A Study of the Bystander Effect and Its Enhancement in HSV-TK Gene Therapy Using a Murine Neuroblastoma Model

PURPOSE: Selective introduction of genes conferring chemosensitivity into proliferating tumor cells may be used to treat cancer. We first investigated the bystander effect of retrovirus-mediated gene transfer of herpes simplex virus thymidine kinase(HSV-TK) gene to murine neuroblstoma cell line(neuro-2a) in vitro and in vivo. Second, we examined the mechanism and its enhancement of the bystander effect in murine neuroblastoma. METHODS: To investigate the bystander effect, we studied tumor growth and survival time after HSV-TK/ganciclovir(GCV) treatment in a syngenic A/J mouse neuroblastoma model by mixing various ratios of HSV-TK-expressing neuro-2a cells with wild type neuro-2a cells followed by GCV treatment. To investigate the mechanism of the bystander effect in murine neuroblastoma, immunohistochemistry using connexin 43, CD4 and CD8-specific monoclonal antibodies was analyzed. We studied whether IL-2-secreting neuro-2a cells(neuro-2a/IL-2) would potentiate the bystander effect. RESULTS: A strong bystander effect was observed in vitro and in vivo. The bystander effect in murine neuroblastoma was dependent on the immune response rather than connexin-mediated gap junction. Neuro-2a/IL-2 treatment enhanced the bystander effect in the HSV-TK/GCV system in murine neuroblastoma model. CONCLUSION: We conclude that the bystander effect in murine neuroblastoma depends on immune response and is enhanced by neuro-2a/IL-2.

Epidemiologic and Clinical Features of Pertussis in Children (2000.3-2001.3)

PURPOSE: Pertussis is a highly communicable infectious disease in children with high mortality, especially in young infants. The incidence of pertussis in South Korea has decreased to about 10 cases a year in late '90s. Doubting previously reported incidences of pertussis, we designed this study to establish exact epidemiology and a diagnostic basis of pertussis. METHODS: From Mar. 2000 to Mar. 2001, polymerase chain reaction(PCR) and cultures of nasopharyngeal aspirates were taken from 49 patients who were clinically suspected of pertussis in Kangdong Sacred Heart Hospital. RESULTS:Among 49 patients suspected of pertussis, 10 cases showed positive results by PCR method. Four out of those 10 cases were positive in culture. The peak outbreak was noticed in the spring(Mar.-May) and the autumn(Sep.-Nov.). The mean age of the patients was 3.6 months. Eight of the 10 cases which were PCR positive results proved not to be immunized against pertussis. CONCLUSION: Most of the pertussis patients in our study were diagnosed as bronchiolitis, pneumonia or bronchitis at the beginning of the disease and only a few patients showed typical clinical manifestations of pertussis, including whooping. When the above results are taken together, we suggest the possibility that the actual prevalence of pertussis in South Korea might be higher than that of previous reports. The importance of pertussis screen tests should be emphasized in children with severe coughs.

Tumor Vaccine Effect by IL-16 Gene Transfer into Murine Neuroblastoma Model

PURPOSE: Interleukin(IL)-16 is a potent chemoattractant factor for CD4+ T cells, monocytes, and eosinophils. It up-regulates IL-2R on CD4+ T lymphocytes and regulates the function of antigen presenting cells. We used retrovirus-mediated gene transfer of the human IL-16 gene into the neuro-2a cells, which is the murine neuroblastoma cell lines, to investigate whether locally secreted IL-16 might generate anti-tumor immune responses. METHODS: We estimated whether the local secretion of IL-16 from the genetically-modified tumor cells would affect their tumorigenicity in vivo, and then, IL-16 transfected neuroblastoma cells would protect mice from tumor development after wild-type tumor cell challenges. And we investigated the mechanism of IL-16 by nude mice trial of an anti-tumor immune response. RESULTS: The IL-16 gene-transduced neuro-2a clones secreted 4.2-6.0ng of IL-16 per mL per 10(5) cells during 24 hr. None of the mice(N=6) injected with 2x10(6) of irradiated, IL-16 gene-transfected neuro-2a cells developed tumors within 6 weeks while all of the mice(N=6) injected with wild-type neuro-2a cells developed tumors. Immunization of mice(N=6) with 2x106 IL-16 gene- transfected, irradiated neuro-2a cells protected these animals against a subsequent challenge with 2x10(6) wild-type tumor cells. Nude mice also showed an anti-tumorigenicity effect. However, the mice did not reveal the prophylactic effect against murine neuroblastoma. CONCLUSION: The local secretion of IL-16 gene-transduced tumor cells abrogated their tumorigenicity and induced protective immunity.

IL-2/HSVtk Gene Expression in Neuroblastoma Cell Line / 대한소아혈액종양학회지

PURPOSE: We investigated the efficacy of in vitro transduction of neuro 2a cells with interleukin-2 (IL-2) and herpes simplex virus-thymidine kinase (HSVtk) gene followed by assay of IL-2 and administration of the antiviral drug ganciclovir (GCV). METHPDS: The LNC/IL-2/IRES/HSVtk vectors were transferred in vitro into the murine neuro 2a-cell lines and the transduced cell lines were selected in G-418, 500 mug/mL, for 14 days. The neuro-2a cells transduced with 1x10(6) LNC/IL-2/IRES/HSVtk vector (neuro- 2a/IL-2 /HSVtk) were cultured in 6 well culture plates for 24 hours and we measured IL-2 concentrations of 1 x10(5) neuro-2a/IL-2/HSVtk by ELISA method. And also, 1x10(5) neuro- 2a/IL-2/HSVtk were cultured in 96 well culture plates in 10 mug/mL concentrations of GCV for 72 hours and then we measured the surviving cells 24 hours, 48 hours and 72 hours after GCV administration. RESULTS: We selected 5 colonies of the neuro-2a/IL-2/HSVtk and expanded in G-418 contained media. The IL-2 concentration of the neuro-2a/ IL-2/HSVtk was from 78.0+/-8.7 IU/day to 92.1+/-7.5 IU/day. The cell numbers of neuro-2a/IL-2/HSVtk survived after GCV administration were 3.7+/-1.5x10(2), 4.4+/-0.4x10(3), 5.0+/-1.0x10(2), 1.0+/-0.2x10(4), and 1.5+/-0.5x10(2), respectively. And the cell numbers of LNCX transduced neuro-2a cells survived were 7.5+/-0.5x10(5). CONCLUSION: In vitro transduction of neuro-2a cells with the LNC/IL-2/IRES/HSVtk vector expressed effectively IL-2 and HSVtk gene simultaneously.

A Case of Cerebral Infarction in a Child with Acute Lymphoblastic Leukemia Developed during Chemotherapy with E coli Asparaginase / 대한소아혈액종양학회지

E. coli L-asparaginase treatment during induction therapy in acute lymphoblastic leukemia is known to be rarely complicated by thromboembolic events. It causes deficiencies of antithrombin III, plasminogen, fibrinogen, factor IX, XI, protein C and protein S. We recently experienced a case of infarction during induction therapy in a 9-year-old child diagnosed with ALL. After the four dose of L-asparaginase, she had a generalized tonic- clonic seizure and MRI of the head showed both occipital infarction. She had gross recovery of the neurological impairment in 4 days. We report this case with brief review of literature.

A Case of T-cell Acute Lymphoblastic Leukemia presented with Spontaneous Tumor Lysis Syndrome and Superior Bena Cava Syndrome

Acute spontaneous tumor lysis syndrome is a condition resulting from the rapid release of cellular breakdown products into the circulation due to massive cytolysis occurring before start of treatment. It occurs most often in Burkitt's lymphoma and T-cell ALL, both of which have been well described, following cytotoxic chemotherpy and other single agent administrations. However, only a handful of spontaneous acute tumor lysis syndrome cases have recently been reported in the literature. We have recently experienced a case of a T-cell ALL in a 9-year-old girl presented with superior vena cava syndrome(SVC syndrome) and uric acid nephropathy due to acute spontaneous tumor lysis syndrome. On admission, she had marked elevation in serum uric acid, BUN and creatinine. She was given dexamethasone administration as a treatment of SVC syndrome and was supported with allopurinol therapy, hyperhydration and alkalinization of urine. On day 7 following continuous dexamethasone administration, her BUN and creatinine returned to normal and no blast cells was found in peripheral blood. Then, ALL induction chemotherapy (CCG-1882 protocol) was used, resulting in complete remission.

A Case of Childhood Multiple Focal Nodular Hyperplasia of the Liver / 대한소아혈액종양학회지

Focal nodular hyperplvasia (FNH) is a rare benign hepatic tumor that likely represents a local hyperplastic response of hepatocytes to a congenital vascular anomaly. FNH is typically asymtomatic and has a benign course. Hepatic resection is performed when the lesions are large, symptomatic and complicated or when the diagnosis remains uncertain. Although many cases of FNH in children have been described to date in other countries, only one Korean case of multiple FNH has been reported on English literature. We recently experienced a rare case of multiple FNH in a 10-year-old boy, that was confirmed by right inferior subsegmentectomy, left lateral segmentectomy and left medial tumorectomy. We report this case with brief review of literature.

The Case Report of a Child with High-Risk Acute Lymphoblastic Leukemia, Treated with Allogenic Peripheral Blood Stem Cell Transplantation

Allogenic peripheral blood stem cell transplantation could be used instead of allogenic bone marrow in treatment of leukemia in children. This 10-year-old female patient with high-risk acute lymphoblastic leukemia received a myeloablative regimen followed by allogenic peripheral blood stem cell transplantation from an HI A-identical sibling donor. Neutrophil recovery to greater than 500/pL occurred at day 11 and platelets recovered to greater than 20,000/pL at day 13. Allogenic peripheral blood stem cell transplantation can be performed safely and may result in a rapid neutrophil and platelet engraftment, without any apparent increased risk of acute graft versus host disease.

Retroviral-mediated IL-2 gene transfer into murine neuroblastoma

We used retroviral-mediated gene transfer of the human interleukin (IL)-2 gene into murine neuroblastoma cells to investigate whether locally-secreted IL-2 is able to influence the generation of anti-tumor immune responses. Supernatant obtained from cultures of approximately 1 x 10(6) IL-2 gene-transduced, G-418 selected neuro-2a cells was assayed for human IL-2 production by ELISA kit. First, to estimate whether the local secretion of IL-2 from the genetically-modified tumor cells would affect their tumorigenicity in vivo, IL-2-secreting neuro-2a cells were s.c. injected into A/J mice and tumor growth was measured weekly. And to estimate whether IL-2 transfected neuroblastoma cells protect mice from tumor development after wild-type tumor cell challenge, IL-2-secreting neuro-2a cells were s.c. injected into A/J mice. Seven days after IL-2 gene-transfected neuroblastoma cell injection, unmodified neuro-2a cells were s.c. injected into the contralateral site of A/J mice and tumor growth was measured weekly. Finally, to estimate IL-2 effect on pre-established large tumor burdens, IL-2-secreting neuro-2a cells were s.c. injected into A/J mice with established tumor and its growth was measured weekly. The IL-2 gene-transduced neuro-2a clones secreted 120.25-177.3 IU of IL-2 per ml per 10(6) cells during 24 hr. None of the mice injected with IL-2-secreting neuro-2a cells developed tumors within 6 weeks, while all of the mice injected with wild-type neuro-2a cells developed tumors. Immunization of mice with IL-2 gene-transfected, irradiated neuro-2a cells protected these animals against a subsequent challenge with wild-type tumor cells. Finally, the size of large neuroblastomas decreased after IL-2-secreting neuro-2a cell injection into mice. Local secretion of IL-2 gene-transduced tumor cells abrogates their tumorigenicity and induces protective immunity and may inhibit the growth of neuroblastoma.

A Case of Neonatal Graveses Disease / 대한소아내분비학회지

Neonatal Gaves disease is a relatively rare condition due to transplacental passage of Thyroid-stimulating antibody(TSAb) from a mother with active or inactive Graveses disease or autoimmune thyroiditis. A 11-day-old female newborn was referred to our department of pediatrics from a local clinic because of low level T4(3.55microg/dl) concurrent with high level TSH (501.74uIU/ml) on the 5th day neonatal metabolic screening. But, our repeated laboratory data showed very high serum T4(59.6microg/dl), T3(1,600ng/dl), suppressed TSH(0.43uIU/ml), and the presence of TSH receptor antibody. Her mother was treated with propylthiouracil(PTU) for Graves disease during pregnancy. Therefore, we thought it was a delayed-onset neonatal hyperthyroidism, because the fetal thyroid gland was initially suppressed by antithyroid drug taken during pregnancy. After initiating antithyroid drug therapy for the hyperthyroid nature, TSH levels became elevated again, while thyroid hormone levels decreased. Maternal and infant blood samples at the 23th day after birth were examined for serum autoantibodies directed towards the TSH receptor(Thyrotropin-binding inhibitory immunoglobulin:TBII, Thyroid-stimulating antibody:TSAb, Thyroid-stimulating blocking antibody:TSBAb) and high levels of TBII and TSAb were detected. About 2 months after birth, TBII and TSAb decreased within normal limit, and then we could stop antithyroid medication in safety. We report here a case of neonatal Graveses disease with very high level of T4 and T3, but firstly presented as hypothyroid nature on neonatal screening because of the maternally transferred antithyroid drug, PTU.

Effects of Hepatitis B Revaccination in Nonresponsive Children

PURPOSE: Hepatitis B virus infection is prevalent in Korea. Active immunization of Hepatitis B has been proceeded extensively for the last decade. This study was performed to estimate the negative rate of anti-HBs after immunization and to evaluate the effect of revaccination among Korean children between 1995 and 1997, as well as to determine a proper revaccination schedule. METHODS: Anti-HBs was measured with enzyme immunoassay. Hepatitis B revaccination was performed on nonresponders, those who were previously vaccinated and whose anti-HBs titers were under 10mIU/mL. Group A was revaccinated one dose of the same amount of the previous vaccine. Group B was given three doses of the same amount of the vaccine. Group C was given one double dose of the vaccine. The seroconversion rate and geometrical mean titer were measured one month later. RESULTS: Negative anti-HBs rate was 14.5% in children who had been vaccinated. The seroconversion rate was high in all revaccination groups(86.7-94.7%). Three doses of revaccination had no significant difference from one dose of revaccination. There was no positive effect of double dose of revaccination in comparison with the usual dose. CONCLUSION: In our study, one dose of hepatitis B vaccine is as effective as three doses or double dose of hepatitis B vaccine for the nonresponsive children. We recommend administering one dose of hepatitis B vaccine to those children whose three anti-HBs titer is under 10mIU/mL and examining of the anti-HBs titer one month later after revaccination.

A Case of Hemolytic Disease of the Newborn in Identical Twin due to Anti-c antibody / 대한소아혈액종양학회지

Anti-c is an important Rh antibody that causes hemolytic disease of the newborn. Recently we had a case of hemolytic disease of the newborn in identical twin due to anti-c. The five-day-old female twin were admitted at our hospital due to jaundice. There were no ABO and Rh (D) incompatibilities between mother and babies. The newborn's direct and indirect antiglobulin tests were positive and the maternal serum showed a positive antibody screening test. The laboratory findings warranted hemolytic disease of newborn due to other Rh antibodies. The specificity of unexpected antibodies were anti-c in maternal serum and fetal serums. The babies were treated with only phototherapy for 10 days and discharged in recovery.

A Clinical Analysis on Acute Lower Respiratory Tract Infections in Children Caused by Influenza Virus in Children

PURPOSE: Although annual epidemics occur, there are only a few clinical studies on influenza in Korea. We evaluated the epidemic and clinical features of acute lower respiratory tract infections in children by influenza virus. METHODS: From Feb., 1995 to July, 1997, influenza virus isolations and clinical review were performed on hospitalized children with acute lower respiratory tract infections at Hangang Sacred Heart Hospital. RESULTS: The influenza virus was isolated in 34 out of 545 (6.2%) patients examined. The number of influenza A and B viruses isolated were as follows : 0 and 2 from Feb. to March, 1995, 8 and 1 from Nov., 1995 to May, 1996, and 15 and 9 from Dec., 1996 to June, 1997. The patients were 27 boys and 7 girls with a mean age of 27.6 +/- 25.1 months. Eight patients (23.5%) had preceding underlying diseases such as asthma, bronchopulmonary dysplasia and ventricular septal defect (VSD) with Down syndrome. Three out of twenty-two patients surveyed had been vaccinated against influenza virus before infection. The acute lower respiratory tract infections diagnosed were pneumonia in 11, bronchiolitis in 9, croup in 8, and tracheobronchitis in 6 patients. Fever, cough, and rhinorrhea developed in all patients and fever continued for a mean 5.5 +/- 4.0 days. All patients recovered without antiviral treatment except one expired case with penumonia/VSD/Down syndrome. CONCLUSION: Acute lower respiratory tract infections caused by influenza virus developed every winter and spring during the period of the study. Influenza vaccination before epidemic season should be encouraged in risky patients.

A Case of Wiskott-Aldrich Syndrome Misdiagnosed as Chronic Idiopathic Thrombocytopenia / 대한소아혈액종양학회지

Wiskott-Aldrich syndrome is a rare inheritable disease. Though there are many reported cases in the world, there are only 3 reported cases in Korea. We experienced a 7 years old boy with Wiskott-Aldrich syndrome. The initial presentation was generalized petechiae due to thrombocytopenia. We diagnosed him to have idiopathic thrombocytopenic purpura and followed up him for several years. During follow-up the patient have been suffered from croup, perianal abscess, bronchitis, and otitis media. One year ago, inguinal mass developed and 3 months ago, cervical and axillary masses developed. The fine needle aspiration cytology and biopsy revealed angioimmunoblastic lymphadenopathy like atypical lymphoproliferative disorders associated with congenital immune deficiency. So we diagonsed the patient to have Wiskott-Aldrich syndrome through his clinical course and laboratory findings including eczema, persistent low platelet counts, low mean platelet volume, monoclonal gammopathy on serum electrophoresis and biopsy finding.

A Clinical Study on Acute Lower Respiratory Tract Infections by Adenovirus in Children

PURPOSE: This study was performed to characterize the epidemiologic and clinical features of acute adenoviral lower respiratory tract infections. METHODS: Culture and indirect immunofluorescence for adenovirus was done with nasopharyngeal aspirates from patients with acute lower respiratory tract infections from April to September, 1996. Cultured virus was serotyped for type 3, 4, and 7a by neutralization test, and medical records were reviewed. RESULTS: Adenovirus was isolated from 29 of 187 (15.5%) patients. Monthly distribution from May to September, 1996 was 4, 17, 7, 0, and 1 case, respectively. Seventeen out of 18 cases serotyped (94.4%) were type 7. Male to female ratio was 21:8 and ranged in age from 1 month to 8 years with a mean of 22.6 +/- 22.5 months. Clinical diagnosis was pneumonia in 18, tracheobronchitis in 6, and bronchiolitis in 4 cases. The main clinical features were cough (100%), sputum (100%), fever (89%), pharyngeal injection (85%), increased ESR (76%) and CRP (64%), and leukocytosis (59%). Radiologic findings of chest, included consolidation (40.7%), parahilar peribronchial infiltration (22.2 %), pleural effusion (7.4%), and hyperaeration (3.7%). The mean duration of admission was 8.9 +/- 5.1 days and all the patients showed favorable clinical outcome without acute respiratory distress syndrome. CONCLUSION: There was a respiratory epidemic by adenovirus between May and July, 1996, and 17 out of 18 cases serotyped was type 7. All of the 29 patients with acute adenoviral lower respiratory tract infections improved without significant complication.

A Clinical Study on Acute Lower Respiratory Tract Infections by Adenovirus in Children

PURPOSE: This study was performed to characterize the epidemiologic and clinical features of acute adenoviral lower respiratory tract infections. METHODS: Culture and indirect immunofluorescence for adenovirus was done with nasopharyngeal aspirates from patients with acute lower respiratory tract infections from April to September, 1996. Cultured virus was serotyped for type 3, 4, and 7a by neutralization test, and medical records were reviewed. RESULTS: Adenovirus was isolated from 29 of 187 (15.5%) patients. Monthly distribution from May to September, 1996 was 4, 17, 7, 0, and 1 case, respectively. Seventeen out of 18 cases serotyped (94.4%) were type 7. Male to female ratio was 21:8 and ranged in age from 1 month to 8 years with a mean of 22.6 +/- 22.5 months. Clinical diagnosis was pneumonia in 18, tracheobronchitis in 6, and bronchiolitis in 4 cases. The main clinical features were cough (100%), sputum (100%), fever (89%), pharyngeal injection (85%), increased ESR (76%) and CRP (64%), and leukocytosis (59%). Radiologic findings of chest, included consolidation (40.7%), parahilar peribronchial infiltration (22.2 %), pleural effusion (7.4%), and hyperaeration (3.7%). The mean duration of admission was 8.9 +/- 5.1 days and all the patients showed favorable clinical outcome without acute respiratory distress syndrome. CONCLUSION: There was a respiratory epidemic by adenovirus between May and July, 1996, and 17 out of 18 cases serotyped was type 7. All of the 29 patients with acute adenoviral lower respiratory tract infections improved without significant complication.

Immunogenicity and Safety of Recombinant Hepatitis B Vaccine(Engerix B) / 감염

BACKGROUND: Several studies on the efficacy and safety of the hepatitis B vaccine have shown variable immunogenicity. In this study we reexamined the immunogenicity and safety of recombinant hepatitis B vaccine, Engerix B which have currently been administered to the children in Korea. METHODS: Serum samples were collected from 126 children and 111 adults who were immunized according to the 0, 1, 2-month and 0, 1, 6-month vaccination schedule. Anti-HBs antibody titers were measured by ELISA in sera obtained after each immunization, and compared by immunization schedules. RESULTS: In 62 children with 0, 1, 2-month immunization schedule seroconversion rate was 83.9% after 1st vaccination, 96.8% after 2nd, and 98.4% after 3rd. In 64 children with 0, 1, 6-month immunization schedule seroconversion rates was 78.1% after 1st vaccination, 87.5% after 2nd and 100% after 3rd. In 50 adults immunized with 0, 1, 2-month schedule seroconversionrates was 48.0% after 1st vaccination, 74.0% after 2nd and 90.0% after 3rd. In 61 adults immunized with 0, 1, 6-month schedule seroconversion rate was 44.3% after 1st vaccination, 65.6% after 2nd and 93.4% after 3rd. Seroconversion rate after 0, 1, 2- month vaccination schedule were 98.4% in children and 90.0% in adults. Seroconversion rate after 0, 1, 6-month schedule were 100% in children and 93.4% in adults. There were no significant local and systemic untoward reactions among vaccinees. CONCLUSION: The recombinant Engerix B is excellent in immunogenicity with 93.4% and 100% seroconversion rates in adults and children, respectively. There is no significant difference in seroconversion rate between two vaccination schedule. The vaccine is safe.

Epidemiologic and Clinical Feature of Acute Lower Respiratory Tract Infections by Respiratory Syncytial Virus and Parainfluenza Virus in Children

PURPOSE: This is to analyze epidemic and clinical features of acute respiratory tract infections (ALRTI) by respiratory syncytial virus (RSV) and parainfluenza virus (PIV), which are considered to be the major respiratory pathogens in children. METHODS: Nasopharyngeal aspirates were collected from 515 patients with ALRTI hospitalized at Hangang Sacred Heart Hospital between Apr. '94 and Oct. '96. Nasopharyngeal aspirates were inoculated to HEp-2 cell, MDCK cell, and LLC-MK2 cell for the cultivation of viruses. The cultivated cells were observed for cytopathic effect on the 4th and 10th day. In case cytopathic effect was seen, indirect IF was done by using monoclonal antibodies for RSV and PIV 1, 2, 3 types. RESULTS: 1) The RSV and/or PIV have been identified in 150 out of 515 patients (29.1%), which break down into 86 patients (cultured only RSV), 46 patients (only PIV), 18 patients (both RSV and PIV). 2) ALRTI caused by RSV and PIV occurred mostly in the first two years of life (93%). The ratio of male to female patient was 2.1:1 and 74% of ALRTI was found in the patients with no history of underlying diseases. 3) RSV infection occurred mostly late autumn and winter, while PIV infection occurred all the year round, mostly in May. 4) RSV infection caused bronchiolitis in 67%, pneumonia in 28%, croup in 4%, while PIV infection caused bronchiolitis in 41%, croup in 37%, pneumonia in 20% clinically. And combined infection caused bronchiolitis in 67% and pneumonia in 28%. 5) The WBC count was normal in 49% of the RSV, 35% of the PIV, and 56% of the combined infection. The ESR was normal in 71% of the RSV, 59% of the PIV, and 79% of the combined infection. The CRP was normal in 83% of the RSV, 66% of the PIV, and 89% of the combined infection. 6) The following non-respiratory signs and symptoms were detected: diarrhea, increased AST/ALT, conjunctivitis, febrile seizure, exanthem, acute otitis media, enanthem. 7) The major radiologic features of RSV were normal in 54%, hyperaeration in 28%, peribronchial infiltration in 8%, and consolidation in 8%. PIV infection shows normal in 30%, hypopharyngeal dilatation in 33%, hyperaeration in 17%, and peribronchial infiltration in 4%. 8) The hospitalized period was 7.1 days on the average. None of them was died or mechanically ventilated due to ALRTI. CONCLUSIONS: RSV and PIV are considered to be the major causes of ALRTI. Diagnosis and treatment of RSV and PIV infections will be improved through further epidemiologic or clinical studies.

A Case of Huge Cystic Lymphangioma of the Greater Omentum

Lymphangioma is a tumor which is composed of lymph vessels and spaces containing lymph. It consists of endothelial cells and supporting tissue elements of the lymphatic system which are involved in the neoplastic process. Grossly, the cysts are thin walled and multiloculated. Intra-abdominal omental origin lymphangiomas are quite rare and only 21 cases were reported in English literature by 1978. The most common location is the mesentery, followed by the omentum, mesocolon, and retroperitoneum. We report a case of huge cystic lymphangioma originating from the greater omentum in a 14-year-old male patient with brief review of literatures.

Report of Nationwide Epidemiology of Aseptic Meningitis Outbreak in 1993 in Korea

PURPOSE: There has been no nationwide report pertaining to the epidemiology of aseptic meningitis, although a great numer of patients have been diagnosed of the illness. Therefore, we report an explosive outbreak of aseptic meningitis occured in a nationwide scale in 1993. METHODS: Aseptic meningitis epidemiology surveillence was performed retrospectively on the patients diagnosed of aseptic meinigitis from January 1993 to December 1993 at 60 hospitals (the third graded medical centers and comparable training hospitals) located in 9 districts. The data pertaining to the patients were obtained through the questionnaire answered by the pediatricians or pediatric houseofficers. Monthly and geographical distributions, age and sex distributions, clinical manifestations, laboratory data, complications, and the causative virus of aseptic meningitis were described. RESULTS: 1) The total number of cases reported in 1993 aseptic meningitis epidemiology surveillence was 5,090. Geographically the greatest number of patients was reported from Seoul (2,693), followed by Kyungnam (851), Chunbook (497), Kyungi (492), Chungnam (189), Kangwon (133), Kyungbook (127), Chunnam (82), and Cheju (26). 2) Monthly distribution revealed that the number of patients was increased from April to August and 95.4% (4,858 cases) of the totoal were diagnosed from May to July. The median dates for the diagnosis of aseptic meningitis in various districts were May 8 in Cheju, followed by Chunbook, Kyungnam, Chunnam, Kyungbook, Chungnam, Kyungi, Seoul in June and July 3 in Kangwon. 3) Average age of the study population was 4.7+/-2.9 years and male to female ratio 2.1:1. 4) Subjective symptoms consisted of headache, abdominal pain, poor appetite, irritability, etc, and physical findings fever, local neurological signs, etc in order of frequency. Duration of temperature elevation was 6.1+/-3.7 days in average and 22 cases had no temperature elevation at all. 5) Initial CSF findings revealed pressure of 132 66 mmH2O, leukocytes 594+/-890/mm3 with PMNL 25.6+/-24.7% and lymphocytes 72.3+/-26.1%, protein 47.0+/-37.6 mg/dl, and glucose 60.3+/-14.9 mg/dl. In 35.7% of the patients, CSF leukocytes were more than 500/mm3 and in 19.9% were greater than 1000/mm3. Thirty five patients did not have pleocytosis in the initial CSF examination. 6) The associated illnesses were pharyngotonsillitis (1,285 cases, 31.3%), pneumonia (104 cases, 2.7%), sinusitis (74 cases, 1.9%), etc. 7) While almost all the patients (99.0%) were reported to be improved without complications, 48 cases had complications with 7 encephalitis, 2 neurogenic bladder, 2 Guillian-Barr syndrome, 5 paralysis, and 32 unspecified. Six cases were reported to be deceased. 8) Virus was isolated from 25 out of 55 cases from Seoul and Kyungnam areas on whom virus isolation was tried, and all were echovirus 9. CONCLUSIONS: Aseptic meningitis outbreak in 1993 was nationwide, geographically begun in the southern part of the peninsula spreading rapidly northward, and seasonally occurred from April to August with the peak in June. The average age was 4.7+/-.9 years and male to female ratio 2.1:1. Clinical manifestations and laboratory findings of the study patients were comparable to the reported previoulsy. The causative virus for the nationwide aseptic meningitis outbreak in 1993 was echovirus 9.