척수 손상 환자의 우울에 대한 정신과적 고찰

김문두,신태균,심기범,신지남 최신의학사 2003 最新醫學 Vol.46 No.9-10

Urokinase 뇌실내 주입법을 이용한 중증 뇌실내 혈종의 치료

정영선,김민호,이지영,심기범,홍승관 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.4

The authors applied extraventricular drainage combined with intermittent intraventricular injection of urokinase to 21 patients with intraventricular hematoma and ventricular dilatation. Ten-thousand lU of urokinase was injected every 12 hours for 3 days. Follow-up CT on day 4 after the treatment showed complete disappearance of the hematoma in the 3rd and 4th ventricles and a small residual hematoma in the occipital horns of lateral ventricles in the majority(14 patients) of th8 patients. Obstruction of the drainage catheter did not occur in any case. but transient pleocytosis in CSF study. ventriculitis. and rebleeding complicated 6. 4. and 4 cases. respectively. The duration of extraventricular drainage in the 17 patients without major complications was 3-l7 days. The clinical results on discharge were good recovery in 3. moderate disability in 1, severs disability in 4. vegetative state in 0.and death in 7 cases. The decisive events that were thought to have caused vegetative states or death in the 13patients with poor results were low initial GCS in 7 rebleeding in 4, ventriculitis in 1. pneumonia in 1, and unknown in 1 case. The method of extraventricular drainage combined with intermittent intraventricular injection of urokinase seems useful in removing intraventricular hematomas more rapidly. In regards to various other factors that influence the clinical course of severe intraventricular hematomas. further investigation including prospective studies is necessary to determine whether the intraventricular injection of urokinase significantly improves the final outcomes of those patients with severe intraventricular hematomas.

A Study for Normal Development of the Posterior Cranial Fossa in the Chick Embryos (gestation 14-20 days) with MR Images and Histopathology

Sim Ki Bum,Lee Chang Sub,Shin Tae Kyun Korean Environmental Mutagen Society 2005 한국환경성돌연변이·발암원학회지 Vol.25 No.1

The objective was to use MR imaging to provide a template of posterior fossa development during the late stages in the chick embryos. The MR findings were then correlated with histological data. Fourteen normal formalin-fixed embryonic specimens with a gestational age of 14 to 20 days were examined with 1.5 Tesla unit MRl using a conventional clinical magnet and pulse sequences. The MR findings were correlated with the whole-mount histological specimens. Resolution of the morphological features of posterior fossa development in embryos greater than 14 days gestational age was possible. Development of cerebellum, brain stem, 4th ventricle and bony posterior fossa was documented. In the 14-day-old embryos, a premordial cerebellum was visualized in the enlarged bony posterior fossa, and it covered the the roof of the primitive fourth ventricle. The bony posterior fossa grows at the same rate along the supratentorial skull. The supratentorial skull and the rostral part of the brain grows at the same rate. The cerebellum begins to grow later than the rostral part of the brain. In the 19- to 20-day-old embryos, MRl revealed the rapid development of the cerebellar hemispheres, along with an increase in volume manifested by the more typical mushroom-shaped configuration observed in the newly hatched. At this stage, the cerebellum almost completely filled the posterior fossa and covered the entire fourth ventricle. The brain stem grew steadily, but the volume change was too subtle to evaluate. Features of cerebellar histogeneis were beyond the resolution of MRl. However, there were lots of artifacts in the features of the bony posterior fossa. An MR template of normal posterior fossa development would be useful to avoid confusion of normal development with abnormal development and to identify the expected developmental features when provided the estimated gestational age of a embryo.

Risk Factors of Ventriculitis Following Ventriculostomy

Sim, Ki-Bum,Chung, Chun Kee,Kim, Dong Gyu,Han, Dae Hee 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.5

본 저자들은 뇌실조루술 후 발생하는 뇌실염을 예방하고, 치료하는 지침을 마련하고자 본 연구를 시행하였다. 연구 대상은 1990년 3월부터 1991년 7월까지 서울대학교병원에서 경험하였던 뇌실염 환자 14명이었다. 그중 8명은 서울대학교병원에서 뇌실조루술을 시행한 100명의 환자 중에서 발생하였으며, 6명은 타병원에서 전원되었다. 뇌실염의 진단은 전적으로 뇌실내 뇌척수액의 배양 결과에 준하였다. 치료는 지속적인 뇌척수액의 배출, 뇌실조루술 도관의 간헐적 제거 및 재배치, 그리고 감도시험 결과에 따른 항생제의 투여를 시행하였다. 뇌실염의 원인균은 코아귤라제 음성 포도구균(9명), 황색포도상구균(2명), 녹색연쇄구균(1명), 엔테로박테르(1명), 그리고 장내구균(1명)이었다. 뇌실조루술후 뇌실염의 발생기간은 평균 7일(4일부터 15일)이었다. 본 연구결과에 의하면 뇌실조루술 시행후 4일째부터 뇌실염이 발생하였다. 뇌실염 환자중 10명은 평균적으로 뇌실염 치료 33일(9일부터 142일)만에 회복하였다. 4명은 사망하였다. 본 연구결과와 문헌고찰을 기초로 하여 본 저자들은 뇌실조루술 후 발생하는 뇌실염을 예방하고, 치료하기 위해서는 1) 뇌실조루술 도관을 엄격히 무균적으로 삽입하고, 피하터널을 만든 후 절대적으로 폐쇄된 상태로 유지하고, 2) 뇌실조루술을 필요로 한 원인질환을 가능한 빨리 치료하고, 3) 뇌실조루술 도관을 장기간 유지하여야 할 경우 3일 적어도 5일마다 제거후 재배치하고, 4) 뇌실조루술을 유지하고 있는 동안에는 주기적으로 세균 상용검사를 시행하고, 5) 치료를 위한 항생제는 반드시 감도시험 결과에 따라 선택하여 사용할 것을 권유한다.

Precedence of Parenchymal Enhancement on CT Angiography to a Fatal Duret Hemorrhage

Sim, Ki-Bum,Na, Dong Gyu,Park, Ji Kang The Korean Neurosurgical Society 2013 Journal of Korean neurosurgical society Vol.53 No.6

We report a case of fatal duret hemorrhage (DH) in a patient with acute tentorial subdural hematoma and bilateral chronic subdural hematoma along the cerebral hemispheres. Preoperative CT angiography (CTA) revealed prominent parenchymal enhancement in the ventral pontomesencephalic area. After burr-hole drainage, a large hemorrhage developed in this area. The parenchymal enhancement in the CTA may reflect the pontomensencephalic perforating vessel injury, and may be a sign of impending DH of acute transtentorial downward herniation. Previous use of aspirin and warfarin might have potentiated the process of DH and increase the extent of the bleed.

Terminal Myelocystocele

Ki Bum Sim Korean Academy of Medical Science 1996 Journal of Korean medical science Vol.11 No.2

Cerebral Aneurysm in the Long Fenestration at the Middle Portion of M1 Segment

Ki-Bum Sim,Chang Sub Lee,박중철,Ji Soon Huh 대한신경외과학회 2010 Journal of Korean neurosurgical society Vol.48 No.11

We report a unique case of bilateral mirror image M1 aneurysms, one of which was an unruptured aneurysm arising from the proximal end of right middle cerebral artery fenestration with long loop and the other ruptured aneurysm from the contralateral side. We clipped ruptured aneurysm first and unruptured one in three months after the first operation. The difficulties of identifying this unusual vascular anomaly and possible problems during the surgery of an aneurysm at the site of fenestration are discussed with a review of the literature.

Cerebral Aneurysm in the Long Fenestration at the Middle Portion of M1 Segment

Sim, Ki-Bum,Lee, Chang-Sub,Park, Jung-Cheol,Huh, Ji-Soon The Korean Neurosurgical Society 2010 Journal of Korean neurosurgical society Vol.48 No.5

We report a unique case of bilateral mirror image M1 aneurysms, one of which was an unruptured aneurysm arising from the proximal end of right middle cerebral artery fenestration with long loop and the other ruptured aneurysm from the contralateral side. We clipped ruptured aneurysm first and unruptured one in three months after the first operation. The difficulties of identifying this unusual vascular anomaly and possible problems during the surgery of an aneurysm at the site of fenestration are discussed with a review of the literature.

Demonstration of Traumatic Subarachnoid Hemorrhage from the Anterior Choroidal Artery

Sim, Ki-Bum,Park, Sukh Que,Choi, H. Alex,Kim, Daniel H. The Korean Neurosurgical Society 2014 Journal of Korean neurosurgical society Vol.56 No.6

We present a case of angiographically confirmed transection of the cisternal segment of the anterior choroidal artery (AChA) associated with a severe head trauma in a 15-year old boy. The initial brain computed tomography scan revealed a diffuse subarachnoid hemorrhage (SAH) and pneumocephalus with multiple skull fractures. Subsequent cerebral angiography clearly demonstrated a complete transection of the AChA at its origin with a massive extravasation of contrast medium as a jet trajectory creating a plume. We speculate that severe blunt traumatic force stretched and tore the left AChA between the internal carotid artery and the optic tract. In a simulation of the patient's brain using a fresh-frozen male cadaver, the AChA is shown to be vulnerable to stretching injury as the ipsilateral optic tract is retracted. We conclude that the arterial injury like an AChA rupture should be considered in the differential diagnosis of severe traumatic SAH.

The Relation between Body Composition of the Aged and the Change of Physical Fitness Level through Complex Exercise Training for 12 weeks

Suk Bum Zoo,Yoo Rim Choi,Ki Cheol Sim,Mi Jung Kim,Wan Suk Choi,Ja Pung Koo,Suk Hee Lee,Sang Bin Lee 국제물리치료학회 2011 Journal of International Academy of Physical Ther Vol.2 No.1

The purpose of this study is to investigate and reveal the effects that the complex exercise training consisting of aerobic exercise and strength training(sit up, push up) that everyone can easily practice regardless of a time and a place in order to manage practically the physical strength of the aged affects the difference on their body composition and the change of physical fitness level. Looking into the change of body composition of an experimental group, the weight of 2.5kg was reduced after applying complex training for 12 weeks and the body fat mass of 2.65kg was reduced. Also, the abdominal fat of 0.13% was decreased and the muscle mass of 1.56kg was increased. For the change factors of physical fitness, cardiovascular endurance, muscular strength, muscular endurance, balance and flexibility excluding agility showed significant improvement after applying complex exercise training. The improvement of health fitness of the aged under this study was significantly effective to improve specified body functions which had been lowered by aging and insufficient physical activities. So, it is regarded that their health fitness is the important factor to improve the activity competence required for daily life and to lead healthy living by the improved activity competence. Henceforth, it needs to study more the complex composition of several sports, exercise intensity and the frequency based on the previous researches and studies. In addition, it needs to develop the complex exercise training in accordance with various characteristics such as a sex of the aged, an age, a physical fitness level, environment, a disease and the program in consideration of the efficacy and safety during training.