The Effect of Initial Duloxetine Dosing Strategy on Nausea in Korean Patients with Major Depressive Disorder

OBJECTIVE: To assess the relative severity of nausea in patients from Korea with major depressive disorder (MDD) who were treated with duloxetine at low (30 mg) or high (60 mg) doses, with or without food, for the first week of an 8 week treatment. METHODS: Adult patients (n=249), with MDD and a 17-item Hamilton Rating Scale for Depression (HAMD17) score of > or =15, received open-label once daily duloxetine. At Week 0, patients were randomized to 4 groups: 30 mg with food (n=63), 60 mg with food (n=59), 30 mg without food (n=64), and 60 mg without food (n=63). At Week 1, all patients switched to duloxetine 60 mg for 7 weeks. The primary outcome measure was item 112 (nausea) of the Association for Methodology and Documentation in Psychiatry adverse event scale. Effectiveness was assessed by change in HAMD17 total score. RESULTS: Overall, 94.4% (235/249) of patients completed Week 1 and 55.0% (137/249) of patients completed the study. For Week 1, nausea was significantly less severe for patients who received 30 mg compared with 60 mg duloxetine (p=0.003), regardless of food intake. In all groups, nausea severity was highest at Week 1 and declined throughout the study. HAMD17 score was reduced in all groups and the most common adverse event reported was nausea (145/249; 58.2%). CONCLUSION: To minimize nausea, Korean patients with MDD who require duloxetine treatment could be given 30 mg once daily, regardless of food, for the first week followed by 60 mg once daily for the course of therapy.

Heart Rate Variability in Metabolic Syndrome

BACKGROUND: Metabolic syndrome is a cluster of multiple cardiovascular risk factors. There are many suggestions that decreased Heart Rate Variability (HRV) is associated with cardiovascular disease. The purpose of this study was to find out the association between metabolic syndrome and HRV and to find out the affecting factors to HRV. METHODS: The study subjects were people who visited a health promotion or obesity center of a medical college in Suwon from January to February, 2002. Healthy 149 subjects were divided into two groups of metabolic vs non-metabolic syndrome. Mean Heart Rate (MHR), Standard Deviation of N-N interval (SDNN), The Square Root of the Mean Squared Difference of successive NN intervals (RMSSD), Total Power (TP), Low Frequency (LF), High Frequency (HF), and LF/HF ratio were used as the indices of HRV. T-test was used to compare the HRV of metabolic and non-metabolic syndrome, and multiple regression analysis was used to find out the affecting factors to HRV. RESULTS: HRV indices were significantly lower in metabolic syndrome. The mean+/-SD of SDNN, RMSSD, TP, LF, HF of metabolic vs non-metabolic syndrome was 39.2+/-14.5 vs 32.9+/-10.8 (ms, P=0.015), 30.5+/-14.6 vs 23.3+/-11.6 (ms, P=0.006), 1270.0+/-975.3 vs 893.2+/-652.6 (ms2, P=0.028), 354.4+/-410.8 vs 198.3+/-259.2 (ms2, P=0.008), 273.3+/-292.1 vs 148.9+/-137.2 (ms2, P=0.001), respectively. RMSSD and LF significantly decreased in the hypertensive group. Parameter estimate was 5.52 (ms, P=0.041), and 217.63 (ms2, P=0.002), respectively. TP and LF decreased as HDL cholesterol decreased. Parameter estimate was 24.31 (ms2, P=0.02), 11.12 (ms2, P=0.008), respectively. CONCLUSION: The HRV decreased in metabolic syndrome, and BP and HDL-cholesterol significantly affected HRV.

The Treatment of Scaphoid Nonunion / 대한정형외과학회잡지

Fracture of the scaphoid constitute 60% to 70% of all diagnosed carpal injury. The acute fracture will heal approximately 90% of the time if recognized early and properly immobilized. But nonunion are common since the symtoms do not alert patients to seek early medical treatment and the diagnosis is easily missed. Authors have experienced 19 cases of scaphoid nonunion and accomplished good result in all case by Russe procedure. The results were summerized as follow: 1 The cause of fratures was mainly due to fall down dinjury (36.8%). 2. The most common mechanism of the fracture was fall on the outstretched hand (52.7%). 3. Fractures were shown on the anterior-posterior, lateral and billiards view in all cases. 4. In ten cases, the fractures were found on the waist of scaphoid. 5. The cases of nonunion were probably inadequate intial treatment and delayed diagnosis. 6. The good results were obtained by bone graft according to Russe procedure.

The Clinical Analysis of Spondylolisthesis / 대한정형외과학회잡지

The morbidity of spondylolisthesis tends to increase in accordance with the popularization of sports and increase of mean life span by the development of medicine. We had applied surgical treatment for 39 cases of spondylolisthesis during the period of 8 yrs. from Jan. 1976 to Dec. 1983 at Department of Orthopaedic Surgery, National Police Hospital, among them 35 cases were followed up for mean 27 months. Twenty eight cases with posterolateral spinal fusion were isthmic spondylolisthesis and seven cases with posterior spinal fusion and facetectomy were degenerative type. We analysed them with clinical aspects and surgical treatment for 35 cases. The results were as follows: 1. The most common clinical symptoms were low back pain (96.7%) and tenderness (93.5%). 2. The degree of slipping was Grade I by Meyerding's classification in all cases and mean 12.5% by Taillard method. 3. In the 7 cases of isthmic spondylolisthesis, the degree of slipping increased on standing lateral view. And in these cases the clinical symptoms were aggrevated at welking. 4. In the degenerative spondylolisthesis with posterior spinal fusion and facetectomy, we found mean 70% spontaneous correction of slipping commpared with preoperative. 5. In postoperative evaluation we gained 94.3% above good according to Gill's criteria and no pseudarthrosis.