하여 고주파 절제부위 이하로 심박동이 전달되는지를 관찰하여 절제술의 성공 여부를 판단하였다. 또한 심방조직에 대해 조직학적 검사를 시행하여 심외막, 심근, 그리고 심내막층에 고주파에너지에 의한 열손상의 생성 유무를 관찰하였다. 결과: 실험군에서 5예, 대조군에서 3예 등 총 8예에서 심박동의 전달 차단 (conduction block)이 관찰되었으며 조직학적 검사 소견상 심내막(endocardium)에서 탄성섬유(elastic fiber)의 소실과 급성 염증세포의 축적 등 급성 열손상의 소견이 관찰되었다. 한편 심박동의 전달 차단이 관찰되지 않았던 대조군의 2예에서는 심내막이 정상으로 나타났다. 또한 기관 및 식도에 대한 조직학적 검사에서 열손상에 의한 병변은 관찰되지않았다. 결론: 고주파에너지에 의한 절제술 시 심방의 전층에 병변을 만들기 위해서는 심장과 도자간의 접촉이 가장 중요한 인자로 생각된다. 본 연구에서 새로 개발한 기구는 고주파에너지를 이용한 도자절제술 시 심장과 도자 간의 확고한 접촉을 유도하여 심방 전층에 병변을 만드는 데 매우 효과적이었으며 이러한 기구의 사용은 향후 고주파에너지를 이용한 미로술식의 성적향상에 도움이 될 것으로 사료된다.

• 식물조직배양학회지
• /
• 제27권6호
• /
• pp.423-428
• /
• 2000

In 1997 when cloned sheep Dolly and soon after Polly were born, it had become head-line news because in the former the nucleus that gave rise to the lamb came from cells of six-year-old adult sheep and in the latter case a foreign gene was inserted into the donor nucleus to make the cloned sheep produce human protein, factor IX, in e milk. In the last few years, once the realm of science fiction, cloned mammals especially in livestock have become almost commonplace. What the press accounts often fail to convey, however, is that behind every success lie hundreds of failures. Many of the nuclear-transferred egg cells fail to undergo normal cell divisions. Even when an embryo does successfully implant in the womb, pregnancy often ends in miscarriage. A significant fraction of the animals that are born die shortly after birth and some of those that survived have serious developmental abnormalities. Efficiency remains at less than one % out of some hundred attempts to clone an animal. These facts show that something is fundamentally wrong and enormous hurdles must be overcome before cloning becomes practical. Cloning researchers now tent to put aside their effort to create live animals in order to probe the fundamental questions on cell biology including stem cells, the questions of whether the hereditary material in the nucleus of each cell remains intact throughout development, and how transferred nucleus is reprogrammed exactly like the zygotic nucleus. Stem cells are defined as those cells which can divide to produce a daughter cell like themselves (self-renewal) as well as a daughter cell that will give rise to specific differentiated cells (cell-differentiation). Multicellular organisms are formed from a single totipotent stem cell commonly called fertilized egg or zygote. As this cell and its progeny undergo cell divisions the potency of the stem cells in each tissue and organ become gradually restricted in the order of totipotent, pluripotent, and multipotent. The differentiation potential of multipotent stem cells in each tissue has been thought to be limited to cell lineages present in the organ from which they were derived. Recent studies, however, revealed that multipotent stem cells derived from adult tissues have much wider differentiation potential than was previously thought. These cells can differentiate into developmentally unrelated cell types, such as nerve stem cell into blood cells or muscle stem cell into brain cells. Neural stem cells isolated from the adult forebrain were recently shown to be capable of repopulating the hematopoietic system and produce blood cells in irradiated condition. In plants although the term$\boxDr$ stem cell$\boxUl$is not used, some cells in the second layer of tunica at the apical meristem of shoot, some nucellar cells surrounding the embryo sac, and initial cells of adventive buds are considered to be equivalent to the totipotent stem cells of mammals. The telomere ends of linear eukaryotic chromosomes cannot be replicated because the RNA primer at the end of a completed lagging strand cannot be replaced with DNA, causing 5' end gap. A chromosome would be shortened by the length of RNA primer with every cycle of DNA replication and cell division. Essential genes located near the ends of chromosomes would inevitably be deleted by end-shortening, thereby killing the descendants of the original cells. Telomeric DNA has an unusual sequence consisting of up to 1,000 or more tandem repeat of a simple sequence. For example, chromosome of mammal including human has the repeating telomeric sequence of TTAGGG and that of higher plant is TTTAGGG. This non-genic tandem repeat prevents the death of cell despite the continued shortening of chromosome length. In contrast with the somatic cells germ line cells have the mechanism to fill-up the 5' end gap of telomere, thus maintaining the original length of chromosome. Cem line cells exhibit active enzyme telomerase which functions to maintain the stable length of telomere. Some of the cloned animals are reported prematurely getting old. It has to be ascertained whether the multipotent stem cells in the tissues of adult mammals have the original telomeres or shortened telomeres.