Evaluation of inadevertent dural puncture occuring among 308 epidural blocks done for the relief of pain from various conditions was performed. Dural puncture was suspected in 5 out of 308 eqidural bloks(1.6%). Aspiration of CSF was negative 3 cases in which dural puncture was suspected only after developing spinal anesthesia. Of the 3 negative CSF aspirations, one case had a history of laminectomy. Adhesions of the adjacent tissues might result in the loss of flexibility and a decreases in potential epidural space which might cause dural tearing during injection and subarachoid injection of the local anesthetic followed by high spinal anesthesia. In another case, the needle tip was obstructed by tissue which led to negative aspiration of CSF and failure to feel loss of resistance. The second injection at the same site many cause subarachonold injection of the local anesthetic through the previously perforated dura mater and in turn, lead to spinal anesthesia. In the last case, there was no reason to suspect dural puncture since the loss of resistance plus air rebound were definite and aspiration of CSF was negative, but dural puncture was suspected after the patient developed spinal anesthesia.
Anesthesia, Spinal ; Aspirations (Psychology) ; Dura Mater ; Epidural Space ; Humans ; Laminectomy ; Needles ; Pliability ; Punctures*

The commissural myelotomy in the treatment of bilateral intractable pain was first reported by Armour in 1927. Used sparingly since its introduction it has recently met with renewed interest due to use of the operating microneurosurgical operating technique. We performed the commissural myelotomy in 40 years old male patient who complained of bilateral intractable pain in the lower extremities due to metastatic tumor. After total laminectomy from T10 to L1, employing with magnifying glasses we performed commissural myelotomy about 70 mm in length(T10-S2 segment) and 5 mm in depth on June 26, 1978. After operation, we had good result.
Adult ; Eyeglasses ; Glass ; Humans ; Laminectomy ; Lower Extremity ; Male ; Pain, Intractable

Choriocarcinoma a rare malignant neoplasm of trophoblastic tissue, is characterized by early blood borne metastasis to distant organs such as lung, liver and brain. Involvement of central nervous system by metastatic choriocinoma may be manifested as acute or subacute apoplexy due to vascular invasion with tumor emboli. Therefore the diagnosis of cerebral choriocarcinoma should be suspected in women of child bearing age presenting the signs of acute or subacute intracranial pathology. We present and discuss 2 cases of intracerebral metastatic choriocarcinoma simulating cerebrovascular accident. One case, a 35 years old Korean housewife, was admitted to the department of neurosurgery, Kyung Hee University Hospital, with the chief complaints of headache, vomiting, focal seizure and right sided hemiplegia for 2 weeks duration. She had a history of irregular vaginal bleeding from 3 months before admission. On admission, there were flaccid paralysis of the right extremities with right sided facial palsy, central type and neck stiffness in moderate degree. Gynecologically, round tumor mass about 1.5cm in size at vagina was palpable and urine HCG was positive. Chest X-ray film showed scattered multiple nodular densities at both lung fields. Carotid angiogram showed vascular tumor in the fronto-parietal region. Brain scan revealed increased uptake in the parietal area. She died suddenly 3 days later at home. Another case, 39 years old housewife, was admitted to the hospital with unconscious state. Although she had and operation of hysterectomy 5 months before admission due to massive vaginal bleeding, she was quite well till several hours prior to admission when she complained of headache and vomiting followed by sudden loss of consciousness. Neurologic examination revealed deep comatose state with full dilated and fixed pupil. Chest film showed several nodular densities at both lung fields. Carotid angiogram revealed avascular space occupying lesion at right posterior partietal region. On operation, Dura was tense and scanty subdural hematoma and massive brain swelling were identified and intracerebral hematoma estimated 80cc was evacuated. Atypical trophoblast was found microscopically from biopsy material. She died on the 2nd postoperative day.
Adult ; Biopsy ; Brain ; Brain Edema ; Central Nervous System ; Child ; Choriocarcinoma* ; Coma ; Diagnosis ; Extremities ; Facial Paralysis ; Female ; Headache ; Hematoma ; Hematoma, Subdural ; Hemiplegia ; Humans ; Hysterectomy ; Liver ; Lung ; Neck ; Neoplasm Metastasis ; Neurologic Examination ; Neurosurgery ; Paralysis ; Pathology ; Pregnancy ; Pupil Disorders ; Rabeprazole ; Seizures ; Stroke* ; Thorax ; Transcutaneous Electric Nerve Stimulation ; Trophoblasts ; Unconsciousness ; Uterine Hemorrhage ; Vagina ; Vomiting ; X-Ray Film

Arachnoid cysts are usually classified as developmental anomaly, inflammatory and traumatic in origin. Arachnoid cyst in posterior fossa occur frequently in the midline posterior to the cerebellum. These cyst usually present symptoms and signs due to increased intracranial pressure and may be confused with cerebellar or fourth ventricular tumor. Recently we had experienced a case of multiple retrocerebellar arachnoid cysts coexisted with pathologically confirmed desmoplastic medulloblastoma in eight months lod infant and reviewed the literatures.
Arachnoid Cysts* ; Arachnoid* ; Cerebellum ; Humans ; Infant ; Intracranial Pressure ; Medulloblastoma*

Granular cell myoblastoma is a relatively uncommon lesion of debatable history appearing as a small, solitary but occasionally multiple neoplasm and usually benign course. Most granular cell myoblastoma have been observed tongue, skin and subcutaneous tissue and in the breast but only rarely in the orbit and we know of only 12 well-documented orbital myoblastoma at present. We have recently seen a orbital granuloma cell myoblastoma occurring in a 39 year-old woman, the tumor was firmly attached to the muscle cone and caused exophthalmos with exodeviation of the left eye and was totally removed from the transcranial-orbital unroofing procedure.
Adult ; Breast ; Exophthalmos ; Exotropia ; Female ; Granular Cell Tumor* ; Granuloma ; Humans ; Neoplasms, Muscle Tissue ; Orbit* ; Skin ; Subcutaneous Tissue ; Tongue

Only a few years following its original development by the English Physicist G.N. Hounsfield at 1971, cranial computed tomography has proved to be of revolutionary importance for the diagnosis of brain disorders. This is reflected not least by the almost immediate and worldwide acceptance of the diagnostic method. First in Korea, The EMI Scanner(CT 5005/7, 160(160 matrix) was introduced at Kyung Hee University Hospital on October 1977. Since then, we reviewed 444 CT scans for 1 year. 216 representative examples of abnormal CT findings among these have been chosen from this group of cases for more detailed discussion and illustration. The results were as follows; 1) 216 abnormal CT findings were subdivided into brain neoplasm 50, orbital tumor 6, AVM 1, intracerebral hemorrhage 44, occlusive CVD 30, craniocerebral trauma 46, cerebral abscess 3, meningoencephalitis 8, hydrocephalus 13, atrophy 16, parasite 4. 2) In most brain tumor cases the tissue undergoes a change of density. Vascularized tumors were enhanced after contrast infusion. Solid tumor area are well differentiated against cystic area and necrosis, and hemorrhage in tumor is also well visualized. Tumor type is often surmised, exact classification is not possible. Thus a glioblastoma multiforme of the ring type cannot be differentiated from a metastatic tumor with central necrosis. But tumor density, appearance of contrast enhancement, predilection site of tumor, relation to adjacent structure, a degree of perifocal edema and clinical data are aid to identify the tumor type. 3) Spontaneous intracerebral hemorrhage can be identified with certainty because of high absorption values. Extent of hemorrhage and invasion of the ventricle are usually exactly visualized. Blood filling of basal cisterns and interhemispheric fissure is also well demonstrated. As opposed to spontaneous intracerebral hemorrhage, cerebral infarction shows as a region of low absorption values as early as 6 to 8 hours after ictus, which is often poorly defined with irregular borders and having mass effect during the 1st week thereafter. Sharper margins and more homogenous low density are developed 1 to 2 weeks after ictus and surrounding edema subsides with shrinking of hypodense area. Ipsilateral ventricular dilatation, homogenous low density area and sharp margins are usually found in older infarcts. 4) CT is the best method of assessing craniocerebral injuries. Since extravascular blood is set off by its high density and edematous tissue by its lower density from normal brain tissue, sequelae from injuries whose existence could only be suspected on account of the clinical symptoms but escaped detection regardless of the method used, can now be visualized directly in the CT. 5) Brain abscess has a characteristics but non specific appearance as CT, consisting of a ring configuration of the abscess capsule which shows marked enhancement after injection of contrast material. In acute stage of the meningoencephalitis, routine CT scan may be normal. During the couse of illness, diffuse enhancement of the basal cisterns and varying degree of ventricular dilatation may be found. 6) Brain atrophy is diagnosed by an enlargement of internal and external CSF spaces. Using standard sections a classification of the grade and form of the atrophy is made. The diagnosis of cysticercosis is made primarily calcification and multiple solid dense mass or cystic lesion surrounded by edema which may become enhanced following infusion of contrast media.
Abscess ; Absorption ; Atrophy ; Brain ; Brain Abscess ; Brain Diseases ; Brain Neoplasms ; Cerebral Hemorrhage ; Cerebral Infarction ; Classification ; Contrast Media ; Craniocerebral Trauma ; Cysticercosis ; Diagnosis ; Dilatation ; Edema ; Glioblastoma ; Hemorrhage ; Hydrocephalus ; Korea ; Meningoencephalitis ; Necrosis ; Orbit ; Parasites ; Tomography, X-Ray Computed ; United Nations

The accuracy of percutaneous needle aspiration and biopsies is related to localization of pathology and of the needle tip. Localization methods of percutaneous needle aspiration currently in use are fluoroscopy, ultrasound and angiography. The authors believe that localization by computed tomography is the most accurate method for performing biopsies. The authors have performed the biopsy of the paravertebral lesion under the CT-scan using EMI-5005 on Aug. 23, 1978, at the Department of Neurosurgery, Kyung Hee University Hospital.
Angiography ; Biopsy* ; Fluoroscopy ; Needles ; Neurosurgery ; Pathology ; Ultrasonography

Computed tomography(CT) is a new and innovative radiologic technique, the diagnostic value of which has been well established by many reports. On account of its rapidity and non-invasiveness, CT has become the diagnostic precedure of choice for the initial evaluation of head trauma patients. The authors have performed CT scan using EMI-5005 on 5 cases of subdural hematoma during the period of 8 months from October 1977 to May 1978 at the Department of Neurosurgery, Kyung Hee University Hospital. Various attenuation coefficients of hematoma such as hyperdense, hypodense, isodense and of mixed density were observed by the CT images. One case of isodensity hematoma were clearly identifiable by delayed enhancement technique, which had been confused by ordinary, noninfused method.
Brain* ; Craniocerebral Trauma ; Hematoma ; Hematoma, Subdural* ; Humans ; Neurosurgery ; Tomography, X-Ray Computed

Between 1987 and 1992, 86 tibial fractures were treated with the Ilizarov external fixator at Gyeong-Sang National University Hospital and Okpo Hospital. The mean follow-up period was 31.4 months. Sixty-six were open fractures and twenty were closed fractures with severe comminution. In 66 open fractures, there were 9 Gustilo type I, 10 type II, and 47 type III fractures. Of 66 open fractures, 22 had bone defects ranged from 2cm to 17cm and 16 had extensive loss of soft tissue. Twenty-two bone defects were treated with cancellous bone grafts in 8 cases, bifocal osteosynthesis with bone graft in 12 cases, and trifocal osteosynthesis with bone graft in 2 cases. Thirty-four extensive soft tissue defects were treated with split-thickness skin graft, musculocutaneous flap, soft tissue transportation with ring used in bifocal, trifocal osteosynthesis, and acute shortening of fracture site. Of 20 closed fractures, 14 were treated with cancellous bone graft for decreasing union time and 6 were treated with monofocal compression without bone graft. The mean time to union was 20.5 weeks in closed fractures, and 35.4 weeks in open fractures. Of 40 complications, 12 were knee and ankle joint contractures, 12 were soft tissue and bone infections of pin tract, 5 were refracture, 5 were angular deformities of 10 degree or more, 5 were delayed union, and 2 were nonunion. According to Tucker's classification, the results were graded as excellent in 31, good in 38, fair in 12, and poor in 5 cases. Primary or secondary bone graft is necessary for early bony union and anatomical reduction combined with bone graft could prevent the complications of delayed union and nonunion.
Ankle Joint ; Classification ; Congenital Abnormalities ; Contracture ; External Fixators ; Follow-Up Studies ; Fractures, Closed ; Fractures, Open ; Ilizarov Technique ; Knee ; Myocutaneous Flap ; Skin ; Tibia ; Tibial Fractures ; Transplants ; Transportation

PURPOSE: We aimed to evaluate clinical outcomes including progression-free survival (PFS), overall survival (OS), partial response, and complete response in patients who underwent radiation therapy (RT) for mycosis fungoides (MF). Also, we sought to find prognostic factors for clinical outcomes. MATERIALS AND METHODS: Total 19 patients confirmed with MF between 1999–2015 were retrospectively reviewed. Clinical and treatment characteristics, clinical outcomes, and and toxicities were analyzed. RESULTS: Eleven patients were treated with total skin electron beam radiotherapy (TSEBT) and 8 patients with involved field radiation therapy (IFRT) with median dose of 30 Gy, respectively. The median time interval from diagnosis to RT was 2.6 months (range, 0.4 to 87.3 months). The overall response rate was 100%; 11 patients (57.9%) had a complete response and 8 patients (42.1%) a partial response. The presence of positive lymph node at the time of consultation of RT was associated with lower OS (p = 0.043). In multivariate analysis, PFS was significantly lower for patients with increased previous therapies experienced following RT (p = 0.019) and for patients showing PR during RT (p = 0.044). There were no reported grade 3 or more skin toxicities related with RT. CONCLUSION: Both IFRT and TSEBT are effective treatment for MF patients. Patients with short disease course before RT or complete response during RT are expected to have longer PFS. Positive lymph node status at the initiation of RT was associated woth poor OS, suggesting other treatment modalities such as low-dose RT for patients with low life-expectancy.
Diagnosis ; Disease-Free Survival ; Humans ; Lymph Nodes ; Lymphoma, T-Cell, Cutaneous ; Multivariate Analysis ; Mycosis Fungoides ; Radiotherapy ; Retrospective Studies ; Skin