In 1861, Rokitansky first reported a unusual syndrome compatible with neurocutaneous melanosis, but it was coined by Van Bogaert in 1948. Neurocutaneous melanosis is a very much rare and less well-known member of phakomatoses. A review of the published material showed that only 40 cases of this syndrome had been reported until 1968 by Fox. It has been defined as a congenital disease which is manifested by parallel development of benign melanotic pigmentation of central nervous system and pigmented nevi of the skin. We have recently experienced a case of neurocutaneous melanosis. A 23 years old female was admitted to our hospital with complaints of generalized cafe au lait spots and giant nevi on the back and the left thigh accompanying severe headache, vomiting and right hearing disturbance. Diagnostic studies did not suggest any intracranial space-taking lesion except for evident hydrocephalus. Under the impression of Von Recklinghausen disease with right acoustic neurinoma the posterior fossa exploration was performed but no space talking lesion was noted. Numberous dark black-brownish pimentation was spread over the leptomeninges of the cisterna magna, brain stem, and right cerebellum. The increased intracranial pressure signs were completely relieved by ventriculo-atrial shunt. On biopsy it was identified as leptomeningeal melanin pigmentation. Detail consideration of neueurocutaneous melanosis was introduced with review of ever reported cases.
Biopsy ; Brain Stem ; Cafe-au-Lait Spots ; Central Nervous System ; Cerebellum ; Cisterna Magna ; Female ; Headache ; Hearing ; Humans ; Hydrocephalus ; Intracranial Pressure ; Melanins ; Melanosis* ; Neurocutaneous Syndromes ; Neurofibromatosis 1 ; Neuroma, Acoustic ; Nevus ; Nevus, Pigmented ; Numismatics ; Pigmentation ; Skin ; Thigh ; Vomiting ; Young Adult

PURPOSE: The purpose was to compare the marginal fidelity and the fracture resistance of the zirconia crowns according to the various coping designs with different thicknesses and cement types. Material and METHODS: Zirconia copings were designed and fabricated with various thicknesses using the CAD/CAM system (Everest, KaVo Dental GmbH, Biberach., Germany). Eighty zirconia copings were divided into 4 groups (Group I: even 0.3 mm thickness, Group II: 0.3 mm thickness on the buccal surface and the buccal half of occlusal surface and the 0.6 mm thickness on the lingual surface and the lingual half of occlusal surface, Group III: even 0.6 mm thickness, Group IV: 0.6 mm thickness on the buccal surface and the buccal half of occlusal surface and the 1.0 mm thickness on the lingual surface and the lingual half of occlusal surface) of 20. By using a putty index, zirconia crowns with the same size and contour were fabricated. Each group was divided into two subgroups by type of cement: Cavitec(R) (Kerr Co, USA) and Panavia-F(R) (Kuraray Medical Inc, Japan). After the cementation of the crowns with a static load compressor, the marginal fidelity of the zirconia crowns were measured at margins on the buccal, lingual, mesial and distal surfaces, using a microscope of microhardness tester (Matsuzawa, MXT-70, Japan, x100). The fracture resistance of each crown was measured using a universal testing machine (Z020, Zwick, Germany) at a crosshead speed of 1 mm/min. The results were analyzed statistically by the two-way ANOVA and oneway ANOVA and Duncan's multiple range test at alpha= .05. RESULTS: Group I and III showed the smallest marginal fidelity, while group II demonstrated the largest value in Cavitec(R) subgroup (P < .05). For fracture resistance, group III and IV were significantly higher than group I and II in Cavitec(R) subgroup (P < .05). The fracture resistances of Panavia-F(R) subgroup were not significantly different among the groups (P > .05). Panavia-F(R) subgroup showed significantly higher fracture resistance than Cavitec(R) subgroup in group I and II (P < .05). CONCLUSION: Within the limitation of this study, considering fracture resistance or marginal fidelity and esthetics, a functional ceramic substructure design of the coping with slim visible surface can be used for esthetic purposes, or a thick invisible surface to support the veneering ceramic can be used depending on the priority.
Cementation ; Ceramics ; Collodion ; Crowns ; Esthetics ; Japan ; Zirconium

The purpose of this study is to analyze the statistics of length and obliquity of the transverse processes, transitional vertebra, spina bifida and lumbar rib in the lumbar spine A-P films of 500 cases by random sample. The length of the transverse process was compared with the shortest distance of from the outmost point of it to the vertical line which was given at the spinous process of the corresponding vertebral body. The obliquity of the transverse process was represented by angle shaped by the central vertical line of the vertebral body and the central line of its transverse process. Transitional vertebra were identified by counting down from the C1 or T1 vertebral body. No difficulty was encountered in distinguishing spina bifida and lumbar rib. The results were as follows: 1. In the typical lumbar spine, the length of the L3 transverse process was the longest of all the transverse processes except for that of L5 and the direction of the transverse process was horizontal in the L1, L2 and L3 but a little oblique upward in the L4 and L5. 2. Lumbarization was slightly higher than sacralization in incidence. 3. The incidence of spina bifida was 11.8% and mainly observed in male. 4. The incidence of lumbar rib was 1.8% and all were attached to the L1.
Humans ; Incidence ; Male ; Ribs ; Spinal Dysraphism ; Spine*

We report three cases of a novel balloon remodelling technique across the anterior communicating artery (ACoA) through simultaneous bilateral internal carotid angiography. In all three cases, simultaneous bilateral carotid angiography for balloon-assisted coil embolisation of anterior communicating artery aneurysms (ACoAA) provided improved anatomical detail and resulted in effective and safe procedures compared to typical unilateral angiography.
Aneurysm ; Angiography ; Arteries ; Intracranial Aneurysm ; Neck

OBJECTIVE: Successful coil embolization of anterior communicating (A-com) artery aneurysms requires good visualization and understanding of the entire H complex. Bilateral carotid angiography may optimize anatomical understanding and visualization of the H complex. We therefore assessed the efficacy of simultaneous bilateral internal carotid angiography during coil embolization for A-com artery aneurysms. METHODS: Of the 153 patients with intracranial saccular aneurysms who underwent embolization between July 2008 and December 2009, 12 had A-com artery aneurysms and were embolized under bilateral carotid angiography. Patients were evaluated angiographically, immediately and 6 months (n=11) after embolization, using a 3-point scale (complete, residual neck, residual aneurysm). The safety, performance and efficacy of this approach were retrospectively evaluated. RESULTS: In all patients, bilateral internal carotid artery angiography provided more detailed anatomical information and understanding around the A-com artery, and, in complex situations, it allowed for more effective coil embolization through bilateral routes to the A-com artery. Angiography immediately after embolization showed occlusion of 11 of the 12 (92%) aneurysms, with none of these 11 showing evidence of recanalization at 6 months. CONCLUSION: These findings indicate that simultaneous bilateral carotid angiography during coil embolization of selected complex A-com artery aneurysms provided improved anatomical understanding, and resulted in more effective and safer procedures than typical unilateral angiography.
Aneurysm ; Angiography ; Arteries ; Carotid Artery, Internal ; Humans ; Intracranial Aneurysm ; Neck ; Retrospective Studies

To study the effect of measurement parameters and hydrocephalus on the pressure volume index(PVI), PVI study was performed in 5 normal and 5 kaolin-induced hydrocephalic cats. The effects of injection volume, speed, laterality and influence of increased intracranial pressure(ICP) in normal and hydrocephalic cats on the PVI value were evaluated. The results were as follows; 1) Larger injection volume, increased ICP by continuous infusion, and presence of ventriculomegaly made the PVI value significantly higher(p<0.01, p<0.001, p<0.05, respectively). 2) Rapid injection made the PVI value significantly lower(p<0.01). 3) Increase of ICP accentuated the effects of injection volume and speed significantly(p<0.01). 4) There was no difference between the PVI values measured with injection into the ipsilateral lateral ventricle and those measured with injection into the cantralateral lateral ventricle. 5) With the above results, it is considered advisable to perform the PVI study with constant injection volume, speed and ICP.
Animals ; Cats ; Hydrocephalus* ; Lateral Ventricles

Preoperative transarterial embolization procedures have been performed in 12 intracranial meningiomas, which were emobolized by superselection technique of the branches of the external carotid artery, using Berenstein superselective catheters or conventional angiographic catheters. PVA(polyvinyl alcohol) and/or Gelfoam particles were used as embolic material. Of the 12 patients, 9 cases were supplied from both internal and external circulation, and 4 of them showed profuse intraoperative bleeding, while 3 cases supplied only from the external circulation could be removed totally with little difficulty in bleeding control. The excised tumor specimens were examined for evidence of thrombosis and infarction, and 6 out of 12 cases showed evident tumor necrosis. Preoperative embolization of the meningioma produced relatively avascular operative conditions in most cases, but in those with dual blood supply, embolization may be of limited value due to an appreciable blood supply from the internal carotid artery.
Carotid Artery, External ; Carotid Artery, Internal ; Catheters ; Gelatin Sponge, Absorbable ; Hemorrhage ; Humans ; Infarction ; Meningioma* ; Necrosis ; Thrombosis

Subarachnoid hemorrhage (SAH) from vertebral artery (VA) dissecting aneurysms is rare and potentially fatal. Early rebleeding from ruptured VA dissecting aneurysms excessively reduces favorable outcome rates of the ruptured dissecting aneurysms, so that early diagnosis and treatment are essential for preventing early rebleeding and devastating results. A 52-year-old man was referred to our hospital due to an abruptly developed severe headache and sequential mental change. SAH due to ruptured left VA dissecting aneurysm was noted. We performed early endovascular internal trapping, and successful flow arrest on final angiogram was confirmed. About 6 hours later after internal trapping of the aneurysm, his mentality abruptly deteriorated and rebleeding was confirmed. We present this case of early rebleeding from vertebral dissecting aneurysm after endovascular internal trapping, along with a literature review.
Aneurysm ; Aneurysm, Dissecting* ; Early Diagnosis ; Headache ; Humans ; Middle Aged ; Subarachnoid Hemorrhage ; Vertebral Artery*

BACKGROUND: Diabetes mellitus is one of the most common chronic diseases which primary care family physician encounters. This study was performed to describe the medical care for patients with diabetes based on the Cheonan Practice-Based Research Network. METHODS: From May 2005 to July 2005, 193 patients with diabetes were assessed among the patients visiting seven family medicine clinics in Cheonan. The data were collected through a questionnaire about patient's socioeconomic characteristics, the details of medical care including screening practices of diabetic complications, self-monitoring of blood glucose and exercise. RESULTS: Among the patients with diabetes, 25.4% reported no exercise and another 29.6% reported regular exercise of more than 4 times a week. The less educated and the more elderly patients reported less exercise. Only 37.3% of patients monitored their blood glucose at home. The more educated, the more likely the patients monitored their blood glucose. Only 18.1% of patients reported having an annual 24-hour urine protein examination. The more educated and the more income they had, the more annual 24-hour urine protein examination was done. Only 32.6% of patients reported having an annual ophthalmologic examination, but there was no associated factors with having an annual ophthalmologic examination. CONCLUSION: These data indicate that the medical care for diabetic patients, including exercise, self-monitoring of blood glucose, screening of complications, may not be optimal for preventing diabetes complications, and was influenced by demographic characteristics such as age and education level. It is necessary for health care team to provide systematic education for diabetes and ongoing close monitoring of self care practices.
Aged ; Blood Glucose ; Chronic Disease ; Chungcheongnam-do ; Diabetes Complications ; Diabetes Mellitus ; Education ; Humans ; Mass Screening ; Patient Care Team ; Physicians, Family ; Primary Health Care* ; Self Care* ; Surveys and Questionnaires

BACKGROUND: Increasing evidence suggests a pivotal role for neuronal inflammation in response to replicating varicella zoster virus in the development of postherpetic neuralgia (PHN). OBJECTIVE: In this study, we investigated the value of serum levels of various inflammatory markers in acute herpes zoster (HZ) as predictors for the development of PHN. METHODS: A total of 116 patients with acute HZ were enrolled in this study. We measured scores on the pain visual analogue scale (VAS) at baseline and at 1, 3, and 6 months after diagnosis of HZ. We defined PHN as pain greater than 1 on the VAS lasting for more than 6 months. Serum samples for laboratory assay, including complete blood count were obtained at the initial visit. Correlations between the levels of each inflammatory marker and the development of PHN were evaluated. RESULTS: Levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), lymphocyte count, and albumin showed significant correlations with development of PHN in univariate analysis. Levels of ESR, CRP, and lymphocyte count also showed significant correlations in multivariate analysis. ESR level showed stronger correlations with development of PHN than levels of CRP and lymphocyte count. CONCLUSION: In this study, we confirmed that elevated ESR was an independent and significant predictor of PHN in patients with acute HZ. To validate these results, further well-designed, randomized clinical trials are needed.
Blood Cell Count ; Blood Sedimentation ; C-Reactive Protein ; Diagnosis ; Herpes Zoster* ; Herpesvirus 3, Human ; Humans ; Inflammation ; Lymphocyte Count ; Multivariate Analysis ; Neuralgia, Postherpetic* ; Neurons