뇌경막외혈종에 대한 임상적 관찰

이봉암 최신의학사 1976 最新醫學 Vol.19 No.12

Of all the potentially lethal complications of head injury, extradural hematoma is the most readily diagnosed and remediable, yet the mortality rate remains distressingly high. The onset of deepening coma, especially a lucid interval, together with an enlarging pupil, contralateral hemiplegia, andd bradycardia all portray the wellknown picture of hemorrhage into the.:g6nial I extradural space. . In such cases, the diagnosis is usually established quickly, -and *her L, appropriate surgical measures are taken the prognosis will be fairly good. Author presents here a series of 52 cases of pure extradural hematoma those were treated by surgically at Department of Neurosurgery, Kyung Hee University -Hospital during the period from. October, 1974 till April, 1976. The results were as follows: 1) There was little significant difference in any decade but some preponderance of youth. Males outnumbered females by almost 4 to 1. 2) The common causes were road traffic accidents(58%), falls from height(27%), and direct blows to head. 3) Altered consciousness revealed about 86.5% of the total patients. Pupillary abnormalities. were seen in 37 patients (71.2%). Babinski's sign and vomiting occured in 24 and 17 each cases. The lucid interval was found in 11 cases. 4) Of 37 cases with pupillary abnormalities, in 11 cases the pupils were anisocoric and fixed. In 8 cases the ipsilateral pupil was much dilated but the presence of light reflexes. In theremaining 13, various degrees of pupillary abnormalities were found. 5) In 51 cases with skull fracture, 50 was demonstrated by x-ray, 1 had no fracture by x-ray but the fracture was demonstrated by operation. 46 cases showed lineal fracture, while theremainder had depresed one. The location of skull fracture in order of frequency were temporal (16 Cases) and parietotemporal (15 cases) bone. 6) The interval between injury and operation was the greatest at 3 to 6 hours. 7) The site of origin of the extradural hemorrhage was observed to be arterial in 24 and 'venous in 11, in 12 it' arose 11 :2, OtW artery' and vein, the remaining 5 : the origin 1vas not determined. 8) The surgical morality ate fly q yes).. All those were operated within 24 hours after injury. There was na-correlatibn `between' the ''age' and mortality but a good: correlation. between the deterioration of consciousness and mortality, of 16 cases in coma, 75% died. In 17 cases which site of origin of hemorrhage was both artery and vein, 6 died (37.5%). The surgical prognosis was very poor when the 'pupillary abnormalities were present; 16 cases manifested evidence of either bilaterally full dilated with fixed : pupils or anisocoric with fixed prior to operation and 56.3% died after operation.

가토 대뇌피질내의 Na-K-ATPase 활성에 관한 연구

이봉암,임광세 중앙대학교 의과대학 의과학연구소 1981 中央醫大誌 Vol.6 No.3

가토 내외피질 homogenate를 이용하여 Na-K-ATPase 활성에 대한 incubation 용액의 조성, 수종물질의 영향, pH 및 온도의 영향등을 관찰하여 다음과 같은 결론을 얻었다. 1) 효소 활성도는 incubation 시간이나 효소 농도에 따라 증가하였으며, incubation 용액의 조건이 1mMATP, 50-100mM Na, 5-10mM K, 2-4mM Mg과 37℃에서 pH7.2일 때 최대 활성도를 보였다. 2) Na-K-ATPase 활성을 위한 최적 pH는 37℃일때는 7.2이었고 15℃일 때는 7.6으로 증가하여 온도 변화에 대한 pH의 변화율(ΔpH/ΔT)은 -0.0181 unit/℃이 었다. 3) 효소 활성을 위한 용액내 최적 pH는 온도에 따라 변하였으나 용액내의 OH^-/H^+qlrk 6.3으로 일정하게 우지될 때 온도의 변화에 관계없이 최대 활성도를 나타내었다. 4) Arrhenius plot 결과 activation energy는 15℃∼25℃에서는 25℃∼37℃에 비하여 증가되었으며 또한 용액내의 OH^-/H^+비가 6.3으로 일정하게 유지될 때에 비하여 일정한 pH로 유지시켰을 때 15℃∼25℃ 범위에서는 activation energy가 더 증가되는 양상을 보였다. 5) 37℃에서 ouabain, PbCl_2, SITS, PCMB, valium 및 chlorpromazine의 50% 억제를 위한 농도는 각각 5.2x10^-7M, 7.5x10^-6M, 4.0x10^-4M, 6.5x10^-6M, 4x10^-4M, 및 1ㅌ10^-4M이 있다. 6) PbCl_2는 온도가 25℃에서 37℃로 변함에 따라 그 억제 정도가 증가하였으며, ouabain, SITS, PCMB, valium 및 chlorpromazine은 억제 작용이 온도에 무관하였다. The Na-K-ATPase activity was determined in homogenate of the rabbit cerebral cortex. The general properties of Na-K-ATPase activity, the effects of the temperature and the inhibitors such as ouabain, PbCl_2, SITS, PCMB, valium and chlorpromazine on Na-K-ATPase activity were investigated. The results were as follows; 1) The initial velocity of the Na-K-ATPase reaction was directly proportional to the incubation time and to the enzyme concentration in the medium. However, the rate of the reaction was dependent on the concentrations of ATP, Mg, Na, K, and H ions in the medium, showing the maximal activity at about 1mM ATP, 2-4mM Mg, 50-100mM Na, 5-10mM K, and PH 7.2 at 37℃. 2) Medium pH for the maximal enzyme activity increased from 7.2 at 37℃ to 7.6 at 15℃, showing ΔpH/ΔT of approximately -0.0181 unit/℃. However, the OH^-/H^+ ratio of the medium for the maximal activity was 6.3 regardless of temperature. 3) The Arrhenius plot indicated that the activation energy was more increased at lower temperature range (15℃-25℃) than higher temperature range (25°-37℃) and increased at a constant pH of 7.2 than at a constant OH^-/H^+ ratio of 6.3 between 15° and 25℃. 4) The enzyme activity was inhibited by ouabain, PbCl_2, SITS, PCMB, valium and chlorpromazine with I_50 (the inhibitor concentration to cause 50% inhibition) of 5.2×10^-7M, 7.5×10^-6M, 4.0×10^-4M, 6.5×10^-6M, 4×10^-4M, and 1×10^4M, respectively, at 37℃. 5) The effect of inhibition by PbCl^2 was temperature-dependent, showing that the effect of inhibition at the same concentration of PbCl_2, was more increased at 37℃ than at 25℃.

높은 위치의 뇌기저동맥 분기부주위의 동맥류에 대한 Frontosupraorbital(FSO) Approach와 Orbitozygomatic Temporopolar(OZTP) Approach의 수술접근술

이봉암,이중석,박종태,임영진,김태성,임 언,김국기 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.2

삼차신경과 상소뇌동맥 접촉부위의 신경해부-외과적 연구

이봉암 慶熙大學校 1998 論文集 Vol.27 No.-

Neurovascular decompression in a widely practiced technique for the treatment of trigeminal neuralgia, and yet there is still debate as to whether the beneficial effect results front relieving the nerve of compression by an anatomically abnormal vessel or from the manipulation and trauma of the nerve during the procedures. The development of this operation has been hampered by the lack of adequate anatomical studies is normal controls. The author present a combined study of anatomical and surgical material employing standardized definitions of the neurovascular relationships in both groups. In order to meet this need, 40 trigeminal nerves and the adjacent superior cerebellar artery (SCA) were examined in 20 adult cadavers. Twenty-two of the 40 nerves examined had a point of contact with SCA, but it was uncommon for the arterial contact to produce distortion of the nerve. One of the 23 contact was with the anterior inferior cerebellar artery (AICA). In the 22 nerves with point of contact with the SCA, the segment of the SCA involved was the main trunk of the SCA in 9, the caudal trunk in 10, the rostral trunk in 2, both the rostral and caudal trunk in one. The diameter of the SCA at its origin ranged from 0.6 to 2.3 mm. The length of vessel between its origin and its point of contact with the nerve varied from 13 to 27.5 mm depending on the tortuosity of the vessel. These datas support the hypothesis that arterial compression of the trigeminal nerves is associated with trigeminal neuralgia.

중증 두뇌손상환자에 대한 양측 전두감압개두술

이봉암 대한신경외과학회 1973 Journal of Korean neurosurgical society Vol.2 No.2

A clinical analysis for bifrontal craniectomy had been carried out with 30 cases at Busan National University Hospital during the period from July of 1972 to June of 1973. The patient's conditions such as bilateral dilated fixed pupils, decerebrated rigidity, apneic respiration, and coma were sometimes regarded to contraindication for the department of neurosurgery to operate. This wide procedure enabled to allow identification of contused and lacerated brain, evacuation of acutely accumulated blood and necrotic brain, and decompression of swollen brain under direct visualization. The author reviews 30 cases operated, and among them, 6 were survived. Before report this technique, we did not operate on the patients who exhibiting apnea and bilaterally dilated fixed pupils. Such clinical signs are commonly preceded to death, and we have recommended conservative therapies such as hyperosmolar agents and steroids to combat brain swelling in this desperately ill patient. Our clinical impression that bifrontal decompressive craniectoiny was useful for severe craniocerebral injury and swelling was unable to prove with unequivocal documentation from these cases that their survival was uniquely attributable to the bifrontal craniectomy. I presents my appraisal of the case material, not so much as proof of it's superiority over other methods, but rather as provocation for further critical appraisal of it's use.

다발성 선천적 기형이 동반된 척수수막류 1례

이봉암,한태희,김취열,이영우,송봉환 대한신경외과학회 1973 Journal of Korean neurosurgical society Vol.2 No.1

We were recently encountered a case of newborn infant with a congenital lumbar mass with associated anomalies which proved to be quite bizarre. This case is prsented with review of the literatures because we were seldom able to find a case of myelomeningocele as usual, interesting as this. A 15 day-old infant, the product of full term, was admitted to Busan National University Hospital on May 26th, 1972, because of a large pedunculated lumbar mass without any neurologic deficits. The tumor mass was translucent, flabby, infected and increased in tension when the infant cried. Chest film showed the underdeveloped with agenesis and fork rib in right upper 5 ribs and narrowed intercostal spaces between right 5,6,7 and 8th ribs. Right scapula was higher in position of axis. Total spine films showed non-fusion pattern of 3rd and 4th thoracic vertebral bodies with cleft vertebrae, scoliosis in upper thoracic region, widening of lumbar canal, a large soft tissue mass overlying the abdominal region and hypoplasia of the spinous process at 4th lumbar vertebra. The sac of myelomeningocele was repaired sucesssfully. He has regularly been followed up in the out-patient after discharge and has remained well- Repeated neurologic examination performed after discharge showed no neurologic deficits. We feel our present case wlil be of added interest.

경동맥 해면정맥동루의 2례

이봉암,송봉환 대한신경외과학회 1972 Journal of Korean neurosurgical society Vol.1 No.1

Two cases of carotico-cavernous fistula, which were experienced at Dept. of Neurosurgery of Busan National University Hospital are presented with a brief review of the literature. Because it is the very interesting disease, These were of spontaneous onset. One was 39 year-old woman who was treated with the ligations of internal and common carotid artery in the neck, another was 17 year-old boy treated with the ligations of internal and common carotid artery followed by intraluminal muscular embolization. These surgical managements were successful and there was neither recurrence nor other neurologic deficit.

실험적 두뇌손상가토의 손상정도 및 그 예후와 백혈구수 및 위호산구치에 대한 관찰

이봉암 대한신경외과학회 1974 Journal of Korean neurosurgical society Vol.3 No.2

Author has attempted to measure serial blood leucocyte and pseudoeosinophilic neutrophil counts to study the inter-relationships between blood total leucocyte levels and severity with prognostic significance of various craniocerebral injuries induced experimentally in rabbits. The experiments were performed on 31 rabbits of male sex, weighing between 1.5 and 1.7 ㎏. On the degree of difference and severity of experimental injuries the animals were divided into the following 6 different groups: subarachnoid hemorrhage (GroupⅠ), local brain malacia (Group Ⅱ), intracerebral hematoma (Group Ⅲ), intraventricular hematoma (Group Ⅳ), unilateral carotid ligation (Group Ⅴ), bilateral carotid ligation (Group Ⅵ). In each groups, total leucocyte and pseudoeosinophilic neutrophil counts were measured at times 1 hr., 3hr., 6hr., 12hr., and 1,2,3,4 day, respectively, after the injuries. The following results were obtained 1. Mean levels of total leucocyte and pseudoeosinophilic neutrophil counts were 7263±193/㎣ and 35.1% in the control group. 2. The injured group, when compared to the control group of animals, had significantly raised total WBC and pseudocosinophil counts at 3 hr. after the injuries', and the counts were returned to normal range at the third day after the injuries. 3. In each series of the unilateral carotid ligation, the raised total WBC and pseudocosinophil counts did not differ significantly in the right and left series each other. 4. Total WBC and pseudoeosinophil levels in the group of bilateral carotid ligation were progressively increased and the highest levels were seen between 6 hr. and 12 hr. after the the injuries. 5. The most raised total WBC and pseudoeosinophil levels were seen in the group with bilateral carotid ligation and the next group was intraventricular hematoma, and the least raised group was subarachnoid hemorrhage. 6. It was concluded that the data showed highly significantly positive correlation between total WBC and pseudoeosinophil counts with the severity of injuries and its prognosis of c′ranio-cerebral injuries of rabbits induced experimentally. The greater increase in serial total WBC and pseudoeosinophil counts was seen in the group associated with higher degree of injuries, and the counts became to normal range at the third day with parallel to the degree of recovery after the injuries.

말초신경손상의 진단과 치료

이봉암 한국의학사 1985 診斷과治療 Vol.5 No.7

三又神經痛과 그 治療

李奉岩 藥業新聞社 1987 (月刊) 醫藥情報 Vol.1987 No.2