Relationship between Obesity and Serum 25-Hydroxyvitamin D Concentrations

BACKGROUND: Vitamin D has been known to play an important role in calcium homeostasis and bone metabolism. It has also been implicated in diabetes mellitus, cardiovascular disease, and immune diseases. Several cross-sectional studies conducted worldwide have found that vitamin D is negatively correlated with obesity. In Korea, however, the results of similar studies were found to be inconsistent.METHODS: The study consisted of 585 adults over 18 years of age, who visited a health promotion center at a university hospital from March, 2015 to February, 2016 and their serum vitamin D levels were recorded. They were divided into two groups according to their sex. The correlation coefficients were calculated using Pearson correlation analysis between obesity and vitamin D. Finally, subjects with vitamin D levels less than <20 ng/mL were classified as deficient. Bivariate logistic regression analysis was used to determine the odds ratio of vitamin D deficiency.RESULTS: We observed a significant negative correlation between obesity and vitamin D (P<0.05) among the women but not in the men. The following are the details of the findings: ≥25 in body mass index (model 3 adjusted odds ratio [OR], 4.11; 95% confidence interval [CI], 1.59–10.67), ≥85 cm in waist circumference (model 3 adjusted OR, 1.81; 95% CI, 1.02–4.01), ≥30% in body fat (model 3 adjusted OR, 2.29; 95% CI, 1.17–4.62).CONCLUSION: Based on the results of this study, we suggest that obesity and vitamin D are negatively correlated and that obesity in women predisposes them to vitamin D deficiency.

Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis

Biportal endoscopic spinal surgery (BESS) is a minimally invasive spinal surgery, which is basically similar to microscopic spinal surgery in terms of the use of floating technique and technically similar to conventional percutaneous endoscopic spinal surgery in terms of the use of endoscopic or arthroscopic instruments. Using two independent portals (viewing and working) and maintaining a certain distance from the bony and neural structures allow closer access to the target lesion through a panoramic view by free handling of the scope and instruments rather than through a fixed view by docking into the Kambin's triangle. Minimally invasive surgery allows for reduced dissection and inevitable muscle injury, preserving stability and reducing risks of restabilization. The purpose of fusion surgery is the same as that of the three surgical techniques stated above. Its wider range of view helps to overcome limitations of conventional endoscopic spinal surgery and to supplement the weak points of microscopic spinal surgery, such as limited working space in a tubular retractor and difficulty in accessing the contralateral area. This technique provides an alternative to unilateral or bilateral decompression of lumbar central spinal stenosis, foraminal stenosis, low-grade spondylolisthesis, and adjacent segment degeneration. Early clinical outcomes are promising despite potential for complications, such as dural tearing and postoperative epidural hematoma, similar to other procedures. Merits of BESS include decreased postoperative infection rate due to continuous irrigation throughout the procedure and decreased need for fusion surgery for one- or two-level lumbar stenosis by wide sublaminar and foraminal decompression with minimal sacrifice of stabilizing structures.

Factors Affecting Adherence to Antihypertensive Medication / 가정의학회지

BACKGROUND: Hypertension is a major contributor to the global disease burden of cardiovascular and cerebrovascular disease. The aim of this study was to determine demographic and clinical factors associated with adherence to antihypertensive medication. METHODS: From August 2012 to February 2015, we recruited 1,523 Korean patients with hypertension who visited family physicians. The study was conducted in 24 facilities located in urban and metropolitan areas. Of these facilities, two were primary care clinics and 22 were level 2 or 3 hospitals. Adherence was assessed using the pill count method; a cut-off value of 80% was used as the criterion for good adherence. Sociodemographic and lifestyle factors were compared between the adherent and nonadherent groups using the chi-square test for categorical variables and t-test for continuous variables. Binary logistic regression analysis was performed with medication adherence as the outcome variable. RESULTS: Of the 1,523 patients, 1,245 (81.7%) showed good adherence to antihypertensive medication. In the multivariate logistic analysis, age ≥65 years, exercise, treatment in a metropolitan-located hospital, being on ≥2 classes of antihypertensive medication and concomitant medication for diabetes, and a family history of hypertension or cardiovascular diseases were associated with good adherence. Patients who had a habit of high salt intake were less adherent to medication. CONCLUSION: Multiple classes of antihypertensive medications, concomitant medication, and exercise were associated with good adherence to antihypertensive medication, and high salt intake was associated with poor adherence to antihypertensive medication. These factors should be considered to improve hypertension control.

Association between Hepatitis B Surface Antigen Seropositivity and Metabolic Syndrome / 가정의학회지

BACKGROUND: Infection with hepatitis B virus (HBV) may be a risk factor for cardiovascular disease. We investigated the relationship between HBV infection and metabolic syndrome. METHODS: We performed a cross-sectional study of 9,474 Korean men and women who were at least 20 years old and who underwent a routine health check-up at Ulsan University Hospital in Ulsan, South Korea between March 2008 and February 2009. The associations of hepatitis B surface antigen (HBsAg) seropositivity with the presence of metabolic syndrome and its components were investigated by logistic regression analysis. Data were analyzed separately for males and females. RESULTS: HBsAg seropositivity was significantly negatively associated with hypertriglyceridemia and metabolic syndrome in men (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.29 to 0.50; P < 0.001 and OR, 0.75; 95% CI, 0.57 to 0.98, P = 0.033). In women, HBsAg seropositivity was also significantly negatively associated with hypertriglyceridemia, but not with metabolic syndrome (OR, 0.40; 95% CI, 0.17 to 0.91; P = 0.029 and OR, 0.80; 95% CI, 0.38 to 1.66, P = 0.545). CONCLUSION: HBV infection was significantly negatively associated with hypertriglyceridemia and metabolic syndrome in men and hypertriglyceridemia in women.

The Result of Minimally Invasive Transforaminal Lumbar Interbody Fusion in Low Grade Spondylolisthesis - Minimum 2 Years Follow Up -

STUDY DESIGNS: A retrospective study. OBJECTIVES: To analyze the clinical and radiological outcomes of spontaneous reduction via minimally invasive transforaminal lumbar interbody fusion (Mini-TLIF) as the treatment for low-grade symptomatic spondylolisthesis. SUMMARY OF LITERATURE REVIEW: Although minimally invasive transforaminal lumbar interbody fusion is technically demanding, this procedure is an effective method for spontaneous reduction of low grade spondylolisthesis. MATERIALS AND METHODS: We analyzed consecutive series of 41 patients with low grade spondylolisthesis who underwent minimally invasive transforaminal lumbar interbody fusion, between April 2008 and July 2009. The minimum follow-up period was 2 years. Clinical evaluation was performed by an analysis of Visual Analogue Scale and Oswestry Disability Index. For the radiological evaluation, disc space height, slip percentage, and slip angle were analyzed. At the final follow-up, the fusion rate was analyzed according to the Bridwell's anterior fusion grade. RESULTS: For the evaluation of clinical outcomes, the Visual Analogue Scale for back pain decreased from 6.8+/-1.2 to 2.0+/-1.1, and that for radiating pain decreased from 7.9+/-1.3 to 1.7+/-1.1. Oswetry Disability Index decreased from 38.5+/-8.4 to 13.4+/-6.1. For the radiological evaluation, disc space height increased from 8.4+/-2.14mm to 11.8+/-1.54mm(P<0.05), slip percentage was reduced from 18.4+/-5.1% to 13.3+/-3.1%(P<0.05) and slip angle decreased from 10.6+/-4.5degrees to 6.2+/-3.4degrees (P<0.05). At the final follow-up, radiological union was obtained in 38 cases (92.7%). CONCLUSIONS: We conclude that minimally invasive transforaminal lumbar interbody fusion appears to be an effective method for spontaneous reduction of low grade spondylolisthesis if the surgeon becomes familiar with this method.

The Clinical and Radiological Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Single Level Fusion

STUDY DESIGN: This is a retrospective study that was done according to clinical and radiological evaluation. PURPOSE: We analyzed the clinical and radiological outcomes of minimally invasive transforaminal lumbar interbody single level fusion. OVERVIEW OF LITERATURE: Minimally invasive transforaminal lumbar interbody fusion is effective surgical method for treating degenerative lumbar disease. METHODS: The study was conducted on 56 patients who were available for longer than 2 years (range, 24 to 45 months) follow-up after undergoing minimally invasive transforminal lumbar interbody single level fusion. Clinical evaluation was performed by the analysis of the visual analogue scale (VAS) score and the Oswestry Disability Index (ODI) and the Kirkaldy-Willis score. For the radiological evaluation, the disc space height, the segmental lumbar lordotic angle and the whole lumbar lordotic angle were analyzed. At the final follow-up after operation, the fusion rate was analyzed according to Bridwell's anterior fusion grade. RESULTS: For the evaluation of clinical outcomes, the VAS score was reduced from an average of 6.7 prior to surgery to an average of 1.8 at the final follow-up. The ODI was decreased from an average of 36.5 prior to surgery to an average of 12.8 at the final follow-up. In regard to the clinical outcomes evaluated by the Kirkaldy-Willis score, better than good results were obtained in 52 cases (92.9%). For the radiological evaluation, the disc space height (p = 0.002), and the whole lumbar lordotic angle (p = 0.001) were increased at the final follow-up. At the final follow-up, regarding the interbody fusion, radiological union was obtained in 54 cases (95.4%). CONCLUSIONS: We think that if surgeons become familiar with the surgical techniques, this is a useful method for minimally invasive spinal surgery.

Pediatric Lumbar Epidural Abscess Combined with Cauda Equina Syndrome: Case Report

Pyogenic epidural abscess is a very rare disease. Once it occurs, it promptly progresses and can cause neurologic paralysis. Mean age of onset has been reported to be 57 years. Here we report making a diagnosis of pyogenic lumbar epidural abscess accompanying cauda equina syndrome in a 10-year-old girl. We treated this case successfully with surgical drainage and antibiotics. We report our case with a review of the literature.

Conservative Treatment of Valgus Impacted Four-Part Fracture of the Proximal Humerus: A Case Report

For valgus impacted four part fracture of the proximal humerus, surgical stabilization and early mobilization of the joint can produce the best clinical outcomes. But, we have experienced a case of conservative treatment and gained good clinical results. We have reported this case and included a review of the relevant literatures.

The Impact of Weight Changes on Metabolic Syndrome over a Time period of 8 years in Korean Male Workers / 대한산업의학회지

OBJECTIVES: Cardiovascular diseases are common causes of diseases and death for workers. With the increasing prevalence of obesity, the social costs for obesity related diseases are a growing burden in Korea. We aimed to investigate the impact of weight change on metabolic syndrome and its components in Korean male workers. METHODS: We analyzed the data from 2,785 male workers obtained during health checkups in 2000 and in 2008. The subjects were classified into 5 groups as Loss ( or = 9.0 kg) group according to the amount of weight change between the 2 health checkups. The mean values of metabolic syndrome components were compared across the 5 weight change groups by ANCOVA. After classifying subjects into 2 groups according to the normality of their body weight at baseline, the odds ratios for metabolic syndrome and its components each weight-change group were computed by multiple logistic regression analyses, using the Stable group as the reference. RESULTS: There was a strong linear relationship between weight gain and a worsening of the components of metabolic syndrome in 2008 (p<0.001). In normal body weight group, the odds ratios for metabolic syndrome significantly increased in the Mild, Moderate, and Severe gain groups (OR 1.83, 2.82, and 7.56, respectively), and increased with weight gain (p<0.001). In subjects who were obese, the odds ratios for metabolic syndrome significantly increased if their amount of weight gain placed them in the Mild or Moderate gain groups(OR 1.75 and 3.97), increased with the increase of weight gain (p<0.001), and decreased in the Loss group(OR 0.51, 95%CI 0.30 to 0.85). CONCLUSIONS: Weight gain in male workers was positively associated with metabolic syndrome through worsening of metabolic syndrome components. On the other hand, weight loss in obese male workers had a protective effect against metabolic syndrome through the improvement of the components of metabolic syndrome.

The Association between Marital Status and Metabolic Syndrome in Korean Men / 가정의학회지

BACKGROUND: We aimed to investigate the association between marital status and metabolic syndrome, and observed how their lifestyle may influence within their relationship. METHODS: We analyzed the data from 12,288 Korean men over 20 years old taking a health checkup in a university hospital in Ulsan from March 2008 to February 2009. The subjects were classified as married, unmarried, separated, widowed, and divorced. The odds ratios for metabolic syndrome in each marital status were calculated after adjusting for age, educational level, and family income. In only married men and divorced men, odds ratios were calculated again after adjusting for alcohol intake, smoking, or exercise added to age, educational level, and family income. RESULTS: After adjustment for age, educational level, and family income, the odds ratio for metabolic syndrome in divorced men was 1.48 (95% confidence internal [CI], 1.03 to 2.12; P = 0.03) compared to married men. However, the odds ratios in divorced men decreased to 1.47 (95% CI, 0.97 to 2.24; P = 0.07) after adjusting for alcohol intake added to age, educational level, and family income, 1.42 (95% CI, 0.99 to 2.04; P = 0.06) after adjusting for smoking added, 1.35 (95% CI, 0.93 to 1.96; P = 0.12) after adjusting for exercise added, and 1.37 (95% CI, 0.89 to 2.12; P = 0.15) after adjusting for alcohol intake, smoking, and exercise added. CONCLUSION: Divorced men were likely to have metabolic syndrome compared to married men and this finding may be mediated by their bad lifestyle.

The Association between Helicobacter Pylori Infection and Metabolic Syndrome in Korean Men and Women / 가정의학회지

BACKGROUND: Metabolic syndrome is a cluster of metabolic abnormalities leading diabetes and cardiovascular diseases. Helicobacter pylori (H. pylori) infection is suggested to be a risk factor of cardiovascular diseases. We aimed to investigate the association between H. pylori infection and metabolic syndrome. METHODS: This study was designed with Korean adults having a health check-up in a university hospital in Ulsan from March 2008 to February 2009. The subjects were 17,448 over 20 years old. The analysis was undertaken according to sex separately. The association of H. pylori seropositivity (IgG) with metabolic syndrome components was investigated by multiple linear regression analysis. The association of H. pylori seropositivity with metabolic syndrome was investigated by multiple logistic regression analysis. RESULTS: H. pylori seropositivity was significantly inversely associated with high density lipoprotein cholesterol in men (Coefficient, -0.02; 95% confidence interval [CI], -0.03 to -0.004; P = 0.01). However, H. pylori seropositivity was not significantly associated with metabolic syndrome in both men and women (OR, 1.01; 95% CI, 0.90 to 1.14; P = 0.81 for men; OR, 0.75; 95% CI, 0.55 to 1.02; P = 0.06 for women). CONCLUSION: H. pylori infection was significantly negatively associated with high density lipoprotein cholesterol in men, but not significantly associated with metabolic syndrome in both men and women.

The Comparison of the Results Between AO Internal Fixator (Long lever-arm) and Screw-Rod System (Short lever-arm) Through Posterior Approach in Unstable Thoracolumbar Fractures / 대한척추외과학회지

STUDY DESIGN: Prospective study. OBJECTIVES: To analyze the outcome of posterior reduction and fixation with the AO internal fixator and with the screw-rod system in unstable thoracolumbar fractures and to investigate differences in effectiveness between the two methods. SUMMARY OF LITERATURE REVIEW: In unstable thoracolumbar fractures, fixation with the AO internal fixator is an effective method for posterior reduction. However, the results of correction are quite variable. MATERIALS AND METHODS: We analyzed 51 patients with unstable thoracolumbar fractures who underwent correction through posterior approach between 1997 and 2003. We divided the patients into two groups: Patients in Group A (25 cases) were treated with the AO internal fixator, and patients in Group B (26 cases) were treated with the screw-rod system. We added transpedicular bone grafts for 17 patients in Group A. We evaluated correction of deformity (anterior and posterior height of vertebral body, sagittal index, disc height), loss of correction, spinal canal clearance, and neurological recovery. RESULTS: Comparing correction of deformity, we saw better results in Group A than in Group B in regards to sagittal index and anterior height of vertebral body. However, we saw a higher degree of correction loss in the anterior height of the vertebral body in Group A. We grafted autogenous bone into the fracture site by transpedicular approach for 17 patients in Group A. We saw less correction loss in the anterior vertebral body height and sagittal index. In regard to spinal canal clearance, we saw better results in Group A (18%) than in Group B (10%). As for neurological recovery, we could not find any statistically significant difference between the two groups. CONCLUSIONS: Through an operative procedure, we could achieve better results in restoration of anterior vertebral height and canal clearance with the AO internal fixator system. Further study is necessary to keep the reduced state of vertebral height.

The Association between Distal Colon Adenoma and the Metabolic Syndrome and Lifestyle Factors in Male Examinees in a University Hospital

BACKGROUND: According to previous epidemiologic studies, the metabolic syndrome, dietary and lifestyle factors were associated with colon polyps. The aim of this cross-sectional study was to assess the relationship between the risk of the colorectal adenoma incidence and the individual components of the metabolic syndrome with lifestyle factors such as drinking, cigarette smoking and physical activity. METHODS: Sigmoidoscopic examination for colon cancer screening was performed from January 2002 to December 2003 at the Health Promotion Center of Ulsan University Hospital in Ulsan, Korea. A total of 1,565 subjects underwent satisfactory sigmoidoscopy. The subjects with a history of colon cancer or polyps or inflammatory bowel disease were excluded from the study. Alcohol consumption, cigarette smoking and other confounding factors were included as covariates in the models. RESULTS: After adjusting for age, physical activity,smoking and alcohol intake, the subjects of metabolic syndrome (> or =3 vs. 0 components) combined with cigarette smoking had a positive association with colorectal adenoma incidence (OR 3.63, 95% CI 1.49~8.89). Physical activity was negatively associated the risk of the colorectal adenoma incidence (OR 0.60 95% CI 0.44~0.81). CONCLUSION: These results suggest that clustering of components of the metabolic syndrome combined with cigarette smoking significantly increased the colorectal adenoma risk, but physical activity reduced the risk of colorectal adenoma incidence in Korean adult males after multivariate adjustment.

Lifestyle in Relation to Increase in Weight in Korean Middle-aged Men

BACKGROUND: The relationship of lifestyle and socioeconomic factors with weight change over 4 years in Korean middle-aged group was assessed. METHODS: A total of 1,167 men, aged 40~59 years, were selected from the Health Promotion Center of Ulsan University Hospital during the period of Jan. 2000 through Mar. 2000. Including anthropometric measures, designed questionnaires were administered concern lifestyle behavior topics with cigarette smoking, exercise, alcohol consumption, dairy product consumption and socioeconomic factors of monthly income and education. The subjects were divided into three groups by body mass index (BMI: kg/m(2)); normal ( or =25 kg/m(2)). After 4 years of follow-up, the men were classified into weight change categories; 1) stable weight group (from normal to normal, from overweight to overweight) and 2) weight gain group (from normal to overweight/obesity, from overweight to obesity). RESULTS: The weight gain group were 18.4% (n=215) and the stable overweight group were 81.6% (n=952). Adjusted for age, the frequency of dairy product consumption, the frequency of alcohol drinking, the regularity of exercise, education and monthly income, the smokers (> or =10/day) had significantly high incidence rates of increase in weight (odds ratio=1.77, 95% CI 1.07~2.90). The increased dairy consumers (> or =4/week) had significantly low incidence rates of increase in weight (odds ratio=0.43, 95% CI 0.20~0.93). Otherwise, there were no significant relationships in weight change. CONCLUSION: Smoking and decreased dairy product consumption were related to the increase in weight.

Prevalence and Risk Factors for Adenomatous Polyp in Koreans (A Cross-sectional Study)

BACKGROUND: According to previous epidemiologic studies, dietary and life style factors were associated with colon polyps. Despite the high prevalence of colon polyps, little is known about its risk factors in Korean adults. The aim of this cross-sectional study was to assess the relationship between alcohol consumption, smoking, obesity, physical activity and the presence of colorectal polyps. METHODS: Sigmoidoscopic examinations for colon cancer screening were performed from January 2002 to December 2003 at the Health Promotion Center of Ulsan University Hospital. Alcohol consumption, smoking and other confounding factors were assessed by self-administered questionnaire. RESULTS: After adjusting for age, physical activity, obesity, total fat and total energy intake, current smokers who had smoked more than 21 pack-years were at significantly higher risk of adenomatous polyps compared to non-smokers (OR 2.56, 95% CI 1.30~5.01). Alcohol consumption was positively associated with risk of adenomatous polyps compared to non-drinkers (OR 1.48, 95% CI 1.03~2.13). Physical activity was negatively associated withs risk of distal colon polyps. CONCLUSION: These results suggest that alcohol consumption, cigarette smoking, and obesity were positively associated with risk of colorectal polyps and physical activity was negatively associated in Korean adult males.

Efficacy of Intraoperative Facial Electromyographic Monitoring in Patients with Hemifacial Spasm

OBJECTIVE: Hemifacial spasm has characteristic and specific electrophysiological finding, lateral spread response(LSR). We study the correlation between change of lateral spread response during microvascular decompression(MVD) and clinical outcome after MVD. METHODS: Sixty two patients with hemifacial spasm who were treated with microvascular decompression from March 2000 to February 2003 were included in this study. The monitoring of intraoperative facial electromyography(EMG) and brain stem auditory evoked potential were performed. RESULTS: In 28 (44.7%) patients, there was persistence of lateral spread response after vascular decompression in root exit zone of facial nerve. Among these 28 patients, 9 had mild hemifacial spasm at discharge. Three out of 34 patients who had intraoperative disappearance of lateral spread response after MVD had mild hemifacial spasm. But Both groups, disappearance of LSR (Group I), and persistence (Group II) had only 2 patients with mild hemifacial spasm, and 5 patients at 3 months, respectively. CONCLUSION: Although intraoperative EMG monitoring is very useful in assessing the efficacy of MVD, the clinical outcome of MVD in patient with hemifacial spasm does not always correlate with EMG finding. The prognostic value of intraoperative LSR monitoring in the long-term results is questionable.

Kyphotic Angle Measurement Accuracy for Vertebral Osteoporotic Compression Fracture: Reliable Method for Kyphotic Angle Measurement

OBJECTIVE: Having a reliable and reproducible measurement technique to measure the sagittal contour in vertebral fractures is paramount to clinical decision making. This study is designed to determine the most reliable measurement technique in osteoporotic vertebral compression fracture. METHODS: Fifteen lateral radiographs of thoracic and lumbar fractures were selected and measured on two separate occasions by three spine surgeons using six different measurement techniques (Centroid, Harrison Posterior Tangent Methods and 4 different types of modified Cobb method). The radiograph quality was assessed and the center beam location was determined. Statistical analysis including ANOVA for repeated measures was carried out using the SAS software (v 8.0). RESULTS: The inter and intraobserver variance of the Cobb method 4 and Harrison posterior tangent method were significantly lower than the other four methods. The intraobserver correlation coefficients were the most consistent using the Cobb method 4 (0.982), which was followed by the Harrison posterior tangent (0.953) and Cobb methods 1 (0.874). The intraobserver agreement (% of repeated measures within 5 degrees of the original measurement) ranged from 42% to 98% for each technique for all three observers, with the Cobb method 4 showing the best agreement (97.8%) followed by the Harrison posterior tangentmethod (93.7%). CONCLUSION: The Cobb method-4 and Harrison posterior tangent methods, when applied to measuring the kyphosis, are reliable and have a similar small error range. The Cobb method 4 shows the best overall reliability. However, the centroid method and Cobb method using a fractured endplate do not produce an accurate result due to inter and intraobserver differences in determining the baseline.

Convexity Meningioma En Plaque Presenting with Diffuse Hyperostosis of the Skull

Although meningioma is a common and benign intracranial tumor, meningioma en plaque is a rare tumor, especially in the cranial vault. Meningioma en plaque(MEP) usually occurs in the area of the sphenoid wing, and it causes cosmetic and visual problems, as well as the problems that are due to its mass effect. The authors present here a case of convexity meningioma en plaque that involved the skull and scalp with diffuse hyperostosis as the presenting salient radiological findings, which caused marked intraoperative bleeding.

The Development of Quality Assurance Program for CyberKnife / 대한방사선종양학회지

PURPOSE: Standardization quality assurance (QA) program of CyberKnife for suitable circumstances in Korea has not been established. In this research, we investigated the development of QA program for CyberKnife and evaluation of the feasibility under applications. MATERIALS AND METHODS: Considering the feature of constitution for systems and the therapeutic methodology of CyberKnife, the list of quality control (QC) was established and divided dependent on the each period of operations. And then all these developed QC lists were categorized into three groups such as basic QC, delivery specific QC, and patient specific QC based on the each purpose of QA. In order to verify the validity of the established QA program, this QC lists was applied to two CyberKnife centers. The acceptable tolerance was based on the undertaking inspection list from the CyberKnife manufacturer and the QC results during last three years of two CyberKnife centers in Korea. The acquired measurement results were evaluated for the analysis of the current QA status and the verification of the propriety for the developed QA program. RESULTS: The current QA status of two CyberKnife centers was evaluated from the accuracy of all measurements in relation with application of the established QA program. Each measurement result was verified having a good agreement within the acceptable tolerance limit of the developed QA program. CONCLUSION: It is considered that the developed QA program in this research could be established the standardization of QC methods for CyberKnife and confirmed the accuracy and stability for the image-guided stereotactic radiotherapy.

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.