Opioids are effective analgesics, but they are often difficult to use properly, due mainly to adverse events, such as constipation, respiratory depression, addiction, tolerance, and opioid induced hyperalgesia. In the past, the problem of opioids around the world was usually caused by drugs traded illegally, so there was no need for medical and social attention in Korea. On the other hand, with the dramatic increase in the therapeutic use of opioids, which commenced more than a decade ago, problems caused by legally prescribed drugs have emerged, and now a more serious opioid crisis is being experienced than in the days of illegal drugs. A growing number of patients are chronically prescribed opioids, and a growing number of health care providers and hospitals suffer from problems related to chronic prescription. Currently, in Korea, it is the time to pay serious attention to achieve the safe and effective use of prescribed opioids. This paper consists of the following parts. 1) A summary of the issues related to chronic pain, opioids, and problems associated with the use of opioids. 2) Some case examples the authors' experienced. 3) Simple guidelines on the use of opioids in the treatment of chronic non-cancer pain are proposed based on the author's experience and existing literature. These guidelines are by no means comprehensive, and hopefully in the future, related experts will join forces to develop better guidelines.
Analgesics ; Analgesics, Opioid ; Chronic Pain ; Constipation ; Hand ; Health Personnel ; Humans ; Hyperalgesia ; Korea ; Prescriptions ; Respiratory Insufficiency

PURPOSE: To investigate the preoperative factors affecting the visual outcome after a vitrectomy in a rhegmatogenous retinal detachment (RRD). METHODS: A retrospective study of 79 eyes was carried out. The 41 eyes were macula-off RRD (group I), the 38 eyes were macula-on RRD (group II). The preoperative factors examined in this study included the preoperative best corrected visual acuity (BCVA), age, the duration of macular detachment, the extent of the detached retina, the delay of operation. The correlation between these factors and the postoperative 6 months BCVA were investigated. RESULTS: In group I, preoperative BCVA (r = 0.313, p = 0.037) and preoperative retinal detachment (RD) extent (r = 0.483, p = 0.001) were significantly correlated with postoperative 6 months BCVA. In group II, preoperative BCVA and preoperative RD extent were not significantly correlated with postoperative 6 months BCVA. Regardless of including macula, the patient's age, duration of symptom and delay of operation after clinic visit were not affected to the visual outcome. Patients with symptom duration of 7 days or less achieved better final BCVA (0.36 ± 0.45 log MAR, n = 29) than patients with longer symptom duration (0.79 ± 0.55 log MAR, n = 16) (p = 0.008). CONCLUSIONS: After vitrectomy for macula-off RRD, the factors related to favorable visual outcome were the better preoperative BCVA, the less extent of the detached retina. And surgical repair within 7 days of the symptom onset yielded better visual outcomes. Otherwise, in macula-on RRD, preoperative BCVA, age, the duration of retinal detachment, the extent of the detached retina, the delay of operation did not impact on visual outcome.
Ambulatory Care ; Humans ; Retina ; Retinal Detachment* ; Retinaldehyde* ; Retrospective Studies ; Visual Acuity ; Vitrectomy*

BACKGROUND: Hemorrhagic shock and trauma are two of the most common causes of acute lung injury. The activation of cyclooxygenase is one of the important causes of acute lung injury. This study investigated the effect of aspirin, a well-known cyclooxygenase inhibitor, on severe hemorrhage-induced acute lung injury in rats. METHODS: The hemorrhagic shock was induced by withdrawing blood; 20ml/kg of B.W., through the femoral artery in 5 min. The mean arterial pressure was recorded through the femoral artery on a polygraph. RESULTS: In the present investigation, the lung tissue myeloperoxidase activity, protein contents and leukocyte counts, in bronchoalveolar lavage fluid, increased significantly 2 and 24 h after the hemorrhage induction. Although the decreased mean arterial pressure spontaneously recovered, acute lung injury occurred after severe hemorrhage. These changes were effectively prevented by a single intravenous injection of aspirin (10 mg/kg of B.W.) 30 min before the hemorrhage. CONCLUSION: These results suggest that severe hemorrhage-induced acute lung injury is mediated, in part, by the activation of cyclooxygenase. Furthermore, pretreatment of aspirin in acute lung injury-prone patients, or prophylactic treatment of aspirin to the patients with precipitating conditions, could be helpful in the prevention of acute lung injury.
Acute Lung Injury* ; Animals ; Arterial Pressure ; Aspirin* ; Bronchoalveolar Lavage Fluid ; Femoral Artery ; Hemorrhage* ; Humans ; Injections, Intravenous ; Leukocyte Count ; Lung ; Peroxidase ; Prostaglandin-Endoperoxide Synthases ; Rats* ; Shock, Hemorrhagic

Methods: Three hundred and sixty-nine students in art high school completed a battery of measures, including the Korean version of the KMPAI, State-Trait Anxiety Inventory (STAI), Liebowitz Social Anxiety Scale (LSAS), Center for Epidemiologic Studies-Depression Scale (CES-D), and Frost Multidimensional Perfectionism Scale-Korean version (FMPS-K). The construct validity of the Korean version of KMPAI was examined by performing explorative factor analysis. The reliability was assessed by the internal consistency using Cronbach’s alpha. Results: Explorative factor analysis for the construct validity showed that the Korean version of KMPAI was composed of seven factors (factor 1: Worry/dread and Negative cognitions; factor 2: Proximal somatic anxiety and Worry about performance; factor 3: Depression/hopelessness; factor 4: Parental empathy–Memory–Controllability; factor 5: Generational transmission of anxiety;factor 6: Trust; factor 7: Rumination), explaining 61% of the total variance. The T Concurrent validity with the other scales (STAI, LASA, CES-D, and FMPS-K) was statistically significant. The Cronbach’s alpha value for the internal consistency of the Korean version of KMPAI was excellent (r=0.961). Conclusion The Korean version of the KMPAI is a reliable and valid instrument for measuring music performance anxiety in Korea.

No abstract available.
Kidney Transplantation* ; Wegener Granulomatosis*

Morphological changes in the ependymal lining of the hydrocephalic brain included stretching and tearing of the ependyma, thickening and gliosis of the subependymal layer, progressive loss of cilia and microvilli from the ependymal surface, and widening of the extracellular space. In the CT scan of the brain, periventricular low density was one of the common findings in hydrocephalus. The present experiment was performed to investigate not only the ultrastructural changes of the ventricular walls in hydrocephalus but also the morphological basis of periventricular lucency detected in the brain CT scan of the hydrocephalic patients. Hydrocephalus was induced in rats by intracisternal injection of thick kaolin suspension after surgical exposure of atlanto-occipital membrane. Lateral wall of the lateral ventricle was examined with transmission electron microscope in 3 different groups(6 rats at 1 week after the hydrocephalus, 8 at 2 weeks, and 4 at 8 weeks). The results were as follows: 1) Ultrastructural changes of the ependymal lining in hydrocephalic rat were flattening of ependymal cell and its nucleus, loss of cilia and microvilli from the ependymal surface, widening of the junctional complex, vacuoles and enlargement of cisternal space of rough endoplasmic reticulum in cytoplasm, and thicking and gliosis of subependymal layer. 2) These changes became more severe with longer duration of hydrocephalus. 3) Widening of junctional complex was considered to be the morphological basis for migration of ventricular cerebrospinal fluid into the periventricular white matter with resultant periventricular low density in the CT scan of the brain.
Animals ; Brain ; Cerebrospinal Fluid ; Cilia ; Cytoplasm ; Endoplasmic Reticulum, Rough ; Ependyma ; Extracellular Space ; Gliosis ; Humans ; Hydrocephalus ; Kaolin ; Lateral Ventricles ; Membranes ; Microvilli ; Rats* ; Tomography, X-Ray Computed ; Vacuoles

Background: Lessons learned from the Household Humidifier Disinfectant Tragedy (HHDT) in Korea, which poisoned thousands of citizens over a period of years, necessitated an examination of national poison prevention and surveillance systems. The objectives of this study are to identify essential changes needed in chemical poisoning prevention regulations and surveillance systems for effective poison control by comparing recent trends in international poison control center (PCC) operations, and to delineate the critical elements for establishing a state-of-the-art poison control surveillance system in Korea based on recent advances in PCCs with toxicovigilance. Methods: A comprehensive review of Korea’s regulatory and surveillance systems for chemical health hazards, with a focus on household products under the HHDT, was conducted. A review of toxicovigilance systems in major countries shows that creating an effective national PCC requires key elements: a centralized database of toxic substances and poisoning cases, mandatory or voluntary reporting of poisoning cases, real-time alerts, collaboration among health organizations, and targeted follow-up of poisoned individuals. Results: Significant deficiencies in Korea’s legislation, toxicological data management, and poisoning surveillance systems, explained the inadequate response of the Korean government to the HHDT for nearly 17 years until the end of 2011. Based on a review of PCC toxicovigilance systems in major countries, a national framework with five core components is recommended for establishing a modern comprehensive Korea PCC system with toxicovigilance capacity. The core components include establishment of a centralized database of toxic substances information and clinical poisoning cases, implementation of mandatory or permissive reporting of poisoning cases, real-time alert mechanisms, collaborative systems among health-related organizations, and clinical follow-up of poisoned sub-groups. Conclusion A rationale and framework for a state-of-the-art national Korean PCC with toxicovigilance is justified and offered. This proposed system could assist neighboring countries in establishing their own sophisticated, globally integrated PCC networks.

OBJECTIVE: The aim of this study is to investigate abnormal findings of social brain network in Korean children with autism spectrum disorder (ASD) compared with typically developing children (TDC). METHODS: Functional magnetic resonance imaging (fMRI) was performed to examine brain activations during the processing of emotional faces (happy, fearful, and neutral) in 17 children with ASD, 24 TDC. RESULTS: When emotional face stimuli were given to children with ASD, various areas of the social brain relevant to social cognition showed reduced activation. Specifically, ASD children exhibited less activation in the right amygdala (AMY), right superior temporal sulcus (STS) and right inferior frontal gyrus (IFG) than TDC group when fearful faces were shown. Activation of left insular cortex and right IFG in response to happy faces was less in the ASD group. Similar findings were also found in left superior insular gyrus and right insula in case of neutral stimulation. CONCLUSION: These findings suggest that children with ASD have different processing of social and emotional experience at the neural level. In other words, the deficit of social cognition in ASD could be explained by the deterioration of the capacity for visual analysis of emotional faces, the subsequent inner imitation through mirror neuron system (MNS), and the ability to transmit it to the limbic system and to process the transmitted emotion.
Amygdala ; Brain* ; Autism Spectrum Disorder* ; Child* ; Cognition ; Humans ; Limbic System ; Magnetic Resonance Imaging* ; Mirror Neurons

We report a case of free flap deterioration which may have been induced by pressure gradient resulting from cranial defect overlying a ventriculoperitoneal shunt (VP shunt). The patient, male and aged 78, had a VP shunt operation for progressive hydrocephalus. Afterwards, the scalp skin flap surrounding the VP shunt collapsed and showed signs of necrosis, exposing part of the shunt catheter. After covering the defect with a radial forearm free flap, the free flap site showed signs of gradual sinking while the vascularity of the flap remained unimpaired. An agreement was reached to remove the shunt device and observe the patient for any neurological symptoms, and after the shunt was removed and the previous cranial opening filled with fibrin glue by Neurosurgery, we debrided the deteriorated flap and provided coverage with 2 large opposing rotational flaps. During 2 months' outpatient follow-up no neurological symptoms appeared, and the new scalp flap displayed slight depression but remained intact. The patient has declined from any further follow-up since.
Catheters ; Decompressive Craniectomy ; Depression ; Fibrin Tissue Adhesive ; Follow-Up Studies ; Forearm ; Free Tissue Flaps* ; Humans ; Hydrocephalus ; Male ; Necrosis ; Neurosurgery ; Outpatients ; Scalp ; Skin ; Ventriculoperitoneal Shunt*

BACKGROUND: We examined whether increases of intra-abdominal pressure would decrease compliance (C) of both lung and chest wall. METHODS: We measured airway and esophageal pressure in 10 anesthetized/paralyzed tracheally intubated patients during mechanical ventilation at the respiratory rate of 10 freq/min and the tidal volume of 10 ml/kg undergoing laparoscopic cholecystectomy. Measurements were made at 0 mmHg intra- abdominal pressure the (Pab) in supine position and at 15 mmHg Pab in 10 head-up (reverse Trendelenburg) position at 0, 5, 10 and 15 min. after CO2 insufflation. RESULTS: We found that abdominal carbon dioxide insufflation caused a marked increase in peak airway pressure, plateau pressure and esophageal pressure (p<0.05); a reduction in compliance of respiratory system and chest wall (p<0.05). CONCLUSION: These changes should be considered in patients such as those with pulmonary disease, undergoing laparoscopic cholecystectomy where increase in impendance may be critical.
Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Compliance* ; Humans ; Insufflation ; Lung ; Lung Diseases ; Respiration, Artificial ; Respiratory Rate ; Respiratory System* ; Supine Position ; Thoracic Wall ; Tidal Volume