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*

We investigated fifty four patients with spontaneous intracerebral lobar hemorrhage who were admitted to the Seoul National University Hospital Neurology Sercice during a period of five and a half years. Of these patients 25 (46.3%) had hypertension as the probable cause of hemorrhage Of the remaining cases, 12(22.2%) had other etiologies including 5 arteriovenous malforrnations. 3 aneurysms, 2 tumors, 1 Moyamoya disease and 1 superior sagittal sinus thrombosis, while 14(25.2%) had no apparent etiology. But some of them seemed to be due to cerebral amyloid angiopathy or occult vascular malformation. Parietal region was the most frequent site of hemorrage(23 cases, 42.6%). Six cases had multiple intracerebral hematoma. Common clinical manifestations were headache, vomiting, hemiparesis, seizure in order of frequency. Mortality rate was 16.7%, which was correlated with the size of hematoma (P<0.05) and consciousness level at the initial stage (p<0.05). But not with the presence of intraventricular or subarachnoid hemorrhage. Hypertension or age of onset.
Age of Onset ; Aneurysm ; Cerebral Amyloid Angiopathy ; Cerebral Hemorrhage* ; Consciousness ; Headache ; Hematoma ; Hemorrhage ; Humans ; Hypertension ; Mortality ; Moyamoya Disease ; Neurology ; Paresis ; Rabeprazole ; Seizures ; Seoul ; Subarachnoid Hemorrhage ; Superior Sagittal Sinus ; Thrombosis ; Vascular Malformations ; Vomiting

OBJECTIVE: Although little is known about its origins, neck pain may be related to several associated anatomical pathologies. We aimed to characterize the incidence and features of chronic neck pain and analyze the relationship between neck pain severity and its affecting factors. METHODS: Between March 2012 and July 2013, we studied 216 patients with chronic neck pain. Initially, combined tramadol (37.5 mg) plus acetaminophen (325 mg) was administered orally twice daily (b.i.d.) to all patients over a 2-week period. After two weeks, patients were evaluated for neck pain during an outpatient clinic visit. If the numeric rating scale of the patient had not decreased to 5 or lower, a cervical medial branch block (MBB) was recommended after double-dosed previous medication trial. We classified all patients into two groups (mild vs. severe neck pain group), based on medication efficacy. Logistic regression tests were used to evaluate the factors associated with neck pain severity. RESULTS: A total of 198 patients were included in the analyses, due to follow-up loss in 18 patients. While medication was successful in reducing pain in 68.2% patients with chronic neck pain, the remaining patients required cervical MBB. Lateral cervical curvature, such as a straight or sigmoid type curve, was found to be significantly associated with the severity of neck pain. CONCLUSION: We managed chronic neck pain with a simple pharmacological management protocol followed by MBB. We should keep in mind that it may be difficult to manage the patient with straight or sigmoid lateral curvature only with oral medication.
Acetaminophen ; Ambulatory Care Facilities ; Colon, Sigmoid ; Factor Analysis, Statistical* ; Follow-Up Studies ; Humans ; Incidence ; Logistic Models ; Neck Pain* ; Neck* ; Pathology ; Tramadol

A rat model of focal cerebral ischelma has been established by mhe tecbnique of elecvrocamtery for me middle oerebral artery occlusion (MCAO). We investigated mhe effect of naloxone pretreatment on the size of infarction and the regional cerebral blood flow (rCBF) Another purpose of this study was to determine the effecbve dose (high-or lowdose) in focal cerebral ischemia. The rats were given Img/Kg I.v. (low-dose), 4mg/Kg I.v. (high-dose) of naloxone 30 min before MCAO and infused continuously with 0.5mg/Kg/hr (low dose) or 2mg/Kg/hr (high-dose) over next I hour by am infusion pump. The control group was given normal salin of the same amount by the same method. Dunng the peDod of saline amd naloxone infusion, mean arterial blood pressure was monitored. Arterial blood gas analysis and blood glucose measuremert were performed just after MCAO. The rectal temperature of rat was maintained within 37)0.5C by a heating lamp. Twenty-fow hours after MCAO, eight 2mm-thick coronal sections of one rat brain were stained by TTC solution and the size of infarction was described as the percentage of ipsilateral hemisphere. The rCBFs were measured by an autoradiography using 14C-iodoantipyrine and the chamges of rCBFs were analyzed by three methods of (1) rCBF ratio, (2) 1 mm-serial rCBF measurement of cerebral cortex, and (3) areas of rCBF below critical values(<25, 25-50, <50ml/100g/min). The results were as follows; 1. There was no significamt chamge of blood pressure during the infusion of saline. Iow-dose and high-dose naloxones 2. Arterial blood gas amalysis amd blood glucose measurement showed that there were no significant differences of pH, PC02, PO2 and blood glucose between saline and low dose and high-dose naloxone groups 3. High-dose naloxone pretreatment reduced significantly the size of infarction(p<0.05 vs saline-treated group by Mann-Whitney U test). 4. High-dose naloxone pretreatment improved significantly the rCBF ratios of caudate head and CA 3 area (p<0.05 vs. saline-treated group by Mann-Whitney U test) There was no significant improvement of rCBF ratios in the low-dose naloxone treated group. 5. One-mm serial rCBF measurement of cerebral cortex indicated that while low-dose naloxone group showed no improvement of rCBF of cerebral cortex, high-dose nalox one pretreatment produced an improvement of rCBF in penumbra and its neighboring area 6. The area below 25ml/100g/min or rCBF was reduced significantly by high-dose naloxone pretreatment(high-dose naloxone group: 15.0+4.1mm2, saline group:23.3)5.3 mm2, p <0.05). In summary these results indicate that high-dose naloxone pretreatment reduced the size of infarction and improved the rCBFs in the focal cerebral ischemia of rats.
Animals ; Arterial Pressure ; Arteries ; Autoradiography ; Blood Gas Analysis ; Blood Glucose ; Blood Pressure ; Brain ; Brain Ischemia* ; Cerebral Cortex ; Head ; Heating ; Hot Temperature ; Hydrogen-Ion Concentration ; Infarction* ; Infusion Pumps ; Models, Animal ; Naloxone* ; Rats*

BACKGROUND: Vascular endothelial growth factor (VEGF) is an angiogenic peptide that enhances microvascular perfusion. Recently, VEGF is known to have neurotrophic effect and rescues neurons from cell death induced by serum deprivation. To investigate the serial changes in VEGF expression and neuroprotective properties of VEGF during acute ischemia. METHODS: Human cortical-neuroblastoma hybrid cell line (A1G11), human neuroglioma cell line (H4), and human vascular endothelial cell line (ECV304) were placed in the glucose/serum free media and incubated in the hypoxic chamber (94% N2/5% CO2/1% room air) at 37 degrees C. Cell viability was determined by MTT assay. Western blot analysis was performed to detect VEGF and its receptor (VEGFR) expression. To test the protective effect of VEGF, human recombinant VEGF165 was used. RESULTS: Morphological changes and the decrease of cell viability were observed following 6 hr ischemia. In A1G11 cells, VEGF expression was not noted until 3 hr ischemia, but was induced after 6hr and continued to 12 hr and then diminished. In H4 and ECV304, the change of VEGF expression was not observed. VEGFR-2/Flk-1 expression was induced from 6 hr (peak level) to 12 hr in A1G11, and induced after 3 hr and continued to 12hr in ECV304. Administration of VEGF increased cell viability in A1G11 cells at 6 hr, 12 hr and 18 hr ischemia (p=0.009, p=0.01 p=0.013), but not in H4 or ECV304 cells ( p>0.05). CONCLUSION: Ischemia induces VEGF production in neurons and VEGF may exert a direct neuron-specific protective effect through VEGFR-2/Flk receptors during the acute phase of ischemic neuronal injury.
Blotting, Western ; Cell Death ; Cell Line ; Cell Survival ; Endothelial Cells ; Humans ; Hybrid Cells ; Ischemia* ; Neurons ; Perfusion ; Vascular Endothelial Growth Factor A*

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