韓國 環境政策의 決定 過程에 관한 社會學的 연구 : 물 管理體系의 變化 過程을 中心으로

학위논문(석사)--서울大學校 大學院 :社會學科,1995.Maste

Epigallocatechin gallate가 피부 피판 생존에 미치는 영향

의학과/석사Surgical skin flaps are often used in plastic and reconstructive surgery to repair defects resulting from trauma, congenital defects, tumor excision, or other causes. Partial or complete skin flap necrosis is a common problem encountered postoperatively. Epigallocatechin gallate (EGCG), the major polyphenol of green tea has been investigated as a vasodilator and antioxidant. The author’s hypothesis is that EGCG could improve viability of random pattern skin flaps through its vasodilatory effect, vasoprotective effect and neovascularization effect. The rat dorsal skin flap model was applied. Forty rats were randomly divided into four groups, with 10 rats in each group. Group A is the experimental group for local injection of EGCG to the flap. Group B is the experimental group for topical application. Group C is the control group for local injection. Group D is the control group for topical application. At 1, 5, and 10 days after the operation, the surviving area of the flap, regional blood flow, capillary density and VEGF expression were evaluated. We could observe increment of survival area in group A and B compared to group C and D (ANOVA, p < 0.05). However, no difference was observed between the two experimental groups. Doppler measurement showed greater blood flow in groups A and B compared to groups C and D in distal, middle and proximal portions of the flap. (ANOVA, p < 0.05) Between groups A and B, group B showed greater blood flow than group A only in the proximal portion. Quantitative analyses revealed that the capillary density and VEGF expression in groups A and B were significantly higher than those of groups C and D (ANOVA, p < 0.05). To summarize, the EGCG treatment could enhance neovascularization and enhance regional blood flow, and as a result, improve the skin flap survival. The topical application of EGCG seems to be more effective in increasing blood flow, however, the overall survival of the flaps showed no difference between local injection and topical applicationrestrictio

쥐 피판 모델에서 혈소판 농축 혈장이 허혈-재관류 손상에 미치는 영향

의학과/박사허혈-재관류 손상은 피판의 실패와 장기 기능 부전의 주요 원인으로 이를 줄이기 위한 많은 연구가 진행되어 왔다. 활성화된 혈소판은 허혈 재관류 손상에서 혈전과 함께 내피세포의 손상을 일으키지만 체외에서 투여된 다량의 혈소판은 오히려 혈소판의 모임을 저하함이 심근 경색 모델에서 규명되었다. 본 연구의 목적은 쥐의 피판 모델에서 허혈-재관류 손상에 대해서 혈소판 농축 혈장의 영향을 규명하고 그 기전을 밝히는데 있다. 4개의 군을 무작위로 나누었으며 군별로 30마리의 마우스를 사용하였다. A군은 피판을 거상 후 아무 처치 없이 제자리에 봉합하였으며 B군은 혈소판 농축 혈장을 피판 봉합전 주입하였다. C군은 피판 거상 후 미세클램프를 이용하여 4시간의 허혈 후 재관류 손상을 주었으며 D군은 허혈-재관류 손상 후 혈소판 농축 혈장을 피판에 주입하였다. 피판 거상 1,3,7,10일 후 생존 면적과 혈류량을 측정하였다. 혈소판 농축 혈장이 피판의 생존 면적과 혈류량을 유의하게 증가 시켰으며 특히 허혈-재관류 손상이 있을 때 그 효과가 증대되었다. 피판의 생존부분을 채취하여 조직 샘플을 광학 현미경으로 관찰한 결과 혈소판 농축 혈장이 혈관 신생을 촉진시키며 또한 호중구의 모임과 혈전을 감소시켜 허혈-재관류 손상으로부터 조직을 보호하였다. 허혈 재관류 손상의 정도를 측정하기 위하여 재관류 12시간 후 조직에서 일산화 질소, 마이엘로퍼옥시다아제 (Myeloperoxidase), 말론디알데하이드 (Malondialdehyde), 과산화물제거효소 (Superoxide dismutase)를 측정하였다. 허혈-재관류 손상을 입은 군과 비교하였을 때 혈소판 농축 혈장은 일산화 질소, 마이엘로퍼옥시다아제, 말론디알데하이드 (Malondialdehyde)를 감소시키는 작용을 보였으며 과산화물제거효소는 증가가 확인되었다. 또한 전염증 사이토카인(proinflammatory cytokines)의 변화를 알기 위하여 실시간 중합효소 연쇄반응 (RT-PCR)응 이용하여 단핵세포 화학주성 단백질(monocyte chemotactic protein-1), 종양괴사인자 (tumor necrosis factor-α), 인터루킨 (IL-1β, IL-6)를 측정하였다. 혈소판 농축 혈장은 허혈-재관류 손상에 있어서 전염증사이토카인을 모두 감소시켜서 조직을 보호하는 효과를 보였다. 이러한 혈소판 농축 혈장의 작용은 세포사멸신호조절 카이네이즈(Apoptosis signaling regulating kinase 1)의 표현 저하와 연관이 있을 것으로 사료된다. 본 연구에서 혈소판 농축 혈장은 쥐의 피판 모델 허혈-재관류 손상을 감소시키며 조직을 보호하는 것으로 판명되었다. 이를 이용하여 임상에 적용함으로 보다 얻기 쉽고 저렴한 보호제로 이용될 수 있을 것이다.ope

Gluteal artery perforator flap: a viable alternative for sacral radiation ulcer and osteoradionecrosis

Radiotherapy is a crucial part in the treatment of cancer; however, it may cause adverse effects to normal tissue such as radiation-induced ulcer and osteoradionecrosis. The few cases of conservative management that were reported had a limited value and unsatisfactory results. The most reliable method to treat sacral radiation ulcer and osteoradionecrosis is a wide excision of the affected tissue, followed by coverage with well-vascularised tissue. Musculocutaneous free flaps and local gluteus maximus musculocutaneous flaps have been used; however, there were many drawbacks such as dissection of recipient vessel in the previously radiated area and donor-site morbidity. During a 4-year time period at our institute, we found favourable clinical results using gluteal artery perforator procedure for radiation-induced ulcers and osteoradionecrosis of the sacral area. The 10 patients, who were treated with gluteal artery perforator flaps, had chronic non-healing radiation ulcers or bone exposure of the sacrum. Intra-operatively, massive debridement of bone and soft tissue was performed, while the well-vascularised skin with only a colour change was preserved. The flap was designed to include two or more perforators using Doppler flowmetry and the perforators were preserved with surrounding subcutaneous tissue during the flap elevation. The mean post-operative follow-up period was 25.7 months. As regards the surgery, there was one major complication (of partial flap loss) and three minor complications (of wound dehiscence). In the patient with partial flap loss due to infection and a floating flap, the contralateral superior gluteal artery perforator flap was used to treat complications. Other complications were conservatively treated and well healed. Gluteal perforator flaps are a valuable alternative in treating sacral radiation ulcers and osteoradionecrosis. Sufficient excision of devitalised tissue is a crucial procedure to achieve optimal resultsope

Multiple Symmetric Lipomatosis: Characteristics and Treatment in Korean Patients

Purpose: Multiple symmetric lipomatosis (MSL) is a relatively rare disorder characterized by presence of multiple, symmetric, nonencapsulated fat masses in face, neck, shoulder and other areas. There has been only a few cases reported in Korea. The main purpose of this research is to examine the Korean patients to see what kinds of special characteristics occurred due to this disease and to decide the proper treatment.Methods: A total of 16 patients were evaluated retrospectively. 5 patients were treated at our hospital. The other patients were reviewed from literature. We analyzed the biological characters of patients, location of fat deposit, morphologic characters of patients, clinical evidence of neuropathy, associated metabolic disorders and treatment modality.Results: All cases were male patient. The mean age of onset was 47.43 years. All patients were moderate to heavy alcoholics. The most common location of fat deposition was posterior neck and abdomen. In neurologic exam of 9 patients, 5 patients showed muscle weakness, tremor, pain and autonomic nerve dysfunction. In metabolic studies of 9 patients, total cholesterol values were higher in 1 patient. A glucose tolerance test was abnormal in 1 patient. In treatment modality, 14 patients were treated with surgical resection, 1 patient was treated with liposuction and surgical excision, 1 patient was treated only with liposuction. Conclusion: To treat MSL patients successfully, we should concentrate not only on the removal of the fatty tissue but also on neurologic abnormities, metabolic disorders and associated diseases.ope