Parvovirus B19 Infection in a Child with Acute Lymphoblastic Leukemia during Maintenance Chemotherapy / 임상소아혈액종양

Parvovirus B19 targets human erythroid progenitor cells, causing a self-limiting subclinical erythroid aplasia in the healthy hosts, whereas the immunocompromised subjects generate a prolonged viremia and chronic anemia with or without thrombocytopenia or neutropenia. The attenuated immune response in patients with acute lymphoblastic leukemia (ALL), receiving chemotherapy, may generate the hematologic aberration which mimic a leukemia relapse or therapy-induced cytopenia. This mimicry may lead to the unnecessary examination and the recess of chemotherapy. If the anemia with or without thrombocytopenia or neutropenia is noticed during the chemotherapy of ALL, the parvovirus B19 infection should be considered as a cause of hematologic aberration. We report a case of parvovirus B19 infection confirmed by PCR in a child with ALL who was initially sero-negative (IgM and IgG) against parvovirus B19 to highlight the importance of alertness to the possibility of parvovirus B19 infection during chemotherapy.

Parvovirus B19 Infection in a Child with Acute Lymphoblastic Leukemia during Maintenance Chemotherapy / 임상소아혈액종양

Parvovirus B19 targets human erythroid progenitor cells, causing a self-limiting subclinical erythroid aplasia in the healthy hosts, whereas the immunocompromised subjects generate a prolonged viremia and chronic anemia with or without thrombocytopenia or neutropenia. The attenuated immune response in patients with acute lymphoblastic leukemia (ALL), receiving chemotherapy, may generate the hematologic aberration which mimic a leukemia relapse or therapy-induced cytopenia. This mimicry may lead to the unnecessary examination and the recess of chemotherapy. If the anemia with or without thrombocytopenia or neutropenia is noticed during the chemotherapy of ALL, the parvovirus B19 infection should be considered as a cause of hematologic aberration. We report a case of parvovirus B19 infection confirmed by PCR in a child with ALL who was initially sero-negative (IgM and IgG) against parvovirus B19 to highlight the importance of alertness to the possibility of parvovirus B19 infection during chemotherapy.

The Effects of Selective Amygdalectomy in Experimental Epileptic Model in Rat

In order to study the effects of stereotaxic destruction of distinct epileptogenic focus, the amygdala was destroyed with radiofrequency coagulator. A total of twenty Sprague-Dawley rats were divided into two group : the control group which underwent craniectomy on the biparietal area and was instilled crytal penicillin solution into the right amygdala on the basis of stereotaxic coordinates(n=10), and the amygdalectomy group which was performed selective amygdalectomy with radiofrequency coagulator after confirmation of clinical and electroencephalographic epileptic features after proceeding same methods of control group(n=10). The experimental epileptic models in rats were obtained by selective instillation of crystal penicillin solution into the right amygdala. The effects of amygdalectomy were investigated by observation of the changes in behavior and electroencephalographic recordings. The results were as follows ; 1) A typical behavioral seizure was shown in the control group and epilepticform discharge was prominent in crystal penicillin soultion instilled side, but there was no bilateral synchronous epileptic discharges during ictal stages. 2) In comparision to two groups, the severity and the frequency of behavioral seizure were more decreased in the stereotaxic amygdalectomy group. 3) The amygdalectomy group was shwon a significant decrease in amplitude and frequency of spikes, especially during interictal stages, compared to the control group. From the results of electroencephalographic and behavioral analysis, selective amygdalectomy with radiofrequency coagulator seemed to be an effective method to treat the crystal penicillin soulution induced epileptic rats.

The Clinical Analysis of 75 Patients which were Operated on MVD

A series of 75 microvascular decompression(MVD) for 23 cases of trigeminal neuralgia, 50 cases of hemifacial spasm and 2 cases of paroxysmal vertigo has been reviewed with assessment of outcome at the last follow-up examination. In hemifacial spasm, average of symptom duration was 7 years, and female had longer duration as trigeminal neuralgia. The offending site was found more frequent in right side of the trigeminal neuralgia and hemifacial spasm. Meaningfully female in hemifacial spasm and male in trigeminal neuralgia was noted more frequent in right side. The offending vessels were considered anterior inferior cerebellar artery and posterior inferior cerebellar artery in hemifacial spasm and superior cerebellar artery in trigeminal neuralgia. There were good or excellent results in 31 cases(62%) of hemifacial spasm and in 15 cases(65%) or trigeminal neuralgia. The serious complications were not occurred in both diseases except one who died of brainstem infarction.

Brain Tumor Immunology: Part I : Basic Concepts of Tumor Immunology and Immunological Characteristics of Brain Tumors

As a potential adjuvant therapy of malignant brain tumors, immunotherapy has aroused the interest of neurooncologists. This review attempt to provide an introduction to the general concepts of tumor immunology and immunological characteristics of brain tumors, especially of gliomas, to promote an understanding of brain tumor immunotherapy(Part II) finally.

The Effect of Fetal Mesencephalon Implants in Rats with 6-Hydroxydopamine Lesion of the Nigro-Striatum : Behavioral, Biochemical Immunohistochemical Study

Parkinson's disease most consistently involves pathologic changes in the substantia nigra, which is the major source of dopamine to the striatum. It has been shown that either fetal substantia nigra or adrenal medulla tissue implanted to the rat brain survives, produces dopamine, and improves behavioral abnormalities induced by deprivaion of the caudate nucleus of its dopaminergic innervation. Thus, grafts containing dopamine could be potential replacement for destroyed or damaged dopaminergic neurons in patients with Parkinson's disease. In the present study, authors administrated 6-hydroxydopamine into the right substantia nigra, and produced unilateral dopamine denervated Parkinson's experimental model using solid graft method and cell suspension implant, the results of these grafts were examined behaviorally, biochemically, immunohistochemically 3 months after grafting. In this study, a total of forty-five young(4 to 5 week old) rats were used and divided into three experimental groups-control group which underwent dopamine denervation without any grafting(15), solid graft group which was grafted fetal mesencephalon to the caudate-putamien(n=15) and cell suspension implant group which was grafted cell suspension fetal mesencephalon to the caudate-putamen(n=15). The apomorphine induced rotation test was performed at four weeks, eight weeks, twelve weeks after grafting. The dopamine concentration in the caudate-putamen was biochemically measured by High Performance Liquid Chromatography(HPLC) and immunohistochemically these grafts containing dopamine granules were stained by Avidin-Biotin immunoperoxidase staining with dopamine monoclonal antibody. The results were as follows ; 1) Behavioral testing was performed by apomorphine induced rotational test. A mean rotation number during the first five minutes following apomorphine injection was 40.0+/-.5 in control and 18.3+/-.9 in cell suspension implanted group at one month after grafting and these was more reduction of turning than that in solid graft group. The both graft groups demonstrated explicit reduction of turning by 58% and 55.3% when compared to the control group respectively 3 months after grafting. However the difference in reduction of turning between the two grafted groups was statistically not significant. 2) Biochemical measurements of dopamine concentration was done in pathologic and normal caudate-putamen. The concentration of dopamine was 13.5+/-3.1ng/mg of protein in normal subject and 0.6+/-0.2ng/mg of protein in the dopamine denervated caudate-putamen of the control group which was markedly reduced by 4.4% of dopamine concentration in the normal caudate-putamen. The concentration of dopamine in the cell suspension implant group was 3.2+/-1.2ng/mg of protein at three months after grafting and 3.0+/-1.1ng/mg of protein in the solid group and these values were increased in the concentration give 5 times more than those of pregrafting state. 3) In the results of immunohistochemical examination cells containing granules of dopamine were exclusively found in the grafted groups. In experimental Parkinson's disease model of Sprague-Dawley rats, it was found that the grafts of fetal mesencephalon to the caudate nucleus induced an elevation of dopamine concentration and symptomatic improvement. In the method of graft, cell suspension implant method brings faster effect, leaves less amount of damage to the host brain, and can be used in any area of the brain for the transplantation. Therefore graft of fetal mesencephalon using cell suspension grafting method might be effective treatment of patients with Parkinson's disease.

3 Cases of Coincidental Cerebral Aneurysm with Pituitary Tumor

We report three cases of coincidental cerebral aneurysm with pituitary tumor. In our hospital the incidence of such cases was 4.4% of 68 patients with pituitary tumors from March, 1970 to October, 1990. Cases No. 1 was a 47-year-old female suffering from progressive loss of visual acuity. Preoperative brain C-T scan and angiographies revealed unruptured posterior communicating aneurysm with pituitary tumor. Case No. 2 was a 39-year-old male suffering from headache after head trauma with acromegaly. Preoperative brain C-T scan and angiographies appeared unruptured anterior communicating aneurysm and pituitary tumor. Case No. 3 was a 62-year-old female suffering progressive loss of visual acuity and headache. Left middle cerebral artery aneurysm and pituitary tumor were found by preoperative brain C-T scan and angiographies. All cases were operated by transcranial route and performed tumor removal after primary clipping of aneurysm. Postoperatively remained tumor of all cases was treated by radiosurgery successfully.

A Neurenteric Cyst in Cervical Spinal Canal: Case Report

A case of neurenteric cyst within the cervical canal is reported. He has been suffered from gradual aggravated quardriparesis since 4 months. On spine C-T scan and cervical myelographic examination, intradural extramedullary mass was detected. And so total laminectomy of C4, C5 and C6 was performed. We could diagnose by the pathological findings.

Thoracic Spinal Canal Stenosis Caused by Degenerative Hypertrophy of Posterior Elements: An Analysis of 21 Surgical Cases

Twenty-two surgical cases of myelopathy due to narrow thoracic spinal canal associated with degenerative changes of the posterior spinal elements have ever been reported in the literature since Govoni presented the first cases in 1971. Authors have experienced five surgical cases and added them to the above twenty-two cases. And clinical analysis was made with twenty-one cases, which had proper data to be analysed and included our own five cases. Thirteen patients were male and the average age was around fifty-five years. Most of the lesions were found in the lower thoracic spines and involved single segment in each patient. The symptoms were so various and non-specific that pertinent treatments were delayed and the disease had been misdiagnosed in most of the patients. Intrathecal enhanced spine CT might be most accurate diagnostic tool. Surgical decompression may proceed good results, even when symptoms have been presented for years.

Effect on the Regional Cerebral Blood Flow and Biomechanical Factors in Ventricular Enlargement of Experimental Hydrocephalus

To evaluate the biomechanical changes and cerebral blood flow in hydrocephalic brain, this study was designed to determine the regional cerebral blood flow(rCBF; frontal cortex and periventricular area), the pressure volume index(PVI) and the resistance to the absorption of cerebrospinal fluid(Ro) in different stages of the kaolin-induced hydrocephalus. Fifty five 8 week-old cats, weighing 900g to 1300g were used in this experiment. The experimental animals were divided into 2 groups ; a normal control(5 cats), and kaolin-induced hydrocephalic groups(50 cats). The kaolin-induced 1,2,4,6 and 8 weeks hydrocephalic groups after intracisternal injection of the kaolin. The rCBF was measured by hydrogen clearance technique and the PVI and Ro were determined by the technique of bolus manipulation of CSF. A significant elevation of the intracranial pressure(ICP) was observed in 2 weeks after kaolin injection and peak value(ICP=10.2+/-0.9mmhg) was obtained in 4 weeks after Kaolin injection. The significant decrease in rCBF were revealed in both frontal cortex and periventricular area of kaolin-induced hydrocephalic cats. The PVI was significantly increased from the normal value 0.77+/-0.02ml to 1.60+/-0.16ml at 4 weeks after kaolin injection and increased to 2.12+/-0.34ml at 6 weeks after kaolin injection. Ro was significantly decreased from the normal value 90.6+/-1.3mmHg/ml/min to 36.8+/-4.3mmHg/ml/min at 4 weeks after kaolin injection and further decreased to 6.2+/-1.9mmHg/ml/min at 8 weeks after kaolin injection. In Hydrocephalic cats, the size of the ventricle(septum pellucidum-caudate nucleus distance) continued to increase in size up to 9.40+/-0.7mm at the 4th week. However, there was no further increase in ventricular size after the 4th week. This study indicated that kaolin-induced hydrocephalic cats led to dramatic changes in volume-buffering capacity expressed as PVI, coupled a reduction in the Ro. The absorptive defect and also loss of volume-buffering capacity are not sufficient to cause progressive ventricular enlargement. It is assuming that some microcirculatory impairment in the brain parenchyma is playing an important role which facilitates ventricular expansion with changes of biomechanical property of the brain.

The Clinical Analysis of Surgical Treatment in the Medically Intractable Seizure

We performed callosotomy and amygdalo-hippocampectomy in medically intractable seizure patients. Symptom duration of these patients was over 2 years and seizure was not controlled with anticonvulsants in spite of high level in drug monitoring according to their seizure type. 7 patients with generalized epilepsy were treated by anterior callosotomy and 8 patients with temporal lobe epilepsy were treated by amygdalo-hippocampectomy. Anyone of these patients were not dead and discovered permanent complications. And so these methods, anterior callostomy and amygdalo-hippocampectomy seems to be relatively safety and effective methods in treatment of medically intractable seizure.

Motor and Sensory Evoked Potential in the Evaluation of Increased Intracranial Pressure in Cats

Motor evoked potential(MEP) and sensory evoked potential(SEP) were recorded in 30 experimental cats in accordance with change of intracranial pressure. MEP was obtained on the thoracic cord after electric stimulation through a ball electrode directly installed on the cerebral motor cortex. SEP was elicited on the cerebral cortex after stimulation of thoracic cord. Experimental animals were composed of control group(10 cats) and raised intracranial pressure (ICP) group(20 cats) which included a group of 10 cats with 30 mmHg increased ICP and another group of 10 cats with 50 mmHg elevated ICP. Each evoked potential according to changes in ICP was obtained and the results were as follows: 1) MEP in control group showed that latency was 14.8+/-0.8 msec and amplitude was 24.4+/-2.1 microV. MEP after elevation of ICP showed more profound change in 50 mmHg increased ICP group than in 30 mmHg increased ICP group. Latency was prolonged by 152%(37.4+/-1.8 msec) of control group and amplitude was reduced to 82%(4.58+/-1.2 microV) of control group in the 50 mmHg increased ICP group. Recovery of MEP changes from increased ICP by reduction of the pressure was more prominent in 30 mmHg elevated group than 50 mmHg elevated group. 2) In control group SEP showed that latency was 25.38+/-1.5 msec and amplitude was 22.8+/-1.4 microV. SEP after elevation of ICP showed more profound change in 50 mmHg increased ICP group than 30 mmHg increased ICP group. Latency of SEP in 50 mmHg increased ICP group was prolonged by 54%(39.18+/-2.2 msec) of control group and amplitude reduced by 47%(10.98+/-0.9 microV) of control group was more prominent in 30 mmHg elevated group than 50 mmHg elevated group. changes in MEP after raised ICP were more remarkable than that of SEP. The degree of Recovery from raised ICP was more prominent in 30 mmHg group than 50 mmHg group. This study indicates that because change of MEP is more sensitive than that of SEP in the evaluation of cerebral function in case of increased ICP, MEP might be a paramount indicator in the evaluation of cerebral injury. Recording of MEP as well as ICP monitoring system might be a new method for the early detection of changes in cerebral function.

A Clinical Analysis of 22 Patients with Discitis

From March 1966 to July 1988, 22 patients were diagnosed as discitis among the 2106 operation with total or hemilaminectomy in Department of Neurosurgery of Catholic University Medical College. Main symptoms were severe low back(95%) and buttock pain(86%). Physical examination showed severe paravertebral spasm and tenderness. The erythrocyte sedimentation rate was always elevated in all cases and averaged to 43 mm/hr. X-ray examination of the lumbar spine showed typical findings of decreased intervertebral space, subchondral sclerosis and bony fusion. In bacterial culture staphylococcus aureus and streptococcus epididymis were grown. Good long-term results were seen in all cases.

Pseudoaneurysm of Extracranial High Internal Carotid Artery

Pseudoaneurysm of extracranial high internal carotid artery was rare lesion. Left hemiparesis was suddenly developed after 6 hours following penetrating injury at right mastoid area by air gun. On brain computerized tomography relatively well defined low density was noted at right temporo-parietal area. On right caratid angiography round aneurysmal dilatation, 2.5x3 cm sized was present at the site of metallic shadow in the atlas. The pseudoaneurysm was treated by the method of direct surgical approach, removal of aneurysm and end to end anastomosis with autogenous saphenous vein interposition bypass graft without difficulty. Postoperative course was not uneven.

The Effect of Corpus Callosotomy on the Electoroencephalography in the Experimentally Induced Epileptic Rats

In order to study effect of corpus callosotomy for epileptic lesions located at sensory-motor cortex/cortices, changes in amplitude, frequency of background activity and frequency of abnormal discharges of postcallosotomy electroenencephalography(EEG) recordings were observed in the crystal penicillin induced epileptic models of rats. In control group of 10 rats, simple right(craniotomy was) done and needle electrodes were bilaterally inserted into parietal and occipital scalp, connected to EEG recording system. Experimentally induced epileptic group was obtained by instillation of 1-2 drops of crystal penicillin solution(800,000 IU/ml) at right parietal area(20 rats). Postcallosotomy group was consisted of the animals streotactically performed callosotomy with blunt ended stainless steel, sized 3 mm, width and 0.5 mm, thickness(20 rats). Preoprative and postoperative EEG recordings were obtained in each animals over 20 minates. The results were as follows; 1) Bialteral synchronous epileptic discharges were shown in experimetally induced epileptic group, which compared to control group. 2) Section of the corpus callosum caused the abolition of bilateral synchronous epileptic discharges, when compared to experimentally induced epileptic group. 3) Frequency of abnormal discharges in the contralteral hemisphere was more decreased than crystal penicillin-instillated lesion in postcallosotomy group. 4) The Background activity of postcallosotomy group was slower than control group. From the results of EEG analysis, corpus callosum might paly a important role in formation of bilateral synchronous discharges and callosotomy was seemed to be an effective method to control crystal penicillin induced epileptic rats, which had epileptic focus in sensory-motor cortex.

Clinical analysis of 3rd Decade Male 47 Cases with Intracranial Tumors in Korea

The authors represented a clinical analysis of 3 rd decade male 47 patients with intracranial tumors who had been histologically confirmed after operation and biopsy at the department of neurosurgery of Capital Armed Forces General Hospital From Feb. 1985 to Jan, 1988. We classified the intracranial tumors according to Russell and Rubinstein's classification. The results were as follows: 1) Among the intracranial tumors, gliomas were found most frequently(40.4%), and followed by pituitary adenomas(19.2%), pinealomas(10.6%), osteomas(6.4%), medulloblastomas(4.3%), craniopharyngiomas(4.3%), blood vessel tumors(4.3%). Pituitary adenomas occupied 19.2% of all intracranial tumors and as a single entity these were the highest incidence. 2) Tumors of the pineal region constitutes 10.6% of intracranial tumors. It was relatively high incidence compared with other reports. 3) Intracranial tumors occurred more frequently in supratentorial region(85.1%). The most frequent location was sellar and parasellare region(23.4%), and followed by frontal(14.9%), parietal(12.7%), pineal gland(10.6%), temporal(8.5%), cerebellar region(8.5%) in order. 4) The most common duration of symptoms were within 3 months(42.6%). The main clinical symptoms and signs were headache(80.9%), nausea or/and vomiting(55.3%), papilledema(44.7%), so called symptoms triad of the brain tumor, and other ophthalmic symptoms, gait disturbance, motor dysfunction,cerebellar sign in order.

A Case of Cystic Cavernous Hemangioma

We experienced a case of cavernous hemangioma suspected to cerebral cysticecosis. The 23-year-old male patient was admitted to our hospital due to sudden severe headache and generalized tonic-clonic seizure. The computerized tomography showed multiple calcification of bilateral cerebral hemisphere, especially right, and cystic mass on right frontal area with mass effect. The mass was diagnosed cavernous hemangioma under the microscopic examination.

A Case of Oligodendroglioma in the Septum Pellucidum

The authors report a case of oligodendroglioma in the septum pellucidum. A 22-year-old male presented with symptoms of headache and decreased visual acuity. Simple skull series showed calcified density near the midline. Brain C-T scan revealed huge calcified mass involving right lateral ventricle, 3rd ventricle and obstructive hydrocephalus. The authors diagnosed oligodendroglioma in operative findings and pathologic examination.

Transoral Fusion of the Odontoid Process Fracture

The Odontoid process fracture has been treated by prolonged external immobilization of by internal fixation and fusion. We reported congential and traumatic odontoid process fracture which were successfully treated by transoral fusion. Operative preparation, technique and postoperative management are described by in detail.

A Case of Thoracic Spinal Canal Stenosis

A compression of spinal cord or nerve roots is commonly seen sequale of acquired or congenital stenosis of the cervical of lumbar portions of the spine. The authors have treated a case of thoracic myelopathy associated with thoracic canal stenosis, which was diagnosed with thoracic myelography and thoracic C-T scan. The pathological findings was thickened ligament flavum, hypertrophied articular processes, narrow spinal canal and compression of spinal cord. It is suggested that the syndrome should be considered in any patient who has a thoracic myelopathy.