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백서에서 도서형 피판 작성시 덱사메타손 투여가 세포 자멸사에 미치는 영향
홍기웅,김한구,김승홍 중앙대학교 의과대학 의과학연구소 2003 中央醫大誌 Vol.28 No.1
In order to prevent the damages of the flap tissues due to ischemia following a flap surgery, numerous studies have been conducted for the physiochemical, hemodynamic, and metabolic changes in ischemic flap. There had also been many discussions on the use of different drugs to prevent such damages. Recently apoptosis has been regarded as an important tissue injury mechanism as well as tissue necrosis in flap surgery. In acute tissue injury that can be caused by different reasons, some cells die of tissue necrosis while others may go through a time period, which will determine whether die of apoptosis or not. So survival of certain tissues will depend on the degree of apoptosis. In the post flap surgery period, the degree of apoptosis may influence the survival of ischemic flap with tissue necrosis. The author studied the effects of steroids (dexamethasone) on apoptosis in ischemic skin flap after a flap surgery. Steroids are known to increase the survival of flap by increasing tissue tolerance against tissue necrosis of ischemic flap. For the control group (N=15), after elevating an island skin flap with inferior epigastric vessels as pedicle on the abdominal area of a rat, the pedicle is clamped to create an ischemic state. Microscopical observations confirmed apoptosis as well as tissue necrosis of the flap. For the experimental group (N=l5), dexamethasone, a steroid matter was administered before the the clamping of the pedicle. As a result of microscopic observations and comparison of the effects of dexamethasone on the apoptotic area of ischemic flap between the control and experimental group, apoptosis increased significantly in the experimental group. In this respect, steroids, that are known to increase the survival of flap by reducing tissue necrosis, seem to weaken the survival of a flap by increasing the number of dead cells from apoptosis since they stimulate apoptosis of ischemic flap. Results of this study call for related studies on other drugs that can influence apoptosis of ischemic flap.
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한국 신생아 황달에서 UDP-Glucuronosyltransferase 유전자(UGT1A1)의 다형성에 관한 연구
홍기웅,강훈,김일수,김지숙,김은령,이희제*,김성우*,정주호* 대한소아청소년과학회 2004 Clinical and Experimental Pediatrics (CEP) Vol.47 No.1
Purpose:The incidence of neonatal hyperbilirubinemia is twice as high in East Asians as in whites and its metabolic basis has not been clearly explained. Recently, UDP-glucuronosyltransferase gene (UGT1A1) mutation was found to be a risk factor of neonatal hyperbilirubinemia in Japanese and Taiwanese Chinese. We studied whether neonatal hyperbilirubinemia is associated with mutation of UGT1A1, which is a key enzyme of bilirubin catabolism, in Korean. Methods:The genomic DNA was isolated from 45 Korean full term neonates who had hyperbilirubinemia(serum bilirubin >12 mg/dL) with no obvious causes, and the 64 Korean neonates of the control population. We detected a missense mutation of Gly71Arg of UGT1A1 gene by using allele- specific polymerase chain reaction. Polymorphism was confirmed by direct sequencing. Results:Two of the 45 neonates with serum bilirubin above 12 mg/dL had homozygous mutation and 16 neonates had heterozygous mutation. Two of the 31 neonates with serum bilirubin above 15 mg/dL had homozygous mutation and 13 neonates had heterozygous mutation. Thirteen of the control group had heterozygous mutation and homozygous mutation was not found. Allele frequency of Gly71Arg mutation in hyperbilirubinemia group was 0.22, which was significantly higher than 0.11 in the control group(P<0.0144). Conclusion:The missense mutation causing Gly71Arg of UGT1A1 was detected in the Korean neonatal hyperbilirubinemia. The high frequency of this missense mutation may be attributed to the high prevalence of hyperbilirubinemia in the Korean. 목 적 : 신생아 황달은 백인에 비해 일본, 중국, 한국인등 동아시아인에서 두 배 이상 많이 발생한다고 한다. 이에 대한 대사적인 근거는 확실치 않지만, 최근 일본과 타이완 중국인에서 UDP-glucuronosyltransferase 유전자의 다형성이 위험요소로서 보고되었다. 저자들은 빌리루빈 대사의 핵심 효소인 UGT1A1 유전자의 다형성이 한국인 신생아 황달과 어떤 연관성이 있는지 알아보고자 본 연구를 시행하였다.방 법 : 혈중 빌리루빈 수치가 12 mg/dL 이상의 건강하고, 위험인자가 없는 만삭아 중 신생아 황달 환아 45명과 정상 환아 64명으로부터 혈액을 0.5 cc를 채취하여 DNA을 분리하였다. UGT1A1 유전자를 대립유전자 특이 중합효소반응(allele-specific polymerase chain reaction)방법으로 UGT1A1 유전자에서 exon 1의 Gly71Arg의 유전자 다형성을 확인하였으며, 염기서열 분석을 시행하였다.결 과 : UGT1A1 유전자의 Gly71Arg 돌연변이가 신생아 고빌리루빈군 중 총 혈청 빌리루빈이 12 mg/dL 이상인 45명 중 2명에서 변이형 동형접합으로 16명은 변이형 이종접합으로 나타났고, 총 혈청 빌리루빈이 15 mg/dL 이상인 31명중 2명이 변이형 동형접합, 13명이 변이형 이종접합으로 나타났다. 대조군 64명에서는 13명이 변이형 이종접합이고, 변이형 동형접합은 없었다. Gly71Arg의 대립유전자 빈도는 12 mg/dL 이상에서 0.22로 대조군 0.11보다 높았고(P<0.0144), 15 mg/dL 이상에서는 0.27로 대조군 0.11보다 더 높게 나타났다(P<0.0049).
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가토의 유경 TRAM 피판술시 하복벽 동맥의 결찰이 대측 임의형 피판 생존율의 증가에 미치는 영향
민대홍,김승홍,백무현,홍기웅 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.5
The transverse rectus abdominis myocutaneous(TRAM) flap technique has been a widely accepted method of breast reconstruction after mastectomy, since the first introduction in 1982. Although free TRAM flap technique has been a superior method of breast reconstruction in comparison with the conventional pedicled TRAM flap with the development of microsurgery, it goes without saying that pedicled TRAM flap is the first choice of breast reconstruction, when free TRAM flap is impossible due to the inappropriate recipient vessels. Blood supply to the contralateral side of both the free & pedicled TRAM flap (especially in zone Ⅳ) is often precarious with previous midline abdominal scars or with significant rectus devarication. Various techniques have been described to improve the reliability of the blood supply to the contralateral portion in free & pedicled TRAM flap, including prior delay, double pedicled flap, supercharged & turbocharged flap. To improve flap vascularity of contralateral portion in pedicled TRAM flap, we ligated the superficial & deep inferior epigastric artery of the contralateral portion two weeks prior to raising the conventional TRAM flap. This TRAM flap was based on superior epigastric vascular pedicle attached to the ipsilateral underlying rectus abdominis muscle with a contralateral & ipsilateral random portion of skin. The effectiveness of preoperative ligation of the contralateral superficial & deep inf. epigastric artery in augmentation of skin viabliity was compared to the sham manipulated control group after raising the flap. The results were as follows : 1. Experimental (previous ligation) group; mean total flap area = 227.8cm², mean survival area = 218.46cm², mean survival rate = 96.2% 2. control group ; mean total flap area = 235cm², mean survival area = 205.74cm²mean survival rate = 87.54% From the above results, the increase in skin viability seemed to be accompanied by increased area of viable skin in the treated flap compared to the controls. We postulate that hypoxia resulting from the ligation of the superficial & deep inferior epigastric vessel of contralateral portion prior to the flap surgery may expand vascular territory by the remaining ipsilateral vessels over the contralateral portion.
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구순열 비변형 이차 수술시 구륜근이 포함된 C-FLAP을 이용한 비익기저 함몰의 교정
홍기웅,김승홍,이기룡 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.1
Nearly all the repaired cleft lip patients have varying degree of nasal deformities. Cleft lip nose deformities consist of defects of the lower lateral cartilage on the cleft side, the nasal septum, the columella, the nasal tip, and the entire nasal pyramid. The maxillary cleft and hypoplasia, and malpositioning of the the maxillary segments also contribute to the asymmetry of nose. In the correction of cleft lip nose deformities, numerous methods such as composite graft, deepithelized alar-base flap, dermal-fat flap of nostril floor, scar tissue flap, bone & cartilage graft and silastic implant have been introduced and tried to augment nostril floor and alar base. But there have been no standardized satisfactory method in result. At secondary revision of cleft lip nose deformity, we transposed and sutured the C-flap containing deepithelized orbicularis oris myocutaneous flap to the levator labii superioris & alar nasi muscles beneath the depressed nostril floor & alar base to augment them. We could maintain the musclar function by interconnection and fixation of orbicularis oris muscle to alar facial muscles. So, we prevented volume loss of the inserted muscle to augment the nostril floor & alar base by minimizing the muscular fibrosis and atrophy. In basal view photograph and physical examination, We found superior aesthetic results in most of them who had C-flap containing orbicularis oris muscle, and in long term histologic findings of orbicularis oris muscle inserted into the alar facial muscle, we could only find mild fibrosis and atrophy of the muscle but the general structures were maintained.
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