Clinical Investigation of the Female Urethral Cancer / 대한비뇨기과학회지

Primary cancer of the female urethra is a relatively rare disease. During the past 10 years, we could collect 11 cases of the female urethral cancer which were confirmed by pathological examinations. The results of clinical investigation were as followed: 1. The age distribution was from 28 years old to 72 years old and the average was 57 years old. The most common age group was 50 to 69 years (73%). 2. The intervals from onset of symptoms to admission were distributed as follows: the most common group was within 1 year (64%), the second common group was within 3 year (27%) and the third was within 3 months (9%). 3. The common symptoms were as follows: urinary frequency in 9 cases (82%), dysuria in 7 cases (64%), urethral mass in 6 cases (55%), urinary retention in 5 cases (46%), urethral bleeding in 4 cases (36%), hematuria in 2 cases (18%) and urethral pain in 2 cases (18%). 4. Histopathological findings showed squamous cell carcinoma in 5 cases (45%), adenocarcinoma in 4 cases (36%) and transitional cell carcinoma in 2 cases (18%) in order of their frequency. All of the 5 cases of squamous cell carcinoma were vulvourethral types. Among the 4 cases of adenocarcinoma, 3 cases were urethral types and 1 case was vulvourethral type. The 2 cases of transitional cell carcinomas were urethral type and vulvourethral type. 5. Clinical stages were distributed as follows: 2 cases were stage A, 3 cases. stage B, 2 cases, stage C and 4 cases, stage D. In the 7 cases of vulvourethral type, 5 cases were stage A or stage B and 2 cases were stage C or stage D, but the 4 cases of urethral type were stage C or stage D. 6. Treatment of female urethral cancers consisted of surgery and irradiation in general. 1) Local excision was performed on the 2 cases of stage A, but tumor recurrence occurred in 1 case after 1 month postoperatively. 2) In stage B, local excision and interstitial irradiation were made on 1 case, external and interstitial irradiation on 1 case and external irradiation only on 1 case. In the 1st case, tumor recurred after 1 month postoperatively and urinary retention developed after 6 months postoperatively. so suprapubic cystostomy was performed. In the second case, we couldn`t follow up, and in the last case the treatment showed no beneficial effect. 3) In stage C, anterior pelvic exenteration and Bricker`s operation were made on 1 cases. And only suprapubic cystostomy was performed on 1 case but the patient died after 14 months postoperatively. 4) It stage D, suprapubic cystostomy was performed on 3 cases. Among which 1 case died after 6 months postoperatively and 2 cases couldn`t be followed up. The other 1 case was operated with cystourethrectomy and Bricker`s operation but the metastasis to retroperitoneal lymph nodes was found in operative field. This case also couldn`t be followed up.

A Clinical Analysis of Spontaneous Intracerebral Hemorrhages at the Basal Ganglia and Thalamus

The author analyzed 169 cases of spontaneous intracerebral hemorrhages at the basal ganglia and thalamus, who had been admitted to Jeonju Presbyterian Medical Center from 1975 to 1979. Intracerebral hematoma was confirmed by angiography and the amount of hematoma was divided as small, medium or large according to the angiographic evidence. Among the 169 cases, 145 cases underwent appropriate medical or surgical treatment. 63 cases were treated conservatively and 82 cases were operated ; 22 cases of frontal approach, 51 cases of temporal approach, and 9 cases of extraventricula diainage of clot. Results obtained are as follows : 1. The common pridiection age group was from the fifth to the seventh decades, which was 90.5% of all cases. The ratio of male to female was about 2 to 1. 2. putaminal hemorrhage was 65.1%, and thalamic hemorrhage was 16.6%. 3. Angiographic evidence of arteriosclerosis was seen in 86.4%. 4. The worse prognostic factors were related to age(over 65), site and size of hematoma, and mental state on admission. 5. With conservative management 49.2% were improved, 6.3% not improved, 44.4% moribund or dead. 6. With surgical treatment 58.5% were improved, 3.7% not improved, 37.8% moribund or dead. 7. Microsurgical temporal approach proved to have the following advantages over frontal approach. (1) Better outcome was found in this approach(64.7% vs 54.4%). (2) The distance to the hematoma was closer in temporal approach, and so total removal of hematoma and complete control of bleeding sources with less surrounding structural damages were possible. 8. Early operation seems to be more effective than delayed operation in the cases of large hematoma with deteriorating neurological signs.

A Study of Urodynamics on Neurogenic Bladder / 대한비뇨기과학회지

A study of urodynamics including simultaneous cystometry/rectal pressure/electromyography and simultaneous urethral profilometry/ electromyography on neurogenic bladder was performed in the Department of Urology, Seoul National University Hospital during the period March, 1980 through July, 1980 and the following results were obtained; 1. Of 13 cases, 2 cases were hyperreflexis and 11cases were areflexia on cystometry. On cystometry and urethral electromyography, detrusor sphincter dyssynergia was observed in 1 case of hyperreflexia and 2 cases of areflexia. In 1 case of detrusor sphincter dyssynergia having areflexia voiding cystourethrography was performed under the fluoroscopy in standing position and the site of dyssynergia could be detected. On cystometry and rectal pressure monitoring, the true detrusor pressure could be obtained through electronic subtraction (total bladder pressure minus rectal pressure.) . 2. Of 13 cases, maximum urethral closure pressure was below the normal value in 6 cases of areflexia but functional urethral length was normal in all cases on urethroprofilometry. On urethroprofilometry and urethral electromyography, it was found that the difference of the distribution existed in the urethral sphincter between the both sexes.