Does Retaining Ligament Exist in the Neck? / 체질인류학회지

The goal of this study was to determine the characteristics of the horizontal cervical wrinkle and to investigate histological feature, especially with respect to elastin and collagen fiber. Histologic sample were harvested from two fresh adult cadavers where the cervical wrinkle is in the neck. The tissue sections were stained with hematoxylin and eosin (HE) or Masson's Trichrome. In sections of neck skin, keratinization was observed in the epidermis, and many collagen fibers were observed in the dermis layer as in other skin. Specifically, a lot of short and curly elastic fiber were observed between the collagen fibers in the dermis. These elastic fibers were not stained with eosin and observed in gray. This long ligament-like structures were observed in the dermis. The ligament-like structures were stained with dark red by trichrome. These results indicate that these ligament-like structures are neither typical ligament nor typical smooth muscles. The results obtained from present study showed a ligamentous structure originating from the fascial layer (platysma muscle or investing layer). The results may help to understand the reasons about the formation of horizontal cervical wrinkle.

Surgical Complications are Major Problems Concerning Overseas Kidney Transplantation in Comparison Study with Domestic Deceased Donor Kidney Transplantation / 대한이식학회지

PURPOSE: As increasing overseas kidney transplant recipients, the post-transplantation management of these recipients is not unusual. Shortage of donor information and operative findings is an obstacle to post-transplant evaluation and management of overseas transplant recipients. We retrospectively reviewed the post-transplant clinical manifestation of overseas transplant recipient, and compared with those of domestic deceased donor transplant recipient. METHODS: Sixty overseas transplant recipients and 39 deceased donor transplant recipient in our center from January 2002 to August 2006 were enrolled in this study. Among the post-transplant outcomes, we focused the episodes of post-transplant complication, acute rejection and graft functional status. RESULTS: In comparison of pre-transplant clinical manifestation, overseas transplant recipients were more elderly, male predominant and less retransplantation than domestic deceased transplant cases. Remarkable surgical complications (35%, 21/60) were observed in overseas transplant recipients which was significantly higher than those of domestic transplant recipients (5.1%, 2/39 cases)(P=0.03). The urologic complication was major (14 cases) complication, and intraoperative hematoma (5 cases) and vascular complication (2 cases) succeed. Interventional procedure or surgical correction was performed in six recipients with urinary leakage obstruction. Excluding post-transplant acute tubular necrosis, the post-transplant outcomes, such as incidence of acute rejection, graft survival rate and graft function within post-transplant 3 year, of overseas transplant recipient were statistically similar with these of domestic deceased donor recipients. CONCLUSION: Considering that overseas transplant recipient had high incidence of surgical or urologic complication, the initial evaluation of post-transplant recipient was focused on completion of surgical procedure by using radiologic imaging study.

The Efficacy of Pre-transplant Radiologic Evaluation for Graft Volume and Anatomy in Living Donor Liver Transplantation / 대한이식학회지

PURPOSE: For securing donor safety in living donor liver transplantation (LDLT), we must know the anatomy of hepatobiliary and vascular structures as well as donor-recipient hepatic volume profile. The purpose of this study was to ascertain the role of donor-recipient evaluation by using pre-operative radiologic studies. METHODS: Prospective pre-operative analyses of 94 LDLT candidate pairs (74 recipients and 94 donors) were performed. Tomographic images were reconstructed by 3-dimensional images and used as a resource of calculation of liver volume profile and anatomic structure evaluation. RESULTS: The percentage of anatomical variation in portal, hepatic vein, hepatic artery and bile duct were 20.2, 41.5, 21.3 and 33.0%, respectively. Among 94 cases, 52 (55.4%) potential donors were unacceptable for LDLT due to a various reasons. The leading cause of unacceptability of donor was anatomical variation (n=24, 25.5%) such as anatomical variation of middle hepatic vein drainage patterns (n=20, 21.3%). Too small residual volume of donor (n=17, 18.1%) and 'small-for-size' (n=5, 5.3%) were also considered criticalcauses of unacceptable donor. Only 19 out of 94 cases underwent suc-cessful living donor right hepatic lobe transplantation. CONCLUSION: Pre-transplant evaluations of liver volume and anatomic structure by using three-dimensional imaging study and computerized volume measurement system is useful for performing safe LDLT.

T-tube Related Complication in Overseas Liver Transplantation Recipients / 대한이식학회지

Biliary decompression by T-tube in liver transplantation can reduce the stenosis of biliary anastomosis site, but increase the biliary leakage. Therefore, policy of T-tube insertion is different in each transplantation center. Recently the overseas liver transplantations, especially from China, are increasing, and most of these recipients are transferred with T-tube insertion status. Due to limited operative information, T-tube related complications are frequently occurred. We report four cases of T-tube related biliary complication according to the diagnosis timing after T-tube removal, who underwent liver transplantation in China. The symptoms and treatment was variable from conservative management to open laparotomy. The 3 of 4 cases was the bile leakage after T-tube removal. In early diagnosed case after T-tube removal, the bile leakage was easily controlled by non invasive procedures. If the diagnosis was delayed, not only invasive procedures but also open laparotomy was required for control of bile leakage.

Long-term Effect of Steroid-free Immunosuppressive Protocol in Kidney Transplantation / 대한이식학회지

Purpose: Early experience of steroid-free immunosuppressive protocol for kidney transplant recipient was unsatisfactory due to a remarkable incidence of acute rejection. We also attempted steroid-free protocol in 1990, and experienced painful early result. Therefore, steroid-free protocol have not been tried since 1990. Now, we retrospectively reviewed our experience of steroid-free protocol which was performed in 1990, and verified the long-term effect of steroid-free protocol. Methods: Among 149 recipients who underwent living donor kidney transplantation in 1990, 48 recipients with stable graft function were enrolled in this study. Cyclosporine and steroid were administrated as a maintenance immunosuppressive regimen without induction immunosuppression such as anti- lymphocyte antibodies. Steroid was gradually reduced for 6~8 weeks at 2~3 month after transplantation. If acute rejection or graft dysfunction was developed during tapering period or after cessation, steroid was restarted. And such tapering failure and restart group were defined as steroid-free failure group. We compared the clinical outcomes of steroid-free trial group compared with non-trial (control) group. Results: 17 (35.4%) of 48 recipients failed in steroid-free protocol finally. Acute rejection was the most common cause of steroid-free failure by 11 (64.7%) recipients, and most failure (12 recipients, 70.6%) occurred within 1 year after transplantation. Therefore failure group showed significant inferior graft survival rate than steroid-free group (35.3% versus 80.7%, P=0.001). The overall steroid-free trial group showed similar graft survival rate compared with control group. But the steroid-free group showed superior graft survival rate than control without statistical significance (80.7% versus 60.4%, P=0.383). And also showed lower incidence of post- transplant diabetes, hypertension, hyperlipidemia and bone disease without or with significance. Conclusion: The steroid- free protocol without addition of other immunosuppressive agent causes high incidence of acute rejection and poor graft survival. Hwoever, success group to steroid-free protocol shows beneficial effect in graft survival rate and post- transplant complications.

Effect of Modification of Immunosuppressive Regimen on Renal Allograft Survival Rate in Recipients with Mild Chronic Rejection / 대한이식학회지

Purpose: Concept that modification of immunosuppression can delay the deterioration of graft function and graft failure is the one of strategies for chronic rejection. We analyzed the effect of modification of immunosuppression in 116 recipients with biopsy confirmed mild chronic rejection retrospectively. Methods: Mild chronic rejection was diagnosed by single renal pathologist under the uniformed criteria; mild tubular atrophy & interstitial fibrosis (less than 25%) combined with vascular change such as fibrous intimal thickening. General rules of modification after chronic rejection in our center were (1) strict adjustment of cyclosporine (CsA) dosage around 100~120microgram/L of trough blood level, (2) triple conversion in double therapy recipients (add anti-metabolites; azathioprine or MMF), (3) dose increment of anti-metabolites, (4) maintain of immunosuppression if ongoing immunosuppression is satisfactory to above criteria. Results: After 74.8+/-44.5 months of follow-up, we identified 72 graft failures (62.1%). Overall post-diagnosis graft survival rate were 93.1%, 79.7%, 63.6% and 35.8% in 1, 3, 5 and 10 years respectively. The status of graft function categorizedn by stage of chronic kidney disease (CKD) at diagnosis (CKD 4 or 5 stage), timing of diagnosis (more than post-transplant 3 years) and presence of severe proteinuria (more than 1 g/day of urinary excretion) were significant risk factors affecting the post-diagnosis graft survival rate. In multivariate survival analysis, these factors were confirmed as independent variables affecting post-diagnosis graft survival rate. But modification of immunosuppressive regimen after mild chronic rejection which was classified by modification (yes versus no), type of anti-metabolites (azathioprine versus MMF) and change of immunosuppressive strength (equal versus additional versus incremental) didn't cause the significant difference of post-diagnosis graft survival rate. Conclusion: Though pathologic change is mild, the modification of immunosuppression is not effective to delay graft failure in renal allograft recipient with pathologically established chronic rejection.

STRAIN AND TEMPERATURE CHANGES DURING THE POLYMERIZATION OF AUTOPOLYMERIZING ACRYLIC RESINS / 대한치과보철학회지

The aims of this experiment were to investigate the strain and temperature changes simultaneously within autopolymerizing acrylic resin specimens. A computerized data acquisition system with an electrical resistance strain gauge and a thermocouple was used over time periods up to 180 minutes. The overall strain kinetics, the effects of stress relaxation and additional heat supply during the polymerization were evaluated. Stone mold replicas with an inner butt-joint rectangular cavity (40.0x25.0mm, 5.0mm in depth) were duplicated from a brass master mold. A strain gauge (AE-11-S50N-120-EC, CAS Inc., Korea) and a thermocouple were installed within the cavity, which had been connected to a personal computer and a precision signal conditioning amplifier (DA 1600 Dynamic Strain Amplifier, CAS Inc., Korea) so that real-time recordings of both polymerization-induced strain and temperature changes were performed. After each of fresh resin mixture was poured into the mold replica, data recording was done up to 180 minutes with three-second interval. Each of two poly (methyl methacrylate) products (Duralay, Vertex) and a vinyl ethyl methacrylate product (Snap) was examined repeatedly ten times. Additionally, removal procedures were done after 15, 30 and 60 minutes from the start of mixing to evaluate the effect of stress relaxation after deflasking. Six specimens for each of nine conditions were examined. After removal from the mold, the specimen continued benchcuring up to 180 minutes. Using a waterbath (Hanau Junior Curing Unit, Model No.76-0, Teledyne Hanau, New York, U.S.A.) with its temperature control maintained at 50degrees C, heat-soaking procedures with two different durations (15 and 45 minutes) were done to evaluate the effect of additional heat supply on the strain and temperature changes within the specimen during the polymerization. Five specimens for each of six conditions were examined. Within the parameters of this study the following results were drawn : 1. The mean shrinkage strains reached -3095mu epsilon, -1796mu epsilon and -2959mu epsilon for Duralay, Snap and Vertex, respectively. The mean maximum temperature rise reached 56.7degrees C, 41.3degrees C and 56.1degrees C for Duralay, Snap, and Vertex, respectively. A vinyl ethyl methacrylate product (Snap) showed significantly less polymerization shrinkage strain (p0.05).

A FLUOROSCOPIC STUDY ON THE STABILITY OF SKIN REFERENCE POINTS DURING JAW OPENING AND CLOSING MOVEMENT / 대한치과보철학회지

The current clinical technique for occlusal vertical dimension recording is based on marking the skin reference points on the patient's face and measuring between these pints using caliper-like device. And it is difficult to achieve reliable measurements by this technique because of movable soft tissue. The purpose of this study is to reveal the stability of skin reference points by comparing the relative movement between extra-oral skin reference points and intra-oral reference points using X-ray fluoroscope. 10 test subjects were divided into 2 groups : Group I (natural dentition) and Group II (denture-wearer whose vertical dimension was lost) and Group III consists of identical test subjects to Group II with their upper denture removed and record base inserted. Attaching the 3mm diameter steel ball to nose tip, chin and to existing denture (or record base), fluoroscopic examination and recording were taken during 2 jaw opening and closing movements. After subsequent digitization using personal compute, 1219 still pictures with 0.1 second interval were made. Using the 2 dimensional graphic software, measurements between reference points were executed. Dividing the entire jaw movement into 3 ranges (total, 1st half opening, 2nd half opening), rate of movement and relative movement between extra-oral and intra-oral reference points were calculated and statistically analyzed. The results of this study are as follows. 1. Within the same experimental group, no statistical difference was found in the stability of skin reference between lower lip point and chin point during total range of jaw opening and closing movement (p>.05). 2. In the first half range of jaw opening, statistical difference was found between Group I (natural dentition) and Group II (denture wearer) (p.05). 5. In the second half range of jaw opening, no statistical difference was found in the stability of skin reference between any experimental groups (p>.05). 6. In patients with their occlusal vertical dimension lost, employing other measuring references rather than skin is recommended because of low stability.