Comparison of Two Real-Time PCR Assays for Apolipoprotein E Genotyping / 임상검사와정도관리

Apolipoprotein E (APOE) polymorphisms are used as biological markers to assess the risk of cardiovascular disease, dyslipidemia, and Alzheimer's disease. Consequently, APOE genotyping is one of the most frequently conducted tests in clinical molecular laboratories. Although APOE genotyping may appear to be uncomplicated and a relatively easy test to perform, genotyping errors can still occur due to polymorphisms near codons 112 and 158 in the human APOE gene. Therefore, validation and verification of APOE genotyping assays before clinical use are essential. So far, we have been using the TaqMan SNP Genotyping Assay (Life Technologies, USA). However, recently, the Real-Q ApoE genotyping kit (BioSewoom, Korea) was approved by the Korean Ministry of Food and Drug Safety, which led us to compare the results obtained from this genotyping kit to those of the TaqMan SNP Genotyping Assay. The Real-Q ApoE genotyping kit yielded correct genotyping results for all six APOE genotypes and provided concordant results with the TaqMan SNP Genotyping Assay in a series of blinded comparison samples. Thus, we validated its use in clinical tests.

Comparison of Two Real-Time PCR Assays for Apolipoprotein E Genotyping / 임상검사와정도관리

Apolipoprotein E (APOE) polymorphisms are used as biological markers to assess the risk of cardiovascular disease, dyslipidemia, and Alzheimer's disease. Consequently, APOE genotyping is one of the most frequently conducted tests in clinical molecular laboratories. Although APOE genotyping may appear to be uncomplicated and a relatively easy test to perform, genotyping errors can still occur due to polymorphisms near codons 112 and 158 in the human APOE gene. Therefore, validation and verification of APOE genotyping assays before clinical use are essential. So far, we have been using the TaqMan SNP Genotyping Assay (Life Technologies, USA). However, recently, the Real-Q ApoE genotyping kit (BioSewoom, Korea) was approved by the Korean Ministry of Food and Drug Safety, which led us to compare the results obtained from this genotyping kit to those of the TaqMan SNP Genotyping Assay. The Real-Q ApoE genotyping kit yielded correct genotyping results for all six APOE genotypes and provided concordant results with the TaqMan SNP Genotyping Assay in a series of blinded comparison samples. Thus, we validated its use in clinical tests.

Prevention of Complication and Management of Unfavorable Results in Reduction Malarplasty

PURPOSE: Reduction malarplasty is a popular aesthetic surgery for contouring wide and prominent zygoma. However a few patients complain postoperative results and want to revise the midfacial contour. We analyzed the etiology of unfavorable results and treated unsatisfied midfacial contours after reduction malarplasty. METHODS: Total 53 patients were performed secondary operation for correction of unfavorable results after primary reduction malarplasty from elsewhere. Midfacial contour was evaluated with plain films and three- dimensional computed tomography. Unfavorable midfacial contours were corrected by secondary malarplasty. Flaring of zygomatic arch was reduced with infracturing technique and prominent zygomatic body was reduced with shaving. Drooped or displaced zygoma complex has been suspended to higher position and fixed with interosseous wiring. As adjuvant procedure, autologous fat injection has been performed in the region of depressed zygomatic body region. RESULTS: The etiology of unfavorable midfacial contour after reduction malarplasty was classified into 7 categories: undercorrection of zygomatic arch(n=8), undercorrection of zygomatic arch and undercorrection of zygomatic body(n=6), undercorrection of zygomatic arch and overcorrection of zygomatic body(n=28), overcorrection of zygomatic body(n=3), simple asymmetry(n=4), malunion(n=2) or nonunion(n=2). Slim and balanced malar contour was achieved with treatment. And most of the patients were satisfied with the results of the surgery. CONCLUSION: To prevent the unfavorable results after reduction malarplasty, complete analysis of facial contour, choice of appropriate operation technique, precise osteotomy under direct vision, and security of zygoma position are important.

Facial Rejuvenations in North East Asians

In North East Asians, they have many anatomical characteristics different from Caucasians: thick skin, heavy subcutaneous tissue, relatively weak SMAS and platysma muscle, prominent zygoma and mandible. In addition, Caucasians have lean and narrow face, so facial flap can easily be lifted superiorly and posteriorly, but North East Asians have short and wide face, so facial flap cannot be lifted easily in a three dimensional direction especially superiorly and posteriorly. Recent facial rejuvenation has been improved to solve these problems through various combined adjuvant surgery. We performed facial rejuvenation with following surgical emphases:1. Shaving and infracture of zygomatic prominence and multistaged curved osteotomy of the prominent mandibular angle, body and symphysis 2. Earlier Skin resection before flap dissection protects the skin incision margin 3. Sufficient fat removal by facial liposuction4. Plane of dissection; suborbicularis and submalar fat pad in midface: preplatysmal layer in lower face and neck 5. Excision of lateral part of orbicularis oculi muscle for correction of crow's feet. 6. SMAS plication and platysmal sling. Based on our experiences, we offer these personal techniques for facial rejuvenation of North East Asians.

The Effects of New Recombinant Protein of Fibronectin and beta ig-h3, T-CAM(Tetra Cell Adhesion Molecule) on Wound Healing

T-CAM(Tetra cell adhesion molecule) is new recombinant mixture of fibronectin and beta ig-h3. Fibronectin and beta ig-h3 are extracellular matrix protein involved in each phase of wound healing and sum of these materials may play synergistic effect on the wound healing. In order to evaluate wound healing effect of T-CAM on open wound in rabbit, we made four round full thickness skin defects, 3 cm in diameter, bilaterally on the dorsolateral aspect of New Zealand white rabbit's trunk. We divided the wound into four groups, according to the content of topocally applied onitments: Group A treated with ointment base only; Group B with ointment containing fibronectin microgram/ml; Group C with ointment containing beta ig-h3 300 microgram/ml; Group D with ointment containing T-CAM 300 microgram/ml. These ointments were applied daily on the wound. We compared each group with gross findings by means of percentage of wound contraction, percentage of wound epithelization and percentage of total wound healed area with surface tracing the remained wound area on the 0, 6,th 12th, 18th day after wound formation and wound biopsy were performed on the 3rd, 6th, 10th, 14th, and 21st day after wound formation.The T-CAM group shows statistically significant (p < 0.05 ANOVA test and Scheffe's test) in wound contraction and totalwound healed area than other groups on the 6th day after wound formation, and equally significant on the 12th and 18th day after wound formation except in group C. In histological examination, T-CAM group shows less inflammatory cell infiltration, faster angiogenesis and marked fibroblast proliferation than other groups in early inflammatory period, and more matured, thickened reepithelization and regularly aligned collagen formation on the 14th and 21st day. This study suggest recombinant T-CAM shows synergistic effect on wound healing, and is expected as new potent material for treatment of wound healing.

Effect of Growth Hormone on Early Bony Regeneration in Distraction Osteogenesis

The purpose of this project was to study the effect of growth hormone on early bony consolidation in distraction osteogenesis of a dog mandible. Sixteen dogs were used for this study. An external distraction device was applied to the mandibular body and the mandibular distraction was started five days after the operation at a rate of 1 mm per day up to a 10-mm distraction. Dogs in the growth hormone group received a daily subcutaneous injection of 1 IU of recombinant human growth hormone per kilogram of body weight per week. Normal saline was injected in the control group. Bone mineral density was higher in the growth hormone group than the control group in the whole period. Bone mechanical strength was 300% higher in the growth hormone group than that in the control group. However, results were more suggestive than conclusive. Upon histological examination, the formation of a substantial amount of active woven bone was observed throughout the distracted zone in 6 weeks in the growth hormone group. In the control group, new bone was generated from the edge to the center of the distracted zone. But, the most central area of the distracted zone was filled with fibrous tissue in 6 weeks. In conclusion, growth hormone appears to be effective in early bony consolidation in distraction osteogenesis.

Wound Healing Effect of the Chitosan Sponge

Chitosan is a polysaccharide obtained by deacetylating chitin which is the major constituent of the exoskeleton of crustaceous water animals. Chitosan has many useful biological properties such as biocompatibility, biodegradability, hemostatic effect, antimicrobial activity and the ease of chemical modification. In order to evaluate the efficacy of chitosan as a wound dressing material, authors prepared chitosan as a sponge form and compared it with ointment dressing material, amniotic membrane and hydrocellular dressing material through the animal experiment. Four round( 3 cm) full thickness skin defect were made bilaterally on the dorsolateral aspect of the New Zealand white rabbit's trunk and four groups of dressing material -chitosan sponge, ointment dressing material, amniotic membrane and hydrocellular dressing material-were applied on the wound and evaluated grossly and histopathologically. We compared gross finding by means of percentage of wound contraction, percentage of wound epithilization and percentage of wound healed by tracing the remained wound area every week and wound biopsy were performed every other day. Chitosan sponge group and amniotic membrane group show statistically higher percentage of wound contraction and higher percentage of wound healed than the other groups (p < 0.05). Hydrocellular dressing material group shows statistically lower percentage of wound epithelization than the others(p < 0.05). During the inflammatory phase (postwounding day 1-5) chitosan sponge group and amniotic membrane group absorbed exudate effectively and demonstrate less inflammatory cell infiltration, which induce faster angiogenesis and fibroblast proliferation than the other groups. This study suggest chitosan has a potential as a new dressing material because of high absorbency of exudate, promotion of wound contraction and reduction of inflammatory reaction during the inflammatory phase of wound healing.

Digital Photography in Plastic Surgery

Photography is essential for facial plastic surgery practice and has been used for documentation of patients, assessment of operative result, research, education, publication and medicolegal defense. With rapidly advancing technology, digital photography is emerging as a standard method for patient documentation in clinical setting. Digital photogrphs are captured on CCD(charged coupler device) of camera, and stored in flash memory in camera such as Compact Flash and Smarta Media card and transferred to a computer. The image may be immediately viewed on LCD(liquid crystal display) screen of the camera and reshot if necessary, and may be manipulated using photo-editing software programs, easily incorporated into digital presentation. The advantage of long-term storage, easy retrieval, and database organization make digital photography even more appealing. The authors intend to discuss considerations in selecting digital camera and photographic methods to acquire better image in plastic practice, and recommend digital photography as a new standard for conventional 35-mm film photography for general use in plastic surgery.

Surgical Correction of the Prominent Ear using the Posterior Approach

In prominent ears, major common deformities are a poorly developed antihelical fold and the formation of excessive conchal cartilage, in particular the posterior conchal wall. Goal of the surgical correction of prominent ears is narrowing of the conchoscaphal angle by folding of the antihelix and reduction of the concha. In this study, cartilage sparing otoplasty is refined by the addition of minimal dissection of the medial and lateral margin of the medial and lateral cut cartilage through the posterior approach and horizontal mattress sutures between two margins. A total of 9 patients were operated between 1999 and 2001. Among them, 4 patients were bilateral and 5 patients were unilateral. There were no hematomas. There was mild recurrence of the upper antihelical fold in one patient who requested further surgery. Two patients developed suture extrusion. This technique is a simple and safe procedure with reliable results and does not cause anterior scarring or skin necrosis.

The Treatment of Palpebral Bags by Repositioning of Orbital Fat into a Subperiosteal Pocket

Baggy eyelids or palpebral bags of the lower eyelids are mainly caused by weakening of the orbital septum, atrophy of the orbicilaris oculi muscle and slackness of the skin. These palpebral bags are usually combined with a depression along the inferior orbital rim which is called a tear trough groove and a tear trough groove can be divided into a nasojugal groove and a palpebromalar groove. Excision of the protruded orbital fat as a treatment for palpebral bags may contribute in the long term to the senile enophthalmos due to a volume reduction of the intraorbital adipose tissue. Authors treated palpebral bags and tear trough grooves by reposition of orbital fat flaps into a subperiosteal pocket of the inferior orbital rim. Myocutaneous flaps from the lower eyelids were elevated through subciliary incisions to expose the inferior orbital rim and subperiosteal pockets were made on the orbital rim. The orbital fat flaps protruded through the incised orbital septum near the arcus marginalis were repositioned into the subperiosteal pockets by two or three horizontal mattress sutures. Nine patients with palpebral bags and tear trough grooves were operated with this technique and follow-up range was between 6 to 14 months(an average of 11 months). Palpebral bags and tear trough grooves were corrected well and youthful looking eyes were obtained. The main advantages of this technique are that; the first, we can get wide operative field and easy repositioning of orbital fat into the subperiosteal pocket through the transcutaneous approach than the transconjunetival approach, the second, subperiosteal repositioning of the orbital fat can make more even and smooth skin surface over the periorbital region than the supraperiosteal repositioning of the orbital fat due to coverage of the irregular fat lobules by the periosteum and the third, lower blepharoplasty can be combined with this technique.

The Effect of the Periosteum for the New Bone Formation into Bone Substitutes

To investigate the effect of the periosteum for the new bone formation into bone substitutes, artificial full thickness calvarial bone defects were made in diameter of 6mm in 45 New Zieland white rabbits and the defects were filled with Medpor(R) and Biocoral(R) as bone substitutes and with Surgicel(R) as control material. Each group was then divided into three sub-groups: non-periosteal group, periosteal flap group and periosteal graft group. Bone formation was investigated morphologically, radiologically and histologically and the degree of bone formation was calculated with scanner(Scanmaker III, Microtek Co.)and image processing program. In the non-periosteal group, there was no bone formation in all artificial bone substitutes 10 days after experiment. The amount of bone formation in Biocoral(R), Medpor(R) and Surgicel(R) was 3.58 +/- 1.70%, 0.00%, 2.11 +/- 1.73% respectively 6 weeks after experiment, and 27.43 +/- 11.92%, 15.72 +/- 5.47% and 3.59 +/- 2.18% respectively 3 months after experiment. In the periosteal flap group, there was no bone formation in Medpor(R) and Surgicel(R) but 6.84 +/- 3.21% of the bone formation in Biocoral(R) 6 weeks after experiment. The amount of bone formation in Biocoral(R), Medpor(R) and Surgicel(R) was 41.83 +/- 11.32%, 20.72 +/- 6.53% and 22.32 +/- 5.85% respectively 3 months after experiment. In the periosteal graft group, there was cartilage formation in Biocoral(R) and Medpor(R) 10 days after experiment. The amount of bone formation in Biocoral(R), Medpor(R) and Surgicel(R) was 25.38 +/- 6.49%, 17.16 +/- 4.03%, 7.95 +/- 3.17% respectively 6 weeks after experiment and 80.87 +/- 11.24%, 41.20 +/- 8.87%, 44.93 +/- 16.48% respectively 3 months after experiment. In conclusion, the periosteum played an important role for the bone formation into bone substitutes of Biocoral(R) and Medpor(R). The amount of bone formation was the greatest in the periosteal graft group among three groups and greater in Biocoral(R) than in Medpor(R).

Correction of Severe Cleft Lip Nasal Deformity Using Composite Graft

Correction of the severe cleft lip nasal deformity is challenging and we used the composite graft to correct the cleft lip nasal deformity with severe tissue deficiency or severe nostril asymmetry. A total of 19 patients, who were born with complete cleft type, was operated between 1995 and 1999. Among them, 10 patients were men and nine were women. Age distribution was seven to 35 years old. In nine patients with unilateral cleft lip nasal deformity and six patients with bilateral cleft lip nasal deformity, columella lengthening was performed using composite graft taken from the helix in 14 cases and contralateral alar rim in one case. In four patients with severe asymmetric nostrils due to a short alar rim in unilateral cleft lip nasal deformity, the ear helix was used in two cases. while in the other two cases the alar rim of the unaffected side was transferred to the affected side to make symmetric nostril by reducing the length of the alar on the affected side. Follow up periods ranged from one to three years, and results were as follows: 1. Four days after the graft, the composite tissue exhibited a pinkish color. Complete survival was confirmed after seven days. The absorption rate observed was about 10 percent and color mismatch became minimal with time. 2. Composite tissue taken from the ear was found to be useful for a full layer reconstruction of the alar and columella due to its stiffness, thin nature, and similarity. Composite tissue from the alar rim of the contralateral side was also determined as good material for a full layer reconstruction of the deficient alar.

Investigation of the Appropriate Session for Changing Treatment Modality in situ Extracorporeal Shock Wave Lithotripsy for Ureteral Stones / 대한비뇨기과학회지

No abstract available.

Predictive Value of Microstaging in the Recurrence and the Progression of T1 Superficial Bladder Cancer / 대한비뇨기과학회지

PURPOSE: There are many prognostic factors in the recurrence and the progression of T1 superficial bladder cancer. Among these factors, microstaging evaluation in T1 bladder cancer may be of important value in patients with T1 superficial bladder cancer. To evaluate the usefulness of microstaging evaluation, we analyzed the microstage in T1 superficial bladder cancer and analyzed the recurrence rate and the progression rate of each microstage. MATERIALS AND METHODS: A retrospective analysis was done on 87 patients with T1 primary superficial bladder cancer managed in our hospital between January 1992 and April 1998. Microstages were assigned according to the following system: pT1a, invasion of lamina propria: pT1b, invasion to the level of the muscularis mucosa; pT1c, invasion through the muscularis mucosa but superficial to the muscularis propria. We analyzed the relationship between the microstage and the grade, the relationship between the recurrence or the progression of diseases and the grade of the tumor, the relationship between the grade or the microstage and the recurrence of diseases. All specimens were obtained from transurethral resection. RESULTS: The recurrence rates of pT1a, pT1b and pT1c were 9.1%(3/33), 40%(8/33) and 64.7%(22/33) respectively(p<0.001). The progression rates of pT1a, pT1b and pT1c were 0%(0/33), 10%(2/20) and 20.6%(7/34) respectively(p=0.005). The recurrence rates of grade I, grade II and grade III were 23.1%(3/13), 26.7%(12/45) and 62.1%(18/29) respectively(p=0.002). The progression rates of grade I, grade II and grade III were 7.7%(1/13), 4.4%(2/45) and 20.7%(6/29) respectively(p=0.062). pT1a, pT1b and pT1c were 21.2%(7/33), 20%(4/40) and 5.9%(2/34) in the patients of the grade I. pT1a, pT1b and pT1c were 69.7%(23/33), 50%(10/20) and 35.3%(12/34) in the grade II. pT1a, pT1b and pT1c were 9.1%(3/33), 30%(6/20) and 58.8%(20/34) in the grade III. Thus the relationship between the grade and the microstage was statistically significant(p=0.001). The recurrece rates of pT1a in the grade I, pT1b in the grade I and pT1c in the grade I were 14.3%(1/7), 0%(0/4) and 100%(2/2). The recurrence rates of pT1a in the grade II , pT1b in the grade II and pT1c in the grade II were 8.7%(2/23), 40%(4/10) and 50%(6/12). The recurrence rates of pT1a in the grade III, pT1b in the grade III and pT1c in the grade III were 0%(0/3), 66.7%(4/6) and 77.8%(14/20)(p=0.176). The progression rates of pT1a in the grade I, pT1b in the grade I and pT1c in the grade I were 0%(0/7), 0%(0/4) and 50%(1/2). The progression rates of pT1a in the grade II, pT1b in the grade II and pT1c in the grade II were 0%(0/23), 10%(1/10) and 8.3%(1/12). The progression rates of pT1a in the grade III, pT1b in the grade III and pT1c in the grade III were 0%(0/3), 16.7%(1/6) and 25%(5/20)(p=0.526). CONCLUSIONS: Microstaging in T1 superficial bladder cancer appears to be a significant prognostic factor in the recurrence and the progression of the diseases.