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

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*

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

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

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

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 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 Clinical analysis was carried out with 340 cases of craniocerebral injuries under 15 years of age, admitted at the Department of Neurosurgery, Seoul National University Hospital in 12 years between Jan., 1987 and Dec., 1969. The matrial was classified four groups according to main lesions, i.e. (1) mild cerebral contusion without skull fractures. (2) moderate or severe cerebral contusion without skull fractures. (3) various types of skull fractures. (4) intracranial hemorrhagic lesions, representing such lesions as follows: a. epidural hematoma, b. subdural hematoma, c. subdural hygroma, d. intracerebral hematoma, e. traumatic subarachnoid hemorrhage. The results were as follows: 1) The age incidence was greatest in 6 years of age, and 120 cases (32.6% of the total) were included in the age group between four and six. 2) Males outnumbered females by almost 2 to 1. 3) The accident occurred mostly between 1 p.m. and 4 p.m. in a day. 4) The craniocerebral injuries were caused by traffic accident(173 cases; 50.8%), falls from heights(108 cases; 31.8%), hit(55 cases; 10.9%), firearms(2 cases; 0.6%) and birth injury (2 cases; 0.6%). 5) Early convulsion was the frequent symptom in the age group between 2 and 7. It was felt that convulsions frequently occurred in epidural and subdural hematoma patients. 6) Forty eight per cent of patients had no deterioration of consciousness on admission examination. 7) Epidural hematoma was the common finding in most of the depressed skull fracture cases. 8) The location of skull fractures in the order of frequency were parietal, temporal, frontal and occipital bone. 9) The epidural hematoma was most common lesion in the 13 to 15 year-old group. 10) The over-all mortality rate was 7.1%. In the surgical group(79 cases) the operative mortality was 11.4%(9 cases): the mortality rate of the subdural hematoma, 25.0%(3 cases); the epidural hematoma, 11.1%(2 cases); the compound depressed fracture, 7.8%(2 cases). In the non-surgical group(261 cases) it was 5.8%. The mortality rate of those who and been unconscious after injuries was significantly high(75.0%). 11) The period of hospitalization was two weeks on an average.
Adolescent ; Birth Injuries ; Child* ; Consciousness ; Contusions ; Craniocerebral Trauma* ; Female ; Hematoma ; Hematoma, Subdural ; Hospitalization ; Humans ; Incidence ; Infant* ; Male ; Mortality ; Neurosurgery ; Occipital Bone ; Rabeprazole ; Seizures ; Seoul ; Skull Fracture, Depressed ; Skull Fractures ; Subarachnoid Hemorrhage, Traumatic ; Subdural Effusion

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

The purpose of this report is to evaluate the validity of the differential diagnosis of epidural and subdural hematomas on the basis of the varied angiographic findings and also to determine the correlation between hematoma shape and the injury-angiogram time interval in subdural hematomas. Conventional cerebral angiograms in 27 cases of epidural and 53 cases of subdural hematoma among surgically proven 155 intracranial hematoma patients, observed at the Department of (Neurosurgery) Seoul National University Hospital, during the past 5 years from August, 1968 to July 1973, were reviewed. 53 subdural hematomas were subdivided into three groups upon the injury-angiogram time interval as follows: acute; within 48 hours ---------- 28 cases, subacute; 3 days to 2 weeks ---------- 14 cases, chronic; over 2 weeks ---------- 11 cases. The results were as follows: 1. In epidural hematoma, the A-P view of angiogram showed typical lentiform (biconvex) avascular zone in 11 cases and crescent-shaped avascular zone in 3 cases among total 27 cases, whereas in acute to subacute subdural hematoma it showed crescent-shaped avascular zone in 15 cases but only 2 cases showed the lentiform appearance. 2. Lentiform avascular zone was also typically seen in 5 cases of chronic subdural hematoma, but it might be differentiated from that of epidural hematoma with more clear inner margin in the former. 3. In epidural hematoma, the following characteristic findings providing excellent diagnostic aids were also noted. 1) medial or inward displacement of middle meningeal artery ---------- 3 cases, 2) extravasation from middle meningeal artery into arterio-venous sheath-4 cases into hematoma ---------- 2 cases, 3) amputation of middle meningeal artery ---------- 2 cases, 4) extravasation from dural sinus ---------- 4 cases, 5) displacement of dural sinus from the inner table of skull ---------- 4 cases, 6) lentiform avascular zone only ---------- 4 cases. In 20 cases of epidural hematoma, one or more of the above findings could be found. Among them, extravasation from middle meningeal artery and dural sinus, amputation of middle meningeal artery and displacement of dural sinus were thought as pathognomonic. In subdural hematoma, none of the above findings was seen. 4. In subdural hematoma, hematoma shape (avascular zone) showed some tendency to change its from according to the injury-angiogram time interval: in the group ranging from 1 to 7 days and over a month, the crescent-shaped hematoma was predominant and in the group between these periods, lentiform hematoma and hematoma with flat inner margin were somewhat predominant. But there was no valid basis for predicting the age of subdural hematoma from its configuration at angiography. 5. There was no direct correlation between the shape of the hematoma and the patients' age. 6. Simple skull roentgenogram provided some aids in the differential diagnosis between epidural and chronic subdural hematoma. 20 cases out of 27 epidural hematomas showed linear or depressed skull fracture, whereas only 1 out of 11 cases of chronic subdural hematoma showed linear skull fracture.
Amputation ; Angiography ; Diagnosis, Differential ; Hematoma ; Hematoma, Subdural* ; Hematoma, Subdural, Chronic ; Humans ; Meningeal Arteries ; Seoul ; Skull ; Skull Fracture, Depressed ; Skull Fractures