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Nipple-sparing mastectomy through periareolar incision with immediate reconstruction
Se Hyun Paek,Seung Eun Hong,Kyong-Je Woo,Joohyun Woo,Woosung Lim 대한외과학회 2020 Annals of Surgical Treatment and Research(ASRT) Vol.98 No.2
Purpose: Nipple-sparing mastectomy (NSM) has become increasingly popular due to improved cosmesis without compromising oncologic safety. Radial and inframammary incisions are usually used to achieve NSM, with periareolar incisions usually being avoided because of the risk to nipple-areola complex viability. In an attempt to maximize esthetic effects, we performed NSM through periareolar incision with immediate reconstruction. We report our initial experience. Methods: This case series consisted of all consecutive patients (n = 34) who underwent NSM through a periareolar incision in our institution between August 2017 and December 2018. All patients underwent NSM through periareolar incision followed by immediate reconstruction with an implant or deep inferior epigastric perforator flap. Patient demographics, tumor and treatment characteristics, and short-term postoperative outcomes were reviewed. Results: The mean patient age was 46.74 ± 6.69 years (range, 38–62 years), and the mean operation time was 96.68 ± 28.00 minutes. Indications included in situ cancer in 12 cases and invasive cancer in 22 cases. There was 1 major complication (postoperative hematoma) requiring operative reintervention. No other complications including fistula, implant exposure, or reconstruction failure was observed. At the time of writing, no case of local recurrence has been observed. Conclusion: Our initial report shows that NSM with immediate reconstruction may successfully be performed through periareolar incision. This method maximizes esthetic effects and may be an appropriate surgical option for NSM
On - Site Diagnostic Device Based on Immuno - Separation of Proteins
Paek, Se Hwan,Cho, Joung Hwan,Kang, Moon Sik,Min, Nam Ki 한국화학공학회 2001 Korean Journal of Chemical Engineering Vol.18 No.2
A membrane immuno-chromatographic system that selectively separates plasma lipoproteins and generates a signal in proportion to the concentration of cholesterol (HDL-C) within high-density lipoprotein (HDL) was investigated as a point-of-care device for the prognosis of coronary heart disease. The system consists of three functional membrane strip pads connected in a sequence for: (from the bottom) immuno-separation based on biotinstreptavidin reaction, catalytic conversion of cholesterol to hydrogen peroxide, and production of a signal. For immunochromatography, a monoclonal antibody, specific to apolipoprotein B100 that is present on the surfaces of low-density lipoproteins (LDL) and very low-density lipoproteins (VLDL), with a high binding constant (5×10^ L/mol) was raised and chemically conjugated to streptavidin. The conjugate was first reacted with lipoprotein particles, and this mixture was absorbed by the capillary action into the biotin pad of the system. After being transferred by medium, immunocapture of LDL and VLDL particles onto the biotin pad took place, and in situ generation of a signal in proportion to HDL-C consecutively occurred. The capture was selective as well as effective (minimum 90% of LDL and VLDL in clinical concentration ranges), and the detection limit of HDL-C was far lower than 20 mg/dL. To construct a userfriendly device, we are currently investigating the automation of such processes of reactions and separation by adapting a liquid flow-controlling technology that programs the times for the immune reaction and separation. My group further pursues an interdisciplinary study to develop a micro system employing semiconductor-based technologies that will eventually enable the handling of sub-micro liter volume of body fluid as a specimen.
Clinical usefulness of intraoperative parathyroid hormone monitoring for primary hyperparathyroidism
Se Hyun Paek,Su-Jin Kim,June Young Choi,Kyu Eun Lee 대한외과학회 2018 Annals of Surgical Treatment and Research(ASRT) Vol.94 No.2
Purpose: The availability of intraoperative parathyroid hormone (IOPTH) monitoring allows successful focused parathyroidectomy for primary hyperparathyroidism (pHPT). The objective of this study was to report our initial experience in IOPTH monitoring during parathyroid surgery for primary hyperparathyroidsim. Methods: Between May 2011 and February 2013, 37 patients underwent focused parathyroidectomy due to pHPT. IOPTH monitoring based on Miami criteria was used to confirm complete excision of hyperfunctioning parathyroid gland during surgery. Medical records of patients were reviewed retrospectively. Results: Preoperative mean maximal calcium level was 11.7 ± 0.9 mg/dL. Preoperative technetium (<SUP>99m</SUP>Tc) sestamibi scan and ultrasonography identified 32 of 37 (86.5%) and 29 of 37 (78.4%) of abnormal parathyroid glands, retrospectively. Results of the 2 imaging modalities were discordant for 8 cases (21.6%). The mean pre-excision PTH level was 147.2 ± 201.5 pg/mL. At 5- and 10-minute post tumor resection, PTH levels were 65.3 ± 25.4 pg/mL and 47.5 ± 24.3 pg/mL, respectively. In all cases, IOPTH levels fell by at least 50% after removing all suspected abnormal glands. All patients had a successful return to normocalcemia after surgery (mean follow-up period: 60.2 ± 15.4 months). Conclusion: Surgeon could confirm complete excision of abnormal hyperfunctioning parathyroid glands by IOPTH monitoring during surgery for pHPT. IOPTH monitoring can maximize performance of successful focused parathyroidectomy for pHPT, especially when preoperative imaging results are discordant.
Feasibility of sentinel lymph node dissection using Tc-99m phytate in papillary thyroid carcinoma
Se Hyun Paek,Ka Hee Yi,Su-Jin Kim,June Young Choi,Kyu Eun Lee,Young Joo Park,Do-Joon Park,Keon Wook Kang,June-Key Chung 대한외과학회 2017 Annals of Surgical Treatment and Research(ASRT) Vol.93 No.5
Purpose: Various methods of sentinel lymph node (SLN) biopsy in thyroid cancer have been introduced. Tc-99m phytate as a radiotracer has been successfully utilized for SLN biopsy in breast, cervix, and endometrial cancer. We assessed the feasibility of SLN dissection using Tc-99m phytate in papillary thyroid carcinoma (PTC). Methods: Seventeen patients with PTC were prospectively enrolled. Ultrasound-guided peritumoral injection of 55.5 MBq Tc-99m phytate in 0.25-mL normal saline was performed. Preoperative single-photon emission-computed tomography (SPECT) and intraoperative gamma-probe were used for SLN detection during operation. Results: Identification rate of SLNs was 70.6% (12 of 17) with SPECT, and 88.2% (15 of 17) with gamma-probe. Combined SPECT and gamma-probe had identification rates of 88.2% (15 of 17). Identification rates of SLNs in central LN compartments were 82.4% (14 of 17) and 41.2% (7 of 17) in lateral LN compartments. Overall sensitivity, specificity, positive predictive value, and negative predictive value of the results of SLN biopsy were 91.6%, 100%, 88.4%, and 100%, respectively. Eight patients (47.1%) had metastasis in SLNs; all patients had SLN metastasis in the central compartment and 2 patients had SLN metastasis in both the central and lateral compartments. Conclusion: Combined SPECT and gamma-probe could detect SLNs with an 88.2% identification rate in PTC. SLN biopsy using Tc-99m phytate is technically feasible. Further investigation is warranted for clinical application of Tc-99m phytate in PTC.
Site-directed Immobilization of Antibody onto Solid Surfaces for the Construction of Immunochip
Paek, Se-Hwan,Cho, Il-Hoon,Paek, Eui-Hwan,Lee, Haewon,Park, Jeong-Woo The Korean Society for Biotechnology and Bioengine 2004 Biotechnology and Bioprocess Engineering Vol.9 No.2
The performance of an immuno-analytical system can be assessed in terms of its analytical sensitivity, i.e., the detection limit of an analyte, which is determined by the amount of analyte molecules bound to the capture antibody that has been immobilized onto a solid surface. To increase the number of the binding complexes, we have investigated a site-directed immobilization of an antibody that has the ability to resolve a current problem associated with a random arrangement of the insolubilized immunoglobulin. The binding molecules were chemically reduced to produce thiol groups that were limited at the hinge region, and then, the reduced products were coupled to biotin. This biotinylated antibody was bound to a streptavidin-coated surface via the streptavidin-biotin reaction. This method can control the orientation of the antibody molecules present on a solid surface and also can significantly reduce the possibility of steric hindrance in the antigen-antibody reactions. In a two-site immunoassay, the introduction of the site-directly immobilized antibody as the capture enhanced the sensitivity of analyte detection approximately 10 times compared to that of the antibody randomly coupled to biotin. Such a novel approach would offer a protocol of antibody immobilization in order for the possibility of constructing a high performance immunochip.