• 대한영상의학회지
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• 제81권4호
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• pp.972-978
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• 2020

펜타닐 첩포가 의학적으로 이용됨에 따라 간간이 펜타닐 중독 증례가 보고되고 있다. 지연성저산소성 백색질뇌증(delayed post-hypoxic leukoencephalopathy)은 저산소증에 의한 합병증의 하나이다. 이로 인해 급성 중독으로 인한 혼수상태에서 완전히 회복하더라도, 뒤늦게 신경병적 증상이 발생하고, 이후 백색질뇌증으로 진행하기도 한다. 여기 10개의 펜타닐 첩포를 한 번에 사용하고 13시간 동안 깨어나지 못하여 본원으로 내원한 65세 환자의 증례를 소개하였다. 첫 내원 당시 촬영한 CT 소견은 정상이었으나, 20일 뒤 지연성 신경병적 증상이 발생하여 촬영한 MRI 상 양측 대뇌 백색질에 대칭적인 불균일하고 융합하는 고신호 강도 병변이 T2와 FLAIR 영상에서 관찰되었으며 이 병변은 확산 제한을 보였다. 이후 환자의 신경병적 증상은 빠르게 악화되었고 1년 후 심한 전반적 뇌 위축으로 진행하였다.

• Molecular & Cellular Toxicology
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• 제5권1호
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• pp.32-43
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• 2009

Acetaminophen (APAP) overdose is known to cause severe hepatotoxicity mainly through the depletion of glutathione. In this study, we compared the cytotoxic effects of APAP on both a normal murine hepatic cell line, BNL CL.2, and its SV40-transformed cell line, BNL SV A.8. Gene expression profiles for APAP-treated cells were also obtained using microarray and analyzed to identify differences in genes or profiles that may explain the differences of susceptibility to APAP in these cell lines. These two cell lines exhibited different susceptibilities to APAP (0-$5,000{\mu}M$); BNL SV A.8 cells were more susceptible to APAP treatment compared to BNL CL.2 cells. A dose of $625{\mu}M$ APAP, which produced significant differences in cytotoxicity in these cell lines, was tested. Microarray analysis was performed to identify significant differentially expressed genes (DEGs) irrespective of APAP treatment. Genes up-regulated in BNL SV A.8 cells were associated with immune response, defense response, and apoptosis, while down-regulated genes were associated with catalytic activity, cell adhesion and the cytochrome P450 family. Consistent with the cytotoxicity data, no significant DEGs were found in BNL CL.2 cells after treatment with $625{\mu}M$ APAP, while cell cycle arrest and apoptosis-related genes were up-regulated in BNL SV A.8 cells. Based on the significant fold-changes in their expression, a genes were selected and their expressions were confirmed by quantitative real-time RT-PCR; there was a high correlation between them. These results suggest that gene expression profiles may provide a useful method for evaluating drug sensitivity of cell lines and eliciting the underlying molecular mechanism. We further compared the genes identified from our current in vitro studies to the genes previously identified in our lab as regulated by APAP in both C57BL/6 and ICR mice in vivo. We found that a few genes are regulated in a similar pattern both in vivo and in vitro. These genes might be useful to develop as in vitro biomarkers for predicting in vivo hepatotoxicity. Based on our results, we suggest that gene expression profiles may provide useful information for elucidating the underlying molecular mechanisms of drug susceptibility and for evaluating drug sensitivity in vitro for extrapolation to in vivo.

• 한국환경농학회지
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• 제28권3호
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• pp.310-325
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• 2009

동물용의약품은 가축의 질병예방 및 치료, 성장 촉진 등 생산성을 높이는 목적으로 사용되는 의약품임에도 불구하고 무분별하게 과용 또는 남용되면 축 수산물에 잔류하게 되고 장기간 노출될 경우 인체에 유해할 수 있기 때문에 관리가 필요한 물질이다. 국내 동물용의약품의 관리는 국립수의과학 검역원에서 국내 사용되는 동물용의약품의 허가를 담당하고 있으며, 식품의약품안전청은 해당 동물용의약품의 잔류자료, 일일섭취허용량, 식품섭취량 및 국민평균체중 등을 이용하여 위해평가를 실시하고 그에 알맞은 잔류허용기준을 고시하고 있다. 현재 국내의 동물용의약품에 대한 잔류허용기준은 116 개가 고시되어 있으며, 2009년 말까지 총 142종에 대하여 기준이 설정될 예정이다. 또한 2010년 1월 1일부터 축 수산물 (유, 알 포함) 및 벌꿀에서 기준 미설정 항생제 및 합성항균제가 검출될 경우 0.03 mg/kg의 일률기준을 적용함으로써 축 수산물에 대한 안전관리가 강화하게 된다. 현재 동물용의 약품의 기준관리는 이미 선진국 수준으로 운영되고 있으며, 잔류분석법도 또한 국제적 수준에 맞게 개선할 예정이다.

• 대한임상독성학회지
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• 제3권1호
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• pp.22-26
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• 2005

The majority of acute toxic poisoning occur via oral route. The most important emergency treatment of acute poisoning are gastric lavage. Gastric lavage should be considered a patient has ingested a potentially life-threatening amount of a poison and the procedure can be undertaken within 60 mins of ingestion. But, gastric lavage does not consist properly in the cases of emergency situation or an inexperienced doctors treat. The purpose of this study was to determine whether gastric lavage is performed properly. Eighty patients were enrolled in the study in 12-month period from January to December 2002. A retrospective chart review was performed on patients identified as drug overdose who admitted to ER. To assess whether there was a subgroup of patients who may have been candidates for the initiation of gastric lavage in the ER, the patients divided in two groups by time interval from toxin ingestion to ER arrival. The group 1 that admit within 60 minutes after drug ingestion was 38 cases ($47.5\%$), and the group 2 patient who admitted after 60 minutes was 42 cases ($52.5\%$). The average age was $44\pm19$ years in group 1, and $48\pm24$ years in group 2. There were no differences in sexual distribution of two groups. The mean time interval was $49\pm20$ minutes in the group $1,258\pm190$ minutes in the group 2. Only thirty ($37.5\%$) of the patients had an overdose for which the treatment of gastric lavage was potentially feasible according to guideline. The correctly performed gastric lavage was 18 ($47.4\%$) in group 1, 12 ($28.6\%$) in group 2. We must enforce education about the gastric lavage, and do so that may treat according to guideline.

• 대한임상독성학회지
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• 제13권1호
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• pp.1-10
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• 2015

Purpose: The purpose of this study was to evaluate the usefulness of intravenous lipid emulsion as well as adverse events in acute poisoning patients. Methods: Literature was accessed through PubMed, EMBASE, Cochrane library, Web of science, and KoreaMed. All forms of literatures relevant to human use of intravenous lipid emulsion for acute poisoning were included. Cases reports or letters without description of clinical outcomes for each case were excluded. The literature search was conducted by two investigators in March, 2015, with publication language restricted to English and Korean. The effect, onset time, and adverse event of lipid emulsion and final outcome of each case were analyzed. Results: Eighty-one published articles were included, excluding articles whose title and abstract were not relevant to this study. No articles were classified as high level of evidence. Sixty-eight case reports were identified, consisting of 25 local anesthetics and 43 other drugs, such as tricyclic antidepressants and calcium channel blockers. Although most cases described significant clinical improvements, some of them showed no beneficial effect or worsening of clinical course. Several adverse events including hyperamylasemia and laboratory interference were reported. Conclusion: Although there were many case reports illustrating successful use of lipid for various drug poisonings, the effect cannot be estimated due to significant possibility of publication bias. Therefore, lipids might be considered in severe hemodynamic instability resulting from lipophilic drug poisoning, however further studies should follow to establish the use of lipid as the standard of care.

• Journal of Dental Anesthesia and Pain Medicine
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• 제19권4호
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• pp.181-189
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• 2019

Local anesthetic systemic toxicity (LAST) refers to the complication affecting the central nervous system (CNS) and cardiovascular system (CVS) due to the overdose of local anesthesia. Its reported prevalence is 0.27/1000, and the representative symptoms range from dizziness to unconsciousness in the CNS and from arrhythmias to cardiac arrest in the CVS. Predisposing factors of LAST include extremes of age, pregnancy, renal disease, cardiac disease, hepatic dysfunction, and drug-associated factors. To prevent the LAST, it is necessary to recognize the risk factors for each patient, choose a safe drug and dose of local anesthesia, use vasoconstrictor, confirm aspiration and use incremental injection techniques. According to the treatment guidelines for LAST, immediate application of lipid emulsion plays an important role. Although lipid emulsion is commonly used for parenteral nutrition, it has recently been widely used as a non-specific antidote for various types of drug toxicity, such as LAST treatment. According to the recently published guidelines, 20% lipid emulsion is to be intravenously injected at 1.5 mL/kg. After bolus injection, 15 mL/kg/h of lipid emulsion is to be continuously injected for LAST. However, caution must be observed for >1000 mL of injection, which is the maximum dose. We reviewed the incidence, mechanism, prevention, and treatment guidelines, and a serious complication of LAST occurring due to dental anesthesia. Furthermore, we introduced lipid emulsion that has recently been in the spotlight as the therapeutic strategy for LAST.

• Advances in Traditional Medicine
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• 제3권1호
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• pp.8-17
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• 2003

Water extract (kwath) of six different widely used Ayurvedic medicinal plants were tested in mice for possible neuropharmacological efficacy. In the present experiments it was observed that a number of plant tested causes a significant level of Central Nervous System (CNS) depression, in that it significantly decreased the spontaneous Motor activity, and also lowered the exploratory behavior of the treated animals. Terminalia chebula (HAA), Terminalia bellerica (BHA), Emblica officinalis (AA), Piper longum 1. (PP). exhibited depressant action of on the CNS. Apart from them a mild to moderate degree of depression was evident as a consequence of administration of Zingiber officinale Rosc (SUT), Piper nigrum L. (MRC). However, none of the plant tested did not exhibit significant effects on pentobarbital induced narcosis, and this indicated that the sedating effects of the drug was not associated with the risk of fatal consequences on overdose.

• 한국임상약학회지
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• 제32권3호
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• pp.178-184
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• 2022

Background: Migraine is one of the leading causes of poor quality of life and disability, and migraine incidences in pediatrics are increasing. Proper medication is important for the preventive and acute treatment of migraine. This study aimed to identify the current status of prescribed medication in pediatric patients with migraine. Methods: We used data from a sample of pediatric patients from the Health Insurance Review and Assessment Service (HIRA-PPS-2018) and analyzed the status of prescription drugs and frequency of visits to medical institutions with migraine diagnoses in pediatric patients. Results: A total of 12,228 pediatric patients diagnosed with migraine during 2018 were analyzed. Among these patients, 7,170 (58.64%) were girls and 9,510 (77.77%) were adolescents. Additionally, 9,157 patients (74.89%) received acute treatment, and 592 patients (4.84%) received combination therapy with analgesics and triptans. Acetaminophen for acute treatment and flunarizine for preventive treatment were the most commonly prescribed. In most children and adolescents, acute treatment drugs were prescribed for less than 14 days. Conclusion: Analgesics, such as acetaminophen or non-steroidal anti-inflammatory drugs, were prescribed frequently for acute treatment in pediatric patients with migraine. The drug prescription duration was within the recommended range, indicating a low risk of overdose. For preventive treatment, clinically studied medication for pediatric patients with migraine was used.

• 한국환경농학회지
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• 제32권3호
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• pp.214-223
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• 2013

Dichlorprop(DCPP)는 phenoxyalkanoic acid계열로서 인체에 유해한 것으로 알려진 fenoprop, 2,4-D 및 daminozide의 대체 약제로 사용되어온 auxin 활성 생장조정제로 과수의 낙과 방지에 이용된다. 하지만, DCPP의 과다 사용은 과실의 숙기를 촉진시키며 연화 및 저장력을 현저히 저하하는 부정적인 영향을 나타내며, 제초제의 특성을 나타내기 때문에 농산물에 과다 사용하여 잔류허용기준을 초과할 경우, 인체에 유해할 수 있다. 따라서 본 연구는 생장조정제로 사용되고 있는 DCPP에 대하여 국내에 유통되는 농산물을 대상으로 잔류 실태 조사 연구를 실시하고자 기존 식품공전 분석법을 개선하여 신속하고 효율적인 분석법으로 재확립 하였다. 분석법 검증에 사용된 시료는 농산물의 메트릭스를 대표할 수 있는 농산물 5종(감귤, 감자, 고추, 대두 및 현미)을 사용하였다. 검체에 아세톤을 가하고 산성화시켜 추출한 후 산-염기 액-액 분배법을 이용해 추출, 정제 및 농축 과정을 거쳤다. 농축에 의해 얻어진 잔류물은 메탄올로 재용해한 후, 이중 2 mL를 취해 $BF_3$-메탄올 용액으로 메틸화한 후, 헥산 및 5% 염화나트륨을 사용해 최종 정제를 거친 용액을 헥산으로 재용해하여 GC/ECD에 주입하였다. 기기분석은 DB-17 중간 극성 칼럼과 운반 기체로 질소 가스를 사용하였고, split-less 모드 하에 $1{\mu}L$를 주입하여 승온 조건으로 ECD에 의해 측정하였다. 또한, GC/MS를 통해 확인시험을 수행 하였으며, 모든 검증은 CAC 가이드라인(CAC/GL 40, 1993) 규정에 따라 실시하였다. 그 결과, DCPP의 정량 한계는 모든 검체에서 0.05 mg/kg 수준이었고, 회수율은 감귤89.5-94.3%, 감자 79.4-87.4%, 고추 90.5-102.2%, 대두 78.8-101.1%, 현미 90.5-100.4%였으며, 변동계수는 감귤 2.5-9.5%, 감자 1.4-2.6%, 고추 2.7-3.9%, 대두 3.4-7.3%, 현 미 1.2-2.1%로 나타났다. 이상의 결과는 국제식품규격위원회 가이드라인 규정(CAC/GL 40, 1993)에 만족하는 수준으로, 새롭게 개선된 DCPP 분석법은 향후 국내 유통 농산물을 대상으로 한 생장조정제 DCPP의 잔류 실태 조사 연구에 활용될 계획이다.

• 대한임상독성학회지
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• 제16권2호
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• pp.68-74
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• 2018

Purpose: In 2012, a revised guideline for acute acetaminophen overdose was proposed in the UK, recommending that the treatment threshold should be lowered to 100 mcg/ml at 4 hours after ingestion without risk stratification of hepatotoxicity. However, the poison centers in some developing countries do not have laboratory resources to provide serum drug levels in time. The primary aim of the study is to evaluate the cut-off value of reported dose per kilogram to determine when N-acetylcysteine treatment is warranted under the revised guideline. Methods: Data were collected retrospectively from the toxicology registry of an urban emergency medical center between 1st January 2010 and 30th June 2017. Inclusion criteria were single acute overdose of more than 75 mg/kg in 15 hours from ingestion and over 14 years of age. Subgroups were created by 25 mg/kg increments of reported dose, then sensitivity, specificity, positive predictive value and negative predictive value were calculated for the cut-off values of 100 mg/kg, 125 mg/kg, 150 mg/kg and 175 mg/kg for toxic serum level over '100-treatment line'. Results: A total of 99 patients were enrolled in the study; 24 patients showed toxic serum levels (24.2%). Zero of 17 patients with an ingestion dose under 100 mg/kg showed toxic level (0%), and 0 of 15 under 125 mg/kg (0%), 2 of 14 under 150 mg/kg (14.3%), and 4 of 12 under 175 mg/kg (33.3%) had toxic levels. The higher the ingested dose per kilogram of weight, the higher the frequency of the toxic serum concentration on the first test (${\chi}^2$ test for trend, ${\chi}^2=22.66$, p-value<0.001) and the sensitivity of each value was 100%, 100%, 92% and 76%. Conclusion: In acute single acetaminophen intoxication, the ingestion dose of 100 mg/kg of weight will be useful in determining the need for the N-acetylcysteine antidote in the indigent laboratory environment.