Primary malignant melanoma arising from the leptomeninges is a rare entity. We report two cases of primary intracranial melanoma developed in one aged 65 years female and the other 70 years male. One case died 2 years after the operation, and the other case is still living more than 1 year after operation. Both cases seems to have a relatively long survival. The literature on this subject is briefly reviewed.
Female ; Humans ; Male ; Melanoma*

No abstract available.
Brain Injuries* ; Child* ; Glasgow Coma Scale ; Humans

Recent advances in diagnosis and therapy for head injury have brought some changes in concepts, definition of the terms, therapeutic methods and the duration of treatment. In medical certificates, the diagnosis and duration of treatment also need to be changed according to the new concepts. Mixed use of the terms according to the classic and the new concepts may cause confusion. We investigated with a questionnaire to assess the acceptability of the new concepts of head injury, and seeked for a plan to avoid possible confusion in medical certificates. We sent questionnaires for diagnosis and duration of treatment of 10 given examples of head injury to 367 neurosurgeons whose addresses could be identified. Questionnaires were answered by 52 neurosurgeons. The diagnosis described in the questionnaires showed wide variability with a range of 10 to 32 different descriptions, on average 16.8 different descriptions for each case. Duration of treatment also revealed great discrepancy. Coefficients of variation for duration of treatment varied from 33.44% to 54.37%. Cerebral contusion was the most commonly used term. It was described in every 10 given examples, and to take an average, 32.3 neurosurgeons used cerebral contusion or each case. To avoid possible confusion in medical certificates, it is necessary to make a guide for medical certificates for head injuries according to the new concepts, and a chance of training of this guide should be provided.
Contusions ; Craniocerebral Trauma* ; Diagnosis* ; Head* ; Surveys and Questionnaires*

BACKGROUND AND PURPOSE: Low levels of soluble receptor for advanced glycation end products (sRAGE) are associated with three conventional vascular risk factors (3Fs: diabetes, hypertension, and hypercholesterolemia), nondiabetic coronary artery disease, and Alzheimer's disease. However, the association between sRAGE and acute ischemic stroke (AS), especially AS without a source of cardioembolism, has not yet been established. Methods: Patients with AS without a source of cardioembolism (n=259) and age-matched controls (n=300) were grouped according to the presence of 3Fs: AS patients with and without 3Fs (3Fs+ AS and 3Fs- AS, respectively) and controls with and without 3Fs (3Fs+ control and 3Fs- control, respectively). Levels of sRAGE were analyzed among the four groups. RESULTS: sRAGE was significantly higher in the controls than in the AS patients (855 pg/mL vs. 690 pg/mL, p<0.01). sRAGE was significantly higher in 3Fs- controls (996 pg/mL, p<0.05) than in 3Fs+ controls (721 pg/mL), and in AS group regardless of the 3Fs (629 pg/mL in 3Fs- and 705 pg/mL in 3Fs+). The lowest tertile of sRAGE was associated with an increased risk of AS in the 3Fs- group [adjusted odds ratio (OR) 4.0, 95% confidence interval (CI) 1.6-10.3, p<0.01] but not in the 3Fs+ group. The level of sRAGE was also correlated with neurological severity in the 3Fs- AS group (r=-0.32, p<0.05) but not in the 3Fs+ AS group. CONCLUSIONS: Low plasma levels of sRAGE is a potential biomarker for the risk of AS and may reflect the neurological severity of the condition, especially in subjects without identifiable conventional risk factors.
Alzheimer Disease ; Coronary Artery Disease ; Glycosylation End Products, Advanced ; Humans ; Hypercholesterolemia ; Hypertension ; Odds Ratio ; Plasma ; Risk Factors ; Stroke

Behcet's disease is an uncommon disorder characterized by clinical triad of relapsing iritis, ulcer of mouth and genitalia. It is now recognized as a systemic disorder with mucocutaneous, ophthalmic, intestinal, respiratory, musculoskeletal, cardiovascular, urogenital and neurologic involvement. Systemic complications affecting the arterial system of disease are rare and mainly the aorta and iliac arteries are involved. Invasion of arterial wall is the most common lesion, predisposing to false aneurysm or rupture. As the standard open surgery, although often difficult, needed second surgeries in 30% to 50% of the patients due to the occurrence of anastomotic false aneurysms, endovascular repair emerged as an alter-native treatment of aneurysmal or pseudoaneurysmal manifestrations in Behcet's disease. We report here a case of the pseudoaneurysm at right subclavian artery which is successfully treated with percutaneous stent-graft.
Aneurysm ; Aneurysm, False* ; Aorta ; Behcet Syndrome* ; Genitalia ; Humans ; Iliac Artery ; Iritis ; Mouth ; Rupture ; Subclavian Artery* ; Ulcer

We made use of a neurosurgical care unit (NCN) from May 1986. The NCU differs from the intensive care unit (ICU) in several points. The NCU has 16 beds for neurosurgical patients who require continuous observation while the intensive therapy is not likely to be required. Wall units for oxygen and suction are equipped for each bed. One of the patient's family or relatives could attend the patient in the NCU. Neurosurgical nurse education has been offered monthly according to a scheduled curriculum to enhance an ability of neurosurgical close observation. The NCU has several unique advantages. The NCU can solve the bed availability problem caused by not only increased requirement for beds but also patients who were stabilized but still dependant or had some risk of sudden deterioration. Patients in the NCU require more observation than therapy. Thus, the NCU requires less equipments than the ICU, so it is cheap to set up. Regular neurosurgical nurse education fills up the efficiency of the NCU. Attendance of the family not only adds man-power but also provides a skinship and more intimate therapeutic environment. It also potentiates ability to care at home by their family. Our model of NCU has brought so significant advantages that we may advocate the efficacy of such an intermediate care facility, and present here our model of NCU.
Curriculum ; Education ; Humans ; Intensive Care Units ; Intermediate Care Facilities ; Oxygen ; Suction

During a 36-month period, clinical outcome in 170 patients with traumatic intracerebral hematoma(TICH) was analysed. These patients represented 5.1% of 3328 consecutive patients with head injuries admitted to the Soonchunhyang University Chunan Hospital. The overall mortality was 33.5%. A significant number of patients(52.6%), who were not comators at the time of admission(GCS<8), were dead. The factors affecting prognosis were as follows: 1) Glasgow Coma Scale(GCS) on admission(p>0.005) ; 2) the presence of associated lesions(p>0.01) ; 3) time delay of two hours or more from admission to operation(p>0.05) ; 4) actual midline shift of 4.5mm or above on initial CT scan(p>0.005) ; 5) obliteration of suprasellar cistern(p>0.005) ; 6) the presence of delayed traumatic intracerebral hematoma(DTICH) in non-surgical patients with GCS score of 8 or above(p>0.01). Age and location of hematoma did not affect outcome, but the patients with multiple located hematoma showed higher mortality than the others. Time delay in the treatment of TICH and DTICH contribute significantly to poor outocme. Rapidly progressive DTICH within 48 hours after trauma is high in mortality. Follow-up CT scan might as well be performed till 48 hours after injury and 8 hours after initial operation, even though neurological status did not alter for the worse.
Chungcheongnam-do ; Coma ; Craniocerebral Trauma ; Follow-Up Studies ; Glasgow Coma Scale ; Hematoma* ; Humans ; Mortality ; Prognosis ; Tomography, X-Ray Computed

To investigate the clinical significance of and risk factors for rebleeding in patients with spontaneous subarachnoid hemorrhages(SAH), the authors reviewed the consecutive cases of 527 patients admitted in the 7-year period from 1988 to 1995. Of these patients, 75(14.2%) rebled. Rebleeding occurred within 24 hours in 45 patients, among whom 32 cases rebled within 12-24 hours after initial SAH, within 1-3 days in 19, within 4-7 days in 9, and after 1 week in 2. These patients had an overall mortality of 82.9% compared to 28.4% for patients without rebleeding. The patients with rebleeding within 24 hours after the initial attack had an operative rate of 34.9% and a postoperative mortality of 53.3% compared to 26.8%, 37.5%, respectively, for patients with rebleeding after 24 hours. The significant factors affecting rebleeding were as follows;Over 70 years in age, association with intracerebral hematoma(10-20cc), sizure before operation, aneurysms on the vertebrobasilar system, poor neurological condition on admission, and angiography within 6 hours of initial SAH. Ultra-early operation within 24 hours following intentional delay in angiography of at least 6 hours from the initial rupture is recommended if the associated hematoma is not large enough to show mass effect.
Aneurysm ; Angiography ; Hematoma ; Humans ; Mortality ; Risk Factors* ; Rupture ; Subarachnoid Hemorrhage*

Gangiogliomas are rare tumors, primarily seen in patients under the age of 30 years. They occure least commonly in the spinal cord. We present a 17-year-old girl who harbored an intramedullary conus ganglioglioma.
Adolescent ; Conus Snail* ; Female ; Ganglioglioma* ; Humans ; Spinal Cord

Generally, regular exercise is known to help to improve lipid metabolism. In the spinal cord injured, relative inactivity to able-bodied person causes altered lipid profiles and, in turn, possibly increases cardiovascular mortality. We performed this study to measure serum lipid profiles in paraplegics and to evaluate effect of regular exercise on lipid profiles. The subjects are 21 paraplegics, who are divided into 2 groups, 10 SCI athletes and 11 SCI non-athletes. The serum levels of lipoproteins in these subjects were measured and compared each other. The levels of serum HDL-cholesterol were lower in the order of, non-athlete group, athelte group, and normal control group, and there was a significant difference between athlete and non-athlete groups. The ratios of total cholesterol to HDL-cholesterol were higher in the order of non-athlete group, athlete group, and normal control group, and there was a significant difference between control and non-athlete groups. The serum levels of total cholesterol, LDL-cholesterol, and triglyceride in three groups showed no significant differences. In conclusion, serum levels of HDL-cholesterol were positively affected by regular exercise, and it is advised that the HDL-cholesterol levels of spinal cord injured should be checked regularly for follow-up examinations.
Athletes ; Cholesterol ; Follow-Up Studies ; Humans ; Lipid Metabolism ; Lipoproteins ; Mortality ; Spinal Cord ; Triglycerides