Semi-Replication-Competent Retroviral Vectors Expressing Gibbon Ape Leukemia Virus Fusogenic Membrane Glycoprotein (GALV FMG) Gene for Cancer Gene Therapy

A semi-replication-competent retroviral (s-RCR) vector system in which the gag-pol and env (GALV FMG, gibbon ape leukemia virus fusogenic membrane glycoprotein) genes were split into two separate packageable vectors was developed. These vectors are more efficient than replication-defective retroviral (RDR) vectors in gene delivery and have a higher transgene capacity than replication-competent retroviral (RCR) vectors. For thegag-pol vector construction, internal ribosomal entry site-enhanced green fluorescent protein (IRES-EGFP) was introduced downstream of the gag-pol sequence of the previously constructed MoMLV-10A1-EGFP vector to generate MoMLV-gag-pol-IRES-EGFP. For env vector construction, GALV FMG was inserted into the pCLXSN vector to generate pCLXSN-GALV FMG-IRES-EGFP.MoMLV-gag-pol-IRES-EGFP and pCLXSN-GALV FMG-IRES-EGFP were co-transfected into 293T cells to generate s-RCR viruses. These viruses propagated EGFP and induced syncytium formation due to the cytotoxicity of GALV FMG. To improve the cytotoxicity of s-RCR vector system, GALV FMG or the fusogenic envelope G glycoprotein of the vesicular stomatitis virus (VSV-G) was inserted into gag-pol vector. Co-transfection of MoMLV-gag-pol-IRES-GALV FMG + MoMLV-EGFP or MoMLV-VSV-G + pCLXSN-GALV FMG-IRES-EGFP in 293T cells induced stronger syncytium formation than s-RCR vectors (MoMLV-gag-pol-IRES-EGFP + pCLXSN-GALV FMG-IRES-EGFP). In addition, s-RCR stocks collected from transfected 293T cells induced syncytium formation in the human cancer cell lines HT1080 and TE671.Hence, the s-RCR vector systems developed in this study are useful tools for cancer gene therapy.

Semi-Replication-Competent Retroviral Vectors Expressing Gibbon Ape Leukemia Virus Fusogenic Membrane Glycoprotein (GALV FMG) Gene for Cancer Gene Therapy

A semi-replication-competent retroviral (s-RCR) vector system in which the gag-pol and env (GALV FMG, gibbon ape leukemia virus fusogenic membrane glycoprotein) genes were split into two separate packageable vectors was developed. These vectors are more efficient than replication-defective retroviral (RDR) vectors in gene delivery and have a higher transgene capacity than replication-competent retroviral (RCR) vectors. For thegag-pol vector construction, internal ribosomal entry site-enhanced green fluorescent protein (IRES-EGFP) was introduced downstream of the gag-pol sequence of the previously constructed MoMLV-10A1-EGFP vector to generate MoMLV-gag-pol-IRES-EGFP. For env vector construction, GALV FMG was inserted into the pCLXSN vector to generate pCLXSN-GALV FMG-IRES-EGFP.MoMLV-gag-pol-IRES-EGFP and pCLXSN-GALV FMG-IRES-EGFP were co-transfected into 293T cells to generate s-RCR viruses. These viruses propagated EGFP and induced syncytium formation due to the cytotoxicity of GALV FMG. To improve the cytotoxicity of s-RCR vector system, GALV FMG or the fusogenic envelope G glycoprotein of the vesicular stomatitis virus (VSV-G) was inserted into gag-pol vector. Co-transfection of MoMLV-gag-pol-IRES-GALV FMG + MoMLV-EGFP or MoMLV-VSV-G + pCLXSN-GALV FMG-IRES-EGFP in 293T cells induced stronger syncytium formation than s-RCR vectors (MoMLV-gag-pol-IRES-EGFP + pCLXSN-GALV FMG-IRES-EGFP). In addition, s-RCR stocks collected from transfected 293T cells induced syncytium formation in the human cancer cell lines HT1080 and TE671.Hence, the s-RCR vector systems developed in this study are useful tools for cancer gene therapy.

Thoracolumbar Paraspinal Myonecrosis after Aortic Dissection / 대한신경손상학회지

Thoracolumbar paraspinal myonecrosis can be developed with various etiologies. It can induce compartment syndrome of spinal muscles and cause elevated pressure on back muscles, resulting in severe back pain. Thoracolumbar paraspinal myonecrosis is a very rare disease. There are only a few studies about paraspinal myonecrosis. Here we report a case of a spontaneous thoracolumbar paraspinal myonecrosis in a patient who had asymptomatic abdominal aortic dissection. Through this case, etiologies, clinical features, radiologic findings, and treatment options for thoracolumbar paraspinal myonecrosis are discussed.

The Effectiveness of Early Tracheostomy (within at least 10 Days) in Cervical Spinal Cord Injury Patients

OBJECTIVE: This study aimed to determine the optimal time for tracheostomy by evaluating the benefits and safety of early versus late tracheostomy in spinal cord injury (SCI) patients. METHODS: We retrospectively reviewed a total of 254 patients with spinal cord injury. Of them, we selected 21 spinal cord injury patients who required tracheostomy due to long-term mechanical ventilation and analyzed their medical records. The patients were categorized into two groups. Early tracheostomy was performed day 1-10 from intubation in 10 patients and the late tracheostomy was performed after day 10 in 11 cases. We also evaluated the duration of mechanical ventilation, stay in the ICU and complications related to tracheostomy, the injury level of and clinical severity. All data was analyzed using SPSS 18.0/WIN. RESULTS: The early tracheostomy offered clear advantages for shortening the total ICU stay (20.8 day vs. 38.0 day, p=0.010). There was also statistically significant reduction in the total length of time on mechanical ventilation (5.2 day vs. 29.2 day, p=0.009). However, the reductions in the incidence of pneumonia (40% vs. 82%) and the length of ICU stay post to tracheostomy (6 day vs. 15 day) were found to be statistically not significant. There were also no statistically significant differences in the injury level and clinical severity between the groups. CONCLUSION: We concluded that the early tracheostomy (at least 10 days) is beneficial for SCI patients who are likely to require prolonged mechanical ventilation.

Recurrent Spinal Meningioma: A Case Report

Meningiomas are the second most common intradural spinal tumors accounting for 25% of all spinal tumors. Being a slow growing and invariably benign tumor, it responds favorably to surgical excision. In addition, spinal meningioma has low recurrence rates. However, we experienced a case of intradural extramedullary spinal meningioma which recurred 16 years after the initial surgery on a 64-year-old woman. She presented with progressive neurological symptoms and had a surgical history of removal of thoracic spinal meningioma 16 years ago due to bilateral low leg weakness. She underwent a second operation at the same site and a pale yellowish tumor was excised, which was histopathologically confirmed as meningothelial meningioma, compared with previously transitional type. she showed neurological recovery after the operation. We, therefore, report the good results of this recurrent intradural spinal meningioma case developed after 16 years with literature review.

CSF Leakage through a Subarachnoid-pleural Fistula after Resection of a Malignant Solitary Fibrous Tumor / 대한흉부외과학회지

Solitary fibrous tumor is an uncommon submesothelial mesenchymal neoplasm that primarily arises from the pleura. Most solitary fibrous tumors have a benign course, and the single most important predictor of the clinical outcome is the ability to excise the entire lesion. We experienced a case of CSF leakage through a subarachnoid-pleural fistula after resection of a malignant solitary fibrous tumor and the involved rib. We detected CSF leakage via performing CT myelography and we treated this case with hemilaminectomy and dura repair.

Comparison between Carbon Fiber Composite Frame and PEEK(Polyetheretherketone) Cages in the Efficiency of Interbody Fusion for Surgical Treatment of Cervical Disc Diseases

OBJECTIVE: To evaluate the efficiency of carbon fiber composite frame and polyetheretherketone(PEEK) cages in the interbody fusion for surgical treatment of cervical disc diseases, we analyzed fusion time and subsidence rate. METHODS: From March 2004 to February 2007 fifty patients with cervical disc diseases underwent anterior discectomy and interbody fusion in 60 levels. The subjects were 26 men and 24 women with a mean age of 57.2 years ranging from 29 to 67. Among them 25 patients underwent operations using carbon fiber composite frame cages (Osta-Pek(R), Co-Ligne, Zurich, Switzerland) in 30 levels, and 25 patients using PEEK cages(Cornerstone(R), Medtronic, TN, USA) in 30 levels. The cages were packed with allograft bone or bone substitute(demineralised bone matrix). On lateral flexion-extension radiographs anterior disc height and posterior disc height were measured at preoperative time, postoperative 1, 3, 6 and 12 month respectively. Segmental stability(lordotic angle) was measured at postoperative 3, 6, and 12 months in all 60 levels for fusion time. RESULTS: The anterior disc height and posterior disc height were 4.87+/-1.36mm and 3.25+/-0.73mm at preoperative time, 7.32+/-1.41mm and 4.77+/-0.80mm at postoperative 1month, and 5.87+/-1.47mm and 3.22+/-0.93mm at posto- perative 12 months respectively in carbon fiber composite frame cage group(30 levels). The anterior disc height and posterior disc height were 4.88+/-1.18mm and 3.75+/-0.75mm at preoperative time, 7.26+/-1.17mm and 5.27+/-0.55mm at postoperative 1month, and 6.23+/-1.16mm and 3.96+/-0.69mm at postoperative 12months respectively in PEEK cage group(30 levels). The angular motion at the fused segment was measured in carbon fiber composite frame cage and PEEK group for segmental stability(two degrees or less flexion-extension range of motion at the fusion site). The carbon fiber composite frame cage group was stabilized between postoperative 3 months and 6 months, but PEEK cage group was stabilized between 6 months and 9 months. This result was statistically significant(p-value =0.003)(Fig. 2). Fusion rate of carbon composite frame cage group was 28%, 67% and 83% at 3, 6, 12 months after operation, and that of PEEK cage group was 24%, 48% and 86% at postoperative 3, 6 and 12 months respe- ctively. Complications included transient hoarseness, cage migration and subsidence. There was no persistent hoar- seness or Horner syndrome. We have observed severe subsidence(above 3mm) in two cases(6.7%) of carbon fiber composite frame cage group only. Anterior cage migration was shown in each one case(3.3%) of carbon fiber composite frame and PEEK cage group. CONCLUSION: The carbon fiber composite frame cage group showed a tendency of earlier fusion than PEEK cage group but both cages were same in the fusion rate at postoperative 1 year. But, restoration or maintenance of inter- vertebral height was much better in PEEK cage group than carbon fiber composite frame cage group. Subsidence rate was higher in carbon fiber cage group rather than PEEK cage group.

Size and Location of Ruptured Intracranial Aneurysms

OBJECTIVE: The aim of study was to review our patient population to determine whether there is a critical aneurysm size at which the incidence of rupture increases and whether there is a correlation between aneurysm size and location. METHODS: We reviewed charts and radiological findings (computed tomography (CT) scans, angiograms, CT angiography, magnetic resonance angiography) for all patients operated on for intracranial aneurysms in our hospital between September 2002 and May 2004. Of the 336 aneurysms that were reviewed, measurements were obtained from angiograms for 239 ruptured aneurysms by a neuroradiologist at the time of diagnosis in our hospital. RESULTS: There were 115 male and 221 female patients assessed in this study. The locations of aneurysms were the middle cerebral artery (MCA, 61), anterior communicating artery (ACoA, 66), posterior communicating artery (PCoA, 52), the top of the basilar artery (15), internal carotid artery (ICA) including the cavernous portion (13), anterior choroidal artery (AChA, 7), A1 segment of the anterior cerebral artery (3), A2 segment of the anterior cerebral artery (11), posterior inferior cerebellar artery (PICA, 8), superior cerebellar artery (SCA, 2), P2 segment of the posterior cerebral artery (1), and the vertebral artery (2). The mean diameter of aneurysms was 5.47+/-2.536 mm in anterior cerebral artery (ACA), 6.84+/-3.941 mm in ICA, 7.09+/-3.652 mm in MCA and 6.21+/-3.697 mm in vertebrobasilar artery. The ACA aneurysms were smaller than the MCA aneurysms. Aneurysms less than 6 mm in diameter included 37 (60.65%) in patients with aneurysms in the MCA, 43 (65.15%) in patients with aneurysms in the ACoA and 29 (55.76%) in patients with aneurysms in the PCoA. CONCLUSION: Ruptured aneurysms in the ACA were smaller than those in the MCA. The most prevalent aneurysm size was 3-6 mm in the MCA (55.73%), 3-6 mm in the ACoA (57.57%) and 4-6 mm in the PCoA (42.30%). The more prevalent size of the aneurysm to treat may differ in accordance with the location of the aneurysm.

Is the use of Digital Infrared Thermal Imaging Useful in Whiplash Injury?

OBJECTIVE: The name of whiplash Injury derives from the etiopathogenic description of the sudden sharp whipping movement of the head and neck, symptoms are varied, manifesting as neck pain, occipital pain, dysesthesia, and weakness of arm, and so on. But there is no objective diagnostic tool for the evaluation of its symptoms. The purpose of the study is to visualize the symptomatic region before and after treatment and comparing the images obtained by infrared study. METHODS: From march 2006 to June 2008, 20 patients diagnosed as whiplash injuries were examined by digital infrared thermographic imaging system (DITI, DOREX, USA). The male-to-female ratio was 14:6 and their ages were ranging in age from 20 to 67 years, with mean age of 38.5 years. We evaluated thermal change (deltaT) in lesion area(neck and shoulder) and also compared thermal difference (deltaT (2wk-I)) after pre- & post- treatment. RESULTS: Initial DITI was 34.28 +/- 2.90 on anterior neck, 34.29 +/- 2.98 on posterior neck, 33.42 +/- 2.93 on right shoulder shoulder (Lt), and 33.59 +/- 2.81 on left shoulder. DITI after 2weeks treatment was 33.60 +/- 2.88 on anterior neck, 33.78 +/- 2.99 on posterior neck, 32.79 +/- 2.78 on right shoulder, and 33.05 +/- 2.74 on left shoulder. The thermal difference of lesional area on the initial treatment and after treatment (deltaT (2wk-I)) was 0.68 +/- 0.45 on anterior neck, 0.51 +/- 0.36 on posterior neck, 0.63 +/- 0.32 on right shoulder, and 0.54 +/- 0.64 on left shoulder, and these result were statistically significant (p < 0.05). Thermal difference (deltaT) was neck 0.34 and shoulder 0.33 on initial injury, and 0.39, 0.31 after 2 weeks respectively. This finding was symmetrical and below deltaT 0.5 based on pathologic body temperature. Initial VAS (Visual Analogue Scale) of Neck was 7.9 +/- 0.78 and after 2 weeks was 3.6 +/- 1.21 the initial VAS of shoulder was 7.4 +/- 0.52 and after 2 weeks was 3.2 +/- 0.97. There was statistically significant (p=0.001). CONCLUSION: Therefore DITI was perceived as a reliable tool in the objective assessment of treatment effect after sustaining whiplash injuries, in clinical practice.

Clinical Factors Related With Response to Anti-epileptics in Temporal Lobe Epilepsy With Hippocampal Sclerosis

BACKGROUNDS: Temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) is not always intractable to antiepileptic drugs (AEDs). To identify the responsiveness to AEDs and related clinical factors in TLE-HS, we performed this study. METHODS: Consecutive 100 (51 men, mean age=30.2+/-6.6, age range=19-50) patients with TLE-HS were divided into two groups by their responsiveness to AEDs. Intractable TLE-HS was defined if they had any seizures for the preceding year with at least two AEDs. Clinical factors were analyzed to find the association of the responsiveness to AEDs. RESULTS: Intractable TLE-HS was found in 68% of patients. The younger age of onset (12+/-4 vs. 31+/-8 years, p<0.0001), longer duration of epilepsy (17+/-6 vs. 2+/-1 years, p<0.0001), more than five tonic-clonic seizures (GTCs) with secondary generalization (29.4 vs. 6.3%, p=0.0009) and bilateral epileptiform abnormalities on EEG (30.9 vs 6.3%, p=0.0054) were significantly correlated with the intractable TLE-HS. According to multiple logistic regression analysis, bilateral epileptiform abnormalities on EEG (adjusted OR=9.4, 95% CI: 1.98~44.76) and more than five GTC (adjusted OR=7.7, 95% CI: 1.60~33.39) were independently related with poor responsiveness to AEDs in TLE-HS. CONCLUSIONS: The presence of hippocampal sclerosis does not necessarily mean intractability to AEDs. The clinical variables related with the poor response to ADEs in TLE-HS are more than five GTCs and bilateral epileptiform abnormalities on EEG.

Surgical Experiences for Intracranial Aneurysms(3,000 Cases)

OBJECTIVE: The present study evaluated overall surgical results for 3,000 patients with intracranial aneurysms, operated on in Busan Paik Hospital institution. METHODS: Three thousand aneurysm cases, operated on in Busan Paik Hospital between January 1980 to June, 15th, 2005, were evaluated based on the following criteria;aneurysm form, aneurysm location, surgical results, postoperative complications, and seasonsonality of occuence. 957 cases were anterior communicating artery aneurysms, 776 were internal carotid artery(ICA) aneurysms, 755 were middle cerebral artery(MCA) aneurysms, 96 were anterior cerebral artery(ACA) aneurysms, 128 were vertebro-basilar artery(VBA) aneurysms and 288 were multiple aneurysms. The male to female ratio was 0.7 to 1. Surgical methods included 2,738 clippings, 219 coating and wrappings, 23 aneurysmoraphies, 20 proximal ligations. RESULTS: Rebleeding occured in 5.1% of the early operation group and 16% of the late operation group respectively. Incidence of clinical vasospasm was 16.6% and angiographic vasospasm was 24.1%. The percentage of the multiple aneurysms was 9.5%, the percentage of the dissecting aneurysm was 6 cases (0.2%), 6 of the total (0.2%);De Novo" aneurysm, the percentage of lobectomies with clipping cases was 9 cases (0.3%), the percentage were incidental aneurysms;164 (5.5%). 88.1% had overall favorable surgical results with a 5.5 % mortality rate. Calcium-channel blocker and "Triple H" therapy did not improve mortality but did significantly improve morbidity. In the old age group, early operation reduced vasospasm, rebleeding and medical complications. The early surgery group exhibited a 86.2% favorable outcome with a 8.1% mortality rate. Intraoperative angiography reduced residual or remained aneurysms in large, giant aneurysm, especially in A.com artery aneurysm. CONCLUSION: The surgical results for the early surgery group according to surgical timming was better, but there were not statistically significant. ntraoperative angiography was especially useful on large aneurysms of the anterior communicating artery.

Magnetic Resonance Spectroscopy of Patients with Acute Cerebral Infarction / 대한뇌혈관외과학회지

OBJECTIVE: MR spectroscopy is a noninvasive method of monitoring in vivo metabolite concentration changes over time. In this study we evaluated the usefulness of combined magnetic resonance imaging and spectroscopy on the diagnosis of cerebral infarction. METHODS: Combined magnetic resonance imaging and spectroscopy investigations were carried out with 1.5-T system in 18 volunteers, 10 patients with acute infarction (< 8 hours). RESULTS: Acute ischemic infarctions were characterized by decreased N-acetyl aspartate and elevation of lactate. CONCLUSION: Metabolic alterations in ischemic tissue can be monitored.

Intracranial Chloroma(Granulocytic Sarcoma) by Lymphocytic Leukemia

Intracranial chloroma may occur in leukemia, although they are rare. A 23-year-old female complained diplopia. Brain magnetic resonance MR imaging showed tumors in the both cavernous sinus , both tentorial and anterior falx. Gamma-Knife radiosurgery was performed with maximal dose; 20Gy, marginal dose; 10Gy. Peripheral blood smear revealed leukemia, and bone marrow aspiration biopsy showed acute lymphocytic leukemia. Two weeks later, MR image for the stereotactic biopsy noticed markedly decreased tumor size. Biopsy result was lymphocytic leukemia. She received conventional radiation therapy, chemotherapy, and bone marrow transplantation. Brain involvement by acute lymphocytic leukemia is very rare. Even though chloroma are sensitive to radiation therapy, prognosis is poor because of the gravity of the underlying disease and association with impending blast transformation. The authors reports a intracranial chloroma by acute lymphocytic leukemia.

Thalamotomy without Microelectrode Recording

OBJECTIVE: Tremor, either essential tremor or Parkinsonian tremor, has been effectively and safely treated by lesioning the ventral intermediate(Vim) nucleus of the thalamus with or without mircroelectrode recording. The authors evaluate the treatment outcome of sixteen tremor patients who had been treated with thalamotomy without microelectrode. METHODS: Between September, 2001, and December, 2003, sixteen tremor patients were treated with thalamotomy without microelectrode recording. Twelve patients suffered from Parkinsonian tremor and four patients were essential tremor patients. The male to female ratio was 1.6 to 1 with median age of 59.6 years (range; 39-74 years). Under local anesthesia, a 3mm hole was made using a hand-held twist drill, and the dura mater was penetrated with a 1.2mm sharp drill beat. Radiofrequency(RF) electrode was placed in the Vim nucleus of thalamus. With intraoperative macrostimulation, RF lesion was made. Postoperative CT scan and/or MR imaging was performed to confirm the localization of the target lesioned. Preoperative and postoperative tremor was evaluated with simple tremor severity scale and the development of complications related with the procedure was closely reviewed at the immediate postoperative period and the last follow-up. RESULTS: It produces immediate relief in up to 98.4% of the patients. There were no development of complications related with procedure, all patients discharged one or two days after surgery. CONCLUSION: Vim thalamotomy without microelectrode recording is a safe and effective procedure to control the tremor with minimal morbidity. Intraoperative macroelectrode stimulation safely localizes the Vim nucleus target of the thalamus for the treatment of patients with tremor.

Clinical Aspect of Spontaneous Pontine Hemorrhage / 대한뇌혈관외과학회지

OBJECT: Spontaneous pontine hemorrhage can be diagnosed by CT or MRI, but the clinical course is variable according to the location of the hemorrhage. MATERIALS AND METHODS: Author attempted to analyse 39 cases of spontaneous pontine hemorrhage, considering factors to influence their prognosis, admitted in Inje University Busan Paik Hospital from 1998 to 2002. RESULT: Pontine hemorrhage was classified according to the finding of CT scan;4 cases of Type I (hematoma, localized in the tegmentum), 18 cases of Type II (those in the tegmentolaterally), 16 in Type III (those in the basis pontis mainly with tegmentum and midbrain). Male to female ratio was 31:8, mean age was 48.2 years (9-76 years). Initial Glascow Coma scale was 7.6 (3-14), and mean follow-up period was 5.1 months (0.1-52 months). Associated diseases were as follows;hypertension;20, pulmonary tuberculosis;2, hypertension with D.M;1. Treatment modality was consisted of 36 conservative treatment, 1 stereotactic hematoma aspiration, 2 Gamma-Knife radiosurgery for associated cavernous malformations. Prognosis was good at following order of the tegmentotectal, tegmentolateral type. CONCLUSION: The prognosis of tegmentotectal, tegmentolateral type hemorrhage was better than basis pontis. The little volume of the hematoma, the better prognosis.

Treatment of Intracranial Unruptured Aneurysms / 대한뇌혈관외과학회지

OBJECTIVE: Treatment decisions in patients with unruptured aneurysms required detail assessment of the risk. The most important things to prevent the subarachnoid hemorrhage (SAH) are the measuring of risk of rupture of intracranial aneurysm and the decreasing of operation risk at aneurysm neck clipping. METHODS: Between January, 1994, and April, 2003, data regarding a series of 1586 aneurysm operations performed by a single neurosurgeon (J.H.S). Among them 158 patients with unruptured intracranial aneurysm (UIA) were analyzed retrospectively from the medical records and radiological findings (CT, CT angiography, MR angiography & angiography). The type of aneurysm was classified by three categories : Group 1 : incidental (asymptomatic, unruptured), Group 2 : symptomatic unruptured, Group 3 : UIA with SAH from a separate aneurysm. Unoperated cases were excluded. RESULTS: The treated aneurysms were 91 patients with 103 UIAs. Group 1 : 41 patients with 49 UIAs, Group 2 : 5 patients and Group 3 : 45 patients with 49 UIAs. In Group 1 the results of treatment were 0 mortality and below 4% morbidity. The cases with morbidity were a giant aneurysm, old age patient and the UIAs of posterior circulation. CONCLUSION: The UIA with SAH should be treated surgically and/or endovascular therapy. The treatment of the unruptured, asymptomatic incidental intracranial aneurysm was recommended but the patient's age, size and lcoation of aneurysm, and the skill and experience of neurosurgeon were considered honestly and carefully.

Gamma-Knife Radiosurgery of Upper Cervical Spinal Cord Tumor

OBJECTIVE: The lower limit of gamma knife radiosurgery is considered as foramen magnum. The head is long and narrow in western people, however, the head is short and wide in oriental people. In microcephalic oriental person, gamma knife radiosurgery is tried for the upper cervical cord tumor. METHODS: We have treated seven patients of upper cervical cord tumor with Gamma-plan during the last 8 years. The seven patients consisted of one man and six women, and ages ranging from 25 to 67 years. The histologic diagnoses were cervicomedullary hemangioblastoma in two, meningioma in two, brain stem glioma extending to C2 in one, hemangioma in one, glomus jugulare tumor in one. Preradiosurgical surgical intervention was performed in three patients. Mean marginal dose was 10.8Gy. RESULTS: The median follow-up period was 40 months (12-51 months). Four tumor had markedly decreased in size on follow-up magnetic resonance image. The remaining four cases were stationary in size. There was no complication. CONCLUSION: In microcehalic or normocephalic oriental person, the lower limit of gamma knife radiosurgery is level of second cervical spine.

Familial Multiple Endocrine Neoplasia, Type I, in Identical Twins

We report of case of one monozygotic twin sister with pituitary tumor and multiple endocrine neoplasia, type 1.The older sister, 31-year-old woman, had undergone Gamma Knife radiosurgery for prolactin producing pituitary microadenoma. Four years later, pancreatic insulinoma was detected, distal pancreatectomy and splenectomy were done. The younger sister, 31-year-old woman, had been operated for pancreatic insulinoma, 12 years ago. One year ago, hyperparathyroidism and pituitary macroadenoma were detected. Tumor removal was followed by Gamma Knife radiosurgery for residual tumor.

Cyst Formation after Gamma Knife Radiosurgery for Cerebral Arteriovenous Malformation

OBJECTIVE: The authors present cases of cyst formation after gamma knife radiosurgery for arteriovenous malformation. METHODS: One hundred seventy eight arteriovenous malformation patients were treated with Gamma knife radiosurgery from October, 1994 to October, 2002. Six patients developed cyst after Gamma knife radiosurgery after a mean of 46.5 months(range, 11-62 months). Male to female ratio was 5: 1 and mean age was 19.7 years(range, 15-24 years). RESULTS: The mean marginal dose was 22.7Gy(range, 10-25Gy) and mean volume was 22.4cm3(range, 1.9-80.3cm3). Initial symptoms were hemorrhage in three, seizure in two and headache in one. Symptom after cyst formation was motor weakness in three patients, asymptome in three patients. The locations of the cyst were basal ganglia in two, parietal in two, occipital in one, parietooccipital in one. Ventriculoperitoneal shunt was performed in one, Ommaya's reservoir insertion in one, craniotomy and removal of cyst and then Ommaya's reservoir insertion after 8 months in one and no treatment was given in three. CONCLUSION: Cyst formation after Gamma knife radiosurgery for arteriovenous malformation may occur. However, symptomatic cysts can be effectively treated with Ommaya's reservoir insertion, or cystoperitoneal shunt and in some cases, excision is needed.

Seroepidemiological Survey of Hantaan Virus Infection in Sera of Patients at the Kangnam St. Mary Hospital in Korea from 1998 to 2002

Sera of patients visited at the Kangnam St. Mary Hospital in Seoul were collected randomly at the Department of Clinicopathology from January, 1998 to December, 2002. Specimens were collected two twice a month, in a 15-day interval, and 100 specimens were collected at a time. Specimens test in duplicate, and/or displaying antinuclear antibody reaction were excluded from the seroepidemiological analyses. Detection of antibodies to Hantaan virus, an etiologic agent of hemorrhagic fever with renal syndrome (HFRS), was done by indirect immunofluorescent antibody (IFA) technique. Out of 11,361 sera tested, 445 cases (3.9%) showed specific antibody to Hantaan virus. Sexual difference was not noted. Annual incidence of HFRS cases showed a 3 year-periodicity. In the monthly incidence analysis, two peaks of incidence were appeared in the male cases, the first peak in March and the second in August. Female cases showed a single peak in October. The age distribution showed that 64.9% of the sero-positive cases were from 40 to 69 years of age. Peak age-group was in the 6th decade. Each decade of age-group showed diverse patterns of annual and monthly incidences. These results suggest the incidence of HFRS shows a periodicity and a unique pattern in each age group.