Unknown primary melanoma shows only metastatic malignant malanoma without obvious primary tumor. These unusual instances of unknown primary melanoma have reported incidences of 1.0~8.7%. This 51 year old patient had many intra-abdominal and mesenteric masses without visible primary tumor. The most commonly accepted explanation for unknown primary melanoma is spontaneous regression of a primary skin lesion.
Incidence ; Neoplasm Metastasis

No abstract available.
Ganglia, Spinal* ; Longitudinal Ligaments*

To get the normal values of regional cerebral blood flow (rCBF) in rat brain in our laboratory, we used the digital autoradiographic method with C-14 iodoantipyrine (IAP) in 8 Wistar rats. The rats were anesthetized with 1.5% halothane during the experimental procedure. Right femoral artery and vein were cannulated for blood pressure monitoring. Arterial sampling - and injection of radiotracer. Fifty uCi of C-14 IAP was constantly injected over 30 seconds using infusion pump and 10 to 15 arterial samples were obtained with micropipettes At the end of 30 seconds the brain was removed and freezed in liquid nitrogen. Coronal sections of the brain were exposed to film and the images were analyzed by computer-based digital analyzer system. Values of the regional cerebral blood flow in ml/l00g brain/min were as follows. Frontal cortex, 110.7 +/- 31.0; parietal cortex, 120.9 +/- 31.0; temporal cortex, 123.4 +/- 30.5; occipital cortex, 111.2 +/- 31.; cingulate cortex, 112.8 +/- 32.4; pyriform cortex, 1043 +/- 33.8; entorhinal cortex, 114.5 +/- 40.9; corpus callosum, 55.2 +/- 17.2; caudatoputamen 105.3 +/- 39.8, thalamus, 114.6 +/- 35.0; Cal region of hippocanpus, 79.4 +/- 33.3; CA2. 80.2 +/- 34.9; CA3, 83.4 +/- 37.2; dentate gyrus, 80.0 +/- 37.1. These normal values of rCBF in rat brain may be used as a standard index for future experimental researches on therapy and pathophysiology of cerebral ischemia using autoradiographic measurement of rCBF.
Animals ; Blood Pressure Monitors ; Brain ; Brain Ischemia ; Corpus Callosum ; Dentate Gyrus ; Entorhinal Cortex ; Femoral Artery ; Gyrus Cinguli ; Halothane ; Infusion Pumps ; Nitrogen ; Rabeprazole ; Rats* ; Rats, Wistar ; Reference Values* ; Thalamus ; Veins

We report a 61-year-old right-handed man developing disturbance of memory after a discrete thalamic infarction. Neuropsychological assessment revealed deficits in memory with retrograde and anterograde components, especially for verbal material. Brain MRI showed a left anterior thalamic infarction with normal angiographic findings. Despite the small lesion in the thalamus, he showed prolonged memory disturbance and a Brain SPECT image revealed decreased uptake in the ipsilateral fronto-temporo-parietal cortex and contralateral cerebellum. This diaschisis, a phenomenon caused by disconnection of the neural pathway helped us to evaluate the functional state of the patient and this imaging technique was valuable for obtaining to get more information for the evaluation of the neurological state and neuronal connections. In conclusion our findings correspond well with the understanding of amnesia as a disconnection syndrome because of the evidence of diaschisis on the Brain SPECT image.
Amnesia/*etiology ; Brain/*radionuclide imaging ; Case Report ; Cerebellum/radionuclide imaging ; Cerebral Infarction/*complications/radionuclide imaging ; Human ; Male ; Middle Age ; Thalamic Diseases/*complications/radionuclide imaging ; *Tomography, Emission-Computed, Single-Photon

STUDY DESIGN: A retrospective study. OBJECTIVES: To assess the efficiency of undercorrection and transpedicular screw fixation through a posterior approach in osteoporotic spine fractures with a thoracolumbar kyphotic deformity. SUMMARY OF LITERATURE REVIEW: The surgical treatment of osteoporotic spine fractures with a thoracolumbar kyphotic deformity requires extensive surgical procedures to obtain complete restoration of the sagittal alignment, but it has a few technical limitations due to insufficient mechanical stability at the bone-screw interface. A special strategy is essential for transpedicular screw fixation for osteoporotic spine fractures with a thoracolumbar kyphotic deformity. MATERIALS AND METHODS: We reviewed 14 osteoporotic spine fracture cases, with a thoracolumbar kyphotic deformity, which had undergone undercorrection and transpedicular screw fixation through a posterior approach, between March 2000 and June 2003, with an average follow-up period of 15. 2 months. According to the Jikei grade of the osteoporosis, 9 and 5 cases were grades 2 and 3, respectively. As a radiographic assessment, we measured the kyphotic angles of the fused segments on the preoperative, postoperative and last follow up thoracolumbar lateral views on standing using Cobb's method, and also assessed the kyphotic angle correction (KAC). The clinical results were evaluated at the last follow-up. RESULTS: The kyphotic angles at the preoperative, postoperative and last follow-up were 33.5 degrees +/- 9.3, 22.4 degrees +/- 6.9 and 24.7 degrees +/- 6.8, respectively. We obtained a mean KAC gain of 11.1 degrees postoperatively (p<0.05), but a loss of 2.3 degrees at the last follow-up (p>0.05). The clinical results were analyzed as good, fair and poor in 8, 5 and 1 case, respectively. Fusions were achieved in all cases. CONCLUSIONS: Undercorrection and transpedicular screw fixation for a thoracolumbar kyphotic deformity in osteoporotic spine fractures can be one of the alternatives to avoid fixation failure and an extensive surgical procedure.
Congenital Abnormalities* ; Follow-Up Studies ; Kyphosis ; Osteoporosis ; Retrospective Studies ; Spine*

To preserve function of the acoustic nerve and brainstem during posterior fossa surgery, the authors monitored(brainstem auditory evoked potentials) in 42 cases of posterior fossa surgery who were operated at the Department of Neurosurgery of Yonsei University College of Medicine from March, 1983 to February, 1987. The results were summarized as followings : 1) There were 28 cases of hemifacial spasm, 13 cases of trigeminal neuralgia and 1 case of cerebellopontine angle tumor. 2) Among the 41 cases of neurovascular decompression, there were 10 cases(24%) with hearing impairment postoperatively. But there was no postoperative auditory dysfunction in 13 cases of hemifacial spasm in which caudal approach was utilized. 3) There was no postoperative auditory dysfunction in the patients who showed intraoperative BAEPs of Types I, II, and III which were characterized by no loss of waves, but 10 cases(77%) who showed BAEPs of types IV, V and VI which were characterized by loss of the waves showed auditory dysfunction postoperatively.
Brain Stem* ; Cochlear Nerve ; Decompression ; Evoked Potentials, Auditory, Brain Stem* ; Hearing Loss ; Hemifacial Spasm ; Humans ; Monitoring, Intraoperative ; Neuroma, Acoustic ; Neurosurgery ; Trigeminal Neuralgia

BACKGROUND: Multifocal hypointense cerebral lesions (MHCLs) manifesting as minute round signal loss on T2*-weighted gradient echo MR imaging (GE-MRI), are known to be frequently detected in chronic hypertensive patients. The purpose of this study was to elucidate the correlation among hypertension (HTN), intracerebral hemorrhage (ICH), and MHCLs. METHODS: We prospectively examined GE-MRI in 104 patients with HTN (40 ICH and 64 non-ICH patients) and 72 age and sex matched controls. MHCLs on GE-MRI were counted by two neurologists separately and determined as abnormal by consensus, and the number of MHCLs in each subject was graded as 0 (the number of MHCLs: 0), 1 (1-5), and 2 (>5). RESULTS: MHCLs were found in 71 of 104 patients with HTN (68.3%) and in 11 of 72 controls (15.3%). The grade of MHCLs was significantly correlated with HTN (p<0.001). In addition, MHCLs were discovered in 34 of 40 hypertensive patients with ICH (85%) and in 37 of 64 hypertensive patients without ICH (57.8%). The degree of MHCLs was more severe in the former than that in the latter with statistical significance (p<0.005). Multivariate analysis revealed that only HTN and the presence of ICH were the independent risk factors. CONCLUSIONS: Microaneurysm or microbleeding, which has been known as one of the characteristic findings of hyper-tensive microangiopathy, may be shown as MHCLs on GE-MRI. In this study, the positive correlation between MHCLs and HTN was clear. Moreover, we also found that in hypertensive patients with ICH, MHCLs are more fre-quently seen than in patients without ICH. These suggest the causal relationship between MHCLs and ICH. Further cohort study would be necessary in order to confirm this suggestion.
Cerebral Hemorrhage ; Cohort Studies ; Consensus ; Humans ; Hypertension* ; Intracranial Hemorrhage, Hypertensive* ; Magnetic Resonance Imaging* ; Multivariate Analysis ; Prospective Studies ; Risk Factors

BACKGROUND: Intracerebral hemorrhage (ICH) is associated with a considerable proportion of stroke and head injuries, but except for supportive care, there is no medical therapy available. Transplantation of human neural stem cells (NSCs) can be used to reduce behavioral deficit in experimental ischemic infarct model. However, effect of stem cell transplantation in experimental intracerebral hemorrhage (ICH) is unknown. We hypothesized that NSCs could migrate and differentiate into neurons or glial cells, and improve functional outcome in ICH. METHODS: Experimental ICH was made by intrastriatal administration of bacterial collagenase in adult rats. Animals were randomized to receive intravenously either immortalized Lac-Z positive human NSCs (5x1 06 in 500microL, n=15) or same volume of saline (n=12) on the following day. Animals were evaluated for 8 weeks after surgery with behavioral test battery. After 8 weeks, animals were sacrificed and the brains were sectioned. Transplanted NSCs were detected by X-gal histochemistry or beta-gal immunohistochemistry, and differentiation of grafted NSCs were evaluated by double labeling of GFAP, NeuN, or neurofilament. RESULTS: Transplanted NSCs migrated to the side of peri-hematomal areas, and differentiated into neurons and astrocytes. NSCs injection group showed improved performances on rotarod test after 2 weeks and on limb placing test after 5 weeks compared with control group (p<0.05) and these effect persisted up to 8 weeks. CONCLUSIONS: Intravenously injected NSCs enter rat brain with ICH, and differentiate into astrocytes or neuronal cell, which lead to functional recovery. These findings show the possibility that NSCs can be used to reduce neurological deficits in the experimental ICH.
Adult ; Animals ; Astrocytes ; Brain ; Cerebral Hemorrhage* ; Collagenases ; Craniocerebral Trauma ; Extremities ; Humans* ; Immunohistochemistry ; Neural Stem Cells* ; Neuroglia ; Neurons ; Rats ; Rotarod Performance Test ; Stem Cell Transplantation ; Stroke ; Transplants

We analyzed 91 cases with seizures after stroke(except subarachnoid hemorrhage) to see, recurrence rate, onset time, lesion sites and electroencephalographic findings. Overall incidence of seizure was 5.73%[7.57% of all cerebral infarction(CI; 938 cases) and 3.0% of an intracerebral hemorrhage(ICH; 649 cases)] in all admitted stroke patient(l450) from Jan. 1980 to Jun. 1989 and all stroke patients visited out-patient department(137 ; from Sep. 1989 to Oct. 1989) in the department of neurology, Seoul National University Hosptal. And then, we excluded 22 cases because of insufficient clinical information.1) We followed up 69 patients and in those cases, seizures occurred rnore frequently in CI(51) than in ICH(18). 2) Seizures of ear!y onset(<2week) occurred in 25(49.0%) of 51 cases with cerebral infarction and in 12(66.7%) of 18 cases with IVH. 3) Seizures occurred more frequently in cortical lesions(71.0%)[CI: 71.4% and ICH ; 28.6%] than in subcortical lesions(24.6%)[CI ; 76.5% and ICH ; 23.5%]. 4) Recurrence rate (69.5%) of the patients without antiepileptic medication was signigicantly higher than (16.7%) of patients with medication[Spearman's Rho=0.52, p<0.001]. 5) Of those patients without medication, the recurrence rate was highest in the patients showing epileptiform discharge(100%) in EEG. Followed by focal slowing(66.7%), diffuse slowing(62.5%) and normal EEG features(33.3%)[Spearman's Rho=0.41, P=0.01]. 6) The recurrence of seizures was more frequent in the patients with CI(54.9%) than in ICH(22.2%).
Cerebral Infarction ; Electroencephalography ; Humans ; Incidence ; Neurology ; Outpatients ; Recurrence ; Seizures* ; Seoul ; Stroke

OBJECTIVE: This study sought to identify candidate genes related to the clinical effects of several mood stabilizers through gene expression profiles using microarrays and real time RT-PCR. METHOD: Rats were treated with lithium carbonate, valproate, or clozapine for 10 days. Total RNA was extracted from the rat brains and used for microarray analysis. Of 54 genes showing more than 1.5-fold changes induced by all three mood stabilizers, seven genes were selected, and drug-induced changes in gene expression were confirmed by real time RT-PCR. In addition, genotype distribution of the GRIK2 gene was compared between 181 patients with bipolar disorder and 350 normal controls. RESULTS: Of the seven candidate genes, GRIK2 and PRKAR were confirmed as being downregulated by lithium and valproate. However, none of the genes was affected by all three drugs. The allele and genotype distribution in two SNPs of GRIK2 did not differ between the patient and control groups. CONCLUSIONS: Although this study demonstrated overall negative results, the present findings will be used in future studies for establishing various mechanisms of mood stabilizers.
Alleles ; Animals ; Bipolar Disorder ; Brain* ; Clozapine ; Gene Expression* ; Genotype ; Humans ; Lithium ; Lithium Carbonate ; Microarray Analysis ; Polymorphism, Single Nucleotide ; Rats* ; RNA ; Transcriptome ; Valproic Acid