We report a case of congenital giant pigmented nevus with malignant melanoma of brain in a 14-year-old male patient. He had giant pigmented nevus on the back and neck, and multiple satellite lesions over the whole body since birth. One year prior to visit to our hospital, the patient suffered from various neurologie symptoms including headache, nausea, vomiting, seizure and right side motor weakness. Flistologic findings of skin lesions were benign nevocytic nevi. Computed tomogram of brain demonstrated increased densities in the both fronto-parietal leptameninges and brain parenchyme. Histologic findings of brain parenchyme by stereotaxic long needle biopsy showed the infiltration of melanin containing atypical melanocytes. There was no evidence of malignant melanoma at other organs. All of these findings suggested that origin of malignant melanoma of brain parenchyme was leptomeninges rather than skin.
Adolescent ; Biopsy, Needle ; Brain* ; Headache ; Humans ; Male ; Melanins ; Melanocytes ; Melanoma* ; Nausea ; Neck ; Nevus ; Nevus, Pigmented* ; Parturition ; Seizures ; Skin ; Vomiting

No abstract available.
Tuberculosis, Miliary*

OBJECT: The isolated posterior femoral cutaneous nerve (PFCN) neuropathy has rarely been described in the literature and documented electrophysiologically, based on the paucity of published report. The purpose of this study was to assess the reference value of somatosensory evoked potentials (SSEP) in posterior femoral cutaneous nerve. METHOD: Both legs of twenty healthy adults were tested. Somatosensory evoked potentials were obtained with the active recording electrode placed at Cz', 2 cm posterior to CZ, and the reference electrode at FZ (international 10~20 system). The posterior femoral cutaneous nerve was excited 14 cm proximal to the midpopliteal fossa between the long head of the biceps femoris and the semitendinosus muscles. RESULTS: The mean latency of right P1 were 35.35+/-3.17 msec, N1 were 45.28+/-2.71 msec and mean peak amplitudes were 1.42+/-0.98 microvolt. In the left side, mean latency of P1 were 34.54+/-2.89 msec, N1 were 43.87+/-2.44 msec and mean peak amplitudes were 1.20+/-0.53 microvolt. CONCLUSION: Based on the result of this study, the reference values could be used to differentiate and detect the lesion in the case of isolated dysfunction of the posterior femoral cutaneous nerve.
Adult* ; Electrodes ; Evoked Potentials, Somatosensory* ; Head ; Humans ; Leg ; Muscles ; Reference Values

Between July 1994 and August 1995, 78 patients underwent coronary artery bypass graft at Seoul National University Hospital. Coronary angiogram was performed one year after coronary artery bypass graft in 49 patients(62.8%) for evaluation of the graft patency and analysis of the risk factors for graft occlusion. The patency rates of both the internal mammary artery and the radial artery grafts were 100%, although three internal mammary artery grafts(5.0%) were narrowed(string sign). And that of the saphenous vein grafts were 85.2%. Multivariate analysis for the preoperative, operative, and postoperative factors was done between the widely patent and the narrowed internal mammary artery graft groups, and between the patent and the occluded saphenous vein graft groups by the general linear models procedure. Patient's age(>or=60 years), postoperative intraaortic balloon pump insertion, bleeding, and acute renal failure were found to be the significant risk factors for internal mammary artery graft narrowing, and coronary artery size(<1.5 mm) was the significant risk factor for the saphenous vein graft occlusion (p<0.05). This study confirms that the arterial graft is superior to the vein graft at one-year patency rate, and suggests the risk factors for graft occlusion during the first postoperative year. Knowledge of this study may provide a basis for estimating the risk factors for graft occlusion, and thereby modifying surgical strategy and postoperative surveillance.
Acute Kidney Injury ; Coronary Angiography ; Coronary Artery Bypass* ; Coronary Vessels* ; Graft Occlusion, Vascular ; Hemorrhage ; Humans ; Linear Models ; Mammary Arteries ; Multivariate Analysis ; Radial Artery ; Risk Factors ; Saphenous Vein ; Seoul ; Transplants* ; Veins

BACKGROUD: The purpose of our study was to evaluate the usefulness of the ictal semiology, interictal and ictal electro-encephalography(EEG), brain magnetic resonance imaging(MRI), interictal and ictal single photon emission computed tomography(SPECT), positron emission tomography(PET) and neuropsychometry for localization or lateralization of the ictal onset zone, and analyze the result of surgical treatment. METHODS: We evaluated 13 children with intractable temporal lobe epilepsy, who are diagnosed at children's hospital of Seoul National University, from January 1995 to August 1996. The ictal onset zone was determined by ictal semiology, electrophysiologic study, structural and functional neuroimaging, and neuropsychometry. RESULTS: 1) Ictal semiology : Sixty-nine% of the studied children had change of consciousness, 62% had automatism, 31% had aura, 23% had contralateral versive movement, and 23% had contralateral dystonic posturing. Secondarily generalized seizure occured in 38% of them. 2) Interictal EEG showed localized or lateralized value in 8 cases(62%). In interictal EEG, 12 cases(92%) showed epileptiform discharges on the ipsilateral temporal lobe. 3) Magnetic resonance imaging revealed ipsilateral temporal lobe lesion in 8 cases(62%). Interictal SPECT was performed in 6 cases, only one of them had decreased cerebral blood flow on the ipsilateral temporal lobe. Ictal SECT was done in all, 8 cases(67%) had localized or lateralized value. PET was performed in 11 cases, 8 cases(73%) of them had localized or lateralized value. 4) Neuropsychometry was performed in 7 cases, 6 cases(86%) of them had localized or lateralized value. 5) Nine patients underwent epileptic surgery, 6 of them had class I outcome and each one of the rest had class II, class III and class IV. CONCLUSIONS: Electroencephalography, neuropsychometry, MRI, ictal SPECT, and PET are valuable for localization and lateralization of the ictal onset zone, but interictal SPECT is valuless. The outcome after surgery is relatively good, but more extensive study including patient's social, cognitive and emotional status will be necessary.
Automatism ; Brain ; Child* ; Consciousness ; Electroencephalography ; Electrons ; Epilepsy ; Epilepsy, Temporal Lobe* ; Functional Neuroimaging ; Humans ; Magnetic Resonance Imaging ; Seizures ; Seoul ; Temporal Lobe* ; Tomography, Emission-Computed, Single-Photon

Primary amenorrhea due to intrasella arachnoid cyst is a very rare disease and require careful and frequent evaluation because may produce intracranial hemorrhage, elevated intracranial pressure and rapid expansion. Surgical intervention is needed only when visual disturbance, hypopituitarism or enlarging lesion is shown. Thus, we present a case of primary amenorrhea due to intrasella arachnoid cyst which was resected through the transsphenoidal approach.
Amenorrhea ; Arachnoid* ; Female ; Hypogonadism* ; Hypopituitarism ; Intracranial Hemorrhages ; Intracranial Hypertension ; Rare Diseases

PURPOSE: Vascular endothelial growth factor(VEGF) is recognized as a potent constituent of the vascularization and growth of solid tumors. We assessed the serum levels of VEGF and we evaluated its correlation to the clinicopathologic findings and clinical outcome of patients with renal cell carcinoma(RCC). MATERIALS AND METHODS: Serum samples were collected before surgery from patients with RCC. The levels of serum VEGF were assessed by using quantitative enzyme immunoassay. Comparison of the serum VEGF level with the tumor stage, grade, cell type and clinical outcome was performed, and the survival rate between the RCC patients above and below the mean VEGF level was evaluated. RESULTS: The mean follow-up was 5.1 years. The serum VEGF level was significantly higher in the patients with RCC(mean: 497pg/ml) than that in the controls(mean: 211pg/ml)(p<0.001). The serum VEGF level was correlated with the tumor size, the pathologic T stage and the clinical stage and histologic nuclear grade, but not with the histologic subtype. Patients with a lower VEGF level(<497pg/ml) showed longer survival(p=0.0207 on univariate analysis, p=0.04 on multivariate analysis). CONCLUSIONS: Our study indicated that the serum VEGF level was significantly correlated with the clinical or pathologic stage, the nuclear grade and adverse survival. These results suggest that the serum VEGF level could be a comparable prognostic factor to the tumor stage and grade.
Carcinoma, Renal Cell* ; Follow-Up Studies ; Humans ; Immunoenzyme Techniques ; Prognosis ; Survival Rate ; Vascular Endothelial Growth Factor A

PURPOSE: The role of [18F]fluorodeoxyglucose-positron emission tomography (FDG-PET) in renal cell carcinoma remains to be clearly defined. The sensitivity, specificity and accuracy of FDG-PET to detect renal cell carcinomas and a distant metastatic disease were compared with other established imaging modalities, including computerized tomography (CT), chest PA and bone scan. MATERIALS AND METHODS: FDG-PET and conventional imaging techniques, including CT, chest PA and bone scan, were performed in 43 patients with primary renal tumors and/or metastatic diseases. Radical nephrectomy and metastatectomy were then performed. The results of FDG-PET were compared with the conventional imaging techniques and postoperative histopathological diagnoses. RESULTS: The postoperative histopathological diagnoses of the 43 patients were renal cell carcinomas in 41 and benign renal tumors in 2. The results of FDG-PET were true positive, equivocal and false negative in 26, 8 and 9 of the 41 patients with renal cell carcinomas, respectively. The results of the CT were true positive in all patients. The results of FDG-PET were true negative in 2 patients, but those of CT were false positive in 2 patients with benign renal leiomyoma and angiomyolipoma. Therefore, FDG-PET was less sensitive, but more specific and accurate, than CT for the evaluation of primary renal tumors. CT was false positive for retroperitoneal lymph node metastasis and at the ascending colon in each of 1 patient, but FDG-PET was true negative. FDG-PET detected unsuspected pulmonary metastatic diseases that were not detected on chest PA in 4 patients. FDG-PET was more sensitive, specific and accurate than CT in the evaluation of metastasis. CONCLUSIONS: FDG-PET was complementary to conventional imaging in the initial staging of renal cell carcinomas, but superior in evaluating the metastasis.
Angiomyolipoma ; Carcinoma, Renal Cell ; Colon, Ascending ; Diagnosis* ; Electrons* ; Fluorodeoxyglucose F18 ; Humans ; Leiomyoma ; Lymph Nodes ; Neoplasm Metastasis ; Nephrectomy ; Positron-Emission Tomography* ; Sensitivity and Specificity ; Thorax

The location of pelvic portion of the femoral nerve between the iliacus and psoas muscles makes the nerve particularly vulnerable in hemorrhage within iliacus. We report a uncommon case of bilateral femoral neuropathy resulting from unilateral retroperitoneal hematoma. A 28-year-old man developed zero-trace grade of muscular weakness on both knee extensor muscles, numbness over bilateral anteromedial thighs and medial lower legs, tenderness of both hip adductor muscles after stab wound at left abdominal region. Abdominal computerized tomographic finding showed hematoma of left psoas muscles. Electromyographic examination revealed no motor unit action potentials in both iliopsoas, vastus medialis and adductor longus muscles. Nerve conduction study noted no compound motor action potentials of both femoral nerves. The fascial walls and laminae of the pouches in the lower abdominal wall tend to reinforce the rigidity of the fibrous arch over the femoral nerve in the intermuscular groove. This neuropathy is suggested, when the pouches are filled with blood, would further increase pressure on the subjacent nerves, especially bilateral femoral nerves.
Abdominal Wall ; Action Potentials ; Adult ; Femoral Nerve ; Femoral Neuropathy* ; Hematoma* ; Hemorrhage ; Hip ; Humans ; Hypesthesia ; Knee ; Leg ; Muscle Weakness ; Muscles ; Neural Conduction ; Psoas Muscles ; Quadriceps Muscle ; Thigh ; Wounds, Stab

OBJECTIVE: The previously established method of carpal tunnel syndrome (CTS) diagnosis is relatively troublesome and risk of misleading due to uncertainty of exact distance measurement for stimulation. If we use the wrist crease, an anatomical landmark, there might not be error in length measurement for stimulation at any wrist position. This study was performed to evaluate the wrist stimulation method in the diagnosis of CTS for it's convenience and reducing the errors. METHOD: Seventy healthy adults and sixty-five patients with clinical and electrophysiologic evidence of CTS were studied. Sensory nerve action potentials (SNAPs) in second and fifth digit were recorded antidromically with stimulation at a distance of 14 cm from recording electrode and stimulation at wrist crease. The ratio and difference of distal latency and ratio of amplitude between median and ulnar SNAPs were assessed. RESULTS: The ratio and difference of distal latency and ratio of amplitude in the 14 cm stimulation method were 1.52+/-0.28, 1.59+/-0.91 msec, 1.26+/-0.27 in the right, 1.43+/-0.14, 1.29+/-0.42 msec, 1.18+/-0.20 in the left, respectively in the men patients, and those of women patients were 1.48+/-0.35, 1.43+/-1.04 msec, 1.18+/-0.30 in the right, 1.53+/-0.30, 1.46 0.80 msec, 0.75+/-0.36 in the left. In wrist crease stimulation, those of men patients were 1.72+/-0.39, 1.74+/-0.98 msec, 1.22+/-0.24 in the right, 1.53+/-0.21, 1.31+/-0.46 msec, 1.25+/-0.29 in the left, and those of women patients were 1.67+/-0.46, 1.56+/-1.01 msec, 0.63+/-0.32 in the right, 1.68+/-0.37, 1.56+/-0.82 msec, 0.68+/-0.30 in the left. These results showed a significant positive correlation between the patients group and the control group in two stimulation methods (p<0.001). CONCLUSION: Based on the result of this study, wrist crease stimulation method is a quick and easy procedure, which would be recommended in the early diagnosis of CTS.
Action Potentials ; Adult ; Carpal Tunnel Syndrome* ; Diagnosis* ; Early Diagnosis ; Electrodes ; Female ; Humans ; Male ; Uncertainty ; Wrist*