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*

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

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

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*

PURPOSE: To assess the usefulness of percutaneous drainage of abscess in the treatment of emphysematous pyelonephritis. MATERIALS AND METHODS: Ten cases of nine patients with emphysematous pyelonephritis were percutaneously drained. All were suffering from diabetes mellitus. The procedure was performed under fluoroscopic guidance in nine cases and US guidance in one case in which bilateral multiloculated abscesses were present in the perirenal spaces. The results were classified as cure, partial success, recurrence, or failure. The mean drainage period and complication were analyzed. RESULTS: Eight cases were cured, and there was one partial success. In one case, who had diffuse renal parenchymal destruction without perirenal fluid collection, the treatment failed. The longest drainage period was 45 days, in a case of re-insertion due to incidental catheter removal ; the mean was 23 days. Bacteremia in one case was cured with antibiotic therapy which lasted two days. CONCLUSION: In diabetic patients, percutaneous drainage of abscess is thought to be a safe and effective method for the treatment of emphysematous pyelonephritis, and is one that does not involve diffuse destruction of renal parenchyma.
Abscess* ; Bacteremia ; Catheters ; Diabetes Mellitus ; Drainage* ; Humans ; Pyelonephritis* ; Recurrence

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

The usual manifestations of Moyamoya disease are bilateral carotid narrowing or occlusion at the carotid fork and abundant basal.vascular network with various carotid neurovascular symptoms. We report two unusual cases showing visual symptoms(bilateral cortical blindness, right homonymous hemianopsia, respectively) and angiographically vertebrobasilar and complete proximal internal carotid occlusion, with extensive parenchymal and transdural anastomosis in Moyamoya disease.
Blindness, Cortical ; Carotid Artery, Internal* ; Hemianopsia ; Moyamoya Disease*

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

Insulinoma is a rare tumor occurring more often in the older age range. Because of the neuroglycopenic symptoms initial misdiagnosis or the delayed diagnosis are frequent. We recently experienced a case of insulinoma in a 50-year-old female with the symptoms of complex partial seizure, who had been treated with the antiepileptic drugs. Hypoglycemia was detected and the parenteral supplement of glucose rapidly reversed her symptoms, and the prolonged fasting test showed the pattern of insulinoma. Curative surgery was performed. So we report a case of insulinoma with the review of literature.
Anticonvulsants ; Delayed Diagnosis ; Diagnostic Errors ; Fasting ; Female ; Glucose ; Humans ; Hypoglycemia ; Insulinoma* ; Middle Aged ; Seizures*