The management of children with complete ureteric duplication: selective use of uretero-ureterostomy as a primary and salvage procedure

OBJECTIVE

To determine the optimum management of duplex urinary tracts with refluxing or obstructed units.

PATIENTS AND METHODS

Sixty-three children (19 boys and 44 girls) with complete duplex-system anomalies (84 duplex system units) who underwent corrective surgery by one surgeon (H.C.) between March 1983 and June 1997 were reviewed, analysing their diagnosis and treatment.

RESULTS

Most children had presented with urinary tract infection; a ureterocele was found in 26 renal units, reflux in 12 and a combined anomaly in 18. Ectopic insertion of the ureter causing incontinence was found in six and ureteric obstruction in nine ureteric units. Patients were managed so that whenever possible, functional renal tissue was preserved; thus surgical strategies were basically staged, conservative, and planned preoperatively on the basis of renal function. Initial surgery was undertaken in 71 units (all patients; ureterocele incision in 12, upper pole nephrectomy in 30, ureteric reimplantation in 14, uretero-ureterostomy in 13 and others in two). The median (range) follow-up was 7.6 (2.1-16) years. Secondary procedures were undertaken in 24 units (34%); ureterocele incision (11 of 12 units) was the most common procedure of additional surgery, followed by ureteric reimplantation (six of 27 units), upper pole nephrectomy (eight of 37 units) and uretero-ureterostomy (two of 18 units).

CONCLUSIONS

Uretero-ureterostomy was the most successful nephron-sparing additional operation. When the upper pole is salvageable, uretero-ureterostomy may be the preferred alternative for managing complete duplex system anomalies.

Expression of tenascin-C in astrocytic tumors: its relevance to proliferation and angiogenesis

BACKGROUND

The expression and distribution of the extracellular matrix protein tenascin-C (TN-C) may be enhanced in human astrocytomas. The purpose of this study is to evaluate the expression of TN-C according to histological malignancy of tumor cells and its relevance to neoplastic angiogenesis in human astrocytic tumors.

METHODS

Between 1994 and 1998, 52 astrocytic tumor specimens including 4 pilocytic astrocytomas, 13 astrocytomas, 3 anaplastic astrocytomas, and 32 glioblastomas were used in this study. A retrospective analysis was performed to evaluate a statistical correlation between TN-C expression and proliferative indices. We characterized the expression of TN-C in neoplastic vessels, around individual tumor cells as a tumor network, and in tumor cells by immunohistochemistry using antibodies against human TN-C. The proliferative indices were also investigated by immunostaining with the MIB-1 antibody against the Ki-67 proliferation antigen.

RESULTS

TN-C immunoreactivity was found to be enhanced in tumor vessels and tumor networks of high-grade astrocytic tumors. The vascular TN-C deposition was greater in high-grade than in low-grade astrocytic tumors (p < 0.05). Its expression was the most intense in glioblastomas. Proliferation indices increased with tumor grade and MIB-1 labeling index (LI) was highest in glioblastomas. Moreover, expression of TN-C in tumor vessels was correlated with proliferative indices.

CONCLUSIONS

Our data show that TN-C in human astrocytic tumors may be identified as a factor contributing to malignant progression. And also, enhanced expression of TN-C in tumor vessels having a high proliferative index indicates that TN-C could be involved in neoplastic angiogenesis.

The p53 mutation which abrogates trans-activation while maintaining its growth-suppression activity

The p53 tumor suppressor protein functions as a transcription factor. It has, however, been previously reported that some p53 mutants are able to suppress cell growth independent of their transcriptional activity [Kaneuchi et al., (1999)]. In order to investigate the correlations between the trans-activation and growth-suppressive functions of p53, we have analyzed five p53 mutants by CAT reporter assay, colony formation assay, and growth-rate analysis. Five p53 mutants [Oh et al., (2000)]--199stop (Gly-->stop), 240ile (Ser-->Ile), 250ala (Pro-->Ala), 285lys (Glu-->Lys), and 291asn (Lys-->Asn)--were cotransfected with a reporter construct containing a p53-responsive element and then tested for their trans-activational activity in p53-null Saos-2 cells. As a result of a change in the protein structure, trans-activational activity was negated in 199stop, 240ile, 285lys, and 291asn, while 250ala retained its activity. Colony formation assay revealed that mutants 240ile and 250ala retained their growth suppression, while 199stop, 285lys, and 291asn did not. To study the features of these proteins, a group of isogenic cell lines that express mutant forms of p53 was generated from HeLa cells, and their growth rate was then examined: one group, containing 199stop, 285lys, and 291asn, showed a rapid growth rate, similar to that of the original HeLa cells; the other group, containing 240ile and 250ala, however, exhibited a slow growth rate. In conclusion, mutant p53 240ile, which completely lost its trans-activational activity, nevertheless continued to exhibit its growth-suppressive activity. Further work is required to understand how 240ile is involved in growth suppression.

Analysis of expressed sequence tags from Brassica rapa L. ssp. pekinensis

Non-redundant expressed sequence tags (ESTs) were generated from six different organs at various developmental stages of Chinese cabbage, Brassica rapa L. ssp. pekinensis. Of the 1,295 ESTs, 915 (71%) showed significantly high homology in nucleotide or deduced amino acid sequences with other sequences deposited in databases, while 380 did not show similarity to any sequences. Briefly, 598 ESTs matched with proteins of identified biological function, 177 with hypothetical proteins or non-annotated Arabidopsis genome sequences, and 140 with other ESTs. About 82% of the top-scored matching sequences were from Arabidopsis or Brassica, but overall 558 (43%) ESTs matched with Arabidopsis ESTs at the nucleotide sequence level. This observation strongly supports the idea that gene-expression profiles of Chinese cabbage differ from that of Arabidopsis, despite their genome structures being similar to each other. Moreover, sequence analyses of 21 Brassica ESTs revealed that their primary structure is different from those of corresponding annotated sequences of Arabidopsis genes. Our data suggest that direct prediction of Brassica gene expression pattern based on the information from Arabidopsis genome research has some limitations. Thus, information obtained from the Brassica EST study is useful not only for understanding of unique developmental processes of the plant, but also for the study of Arabidopsis genome structure.

Primary LAMP-2 deficiency causes X-linked vacuolar cardiomyopathy and myopathy (Danon disease)

"Lysosomal glycogen storage disease with normal acid maltase" which was originally described by Danon et al., is characterized clinically by cardiomyopathy, myopathy and variable mental retardation. The pathological hallmark of the disease is intracytoplasmic vacuoles containing autophagic material and glycogen in skeletal and cardiac muscle cells. Sarcolemmal proteins and basal lamina are associated with the vacuolar membranes. Here we report ten unrelated patients, including one of the patients from the original case report, who have primary deficiencies of LAMP-2, a principal lysosomal membrane protein. From these results and the finding that LAMP-2-deficient mice manifest a similar vacuolar cardioskeletal myopathy, we conclude that primary LAMP-2 deficiency is the cause of Danon disease. To our knowledge this is the first example of human cardiopathy-myopathy that is caused by mutations in a lysosomal structural protein rather than an enzymatic protein.

The immunocytochemical localization of neuronal nitric oxide synthase in the developing rat retina

The localization of nitric oxide synthase (NOS) was investigated in the developing rat retina by immunocytochemistry and western blot analysis, using an antiserum directed against neuronal NOS. NOS-labeled cells were first detected at postnatal day 5 (P5) in the inner row of the neuroblastic layer. These cells were considered to correspond to the type 1 cell of the adult rat retina. Type 2 cells, characterized by a small soma and weak immunoreactivity, and a class of displaced amacrine cells were detected at P9 and P7, respectively. By P14 or P15, the time of eye opening, NOS immunoreactivity appeared in some bipolar cells. NOS was first expressed at the protein level at P9. Thereafter, quantitative evaluation by immunoblotting confirmed that the intensity of the immunoreactive bands increased abruptly, reaching the same value as is found in the adult retina at P21. Our results demonstrate that differentiation of NOS-labeled cells follows a discrete developmental pattern and is most active during the 2nd postnatal period in the rat retina.

A micromachined silicon depth probe for multichannel neural recording

A process of making a new type of silicon depth-probe microelectrode array is described using a combination of plasma and wet etch. The plasma etch, which is done using a low temperature oxide (LTO) mask, enables probe thickness to be controlled over a range from 5 to 90 mu. Bending tests show that the probe's mechanical strength depends largely on shank thickness. More force can be applied to thicker shanks while thinner shanks are more flexible. One can then choose a thickness and corresponding mechanical strength using the process developed. The entire probe shaping process is performed only at low temperature, and thus is consistent with the standard CMOS fabrication. Using the probe in recording from rat's somatosensory cortex, we obtained four channel simultaneous recordings which showed clear independence among channels with a signal-to-noise ratio performance comparable with that obtained using other devices.

Neuronal nitric oxide synthase immunoreactive neurons in the mammalian retina

The development of immunocytochemistry has led to a better understanding of synaptic transmission carried out by neuroactive substances in the mammalian brain, including the retina. In the mammalian retina, nitric oxide (NO) is widely accepted as a neuromodulator. Histochemistry based on NADPH-d and immunocytochemistry based on nitric oxide synthase (NOS) have been used to identify the presence of nitric oxide in the mammalian retina. Certain types of amacrine cells and a class of displaced amacrine cells have been labeled consistently in all mammalian retinae studied to date. Other cell types showing NADPH-d reactivity or NOS immunoreactivity varied between species. NADPH-d reactive or NOS immunoreactive amacrine cells may serve as a source of NO for amacrine, bipolar, and ganglion cells in the inner retina, whereas interplexiform cells, bipolar cells, and horizontal cells may serve as a source of NO for the outer retina of mammals.

Rice cooker steam hand burn in the pediatric patient

Burn injuries often lead to significant cosmetic and functional deformity. In the Orient, household electric rice cookers have caused a significant number of steam burns to infant hands. The clinical course and treatment outcome of these burns have been studied retrospectively in a review of the medical records of 79 pediatric patients treated for acute hand steam burns and of 38 other patients who underwent correction for postburn contracture. Electric rice cookers caused all of the acute pediatric steam burns treated at our institute. Of the 81 hands treated between 1995 and 1998, 38.3 percent healed with conservative treatment and 61.7 percent required skin grafting. The volar aspects of the index and middle fingers were those most frequently involved. Eighteen of 36 hands (50 percent) grafted with split-thickness skin developed late contractures requiring additional procedures. Among the 38 patients who underwent correction for postburn deformity, initial treatment was split-thickness grafting for 60.5 percent, full-thickness skin grafting for 7.9 percent, and spontaneous healing for 31.6 percent. Awareness among medical personnel and continued public education should be promoted to help prevent this unique type of pediatric steam burn from occurring.

Identification of p53 gene mutations in breast cancers and their effects on transcriptional activation function

Somatic mutations in the p53 tumor suppressor gene are the most common genetic alterations found in human malignancies. In the present study, we studied 36 primary human breast carcinomas, using a polymerase chain reaction-single-strand conformation polymorphism (PCR-SSCP) and sequencing analysis of exons 2 through 9 for the presence of p53 gene mutations. Six of 36 (17%) breast cancers contained mutations within the core domain of the p53 protein responsible for sequence-specific DNA binding (codons 102-292); all 5 missense mutations clustered between codons 240 and 291 (codons 240, 243, 250, 285, and 291), whereas one nonsense mutation occurred at codon 199. By using recombinant PCR in vitro mutagenesis, we introduced point mutations at codons 199 from Gly to stop (gly199stop), 240 from Ser to Ile (ser240Ile), 250 from Pro to Ala (pro250ala), 285 from Glu to Lys (glu285lys), and 291 from Lys to Asn (lys291asn), and all the p53 sequences were subcloned into the CMVneoBam vector under the control of the cytomegalovirus (CMV) promoter. To test whether the mutants p53 were functionally wild-type (wt) or mutant, we transfected them to p53-null Saos-2 cells with a reporter plasmid containing a p53-responsive element, and performed chloramphenicol acetyltransferase (CAT) assay. Transient CAT assay for transcriptional activation revealed that one group, including gly199stop, ser240ile, glu285lys, and lys291asn, abolished the transcriptional activity, whereas the other group, including pro250ala, retained stronger transcriptional transactivation activity than that of wt p53.

Upregulation of ciliary neurotrophic factor in reactive Müller cells in the rat retina following optic nerve transection

We have investigated the expression and cellular localization of ciliary neurotrophic factor (CNTF) in the rat retina following optic nerve transection. In the normal retina, CNTF immunoreactivity was restricted to profiles in the ganglion cell layer. Following optic nerve transection, immunoreactivity appeared in Müller cell somata and processes and its intensity increased between three and seven days post-lesion. Quantitative evaluation by immunoblotting confirmed that CNTF expression increased continuously up to 7 days after optic nerve transection (to 430% of control levels), but decreased again to 250% of controls at 4 weeks post-lesion. Our findings suggest that CNTF supplied by Müller cells may play a protective role for axotomized ganglion cells in the rat retina.

Metastatic tumors in the sellar and parasellar regions: clinical review of four cases

Metastatic tumors in the sellar and parasellar regions are uncommon and rarely detected in clinical practice. We present four cases of sellar and parasellar metastatic tumors, which metastasized from distant organ in one case and extended directly from adjacent structures in three. Common presenting symptoms were cranial neuropathies, headache and facial pain. Invasion into the cavernous sinus was noted in all cases. We report rare cases of sellar and parasellar metastases. Also, we should consider the possibility of metastasis in these regions for patients who showed the above clinical presentations in systemic cancer patients. In extensive diseases, transient symptomatic relief could be obtained by direct surgical management, even in restricted degree.

Active properties of the urinary bladder: in vitro comparative studies between adult and neonatal rats

OBJECTIVE

To determine, using in vitro comparative studies, developmental aspects associated with the active properties of the urinary bladder in neonatal and adult rats.

MATERIALS AND METHODS

Urinary bladders were removed from neonatal (1-3 days old) and adult (15 weeks old) male Sprague-Dawley rats. Anterior longitudinal muscle strips were obtained from each group and isometric tensions recorded. Nerve-mediated contractions elicited by electrical field stimulation (0.8 ms pulse) or carbachol-induced contractile responses in neonatal and adult bladder strips were compared. Contractile tensions were normalized using the wet weight of the bladder strip or by using the percentage contraction induced by 60 mmol/L KCl.

RESULTS

Nerve-mediated contractile responses showed that the muscarinic component predominated in the neonatal rat bladder, which contrasted with the predominant purinergic components in adult bladder. The pattern of spontaneous activity and carbachol-induced contraction differed in the two groups. Small spontaneous contractions in the basal state occurred in adult bladder strips, while short-lived large spontaneous contractions were present in neonatal strips. The amplitude of carbachol-induced contractions generated in the neonatal bladder was larger than that in the adult bladder. In addition, the time to achieve peak contraction elicited by carbachol (5 micromol/L) was shorter in the neonatal bladder. Repetitive carbachol applications induced an attenuation of the contractile response (desensitization), but the neonatal bladder was more resistant to desensitization than the adult bladder.

CONCLUSIONS

These results show that nerve-mediated or agonist-induced contractile patterns, and spontaneous activity, in the neonatal bladder differ from those of the adult bladder in rats. The results suggest that in addition to neural immaturity, there are functional differences between the bladders of adult and neonatal rats.

Turns-amplitude analysis and motor unit potential analysis in myasthenia gravis

OBJECTIVES

The aims of this study were to investigate myopathic changes in myasthenia gravis (MG) by using turns-amplitude analysis (TAA) and quantitative motor unit potential duration analysis (MUPan), to correlate myopathic changes with severity and duration of the disease and the results of diagnostic tests including repetitive nerve stimulation test (RNS), single fiber electromyography (SFEMG), and anti-acetylcholine receptor antibody (AChR-ab), and to compare the sensitivities of these two methods in detecting myopathic changes in MG.

MATERIALS AND METHODS

We studied both MUPan and TAA in 32 patients with MG.

RESULTS

The MUPan study showed myopathic changes in 12 patients (37.5%); TAA revealed a myopathic pattern in 4 (12.5%) and a neurogenic pattern in 4 cases (12.5%). Two of the 4 patients with a myopathic change by TAA also had short-duration mean MUP on the MUPan. No statistically significant association was found between the myopathic changes either by MUPan or TAA, and the various clinical and laboratory features.

CONCLUSION

We conclude that MUPan is a more sensitive method than TAA in showing myopathic changes in MG, and that TAA is of limited help in demonstrating them.

Increased expression of ciliary neurotrophic factor receptor alpha mRNA in the ischemic rat retina

Using in situ hybridization, we investigated the expression of ciliary neurotrophic factor receptor ((CNTFRalpha) mRNA in the rat retina rendered ischemic by elevation of the intraocular pressure (IOP). The IOP was increased to 120 mmHg and maintained for 60 min. The rats were sacrificed on the day of reperfusion (DRP) 1, 3, 7, 14, and 28. In the normal retina, the signal for CNTFRalpha mRNA was present in retinal cells in the inner nuclear layer (INL) and in the ganglion cell layer (GCL). On DRP 1, numerous cells in the INL and GCL showed a CNTFRalpha mRNA signal. From DRP 3 onwards, CNTFRalpha mRNA appeared in photoreceptor cells located in the outer part of the outer nuclear layer. The signal in these cells increased up to DRP 14 and then decreased at DRP 28. Our findings suggest that cells expressing CNTFRalpha mRNA may resist the degenerative processes induced by ischemic insult in the rat retina.

The expression and cellular localization of brain/kidney protein in the rat retina

Brain/kidney (B/K) protein is a new protein of 474 amino acids, which contains two C2 domains structurally homologous to those present in synaptotagmins. The expression of B/K protein was identified in the rat retina and B/K protein immunoreactivity was localized to a number of ganglion cells, a few amacrine cells and the radial processes of Müller cells. Thus, B/K protein appears to be important in the homeostasis in these cells of the rat retina.

Ice-pack test in myasthenia gravis: electrophysiological basis

We report the first study in which the repetitive nerve stimulation (RNS) test was performed in conjunction with the ice-pack test in three patients with myasthenia gravis. All three patients showed an unequivocal improvement in ptosis on the side where an ice pack was placed. RNS test in the facial nerve revealed a definite improvement in the decremental response. From this we conclude that the ice-pack test produces a clinical and electrophysiological improvement in myasthenia gravis.

Diagnostic value of nerve and muscle biopsy in suspected vasculitis cases

OBJECTIVES

To evaluate the diagnostic value of nerve and muscle biopsy in suspected cases of vasculitis and their correlation with the clinical and electrophysiological data.

METHOD

We conducted a retrospective review of I 15 nerve and muscle biopsy specimens from cases in the past 20 years at the University of Alabama at Birmingham (UAB) Muscle and Nerve Histopathology Laboratory. Clinical and electromyography data in available cases were analyzed to evaluate the histopathologic correlation,:

RESULTS

: The diagnostic sensitivity of nerve biopsy was 39%, Nerve biopsy showed a statistically higher diagnostic yield (P = 0-0001) than muscle biopsy (17%), although muscle biopsies resulted in a more definite diagnosis m 3%. of cases. The highest diagnostic yield (73%) of vasculitis on nerve biopsy was observed in patients with known rheumatologic disease and accompanying neuropathy or myopathy. Nerve conduction study was able to identify diffuse neuropathy in the majority of patients with vasculitis, including asymptomatic neuropathy. Abnormal sural nerve conduction was highly correlated (P = 0.03) with positive nerve biopsy. There was a wide spectrum of neurologic manifestations in vasculitic neuropathy, with the most common clinical manifestation of vasculitic neuropathy being polyneuropathy.

CONCLUSIONS

Nerve biopsy is superior to muscle biopsy for the diagnosis of vasculitis among suspected cases of vasculitis. The highest diagnostic yield of nerve biopsy is observed when patients with known rheumatologic diseases have neuropathy or myopathy. Abnormal sural nerve conduction can be used as a guide for nerve biopsy.

Selective neuronal survival and upregulation of PCNA in the rat inner retina following transient ischemia

In this study we investigated the extent and time course of neuronal cell death and the regulation of the proliferating cell nuclear antigen (PCNA) in the different retinal cell layers following ischemia-reperfusion injury. Retinal ischemia was induced by controlled elevation of the intraocular pressure for a duration of 60 min. Changes in thickness and cell numbers in the retinal cell layers were analyzed at various time points (1 h to 4 weeks) after reperfusion. In parallel, apoptotic cell death was determined by the TUNEL method and the expression of PCNA analyzed by immunocytochemistry. In addition, we tested whether PCNA is expressed in neurons by double immunocytochemistry. The reduction in thickness was found to be less pronounced in the inner nuclear layer (INL). Correspondingly, cell numbers decreased by only 33% in the inner retina, but by more than 80% in the outer nuclear layer (ONL). Alterations in glial cell numbers did not contribute significantly to postischemic changes in the INL and ONL as assessed by using immunocytochemical markers for microglial and Müller cells. The time course of cell death determined by the TUNEL technique also differed markedly in the retinal layers being rapid and transient in the inner retina but delayed and prolonged in the ONL. PCNA immunoreactivity was undetectable in the normal retina, but was specifically induced in neurons of the inner retina within 1 h after reperfusion and was sustained for at least 4 weeks. We conclude that in contrast to photoreceptors in the ONL, a significant proportion of inner retinal neurons is resistant to ischemic insult induced by transiently increased intraocular pressure and that PCNA may possibly play a role in the selective postischemic survival of these cells.

Fist position for skin grafting on the dorsal hand: II. Clinical use in deep burns and burn scar contractures

The fundamental problem in all types of hand burns is a loss of skin and subsequent deformities. The goal of skin grafting on the dorsal hand is to graft a sufficient amount of skin, as much as the original amount, and to restore normal hand function without secondary deformities. The safe, or Michigan, position commonly has been used for immobilizing the hand. However, this position is to protect hand function rather than to provide for adequate skin grafting. This institution has developed a new hand position (the fist position) for grafting the greatest amount of skin on the dorsal side of the hand. In the fist position, the hand is positioned flexing all joints of the wrist and the fingers and maximally stretching the dorsal surface of the hand before skin grafting. Ten hands with deep second- or third-degree burn (n = 6) and burn scar contracture (n = 4) of the dorsal hand in eight patients were treated with split-thickness skin grafting after immobilizing in the fist position. The burns and contractures involved nearly the total area of the dorsal hand. The hand was kept in the fist position for 7 to 9 days after skin grafting. Excellent functional and cosmetic results were observed in all cases during the follow-up period of 6 months to 2 years. Complications resulting from hand immobilization for a short period did not occur. The fist position may be a proper hand position for skin grafting to reconstruct the dorsal hand.

Ganglion cells of the rat retina show osteopontin-like immunoreactivity

Osteopontin (OPN) is a negatively charged, highly acidic glycosylated phosphoprotein that contains an GRGDS amino acid sequence, characteristic of proteins that bind to integrin receptors, thereby playing crucial roles in a number of physiological processes. This study was conducted to examine the expression of OPN in the rat retina by Northern blot analysis, Western blot analysis and immunocytochemistry. The expression of OPN was identified in the retina and OPN-like immunoreactivity was present in a number of ganglion cells. Thus, OPN appears to be important in the retinal homeostasis.

Radiolabeling of paclitaxel with electrophilic 123I

123I-Labeled paclitaxel, [123I]-1 was prepared by electrophilic aromatic radioiodination of 3'-N-(p-trimethylstannylbenzoyl)-3'-debenzoylpaclitaxel 2 with 123I- in the presence of peracetic acid.

Immunocytological localization of dopamine in the guinea pig retina

We examined dopaminergic neurons in the guinea pig retina; antisera against tyrosine hydroxylase (TH), dopamine beta-hydroxylase (DBH), phenylethanolamine N-methyltransferase (PNMT) and an antiserum against gamma-aminobutyric acid (GABA) were used. In the present study, two types of amacrine cells were labeled with an anti-TH antiserum. However, no DBH and PNMT immunoreactivities were seen. The type 1 cell had a larger-sized soma located in the inner nuclear layer with processes ramifying mainly in stratum 1 of the inner plexiform layer (IPL). The type 2 cell had a smaller-sized soma and processes branching in stratum 3 of the IPL. The mean densities were 56.4 +/- 11.5/mm2 for the type 1 cell and 166.6 +/- 30.3/mm2 for the type 2 cell. Double immunocytochemistry using an antiserum against GABA revealed that while none of the type 1 cells showed GABA immunoreactivity, all of the type 2 cells displayed GABA immunoreactivity. Our results suggest that, in the guinea pig retina, the type 1 amacrine cells are pure dopaminergic and the type 2 cells are dopaminergic elements that use GABA as their second transmitter.

Survey of the Korean population for 9 short tandem repeat loci

The short tandem repeats with repeat units ranging from two to several nucleotides became a powerful tool in the field of forensic identification and paternity determination as well as for research in human gene mapping. Allele and genotype frequencies for 9 short tandem repeats including HUMCSF1PO, HUMTH01, HUMPLA2A1, HUMF13A01, HUMCYAR04, HUMLIPOL, HUMHPRTB, HUMCD4, and HUMFABP were determined using PCR and subsequent analysis of the PCR products by denaturing polyacrylamide gel electrophoresis followed by silver-staining. DNA samples were obtained from about 100 Korean people and amplified in a thermocycler adopting glass capillaries rather than traditional tubes. We found that the bovine serum albumin was an essential additive for the capillary PCR, presumably to coat the inner surface of the capillary which may adsorb Taq DNA polymerase. The capillary thermocycler was very effective in reducing the cycling time such that most of the amplification reactions could be finished within 30 min albeit the PCR product was less than that for the tube systems. All loci except HUMHPRTB met the Hardy-Weinberg expectations according to the exact test. The cumulative power of discrimination (PD) was 0.9999998 and the power of exclusion (POE) for the paternity test was a little low, being 0.9873989.

Fist position for skin grafting on the dorsal hand: I. Analysis of length of the dorsal hand surgery in hand positions

In skin grafting for reconstruction of burns and contracture deformities of the dorsal hand, the hand is kept in a proper position to provide the greatest amount of skin and to avoid the secondary functional deformity. The safe position has been commonly used for immobilizing the hand, but this is to protect the hand function rather than to provide maximal surface for skin grafting. Split-thickness skin graft contracts up to 30 to 50 percent of the original size owing to secondary contraction. If insufficient skin is grafted, contracture deformity of the dorsal hand may occur. To graft the greatest amount of skin on the dorsal hand, the hand should be kept preoperatively in a position flexing all joints of the wrist, metacarpophalangeal joints, and interphalangeal joints and maximally stretching the dorsal hand (a fist position). We studied the surface length of the dorsal hand between the wrist, the metacarpophalangeal joint, and the eponychium in the anatomic, safe, and fist positions of the right hand in 60 adults. Difference of total length between the anatomic and safe positions was not statistically significant (p > 0.05). The total length in a fist position was significantly increased in comparison with the other two positions (p < 0.05). In a fist position compared with the safe position, the increase in length of the dorsal surface of the proximal hand was 11 to 20 percent except in the thumb, and the increase in length of the dorsal surface of the finger was 12 to 17 percent. The increase in total length of a fist position was about 9 mm (7 to 8 percent) in the thumb and 20 to 32 mm (14 to 18 percent) in the index to little fingers. It suggests that the safe position fails to provide an increased dorsal hand surface area for skin grafting compared with the anatomic position. The greatest amount of skin can be grafted in a fist position. Hand immobilization in a fist position for 7 to 9 days after skin grafting has not resulted in irrevocable joint stiffness in our experience. If injury of the deep structures is not present, the hand should be immobilized in a fist position before skin grafting on the dorsal hand.