A clinical observation was made on the obstruction at the ureteropelvic Juncture of the inpatient in the Department of Urology. Seoul National University Hospital during the period September, 1961 through August, 1968 and the following results were observed. 1. Of 1824 cases hospitalized, 33 cases werehydronephrosis of non-calculous origin. Among the 33 cages 10 were obstruction ofthe ureteropelvic juncture giving a rate of 30.3%. Age distribution ranged from 4to 48 years with average of 26 years. 2. As to the origin of the obstruction, 5 cases were due to aberrant vessel one congenital stricture one fibrous band and one fibrosis, respectively. The causes were unknown in 2 cases. 3. The most common complaints were pain on the involved site in 8 cases. Palpable mass, gastrointestinal trouble and general weakness were found in 6 cases. Loss of weight and pollakisuria were noted in 3 cases. Hypertension. hematuria, fever andedema were found respectively in one case. 4. All cases including two which showed non-function on IVP showed markedly dilated pelvis and marked narrowing ofthe ureteropelvic juncture. 5. Nephrectomy was performed in 5 cases, removal of aberrant vessel in 2, ureteroplasty in one and ureteral dilation with contralateral nephrectomy in 2.
Age Distribution ; Constriction, Pathologic ; Fever ; Fibrosis ; Hematuria ; Humans ; Hypertension ; Inpatients ; Nephrectomy ; Pelvis ; Seoul ; Ureter ; Urology

RATIONALE: Studies on ictal SPECT as a method of presurgical evaluation in neocortical epilepsy have been rare and inadequate. We evaluated the accuracy in the localization of epileptic foci with ictal SPECT in neocortical epilepsy and tried to find out the determining factors of its accuracy. METHODS: We performed ictal SPECT 66 times with 99m-Tc-HMPAO in 56 patients, who received video-EEG monitoring and had electroclinical features of neocortical epilepsy. Invasive monitoring was performed in 28 patients & epileptic surgery was done in 31. Their results were also used to help determine the location of epileptic foci. In 54 of 66 scans data about injection time and temporal relationship of HMPAO injection to the onset and secondary generalization of seizures were available. RESULTS: Frontal lobe epilepsy(FLE) was most common(35%) followed by lateral temporal lobe epilepsy(28%), occipital lobe epilepsy(11%), parietal lobe epilepsy(9%), and etc. Ictal SPECT demonstrated unilateral hyperperfusion in 53 of 66 scans (80.3 %) which were concordant with electroclinical lateralization in 48 of 53 (90.6 %). Localized hyperperfusion was evident in 42 of 66 scans (63.6 %) which were concordant with electroclinical localization in 33 of 42(78.6 %). Correctly localized hyperperfusion or correctly-lateralized but diffuse hyperperfusion were detected in 37 of 54 scans in which data about injection time were available. The mean injection time was 32.1 seconds. In 16 scans ictal SPECT showed no hyperperfusion or falsely localized/lateralized hyperperfusion. Their mean injection time was 41.6 seconds. The difference of injection time between two groups was not significant(p-value=0.07), but there was a tendency that the mean injection time of the former group was earlier than that of the latter group. We had chances to perform ictal SPECT repeatedly in 8 patients under the similar conditions. The fact that earlier injection improved the accuracy of ictal SPECT in 6 patients supports the importance of early injection. In 48 studies with ictal injection, only 11 scans gave no or incorrect information of the localization or lateralization of epileptic foci. But, in 6 studies with postictal injection, 5 scans was not helpful. The difference between two groups was statistically significant(p<0.05). The presence of focal lesion, the location of epileptic foci, or secondary generalization did not influence the accuracy of ictal SPECT. CONCLUSIONS: Our data suggest that ictal SPECT in neocortical epilepsy is useful in localization of epileptic foci. Whether injected ictally or postictally and the injection time from seizure onset seems to influence the accuracy of ictal SPECT in neocortical epilepsy.
Epilepsy ; Frontal Lobe ; Generalization (Psychology) ; Humans ; Occipital Lobe ; Parietal Lobe ; Seizures ; Technetium Tc 99m Exametazime ; Temporal Lobe ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: To evaluate the efficacy of vigabatrin and valproic acid add-on therapy in the treatment of uncontrolled partial-onset seizures through randomized active controlled parallel-group trial. METHODS: Criteria for entry included a requirement for three or more partial seizures per month despite the blood level of carbamazepine was within therapeutic range. During the 56-day baseline period, patients had at least 6 partial onset seizures. Vigabatrin or valproic acid were administered as the second drug in a randomized fashion. RESULTS: Forty one patients completed the trial(21 for vigabatrin, 20 for valproic acid). There is no statistically significant difference in age, age at onset, baseline seizure frequency, dose of carbamazepine, and serum level of carbamazepine between two groups. Two patients of vigabatrin-treated group and three patients of valproic acid treated group were dropped out because of side effects. The mean vigabatrin and valproic acid does were 2809 and 1490 mg, respectively. The percentage of patients achieving at least a 50% reduction in seizure frequency at the end of 8-week of add-on trial was 62% among vigabatrin-treated patients and was 50% for patients who received valproic acid(not statistically different). There was no significant difference in seizure reduction, percent seizure reduction, and truncated percent seizure reduction between two groups. The side effects were mild and transient neurotoxic symptoms in the patients who completed the trial(5 patients for vigabatrin, 10 patients for valproic acid). CONCLUSIONS: This trial indicates that vigabatrin and valproic acid are safe and effective in the treatment of intractable partial-onset seizures. The efficacy of vigabatrin as a new add-on antiepileptic drug is comparable to the previous valproic acid carbamazepine combination in the sense of seizure reduction and maybe even superior to that in the consideration of side effects
Carbamazepine* ; Humans ; Seizures* ; Valproic Acid* ; Vigabatrin*

The ankle is a complex, weight bearing joint and its injury result in a severe functional disturbance of complex anatomical characteristics. It is very important to understand the mechanism of trauma in order to make definite diagnosis and proper treatment. The authors analysed 52 cases(52 patients) of the ankle fractures which were admitted and treated in Orthopaedic department, Korea University Hospital from Sept. 1980 to Dec. 1986. The results obtained were as follows : l. Of the 52 cases, male was 32 cases(61.5%), female was 20 cases(38.5%) and average age of the patients was 32.9 years. 2. The causes of the injury were slipping down, traffie accident, falling down and sports injuries, in orders. 3. Open fractures were 8 cases(15.4%) and closed fractures were 44 cases(84.6%). The most common type of the ankle fracture was supination-extenal rotation type(18 cases, 34.1%) and next was pronation-external rotation type(15 cases, 30%), according to the classification of Lauge-Hansen. 4. 38 cases(73.1%) were treated by open reduction and 14 cases(26.9%) by closed reduction, and average duration of immobilization was 7.7 weeks in open reduction and 10.4 weeks in closed reduction. 5. The associated fractures other than ankle was 15 cases(28.8%). 6. The better results were obtained from open reduction and the worst results obtained from pronation-dorsiflexion type, according to the criteria of Meyer. 7. The complication was 7 cases(13.5%), traumatic arthritis 4 cases, malunion 2 cases and nonunion 1 case. 8. Accurate reduction and rigid internal fixation of the fractured lateral malleolus, distal fibular and distal tibiofibular diastasis was important in treatment of the ankle fracture.
Accidental Falls ; Ankle Fractures ; Ankle ; Arthritis ; Athletic Injuries ; Classification ; Diagnosis ; Female ; Fractures, Closed ; Fractures, Open ; Humans ; Immobilization ; Joints ; Korea ; Male ; Weight-Bearing

PURPOSE: To evaluate the characteristics of the bronchiectasis in diffuse panbronchiolitis using HRCT. MATERIALS AND METHODS: We retrospectively studied 12 HRCT scans and two bronchography of 12 patients with diffuse panbronchiolitis(DPB). According to Akira et al., DPB was classified into four types: small nodules around the end of bronchovascular branchings(CT type I), small nodules in the centrilobular area connected with small branching linear opacities(CT type II), nodules accompanied by ring-shaped or small ductal opacities connected to proximal bronchovascular bundles(CT type III), large cystic opacities accompanied by dilated proximal bronchi(CT type IV). We compared the type and the extent of bronchiectasis, CTtypes of DPB, and pulmonary function test. RESULTS: Bronchiectasis was defined in 12 cases with the tubular type predominantly involving small and medium-sized bronchi. These bronchiectasis involved the proximal bronchi of the centrilobular lesions of DPB. Among eight cases of advanced DPB(CT type III & IV) which extended to both upper lobes, seven showed tubular bronchiectasis at the same area. Cystic bronchiectasis was shown in eight cases predominantly involving right middle lobe(n=7). There was no linear correlation between the values of pulmonary function test and CTtypes of DPB. CONCLUSION: Characteristic feature of the bronchiectasis in DPB is the tubular ectasis predominantly involving the small and medium-sized bronchi. DPB with associated tubular bronchiectasis can involve whole lung field in advanced cases. HRCT is useful not only to depict the findings of DPB but also to demonstrate the extent of lesion.
Bronchi ; Bronchiectasis* ; Bronchography ; Humans ; Lung ; Respiratory Function Tests ; Retrospective Studies

After the identification by Snyder of specific opiate receptors it the substantia gelatinosa of the posterior horn of the spinal cord, Behar et al. reported that small doses of epidural morphine are effective in treatment of acute and chronic pain. We have administered 3~5 mg of epidural morphine as a single dose with 1.5~2 % lidocaine to 40 patients as a continuous lumber epidural anesthesia and to 20 patients as a single caudal anesthesia. All the patients had remarkable relief of pain and we can confirm that there was no loss of sensation to temperature, touch or pinprick. However the dosage (3. 4 or 5 mg) of morphine administrated did not affect the duration of postoperative pain relief. Arterial blood pressure and heart rate were measured up to 15 minutes after morphine injection at 5 minutes intervals, but were not significantly changed. PaO2, PaCO2 pH and base excess were also not significantly changed.
Anesthesia, Caudal ; Anesthesia, Epidural ; Animals ; Arterial Pressure ; Chronic Pain ; Heart Rate ; Horns ; Humans ; Hydrogen-Ion Concentration ; Lidocaine ; Morphine* ; Pain, Postoperative* ; Receptors, Opioid ; Sensation ; Spinal Cord ; Substantia Gelatinosa

A 41 year-old male underwent resection of a pheochromocytoma under general anesthesia. The patient was treated with phenoxybenzamine for 14 days preoperatively and premedicated with triflupromazine, diazepam, pethidine and hydroxyzine in combination. Following induction of anesthesia with intravenous morphine, thiopental sodium and alcuronium, endotracheal intubation was performed. As soon as intubation, tachycardia(143/min) and hypertension(170/100 mmHg) developed, but were controlled by intravenous injection of propranolol. Anesthesia was maintained with nitrous oxide, oxygen and enflurane, and alcuronium. Blood pressure during manupulation of tumor mass was 160/100 mmHg without arrhythmia but gradually was controlled to the range of 120-130/80-85 mmHg after intravenous infuaion of nitroglycerine at the rate of 0.5-2 ug/kg/min. After removal of the tumor mass, the blood pressure dropped to 100/70 mmHg. Blood pressure was controlled by I.V. low molecular weight dextran, and Hartmanns solution, but a vasoconstrictive agent was not needed. There was no marked tachycardia or arrhythmia during anesthesia. The importance of preoperative preparation, premedication, selection of anesthetics and nitroglycerne for controling the episodic hemodynamic pressure response is discussed.
Adult ; Alcuronium ; Anesthesia ; Anesthesia, General ; Anesthetics ; Arrhythmias, Cardiac ; Blood Pressure ; Dextrans ; Diazepam ; Enflurane ; Hemodynamics ; Humans ; Hydroxyzine ; Injections, Intravenous ; Intubation ; Intubation, Intratracheal ; Male ; Meperidine ; Molecular Weight ; Morphine ; Nitroglycerin* ; Nitrous Oxide ; Oxygen ; Phenoxybenzamine ; Pheochromocytoma* ; Premedication ; Propranolol ; Tachycardia ; Thiopental ; Triflupromazine

Caudal narcotic analgesia was assessed after the injection of 3mg morphine diluted in 30ml(physiologic) saline into the sacral canal in 15 patients after upper abdominal surgery, in 20 patients after lower abdominal surgery under general anesthesia, and in 20 patients after perianal surgery under caudal block. Pain relief was evaluated by the subsequent need for systemic analgesics. All cases had considerable relief from pain and the morphine was effective for 12 or more hours. There were no significant differences between pain relief of the upper abdominal and lower abdominal surgery group, upper abdomianl and perianal surgery group, and lower abdominal and perianal surgery group (p>0.05, p>0.05, p>0.05). It is suggested that the morphine, which was administered into the sacral, cannal, reached the subarachnoid space and produced it's effect by direct action on the specific opiate receptors in the substantia gelatinosa of the posterior horn cell of the spinal cord. Consequently, whether analgesia from epidural narcotics appears to be segmental in distribution or not is still in controveray.
Analgesia ; Analgesics ; Anesthesia, General ; Humans ; Morphine* ; Narcotics ; Pain, Postoperative* ; Posterior Horn Cells ; Receptors, Opioid ; Spinal Cord ; Subarachnoid Space ; Substantia Gelatinosa

BACKGROUND: Localizable scalp ictal EEG appears to be rare in neocortical epilepsy. However, there have not been many studies based upon a large number of patients. This study aims to identify the characteristic patterns of variable neocortical epilepsies and to evaluate their clinical usefulness in the localization of epileptogenic foci. METHODS: We retrospectively assessed 394 noninvasive ictal recordings from 86 patients who subsequently underwent invasive study and resective surgery. Ictal EEGs were recorded by video-EEG monitoring systems with electrodes placed according to the international 10-20 system including additional anterior temporal electrodes. Ictal recordings were analyzed accord-ing to the localizing accuracy and frequency characteristics. The durations of discrete or regional ictal rhythms were also measured. RESULTS: The percentage of discrete or regional EEGs were respectively 26, 52, 70, and 10% in frontal lobe epilepsy (FLE), lateral temporal lobe epilepsy, occipital lobe epilepsy (OLE), and parietal lobe epilepsy (PLE). The ictal rhythms in the order of frequency were theta, delta, beta, alpha, and rhythmic spike-and-wave. The duration of discrete or regional ictal rhythms were significantly shorter in FLE and PLE than in other epilepsies. Ictal beta activ-ity was the most common rhythm in discrete-patterned EEGs. There were some tendencies of poor lateralization in the presence of structural lesion. Types of seizure were not related with the degree of localization except for simple partial seizure. CONCLUSIONS: Ictal surface EEG was clinically helpful in the localization of epileptogenic foci especially in particular neocortical epileptic syndromes.
Electrodes ; Electroencephalography* ; Epilepsies, Partial ; Epilepsy* ; Epilepsy, Frontal Lobe ; Epilepsy, Temporal Lobe ; Humans ; Parietal Lobe ; Retrospective Studies ; Scalp ; Seizures

BACKGROUNDS: The Wada test is a useful method in predicting the laterality of a epileptogenic zone. However, past research reveals that material specificity has an influence on the lateralization We examined the material-specificity of memory and its change in epileptic patients to discover reasonable items on the Wada test for the proper lateralization of the epileptogenic zone. METHODS: We analyzed 45 patients with video-EEG-confirmed medial temporal lobe epilepsy (mTLE) and definite hippocampal atrophy by an MRI. Eight items were presented during the Wada test including 3 common objects, 1 geometric object, 1 color, 1 word, 1 phrase, and 1 math expression. We checked recognition memo-ry after recovery of hemiparesis and normalization of EEG. RESULTS: For the right mTLE group, recognition memory following a right hemisphere injection was significantly better than a left hemisphere injection for all categories. For the left mTLE group, a significant difference of scores was found for the left versus right hemisphere injection for common objects. When injected to the left hemisphere, all the items helped lateralization, but when injected to the right hemisphere, a phrase did not help with lateralization. CONCLUSIONS: Items with strong unilateral encodings do not help lateralizing the epileptogenic zone.
Atrophy ; Electroencephalography ; Epilepsy, Temporal Lobe* ; Humans ; Magnetic Resonance Imaging ; Memory* ; Paresis ; Sclerosis* ; Sensitivity and Specificity ; Temporal Lobe*