The Direction of Neurosurgery to Overcome the Living with COVID-19 Era : The Possibility of Telemedicine in Neurosurgery

Objective@#: Due to the implementation of vaccinations and the development of therapeutic agents, the coronavirus disease 2019 (COVID-19) pandemic that started at the end of 2019 has entered a new phase. As a result, neurosurgeons should reconsider the way they treat their patients. As the COVID-19 situation prolongs, the change in neurosurgical emergency patients according to the number of confirmed cases is no longer clear. Outpatient treatment by telephone was permitted according to government policy. In addition, visits to caregivers in the intensive care unit were limited. @*Methods@#: The electronic medical records of patients who had been treated over the phone for a month (during April 2020, while the hospital was closing) were reviewed. Meanwhile, according to the limited visits to the intensive care unit, a video meeting was held with the caregivers. After the video meeting, satisfaction was evaluated using a questionnaire. @*Results@#: During April 2020, 1021 patients received non-face-to-face care over the telephone. Among the patients, no critical medical problem occurred due to non-face-to-face care. From July 2021 to December 2021, 321 patients were admitted to the neurosurgical intensive care unit and 107 patients (33.3%) including their caregivers agreed to video visits. Twice a week, advance notice was given that access would be made through a mobile device and the nurse explained to caregivers how to use the mobile device. The time for the video meeting was approximately 20 minutes per patient. Based on the questionnaire, 81 respondents (75.7%) answered that they agreed, and 26 respondents (24.3%) answered that they strongly agreed that was easy to communicate through video meetings. Fifty-two (48.6%) agreed and 55 (51.4%) strongly agreed that they were easy to understand the doctor’s explanation. For overall satisfaction with this video meeting, three respondents (2.8%) gave 4/5 points and 95 respondents (88.8%) gave 5/5 points, and nine (8.4%) gave 3/5 points. Their reason was that there was not enough time. @*Conclusion@#: In situations where patient visits are limited, video meetings through a mobile device can provide sufficient satisfaction to caregivers. Telemedicine will likely become common in the near future. Health care professionals should prepare and respond to these needs and changes. Therefore, establishing a system with institutional support is necessary.

Delayed Detection of a 5-Aminolevulinic Acid In Vivo: A Case of Metastatic Breast Cancer

A 44-year-old female patient who had been diagnosed with breast cancer visited our oncology department. She had developed right-side weakness and mild dysarthria, and MRI revealed a 4-cm cysticenhancing lesion in her left frontal lobe. Her surgery was postponed 48 hours after receiving 5-aminolevulinic acid (5-ALA), because a problem with thyroid function that had not been noticed before was discovered. The main lesion was enhanced on navigation and appeared to be a gross tumor; its 5-ALA uptake was very high. Specimens obtained from this location were histologically confirmed to contain tumor cells. The operation was completed, and removal of all enhancing lesions was confirmed by MRI within 24 hours postoperatively. The pathology report confirmed metastatic ductal carcinoma. The clinical efficacy of 5-ALA was confirmed even 48 hours after administration into a metastatic brain tumor from breast cancer.

Distinct Specialized Center of Excellence, the Story of Hwasun Neurosurgery at Chonnam National University Hwasun Hospital

The paper provides a comprehensive overview of the growth and development of Hwasun Neurosurgery at Chonnam National University Hwasun Hospital over the past 18 years. As the first brain tumor center in Korea when it was established in April 2004, Hwasun Neurosurgery has since become one of the leading institutions in brain tumor education and research in the country. Its impressive clinical and basic research capabilities, dedication to professional education, and numerous academic achievements have all contributed to its reputation as a top-tier institution. We hope this will become a useful guide for other brain tumor centers or educational institutions by sharing the story of Hwasun Neurosurgery.

Comparative Analysis of COVID-19 Outbreak and Changes in Neurosurgical Emergency Patients

Objective@#: COVID-19 has spread worldwide since the first case was reported in Wuhan, China, in December 2019. Our institution is a regional trauma and emergency center in the northern Gyeonggi Province. The changing trend of patient care in the emergency room of this hospital likely reflects the overall trend of patients in the area. In the present study, whether changes in the surrounding social environment following the outbreak of COVID-19 changed the incidence of neurosurgical emergency patients and whether differences in practice existed were investigated. @*Methods@#: The overall trend was analyzed from January 2020 which is before the outbreak of COVID-19 to September 2020. To remove bias due to seasonal variation, the previous 2 year's records during the same period were reviewed and compared. Confirmed COVID-19 patients in the northern Gyeonggi Province were identified using data released by the government. And patients who came to the emergency department with head trauma and stroke were identified. @*Results@#: Based on the present study results, the total number of neurosurgery emergency patients decreased over the study period. In the trauma patient group, the number of patients not involved in traffic accidents significantly decreased compared with patients involved in traffic accidents. Among the stroke cases, the rate of ischemic stroke was lower than hemorrhagic stroke, although a statistically significant difference was not observed. Meanwhile, an increase in the risk of mortality associated with trauma or stroke cases was not observed during the COVID-19 outbreak compared with the same time period in the previous year. @*Conclusion@#: Due to the occurrence of COVID-19, non-essential activities have decreased and trauma cases not associated with traffic accidents appeared to decrease. Due to the decrease in overall activity, the number of stroke patients has also decreased. This trend is expected to continue even in the post-COVID-19 era, and accordingly, the results from the present study are relevant especially if the current situation continues.

Glioneuronal Tumor with Neuropil-Like Islands in the Cerebellum: A Case Report

Glioneuronal tumor with neuropil-like islands (GTNI) is a rare and novel mixed neuronal-glial tumor that typically affects the supratentorial cerebral hemispheres of adult patients. It is extremely rare for GTNIs to be in the spine of pediatric and adolescent patients, and there have been no reports of infratentorial GTNIs. We report a case of an elderly patient with an anaplastic, infratentorial GTNI that occurred in the cerebellum, including describing MRI features of our case.

Prevalence and risk factors for reduced pulmonary function in diabetic patients: The Korea National Health and Nutrition Examination Survey

BACKGROUND/AIMS: An association between reduced pulmonary function and diabetes has been observed. Our aim was to evaluate the prevalence and risk factors associated with reduced pulmonary function in diabetic patients. METHODS: We analyzed data from the Korea National Health and Nutrition Examination Survey 2011 to 2013. The study population included data from 8,784 participants (including 1,431 diabetics) aged ≥ 40 years. Reduced pulmonary function was defined as patients with restrictive (forced expiratory volume in 1 second/forced vital capacity [FEV₁/FVC] ≥ 0.7 and FVC < 80% of predicted value) or obstructive (FEV₁/FVC < 0.7) patterns. RESULTS: Subjects with diabetes had a higher prevalence of restrictive (18.4% vs. 9.4%, p < 0.001) and obstructive impairments (20% vs. 12.6%, p < 0.001) than those without diabetes. The adjusted odds ratios (aORs) (95% confidence interval [CI]) for obstructive and restrictive pulmonary impairment were 0.91 (0.75 to 1.11) and 1.57 (1.30 to 1.89), respectively. In the diabetes population, age (aOR, 1.04; 95% CI, 1.02 to 1.06), male sex (aOR, 1.40; 95% CI, 1.04 to 1.88), and body mass index (aOR, 1.15; 95% CI, 1.10 to 1.21) were independently associated with restrictive pulmonary impairment. Age (aOR, 1.12; 95% CI, 1.09 to 1.14), male sex (aOR, 4.24; 95% CI, 2.42 to 7.44), and smoking at any point (ever-smoker: aOR, 1.96; 95% CI, 1.16 to 3.33) were independent risk factors for obstructive pulmonary impairment in diabetics. Diabetes duration or glycated hemoglobin had no association with pulmonary impairment in diabetes. CONCLUSIONS: Subjects with diabetes had a higher risk of restrictive pulmonary impairment than those without diabetes after adjusting for confounding factors. Older age, male sex, body mass index, and smoking were associated with reduced lung function in diabetes.

Prevalence and risk factors of periodontitis among adults with or without diabetes mellitus

BACKGROUND/AIMS: This study examined prevalence and risk factors of periodontitis in representative samples of Korean adults, with and without diabetes mellitus (DM). METHODS: Data from the 2012 Korean National Health and Nutritional Examination Survey were analyzed. A total of 4,477 adults (≥ 30 years old) were selected from 8,057 individuals who completed a nutrition survey, a self-reported general health behavior questionnaire, an oral examination, an oral hygiene behaviors survey, and laboratory tests. DM was defined as a fasting plasma glucose ≥ 126 mg/dL, or self-reported diagnosed diabetes, or current use of oral hypoglycemic agents and/or insulin. The community periodontal index was used to assess periodontitis status and comparisons between the periodontitis and the non-periodontitis group, were performed, according to the presence of DM. Risk factors for periodontitis in adults with DM and without DM were evaluated by multiple logistic regression analysis. RESULTS: The prevalence of periodontitis was significantly higher in adults with DM (43.7%) than in those without DM (25%, p < 0.001). In adults without DM, risk factors for periodontitis were older age, male, urban habitation, waist circumference, smoking, oral pain, and less frequent tooth brushing. Significant risk factors for periodontitis in adults with DM were the smoking, oral pain, and not-using an oral hygiene product. CONCLUSIONS: Adults with DM have an increased risk of periodontitis than those without DM. Current smoking and oral pain increase this risk. Using an oral hygiene product can reduce risk of periodontal disease in adults with DM.

Glomerular filtration rate affects interpretation of pulmonary function test in a Korean general population: results from the Korea National Health and Nutrition Examination Survey 2010 to 2012

BACKGROUND/AIMS: The pulmonary abnormalities (principally restrictive abnormalities) are characteristic of renal transplant recipients or those with end-stage renal disease. Our aim was to explore whether the prevalence of spirometric abnormalities was influenced by the estimated glomerular filtration rates (GFRs) in a Korean general population. METHODS: We used data obtained during the 2010 to 2012 Korean National Health and Nutrition Examination Survey, a national cross-sectional survey. We analyzed data from subjects for whom spirometric assays and estimated GFRs were of acceptable quality. RESULTS: A total of 8,809 subjects (3,868 male and 4,941 female) was included. In both males and females with GFR values < 60 mL/min/1.73 m², the linear trends toward the presence of obstructive and restrictive patterns were significant. However, the percent predicted forced vital capacity (FVC) decreased with a decline in the estimated GFR, but only in males (p for trend < 0.0031). Multivariate linear regression analysis showed a decline in the estimated GFR was independently associated with falls in the percent predicted FVC and the forced expiratory volume in 1 second/FVC ratio in both males and females. However, the percent predicted FVC was independently predictive only in males (p = 0.002). CONCLUSIONS: Impaired pulmonary function was associated with a decline in the estimated GFR. The percent predicted FVC decrease paralleled the decline in estimated GFR in male only. Careful interpretation of pulmonary function test data is required in patients with decreased GFRs or impaired renal function, especially males.

Disability of Hearing Impairment Is Positively Associated With Urine Albumin/Creatinine Ratio in Korean Adults: The 2011–2012 Korea National Health and Nutrition Examination Survey

OBJECTIVES: The aim of this study was to determine whether chronic kidney disease (CKD) is associated with hearing thresholds in the nationwide, large-scaled Korean population. METHODS: This study analyzed the data of 9,798 subjects of 19 years and older (4,387 males and 5,411 females). Urine albumin-to-creatinine ratio (ACR) was measured from first-voided spot urine samples. The air-conduction hearing threshold was measured at 0.5, 1, 2, 3, 4, and 6 kHz and pure tone audiogram (PTA) average was calculated as the four-frequency average of 0.5, 1, 2, and 4 kHz. RESULTS: Urine ACR was significantly correlated with the PTA average of better ear in both genders, especially at 3 and 6 kHz in males and at 1, 3, 4, and 6 kHz in females. After adjusting, urine ACR also increased the risk of hearing loss in female, especially if urine ACR was 30 mg/g and more (odds ratio, 1.636–2.229. This study showed that the degree of hearing loss was significantly different according to categories of urine ACR in both genders. Hearing loss without disability was found less but that with bilateral hearing disability was found more as urine ACR increased. In generally, prevalence of hearing loss with disability was higher in males than females. CONCLUSION: This study demonstrated that urine ACR was significantly correlated with the PTA average of better ear in Korean adults of both genders. This study suggests that clinicians should carefully monitor the hearing level for subjects with elevated urine ACR, even though high urine ACR within the normal range.

A Case of Steven-Johnson Syndrome after Live Bee Acupuncture (Bong-Chim)

Bee stings can cause various skin reactions that usually resolve over several days; however, in some patients the venom acts as an allergen, causing a severe immunological response such as anaphylaxis. Bee stings can also induce chronic inflammation because the barbed stinging apparatus and venom sacs, along with the nerve plexus, can lodge in the skin. Chronic non-specific low back pain is the most common medical problem for which patients seek complementary and alternative medical treatment, including bee venom acupuncture. Bee venom acupuncture involves injecting diluted bee venom into acupoints and is used for arthritis, pain, and rheumatoid diseases. Here we report a 75-year-old man with acute urticaria and skin eruption with eosinophilia and interstitial pneumonia 6 weeks later after receiving 5 times bee venom acupuncture.

Atrial Fibrillation during General Anesthesia Induction and Paroxysmal Supraventricular Tachycardia on Emergence / 이화의대지

A healthy 35-year-old man who was scheduled for closed reduction of nasal bone fracture developed atrial fibrillation during induction of general anesthesia after intravenous glycopyrrolate injection. During emergence of general anesthesia, atrial fibrillation was suddenly changed to paroxysmal supraventricular tachycardia with 200 beat per minute and lasted for about 10 seconds. Because blood pressure was stable, esmolol was used to reduce ventricular response. At recovery room, ventricular response reduction about 55 beat per minute was observed after intravenous injection of verapamil 5 mg. Thereafter, the rhythm was returned to normal sinus rhythm with bradycardia.

Seizures in Patients with Brain Tumors

OBJECTIVES: To determine the presentation, incidence, and risk factors of seizures in patients treated for brain tumors. METHODS: One hundred patients who consecutively underwent a craniotomy for the treatment of supratentorial brain tumors were assessed. The pathologies of the patients enrolled in the study included glioma (n=56), meningioma (n=31), metastatic brain tumor (n=7), primary central nervous system lymphoma (n=4), and central neurocytoma (n=2). Anti-epileptic drugs (AEDs) were administered to all patients for up to six months after the surgery. Pre-defined variables for outcome analysis included tumor grade and location, extent of tumor resection, number of seizures, age at tumor diagnosis, adjuvant therapy, medication and radiological abnormalities. RESULTS: Thirty patients (30%) presented at least a single episode of seizure at the time of admission. Five of these patients (16.7%) developed the seizure during the follow-up period. Newly developed seizure was noticed in six out of seventy patients (8.6%) without prior seizure. Histopathology was malignant gliomas in 10 and supratentorial meningioma in one. Early seizure developed only in two patients. CONCLUSION: Compared with patients without seizure, patients with seizure at the time of admission showed younger age (p=0.003), a higher portion of low-grade glioma (p=0.001), tumor location in the frontal and temporal lobes (p=0.003) and cortical involvement (p=0.017). Our study suggestes that tumor progression is considered a significant risk factor for seizure development in glioma patients.

Temozolomide Chemotherapy in Patients with Recurrent Malignant Gliomas

Numerous studies have demonstrated the clinical activity of temozolomide, a second-generation alkylating agent, against malignant brain tumors, however, its activity has not been reported in an Asian population. This study analyzed the efficacy and toxicity of temozolomide in 25 adult patients with recurrent or progressive malignant gliomas after surgery and standard radiation therapy with or without chemotherapy, enrolled in our institution since July 2000. Sixteen patients had glioblastoma multiforme (GBM), six with anaplastic astrocytoma, and three with anaplastic oligodendroglioma. Of the 25 patients, 3 (12%) achieved a complete response (CR), 8 (32%) achieved a partial response (PR), 6 (24%) had stable disease (SD), and 8 (32%) had progressive disease (PD). Two patients achieved a CR, 4 patients achieved a PR, 3 patients had SD and 7 patients had PD in GBM, and 1 patient achieved a CR, 4 patients achieved a PR, 3 patients had SD, 1 patient had PD in the non-GBM patients. Median progression free survival was 8 weeks in GBM and 22 weeks in the non-GBM patients. The median overall survival of each group was 17 weeks and 28 weeks. Temozolomide demonstrated moderate activity in recurrent and progressive malignant gliomas without serious toxicity.

Analysis of Angiographic Findings and Clinical Impact of Anterior Clinoidectomy in Internal Carotid-Posterior Communicating Artery Aneurysm Surgery - Clinical Research - / 대한뇌혈관외과학회지

OBJECTIVE: In the case of internal carotid-posterior communicating (ICPCom) artery aneurysm it is possible to successfully clip the aneurysmal neck without any difficulty. However, if the aneurysmal neck is wide, the aneurysmal sac is giant, the aneurysmal sac is hidden by the anterior clinoid process (ACP), or its dome is located in ventral portion or low-lying ICPCom aneurysm, it is difficult to open the proximal aneurysmal neck and we encounter a barrier in controlling bleeding in case of premature rupture of the aneurysm. They need to be resected the ACP for successful aneurysmal clipping. We propose angiographic criteria for predicting necessity of resection of the ACP before clipping of the ICPCom artery aneurysm. METHODS: Between 1999 and 2003, 16 patients with ICPCom artery aneurysm were treated with the resection of the ACP prior to applying the clip on the neck of the aneurysm. We retrospectively analyzed the preoperative cerebral angiographies, and the clinical and operative findings. We measured various radiometric parameters to reveal the angiographic characteristics. RESULTS: The mean value of the radiographic measurement in case of the cerebral angiography in 16 patients is as follows: angle A (the angle between the midline of the skull and the axis of the C1 segment on A-P view) ranged from 15 to 80 degrees (mean+/-SD, 42+/-5 degrees), angle B (the angle between the axes of the C1 and C2 segments on A-P view) ranged from 70 to 150 degrees (mean+/-SD, 110+/-15 degrees), and distance C (the distance between the tip of the ACP and the most proximal portion of the aneurysmal neck on the lateral view) ranged from 2 to 9 mm (mean+/-SD, 4.5+/-1 mm). CONCLUSION: We have resected the ACP in 16 of the 40 ICPCom aneurysms. The mean values of angle A, angle B, and distance C is 42+/-5 degrees, 110+/-15 degrees, and 4.5+/-1 mm, respectively. We did not encounter any difficulty in clipping in all the cases in which there was no premature rupture of the aneurysm. Most of cases had a good outcome.

Unusual Clinical Course of Giant Vertebral Artery Aneurysm after Proximal Artery Embolization: Case Report / 대한뇌혈관외과학회지

The authors present the case of a patient who suffered from cerebellar dysfunction, radiographically documented brainstem compression, and neurological deterioration after proximal artery occlusion in a giant vertebral artery aneurysm. Symptom resolution was achieved after complete embolization of remained lumen of aneurysm. The cause of neurological deterioration is brainstem compression due to mass effect of the aneurysm. In order to avoid this fatal complication, it is necessary to determine appropriate therapy for the vertebral artery giant aneurysm by evaluating cerebral blood flow and other factors about growth of aneurysm.

Effect of beta-Ig H3 on Chondrogenesis by Human Bone Marrow Mesenchymal Stem Cells / 대한정형외과학회잡지

PURPOSE: This study was undertaken to compare the activity of beta-Ig H3 (BigH3) and transforming growth factor (TGF)-beta on chondrogenesis by mesenchymal stem cells (MSCs). MATERIALS AND METHODS: MSCs in human bone marrow aspirated from 20 healthy donors were isolated by density gradient Ficoll-hypaque separation and expanded in culture. MSC-alginate beads were prepared and incubated for 28 days in the presence of 0.5 or 10 ng/mL of TGF-beta 1, TGF-beta 1+TGF-beta 3 or BigH3. Cellular viability, total collagen and glycosaminoglycan (GAG) contents were measured and compared. SPSS version 9.0 was used for the statistical analysis. RESULTS: TGF-beta 3 significantly enhanced cell viability in beads by day 21 (p=0.029). No significant differences were found in terms of cell viability (p=0.197) or in total GAG content (p=0.253) between 10 ng/mL of TGF-beta 1+3 and 10 ng/mL of BigH3. Total collagen content was higher in the BigH3 added group on day 21 (p=0.041). CONCLUSION: The replacement of BigH3 instead of TGF-beta produced appropriate external signals indicating the chondrogenic differentiation of human bone marrow MSCs.

Temozolomide Chemotherapy for the Treatment of a Recurrent and Progressive Malignant Glioma

OBJECTIVE: Temozolomide is a novel oral alkylating agent, which has been reported to be effective in treating patients with recurrent malignant gliomas. This study report an analysis of the activity and toxicity of temozolomide as second-line therapy for patients with recurrent and progressive malignant gliomas after surgery and standard radiation therapy with or without chemotherapy. METHODS: Twenty patients with malignant gliomas of which thirteen(65%) had glioblastoma multiforme(GBM), five(25%) with anaplastic astrocytoma(AA), and two(10%) with anaplastic oligodendroglioma(AO) were enrolled in this study. They had been treated in our institution since July, 2000 and had been previously irradiated with or without chemotherapy. For the patients with recurrent and progressive disease, temozolomide(150-200mg/m2/d x5 days) was administered every 28 days until the progression of the tumor or toxicity developed. RESULTS: The median number of treatment cycles was 3(total 86). Of the 20 patients, 2(10%) achieved a complete response(CR), 5(25%) achieved a partial response(PR), 5(25%) had stable disease(SD), and 8(40%) had progressive disease(PD). One patient achieved a CR, 3 patients achieved a PR, 2 patients had SD and 7 patients had PD in GBM, and 1 patient achieved a CR, 2 patients achieved a PR, 3 patients had SD, 1 patient had PD in the non-GBM patients. Median progression free survival(PFS) was 8 weeks in GBM and 22 weeks in the non-GBM patients. No hematological toxicity greater than grade 2 was observed, and hepatotoxicity of grade 2 was encountered in 1(5%) patient. CONCLUSION: Temozolomide demonstrate moderate activity in recurrent and progressive malignant brain tumors, and the response rate and PFS were better in the non-GBM tumors than in the GBM tumors. The treatment is well tolerated without any serious toxicity.

The Diagnostic Value of Polymerase Chain Reaction in Intestinal Tuberculosis / 대한소화기내시경학회지

BACKGROUND/AIMS: It is quite difficult to differentiate intestinal tuberculosis from Crohn's disease because of the similarities of their clinical and pathological features and low detection rate of acid fast bacilli. The diagnostic value of PCR has been studied in pulmonary tuberculosis, tuberculous pleuritis and meningitis, but few reports were made in cases of intestinal tuberculosis. The aim of this study is to evaluate the diagnostic value of PCR in intestinal tuberculosis. METHODS: The subjects, a total of 70 cases are composed of clinically diagnosed intestinal tuberculosis, Crohn's disease and intestinal Behcet's disease. We performed PCR with paraffin-embedded intestinal tissue to detect the DNA of Mycobacterium Tuberculosis and the data was analyzed. RESULTS: The positive rate of PCR for Mycobacterium Tuberculosis was 9.8% (4/41) in intestinal tuberculosis, 0% (0/29) in Crohn's disease, and 0% (0/3) in intestinal Behcet's disease. The granulomas were not found in 50% (2/4) of the PCR positive intestinal tuberculosis cases. CONCLUSIONS: We were not able to find evidences to prove the excellent value of PCR assay in making differential diagnosis of intestinal tuberculosis from other granulomatous diseases. But it might be helpful in detecting cases of intestinal tuberculosis which were not pathologically or microbiologically confirmed.

The Clinical Significance of Quantitation of HBV DNA in Serum: Comparison of the Branched-DNA Assay with the Second-Generation Digene Hybrid Capture Assay and Long-term Observation / 대한간학회지

BACKGROUNDS/AIMS: Serum levels of hepatitis B virus (HBV) DNA are direct measures of viral replication in hepatocytes. We compared branched-DNA assay (QuantiplexTM, bDNA) and Hybridization Capture II (HCII), and evaluated the clinical significance of HBV DNA quantitation in the natural course of HBV infection. METHODS: We analyzed results of bDNA in 324 serum samples from 83 untreated male patients with chronic hepatitis B. Mean follow up period was 11.8 years. HCII was also performed in 157 arbitrarily selected samples. RESULTS: HBV DNA levels measured with two assays were very similar (r2=0.893, p<0.0001). HBV DNA detection rate of HCII was 6.4% higher than that of bDNA in HBeAg positive samples. HBV DNA detection rate was higher in cases with higher ALT. Among 73 patients with initial diagnosis of chronic hepatitis, 38 patients (52.1%) experienced progression to cirrhosis, and hepatocellular carcinoma (HCC) was developed in 9 (12.3%). HCC was developed in 5 (50.0%) of 10 patients with initial diagnosis of cirrhosis. While HBeAg positive rates during chronic hepatitis, cirrhosis and HCC were 57.8%, 55.0% and 14.3%, respectively (p=0.006), HBV DNA detection rates were 70.6%, 64.0% and 42.9%, respectively (p=0.08). Especially in HCC, the discrepancy between HBeAg positive rate and HBV DNA detection rate may suggest the appearance of variants which cannot produce HBeAg. CONCLUSION: Both HCII and bDNA were similar HBV DNA quantitation assays for clinical use. HBV DNA level correlated with the severity of liver disease. Screening tests for HCC should be recommended in patients whose HBeAg is negative and have detectable HBV DNA.

Clinical Analysis of Spontaneous Intracranial Hypotension

OBJECTIVE: Spontaneous intracranial hypotension(SIH) is a rare condition presented with cardinal postural headache and low CSF pressure. The authors describe the characteristic clinical features, imaging findings, and treatment methods in the patients with spontaneous intracranial hypotension. METHODS: Between May 1994 and Aug. 2001, eight patients were diagnosed with spontaneous intracranial hypotension based on characteristic radiologic and clinical findings in our department. All cases were shown diffuse meningeal enhancement(DME) on magnetic resonance(MR) image. Two cases had subdural hematoma. RESULTS: The most characteristic feature on Brain MR image is DME with/without subdural fluid collection. Radionuclide image reveals direct leaking point and rapid appearance of urinary bladder activity. Direct leaking points were detected in all four cases who performed radioisotope study. Autologous epidural blood patches were applied to four cases, and all of them were improved without complication. Among four patients treated with conservative method, three were improved, but one patient was died of spontaneous chronic subdural hematoma. CONCLUSION: We suggest that 1) meticulous studies need to be performed aggressively if SIH is diagnosed clinically and radiologically, 2) the most effective study may be radioisotope study, and 3) if leaking point is found, aggressive management such as autologous epidural blood patches is recommended.