That gallamine causes tachycardia during general anesthesia is well known, but the efficacy of its anticholinergic action or an adrenergic beta blocking action remains to be determined. Twelve patients were subjected to this study, in which under halothane anesthesia small doses of propranolol. an adrenergic beta-blocker, was administered. In all cases bradycardia resulted and the greatest decrease was noted five minutes after intravenous injection of propranolol(0. 5 1. 0mg). At the height of bradycardia, gallamine 80 mg was administered intravenously. In all cases gallamine produced a significant increase of heart rate over the level before the injection of propranolol, but not so much as without propranolol pretreatment. But fifth minute values after propranolol expressed as 100 per cent, (per cent change in heart rate after propranolol followed by gallamine,) and after gallamine were similar effectively. This study suggested that gallamine-induced tachycardia is modified, but its anticholinergic action is not impaired by propranolol, and that gallamine-induced tachycardia is caused by anticholiaergic action of gallamine.
Anesthesia* ; Anesthesia, General ; Bradycardia ; Gallamine Triethiodide ; Halothane* ; Heart Rate ; Humans ; Injections, Intravenous ; Propranolol* ; Tachycardia*

Four patients underwent surgery for idiopathic epiretinal membrane at macula. The follow-up was from 5 to 8 months. The epiretinal membrane was removed by vitreous surgical technique with sutherland scissors and forceps. By electron microscopic study of the membrans, four typical cells(fibrous astrocytes, macrophages, fibrocytes and myofibroblast-like cells) were found in one case and hyalocytes in another case. In all cases visual acuity improved by more than 2 lines in Snellen chart.
Astrocytes ; Epiretinal Membrane* ; Follow-Up Studies ; Humans ; Macrophages ; Surgical Instruments ; Visual Acuity

Glycopyrrolate(Robinul) is a potent anticholinergic drug. Being a quaternary ammonium compound, it dose not cross the blood-brain barrier and thus dose not have the central effects. It has been shown that glycopyrrolate has a pharmacologic properties similar to that of atropine, belladonna alkaloid, but it has lesser effect on the heart rate than that of atropine. The author administered a small dose of glycopyrrolate intravenously to 18 people who were awake, 21 compatous cases and 17 halothane anesthetized cases. The effect on the heart rate in these 3 groups was compared. The results are as follows: 1) In the awake state, glycopyrrolate(0.1mg) produced a slight decrease in the heart rate. 2) In the comatose state, glycopyrrolate(0.1mg) produced a slight increase in the heart rate. 3) In the halothane anesthetized state, glycopyrrolate(0.1mg) produced a significant increase in the heart rate. 4) In the comatose state, the absence of bradycardia after a small dose of glycopyrrolate is similar to a small dose of atropine. Therefore we suggest that bradycardia after glycopyrrolate and atropine is caused by sympathetic ganglion block.

OBJECTIVES: This study was designed to integrate the results of community based studies which assessed a relationship between depression and alcoholism by meta-analysis. METHODS: We identified the previons studies and included in meta-analysis by searching MEDLINE. Overall, 21 results of the studies for relationship between depression and alcoholism were selected for quantitative meta-analysis. Before the integration of the each effect size of the relationship between depression and alcoholism, a homogeneity test was conducted. For the publication bias, we also conducted the analyses of funnel plot, normal quantile plot, rank correlation test and the fail-safe n. RESULTS: We used the random effect model to estimate the overall effect size, because the homogeneity of studies was rejected in a fixed effect model. Our quantitative meta-analysis yielded that integrated odds ratio between depression and alcoholism was 2.42 (95% C.I. 1.98-2.97). From the results of analyses of the publication bias, the probability of publication bias is considered low. CONCLUSION: The published evidences suggested that there may be a significant positive relationship between depression and alcoholism.
Alcoholism* ; Depression* ; Odds Ratio ; Publication Bias

OBJECTIVES: This study was designed to integrate the results of community based studies which assessed a relationship between depression and alcoholism by meta-analysis. METHODS: We identified the previons studies and included in meta-analysis by searching MEDLINE. Overall, 21 results of the studies for relationship between depression and alcoholism were selected for quantitative meta-analysis. Before the integration of the each effect size of the relationship between depression and alcoholism, a homogeneity test was conducted. For the publication bias, we also conducted the analyses of funnel plot, normal quantile plot, rank correlation test and the fail-safe n. RESULTS: We used the random effect model to estimate the overall effect size, because the homogeneity of studies was rejected in a fixed effect model. Our quantitative meta-analysis yielded that integrated odds ratio between depression and alcoholism was 2.42 (95% C.I. 1.98-2.97). From the results of analyses of the publication bias, the probability of publication bias is considered low. CONCLUSION: The published evidences suggested that there may be a significant positive relationship between depression and alcoholism.
Alcoholism* ; Depression* ; Odds Ratio ; Publication Bias

For the assessment of the effect of succinylcholine(SCh) on pancuronium, 62 adult patients undergoing elective surgery under gerieral anesthesia were subjected tc this study in which the EMG response(twitch hight) of the hand to TOF stimulation(0.2 Hz) of ulnar nerve was monitored and recorded with Datex Relaxograph. According to the amount and mode of the drugs administered, the patients were divided into four experimental groups: 1) Group I, a bolus intravenous injection of pancuronium in dose of 0.05 mg/kg. 2) Group II, intravenous injection of pancuronium 0.1 mg/kg, a double dose of group I. 3) Group III, intravenous injection of pancuronium(0.05 mg/kg) after 25 to 50 recovery of initial twitch height from twitch height depression induced by SCh(1 mg/kg). 4) Group IV, mixed intravenous injection of SCh(1 mg/kg) and pancuronium(0.05 mg/kg). Followings were the results. 1) Mean onset time of the effect of pancuronium, was 15.6+/-1.1 minutes in group I and 13.8+/-1.5 minutes in group II, to 2,9+/-0.4 and 1.3+/-0.1 minutes in group III and IV respectively, and decreased(p< 0.001). 2) Duration of action of pancuronium was 47.1+/-4.5 minutes in group I and 87.7+/-7.4 minutes in group II, the prolongation of the latter being significantg<0.001). It was, however 48.3+/-5.2 minutes in group III, indicating that SCh showed a little effect, while it was 21.2+/-1.9 minutes in group IV, being significantly shorter than those of group I and III(p<0.001), 3) Potency of pancuronium expressed by the percentage changes of initial twich height was 34.3+/-6.0% in group I and it was noted to decrease significantly to 4.0+/-1.0% in group II and 0% in group IV(p<0.001). This pattern of decrease was almost similar to group II. 4) Presence of pancuronium(0.05 mg/kg) in group IV did not have any effect on the intensity of fasciculation induced by SCh. These results indicate that succinylcholine could potentiate the onset time and action potency of pancuronium by facilitating quick action on the receptor, but it have an antagonistic effect on the duration of action of pancuronium.
Adult ; Anesthesia ; Depression ; Fasciculation ; Hand ; Humans ; Injections, Intravenous ; Pancuronium* ; Succinylcholine* ; Ulnar Nerve

Two schizophrenic patients who had been taking medication for a long period presented with visual disturbance of 6-month duration. Slit-lamp examination revealed fine, discrete, and brownish deposits on the posterior cornea. In addition, bilateral star-shaped anterior subcapsular lens opacities, which were dense, dust-like granular deposits, were noted. Although we strongly suspected that the patient might have taken one of the drugs of the phenothiazine family, we were unable to obtain a history of medications other than haloperidol and risperidone, which were taken for 3 yr. We performed a drug profiling test using urine samples and detected methotrimeprazine. The patient underwent surgery for anterior subcapsular lens opacities. Visual acuity improved in both eyes, but the corneal deposits remained. We report an unusual case of methotrimeprazine-induced corneal deposits and cataract in a patient with psychosis, identified by using the urine drug profiling test.
Adult ; Antipsychotic Agents/*adverse effects/therapeutic use/urine ; Cataract/*chemically induced ; Corneal Diseases/*chemically induced ; Female ; Humans ; Male ; Mental Retardation/diagnosis/drug therapy ; Methotrimeprazine/*adverse effects/therapeutic use/urine ; Middle Aged ; Schizophrenia/diagnosis/drug therapy ; Visual Acuity

There are growing concerns regarding the safety of long-term treatment with opioids of patients with chronic noncancer pain. In 2017, the Korean Pain Society (KPS) developed guidelines for opioid prescriptions for chronic non-cancer pain to guide physicians to prescribe opioids effectively and safely. Since then, investigations have provided updated data regarding opioid therapy for chronic non-cancer pain and have focused on initial dosing schedules, reassessment follow-ups, recommended dosage thresholds considering the risk-benefit ratio, dosereducing schedules for tapering and discontinuation, adverse effects, and inadvertent problems resulting from inappropriate application of the previous guidelines. Herein, we have updated the previous KPS guidelines based on a comprehensive literature review and consensus development following discussions among experts affiliated with the Committee on Hospice and Palliative Care in the KPS. These guidelines may assist physicians in prescribing opioids for chronic non-cancer pain in adult outpatient settings, but should not to be regarded as an inflexible standard. Clinical judgements by the attending physician and patient-centered decisions should always be prioritized.

There are growing concerns regarding the safety of long-term treatment with opioids of patients with chronic noncancer pain. In 2017, the Korean Pain Society (KPS) developed guidelines for opioid prescriptions for chronic non-cancer pain to guide physicians to prescribe opioids effectively and safely. Since then, investigations have provided updated data regarding opioid therapy for chronic non-cancer pain and have focused on initial dosing schedules, reassessment follow-ups, recommended dosage thresholds considering the risk-benefit ratio, dosereducing schedules for tapering and discontinuation, adverse effects, and inadvertent problems resulting from inappropriate application of the previous guidelines. Herein, we have updated the previous KPS guidelines based on a comprehensive literature review and consensus development following discussions among experts affiliated with the Committee on Hospice and Palliative Care in the KPS. These guidelines may assist physicians in prescribing opioids for chronic non-cancer pain in adult outpatient settings, but should not to be regarded as an inflexible standard. Clinical judgements by the attending physician and patient-centered decisions should always be prioritized.