We describe 6 case of ectopic ureteral orifice was on vaginal wall and the most frequent symptom of ectopic ureteral orifice was incontinence. Vagino-gram and indigo carmine test was very important in diagnosis of ectopic ureteral orifice and identification of ectopic ureteral orifice and then nephrectomy, partial nephrectomy with ureterectomy was rational in treating ectopic ureteral orifice combining loss renal function.
Diagnosis ; Indigo Carmine ; Nephrectomy ; Ureter*

Local spinal cord cooling and glucocorticoid administration have been shown to diminish the degree of traumatic hemorrhagic necrosis and improve spinal cord function after impact injury. Local cooling is said to influence multiple neural enzymatic processes diminish the cellular metabolic rate and lessen the oxygen requirements. Steroid is known to maintain vascular integrity after injury and protect cellular membrane in the state of poor perfusion. As a preliminary report, this experimental study demonstrated the sequence of pathologic changes occurring from hours to days after the spinal cord of a cat had been impacted by a 400gm-cm force respectively and, thereafter evaluated the effect of local cooling and steroid administration on the functional recovery of the spinal cord. Spinal injuries was produced by dropping a 20gm weight 20cm height through a vented guide tube to strike the exposed dura and cord. Animals were sacrificed hours or days after injury. The thoracic cord was removed to include the injured tissue adjacent cord for control. The specimens were taken for histological study and this was correlated with the clinical observation by Tarlov's classification. In the acute group (From 1 hour to 8 hours after injury), multiple hemorrhage and necrosis occurred in the central gray matter and periaxonal swelling in the white adjacent to gray matter. At 15 days all most gray matter was replaced by a large central cavity in which numerous lipid phagocytes were accumulated and disruption of white matter was severe in the adjacent to the cavity. The motor neurons were shown complete central chromatolysis in the all groups.
Animals ; Cats* ; Classification ; Hemorrhage ; Membranes ; Motor Neurons ; Necrosis ; Oxygen ; Perfusion ; Phagocytes ; Spinal Cord Injuries* ; Spinal Cord* ; Spinal Injuries ; Strikes, Employee

The purpose of this report is to present the results of clinical observation upon 21 surgical cases with tic douloureux (female 13, male 8) during the period from January, 1960 to August, 1972 at the Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea. The average age at onset was 48 years of age ranging from 22 to 66 years. The average duration from onset to operation was 5 years. The frequency of involvement was the highest in the maxillary division, next was maxillary and mandibular division, and none in the ophthalmic division. Whole division was involved in one case. Right-sided involvement predominated by a ratio of 2 to 1 and bilateral involvement was found in only one case. Extraction of innocent teeth, ungratifying operation upon paranasal sinus had been carried out in 11 cases as consequence of misdiagnosis. Alcohol injection of peripheral branches of trigeminal nerve and medical treatment produced short-lived or none-effectiveness. Trauma to ipsilateral mandible and epidermoid cyst at cerebellopontine angle seemed to be the cause of tic doulourex in 2 cases, respectively. Major complications observed in Frazier's method group, were paresthesia, facial nerve palsy, partial paralysis of motor root, and recurrence of neuralgia. All of the peripheral nerve avulsion group developed recurrence of pin within three years. Mild decrease of cornea reflex was noted in two cases of Dandy's method group. Posterior fossa operation stands in superiority, when it is considered that some pathologic lesions are frequently found in the posterior fossa, that motor root is less frequently injured, and that the light touch is so fairly preserved in all three divisions that the least damage to the cornea is expected.
Cerebellopontine Angle ; Cornea ; Diagnostic Errors ; Epidermal Cyst ; Facial Nerve ; Humans ; Korea ; Male ; Mandible ; Neuralgia ; Neurosurgery ; Paralysis ; Paresthesia ; Peripheral Nerves ; Recurrence ; Reflex ; Seoul ; Tics ; Tooth ; Trigeminal Nerve ; Trigeminal Neuralgia

In modern society, characterized by variability of daily life, complicated industrial structure and surprisingly increased traffics, the danger of unexpected accident if always threatening the people. In America, for instance, almost 0.5% of the whole population annually suffers from head injury. About two thirds of traffic accident patients have head injury of various forms. Among the head injury patients due to traffic accidents, the commonest cause of death is head injury itself in about 70%. In this study, 585 cases of adult head injury patients over 15 years of age, observed at the Department of Neurosurgery, Seoul National University Hospital during the period from January, 1966 till September, 1971 were reviewed. 1) There were 447 men and 138 women; male female ratio was 3:1.2) The commonest cause of head injury was traffic accident (57.3% of the total patients). A second common cause was "falls"(25.5%). 3) In skull fracture patients, vault fractures were twice as frequent as basal skull fracture. The incidence of simple fractures was remarkably higher than that of compound fractures, the ratio being 7:4. The incidence of linear fractures was slightly higher than that of depressed fractures, the ratio being 6:5. Most of linear fractures were simple fractures, but about 79% of depressed fractures were compound fractures. 4) Among the intracranial hemorrhagic lesion, subdural hematoma occupied about half of the total cases, most of whom were acute cases. The predilection site of subdural hematoma was the cerebral convexity (frontal, parietal and temporal areas). The epidural hematoma , of which the predilection site was temporal area, occupied about 30 % of the total intracranial hemorrhage lesions. Temporal lobe was the predilection site of intracerebral hematoma. 5) About half of the patients with intracranial hemorrhagic lesions were accompanied by skull fractures. About 28% of the cases with skull fractures were accompanied by intracranial hemorrhagic lesions. 6) Altered consciousness was observed in about 90% of the total patients. Lucid interval was observed in 26% of the cases with intracranial hemorrhagic lesion. Vomiting occurred in a quarter of the total patients and early convulsive attacks were noticed in 5%. 7) Overall mortality rate of all the head injury patients was 12.3% and their operative mortality rate was 20.1%. The mortality rate in the patients with skull fractures was five times as high as in the patients without skull fractures. The mortality rate in the patients with intracranial hemorrhagic lesions was nearly three times as high as in those without. The mortality rate in the patients with linear skull fractures was about three times as high as in those with depressed skull fractures. 8) Sequelae were noticed in about half of the total patients. The most frequent one was postconcussion syndrome, the incidence being 36% of the total patients. 9) Associated injuries were found in about 10% of the total patients. The frequent ones were clavicle fracture, tibia/fibula fracture and mandible fracture, in order.
Accidents, Traffic ; Adult* ; Americas ; Cause of Death ; Clavicle ; Consciousness ; Craniocerebral Trauma* ; Female ; Fractures, Open ; Hematoma ; Hematoma, Subdural ; Humans ; Incidence ; Intracranial Hemorrhages ; Male ; Mandible ; Mortality ; Neurosurgery ; Rabeprazole ; Seoul ; Skull Fracture, Depressed ; Skull Fractures ; Temporal Lobe ; Vomiting

The medulloblastoma, a neoplastic emtity which was first identified and described in 1925 by Bailey and Cushing, is a highly malignant, rapidly growing tumor mainly confined to the first decade of life. The medulloblastoma rarely calcifies. Many investigator have reported that medulloblastoma may exhibit calcification only on microscopic examination. Roentgenographic evidence of calcification was found in one case of 54 patients with medulloblastomas by McRae, and in only one case of 96 patients with medulloblastomas by Kalan. A twelve-year-old Korean male was admitted to Seoul National University Hospital on May 1, 1972 with the complaints of severe occipital headache, vomiting, and unsteady gait of five months duration. Neurological examination revealed bilateral papilledema of 3 diopters, signs of cerebellar dysfunction on the left side including truncal ataxia, adiadochokinesia, positive Romberg test and markedlv distured tandem gait. Horizontal nystagmus with quick component directed to the left side was also found. Plain skull films showed suture separation and an abnormal calcific shadow measuring about 2 by 2.5cm in the posterior fossa. Reflux brachial angiogram showed marked bowing of anterior cerebral artery, and elevation of middle and posterior cerebral arteries suggesting a large mass in the posterior fossa causing obstruction of CFS pathways resulting in marked dilatation of ventricular system. Exploring the posterior fossa, a soft grayish tumor mass was removed partially. Microscopic diagnosis was medulloblastoma of desmoplastic type with calcification. Postoperatively CSF leakage through the incision site was encountered, but was controlled to be healed up by compression bandage. The patient showed no significant change of neurological status by the time of discharge. The patient was scheduled to undergo Co60 radiation therapy after discharge.
Anterior Cerebral Artery ; Ataxia ; Cerebellar Diseases ; Compression Bandages ; Diagnosis ; Dilatation ; Gait ; Gait Disorders, Neurologic ; Headache ; Humans ; Male ; Medulloblastoma* ; Neurologic Examination ; Nystagmus, Pathologic ; Papilledema ; Posterior Cerebral Artery ; Research Personnel ; Seoul ; Skull ; Sutures ; Vomiting

A 44-year-old Korea woman was admitted to our department on March 5, 1973 with complaints of low back pain and radiating leg pain on the right side which have persisted for past 4 years. Howeve , the patient had a history of radiating leg pain on the left side about 8 years ago. Physical examination revealed paravertebral muscle spasm on both sides, limited backward bending, normal straight leg raising test, decreased ankle jerk on both sides and mild sensory change in the right L5 dermatome. Plain radiograms of the lumbar spine showed decreased normal lumbar lordosis and narrowing of L4-5 and L5-S1 interspaces. Myelogram demonstrated partial obstruction by marked bilateral indentation filling defect at L4-5 level, narrowing of dye column below that level, and abnormal root sleeves. Under the impression of herniated L4-5 intervertebral disc, total laminectomies of the 4th and 5th lumbar vertebrae were performed and found relatively hypertrophic limagentum flavum and bilaterally conjoined roots commonly originating from dural sac. Following decompression that would was closed routinely. Postoperatively all symptoms were improved.
Adult ; Animals ; Ankle ; Decompression ; Female ; Humans ; Intervertebral Disc ; Korea ; Laminectomy ; Leg ; Lordosis ; Low Back Pain ; Lumbar Vertebrae ; Physical Examination ; Spasm ; Spine

A 34-year-old male patient was first admitted to our Department on October 16, 1965. He complained of frontal headaches especially in the morning and ild right hemiparesis over the previous 6 months, which were progressively more severe as time went by. On examination, he was mentally clear ut slightly dysphasic: there were mild right hemisparesis and marked bilateral papilledema. Angiogram showed a left posterior frontal vascular tumor. At operation on November 3, 1965, total excision of a posterior frontal parasagittal tumor was performed. To the naked eye, this seemed to be a meningioma; the tumor was egg-sized, round but somewhat lobulated, graysish white in color, firm and fibrotic appearance, and it attached to the superior longitudinal sinus, involving without occluding it. Histologically. It was considered a meningioma of firbrolastic type, containing small amount of capillaries and some areas of collegen deposition around the fibroblasitc cell masses with foci of meningoendothelial cluster; though some doubt was expressed over its innocence. He tolerated the resection of frontal tumor well, and remained in relatively good health for 7 years, as to do his usual farmer work with minimal right hemiparesis. There were some episodes of generalized seizure during there periods. The patients was readmitted on December 25, 1972, however, because of frontal headaches and vomiting over recent 6 months and dysphasia, mental confusion developing rapidly over the previous 3 months. Urinary incontinence was also complained of. On examination he was drowsy, apathetic and mentally confused, more so than when first admitted. There was a goose-egg sized tense bulging in the left frontotemporal region, previously operated. Central-typed right facial palsy, right hypoglossal palsy and bilateral marked papilledema were noted. There were spastic hemiparesis, greater in the upper extremity, and long tract signs on the right side. Angiogram revealed a posterior frontal parasagittal vascular tumor, much as before. At operation on January 5, 1973, subtotal resection of tumor was performed, remaining the deep-seated parasagittal posterior frontal mass. The gross appearance of tumor was necrotic partially on the surfaces, potato-shaped with nodularith and pinkish white in color. On sectioning cut surface was slightly myxoid with cystic degeneration in the center. There was also patchy degeneration, showing yellow tinge in the cut surface. Microscopically, there were prominent hypercellularity with many mitoses, atypism, pleomorphism and degenerative process. Vascutar reaction with amyloid-like infiltration in perivascular area was also demonstrated as with focal pseudocartilagenous degeneration and partial hemorrhage; overall findings were highly suggestive of recurrent memingioma with malignant change (sarcomatous change) in left posterior frontal parasagittal region.
Adult ; Aphasia ; Capillaries ; Facial Paralysis ; Headache ; Hemorrhage ; Humans ; Male ; Meningioma* ; Mitosis ; Muscle Spasticity ; Papilledema ; Paralysis ; Paresis ; Seizures ; Superior Sagittal Sinus ; Tolnaftate ; Transcutaneous Electric Nerve Stimulation ; Upper Extremity ; Urinary Incontinence ; Vomiting

The purpose of this report is to present the results of clinical observations on the surgical treatment of 26 patients (16 male, 10 female) with intractable pain during the period from May, 1960 to April, 1972 at the Department of Neurosurgery, Seoul National University Hospital. Age at the time of operation raged from 27 to 69 years. Duration of the pain from the onset to surgery was less than one year in most of the cases. The most common causes of the pain were the pelvic malignancies, lung cancer, and metastatic spine tumors in the order. In 20 cases of anterolateral cordotomies, the main complications were urinary retention, ipsilateral motor weakness, and decubitus. The high cervical cordotomy produced high analgesic level and less dropping of established analgesic level postoperatively. Posterior rhizotomy for intercostal neuralgia and a case of thoracic commissurotomy for intramedullary tumor were of gratifying result. The higher the pain located, the longer the pain existed, the operation was less likely to relieve the pain. High cervical cordotomy seems to be superior to high thoracic cordotomy even in the pain of leg, when it is considered in the respect of the high analgesic level, the lack of "island" of pain, and technical easiness.
Cordotomy ; Humans ; Leg ; Lung Neoplasms ; Male ; Neuralgia ; Neurosurgery ; Pain, Intractable* ; Rage ; Rhizotomy ; Seoul ; Spine ; Urinary Retention

We have experienced nine patients with acute optic never injury after blunt head trauma. In each patient the optic cannal was decompressed via an ipsilateral external ethmoidectomy or transcranial approach. Two Patients recieved treatment with steroid during the perioperative period. There patient improved mild visual acuity. There was no morbidity or mortality but the results were controversial.
Craniocerebral Trauma ; Decompression* ; Humans ; Mortality ; Optic Nerve Injuries* ; Perioperative Period ; Visual Acuity

A 46 years old woman was admitted to the department of Neurosurgery, Seoul National University, complaining of a sudden severe headaches and vomiting 7 days before admission. Three days later her vision became poor in the left eye and totally blind on the day of admission. She had amenorrhea for 15 years. On neurological examination, she was somewhat lethargic but fully conscious. Both optic discs were normal. Left pupil was dilated, fixed and totally ophthalmoplegic. Because of poor cooperation the visual field examination was not performed. Tongue protrusion was deviated to the right side. Cerebrospinal fluid was bloody. Skull X-rays showed a large pituitary fossa with erosion of the left anterior clinoid process and dorsum sellae. Left carotid anyiogram showed a finding of suprasellar extension of the intrasella mass. Retrograde brachial angiogram showed remarkable posterior displacement of the distal portion of the basilar artery. Left subfrontal approach was done and found a huge suprasellar mass compressing the left optic nerve. The tumor was aspirated and blood clot was obtained. The capsule was incised and content with hematoma was evacuated. Histologic examination showed complete blood clot with no recognizable neoplasm. Post-operatively, her left eyeball began to move and she was able to see some objects in close distance few hours after surgery.
Amenorrhea ; Basilar Artery ; Cerebrospinal Fluid ; Female ; Headache ; Hematoma ; Humans ; Middle Aged ; Neurologic Examination ; Neurosurgery ; Optic Nerve ; Pituitary Apoplexy* ; Pupil ; Seoul ; Skull ; Tongue ; Visual Fields ; Vomiting