• Korean Journal of Clinical Laboratory Science
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• v.45 no.3
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• pp.91-95
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• 2013

It is important to check the types of drugs when treating acute drug intoxication. This study researches the clinical characteristics and types of patients hospitalized in emergency medical center for drug addiction in 2009 and 2010. By applying a drug addiction selecting kit, it studied the flexibility and clinical efficiency during diagnosis and treatment. The study result shows, among the drugs causing addiction, Sedative accounts for 34.4%, Herdicide 23.5%, Analgesic 17.2%, Insectide 7.8% and else 17.2%. Sedative showed the highest proportion both in 2009 and 2010. Among the drug addicted patients, 39 cases did not know that the drugs are poisonous and among them, the drug addiction selecting kit was positive in 32 cases (82.0%). In 42 cases where addiction was suspicious, 25 cases (59.5%) were positive in the drug addiction selecting kit. In 57 cases of using drug addiction selecting kits, the cases in which benzodiazepine was positive, were 30 and the most frequently cases were as follows; Tricyclic Antidepressants (TCA) 13 cases, Amphetamines 3 cases, barbiturate 3 cases, and piate 3 cases. In the district using drug addiction kit meaningfully had Flumazenil injection much greater impact than the one not using the kit. This proves the efficiency of the kit (p<0.05). The uses of drug addiction selecting kits are for acute drug intoxicated patients and for providing objective and scientific information when emergency medical doctor are checking unchecked poisoning drugs. It is considered that drug addiction selecting kits would give help when treating the early stage of drug addicted patients in emergency medical treatment.

• Journal of Oriental Neuropsychiatry
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• v.16 no.2
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• pp.135-148
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• 2005

Objective : The purpose of this study is to take around the oriental medical treatment about substance related disorder in china. Method : We review the studies which are published by six different journal in China since 1992 to 2002 involved in substance related disorders. Result 1. The kinds of substance which is the subject of each study. It suggest that the narcotics-withdrawal patients in china take kinds of opium many more than phillopon or barbiturate, cocain etc. especially the heroine takes the most portion in the kinds of opium. 2. The type of chinese medicine demonstration which is about the addiction and withdrawal. There are many symptoms in the each period of withdrawal, According to the each period demonstration, the herbal formula must be different. 3. The formula used in treatment and the substance which is used in common Codonopsis radix is widely used, and pinellia ternata, aractylodes japonica, citrus nobilis, vegetable worms, angelica gigas, zizyphus jujuba, panax ginseng, astragalus membranaceus etc are also used in treatment. 4. The methods of acupunture treatment Hapkok(LI-4), Naegwan(PC6), and Sanyinjiao(SP6) are the widely used acu-points. in addition to these acupoints, there are waegwan(TE5) choksamli(ST36) hanggan(LR2)etc. Conclusion : We expect that this review about substance related disorders in TCM help the clinical study of substance related disorders in Korean medicine.

• Journal of Korean Neurosurgical Society
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• v.50 no.6
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• pp.497-502
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• 2011

Objective : This study was conducted to compare the effect of etomidate with that of thiopental on brain protection during temporary vessel occlusion, which was measured by burst suppression rate (BSR) with the Bispectral Index (BIS) monitor. Methods : Temporary parent artery occlusion was performed in forty one patients during cerebral aneurysm surgery. They were randomly assigned to one of two groups. General anesthesia was induced and maintained with 1.5-2.5 vol% sevoflurane and 50% $N_2O$. The pharmacological burst suppression (BS) was induced by a bolus injection of thiopental (5 mg/kg, group T) or etomidate (0.3 mg/kg, group E) according to randomization prior to surgery. After administration of drugs, the hemodynamic variables, the onset time of BS, the numerical values of BIS and BSR were recorded at every minutes. Results : There were no significant differences of the demographics, the BIS numbers and the hemodynamic variables prior to injection of drugs. The durations of burst suppression in group E ($11.1{\pm}6.8$ min) were not statistically different from that of group T ($11.1{\pm}5.6$ min) and nearly same pattern of burst suppression were shown in both groups. More phenylephrine was required to maintain normal blood pressure in the group T. Conclusion : Thiopental and etomidate have same duration and a similar magnitude of burst suppression with conventional doses during temporary arterial occlusion. These findings suggest that additional administration of either drug is needed to ensure the BS when the temporary occlusion time exceed more than 11 minutes. Etomidate can be a safer substitute for thiopental in aneurysm surgery.

• Proceedings of the PSK Conference
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• 2002.10a
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• pp.194-199
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• 2002

Many oxidative metabolites of tetrahydrocannabinols (THCs), active components of marijuana, were pharmacologically active, and 11-hydroxy-THCs, 11-oxo-${\Delta}^8$-THC, 7-oxo-${\Delta}^8$-THC, 8$\beta$, 9$\beta$-epoxyhexahydrocannabinol (EHHC), 9$\alpha$, l0$\alpha$-EHHC and 3'-hydroxy-${\Delta}^9$-THC were more active than THC in pharmacological effects such as catalepsy, hypothermia and barbiturate synergism in mice. Cannabidiol (CBD), another major component, was biotransfomred to two novel metabolites, 6-hydroxymethyl-${\Delta}^9$-THC and 3-pentyl-6, 7, 7a, 8, 9, lla-hexahydro-I, 7-dihydroxy-7, 1O-dimethyldibenzo[b, d]oxepin (PHDO) through 8R, 9-epoxy-CBD and 85, 9-epoxy-CBD, respectively. Both metabolites exhibited some pharmacological effects comparable to d9 - THe. Cannabinol (CBN), the other major component, was mainly metabolized to ll-hydroxy-CBN by hepatic microsomes of animals including humans. The pharmacological effects of the metabolite were higher than those of CBN demonstrating that II-hydroxylation of CBN is metabolic activation pathway of the cannabinoid as is the case in THCs. Tolerance and reciprocal cross-tolerance developed to pharmacological effects d8 - THC and ll-hydroxy-d8-THC , and the magnitude of tolerance development produced by the metabolite was significantly higher than that by d8-THC. The results indicate that ll-hydroxy-d8-THC has an important role not only in the pharmacological effects but also its tolerance development of d8 - THe. THCs and their metabolites competed to the specific binding of CP-55, 940, an agonist of cannabinoid receptor, to synaptic membrane from bovine cerebral cortex. The Ki value of THCs and their metabolites were closely paralleled to their pharmacological effects in mice. A novel cytochrome P450 (cyp2c29) was purified and identified as a major enzyme responsible for the metabolic activation of d8-THC at the II-position in the mouse liver. cDNA of CYP2C29 was cloned from a mouse cDNA library and its sequence was determined. The oxidation mechanism of THC by cyp2c29 was proposed.

• Journal of The Korean Society of Clinical Toxicology
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• v.11 no.1
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• pp.23-27
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• 2013

Zoletil is a non-opioid, non-barbiturate animal anesthetic and proprietary combination of two drugs, a dissociative anesthetic drug, tiletamine, with the benzodiazepine anxiolytic drug, zolazepam. Zoletil has greater potency than ketamine. Zoletil is abused for recreational purposes, especially by people with easy access to medicine. However, in Korea, it is available over-the-counter. Here we report on a case of an 83-year-old woman who received injection of seven vials of "Zoletil 50" by her daughter and presented with an altered mental change. Her mental state was stupor and vital sign was hypotension, bradycardia. Her blood tests indicated metabolic and respiratory acidosis and hyperkalemia. She was treated with intravenous naloxone and flumazenil but was not responsive. She was admitted to the ICU and treated with supportive therapy. Her mental state showed transient recovery, however, her clinical manifestation worsened and she expired.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.316-321
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• 2001

Objectives : The goal of this study is to evaluate the usefulness of mild hypothermia treatment in patients with increased intracranial pressure(ICP). Material and Method : From November 1999 to May 2001, 11 patients were treated with mild hypothermia ($32-34^{\circ}C$) in whom ICP maintained at higher than 20mmHg in spite of decompressive surgery and high dose barbiturate therapy. The patient's rectal temperature were lowered by external cooling. Hypothermia was maintained for not more than 7 days and then the patients were rewarmed slowly for 24 hours. If increased ICP persisted for 2 days of hypothermia, this treatment was continued for several days. The functional outcome of each patient was assessed according to Glasgow Outcome Scale(GOS). Results : All cases except two cases showed decrease of ICP after hypothermia therapy. In 1 case which was right middle cerebral artery(MCA) infarct, ICP re-increased after 24 hours and in another 1 case, ICP was not controlled initially. Among 11 cases, 3 cases showed favorable outcome. Conclusion : Mild hypothermia treatment in patients with increased ICP was effective in controlling ICP and mortality was so decreased. More clinical experience and controlled study was need to determine the effectiveness.

• Journal of Oriental Neuropsychiatry
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• v.20 no.3
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• pp.65-88
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• 2009

Objectives : There has not been the comparison research of medication on the Insomnia as the complementary significance of the Oriental-Western Cooperative Therapeutic Viewpoint so far. The aim of this preliminary research is to study Eastern and Western Medication Model for the Insomnia through the comparison of Oriental Medication based on "Sang Han Lon" and "Dong yui bo gam". Methods : The author researched oriental-western viewpoints and the present treatment condition of Sleep and Sleeping Pills with reference to Korean articles issued since 1975, dissertations, journals registered or candidated on KCI, alternative medicine journals on Pubmed, and books concerning Neuropsychiatry. In the field of Oriental medical study, this study was demonstrated on "The Oriental Medical textbook of neuropsychiatry", "Sang han lon", "Dong yui bo gam" and the present research trend. Results : In Oriental Medicine, Insomnia is treated according to si-jie-bu-shui-zung (思結不睡證) type, rong-xie-bu-zu-zung (榮血不足證) type, yin-her-nae-re-zung (陰虛內熱證) type, xin-dan-her-qie-zung (心膽虛怯證) type, dam-xian-yu-jie-zung (痰涎鬱結證) type, and wei-zhong-bu-he-zung (胃中不和證) type etc. In Western Medicine, Insomnia has been treated by Barbiturate over 60's and BZ over 70's. According to recent treatment on Insomnia, Zolpidem or Zaleplon, which is short-lived and has less side effects, is used much, and tri-cyclic antidepressants are prescribed on a chronic psycho-physiological insomnia. Conclusions : Generally, Insomnia is being treated by controlling whole ways. The oriental medication is less effective for sleep induction. On the contrary, that of western medication is very effective for sleep induction, but there are many possibilities of side effects. If this two mutual therapy is conducted cooperatively, more effective medical care might be expected. Therefore, it is considered that not only the oriental medical study for sleep induction, but the study of Oriental-Western Cooperative Therapy should be preceded to treat Insomnia from now on.

• Journal of Korean Neurosurgical Society
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• v.30 no.3
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• pp.295-306
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• 2001

Objectives : The management of massive brain swelling remains an unsolved problem in neurosurgical field. Despite newly developed medical and pharmacological therapy, the mortality and morbidity due to massive brain swelling remains high. According to many recent reports, surgical decompression with dura expansion is superior to medical management in patients with massive brain swelling. We performed surgical treatment on the first line of treatment, and followed medical management in case with refractory increased intracranial pressure(ICP). To show the quantitative effect of decompressive surgery on the intracranial pressure, we performed ventricular puncture and checked the ventricular ICP continuously during the decompressive surgery and postoperative period. Materials and Methods : Fifty-one patients with massive brain swelling, undergoing bilateral decompressive craniectomy with dura expansion, were studied in this study. In all patients, ventricular puncture was performed at Kocher's point on the opposite side of massive brain swelling. The ventricular pressure was monitored continuously, during the bilateral decompression procedures and postoperative period. Results : The initial ventricular ICP were varied from 13mmHg to 112mmHg. Immediately after the bilateral craniectomy, mean ventricular ICP decreased to $53.1{\pm}15.8%$ of the initial ICP(ranges from 5mmHg to 87mmHg). Dura opening decreased mean ICP by additional 36.7% and made the ventricular pressure $16.4{\pm}10.5%$ of the initial pressure (ranges from 0mmHg to 28mmHg). Postoperatively, ventricular pressure was lowered to $20.2{\pm}22.6%$(ranged from 0mmHg to 62.3mmHg) of the initial ICP. The ventricular ICP value during the first 24 hours after decompressive surgery was found to be an important prognostic factor. If ICP was over 35mmHg, the mortality was 100% instead of additional medical(barbiturate coma therapy and hypothermia) treatments. Conclusion : Bilateral decompression with dura expansion is considered an effective therapeutic modality in ICP control. To obtain favorable clinical outcome in patients with massive brain swelling, early decision making on surgical management and proper patient selection are mandatory.

• The Korean Journal of Physiology and Pharmacology
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• v.12 no.3
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• pp.101-109
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• 2008

The aim of the present study was to examine the effects of ketamine, a dissociative anesthetics, on secretion of catecholamines (CA) secretion evoked by cholinergic stimulation from the perfused model of the isolated rat adrenal gland, and to establish its mechanism of action, and to compare ketamine effect with that of thiopental sodium, which is one of intravenous barbiturate anesthetics. Ketamine ($30{\sim}300{\mu}M$), perfused into an adrenal vein for 60 min, dose- and time-dependently inhibited the CA secretory responses evoked by ACh (5.32 mM), high $K^+$ (a direct membrane-depolarizer, 56 mM), DMPP (a selective neuronal nicotinic NN receptor agonist, $100{\mu}M$) and McN-A-343 (a selective muscarinic M1 receptor agonist, $100{\mu}M$). Also, in the presence of ketamine ($100{\mu}M$), the CA secretory responses evoked by veratridine (a voltage-dependent $Na^+$ channel activator, $100{\mu}M$), Bay-K-8644 (an L-type dihydropyridine $Ca^{2+}$ channel activator, $10{\mu}M$), and cyclopiazonic acid (a cytoplasmic $Ca^{2+}$-ATPase inhibitor, $10{\mu}M$) were significantly reduced, respectively. Interestingly, thiopental sodium ($100{\mu}M$) also caused the inhibitory effects on the CA secretory responses evoked by ACh, high $K^+$, DMPP, McN-A-343, veratridine, Bay-K-8644, and cyclopiazonic acid. Collectively, these experimental results demonstrate that ketamine inhibits the CA secretion evoked by stimulation of cholinergic (both nicotinic and muscarinic) receptors and the membrane depolarization from the isolated perfused rat adrenal gland. It seems likely that the inhibitory effect of ketamine is mediated by blocking the influx of both $Ca^{2+}$ and $Na^+$ through voltage-dependent $Ca^{2+}$ and $Na^+$ channels into the rat adrenal medullary chromaffin cells as well as by inhibiting $Ca^{2+}$ release from the cytoplasmic calcium store, which are relevant to the blockade of cholinergic receptors. It is also thought that, on the basis of concentrations, ketamine causes similar inhibitory effect with thiopental in the CA secretion from the perfused rat adrenal medulla.