• Korean Journal of Clinical Pharmacy
• /
• v.20 no.2
• /
• pp.159-164
• /
• 2010

Radiofrequency ablation (RA) is being used to manage atrial fibrillation (AF) with patients failed at the $1^{st}$-line anti-arrhythmic medications. Patients undergoing this procedure are at increased risk of thromboembolism after ablation, and anticoagulation management surrounding the ablation remains controversial. Although no conclusive recommendations can be made, published guidelines and data support therapeutic anticoagulation with warfarin. The purpose of this study was to analyze effectiveness of current therapy and to find factors fluctuate International Normalized Ratio (INR) values in patients undergone RA followed by anticoagulation service (ACS). Retrospective review was conducted utilizing database in a hospital. Among 110 patients under warfarin around ablation between January 2006 to September 2007, 54 patients were selected and allocated into 2 groups: Group A included 47 who discontinued warfarin after ablation, while 7 in B continued the medication. Information on demographics, amount and length of warfarin dosing, INR values and measuring frequencies, and the causing factors on INR fluctuation were abstracted. Differences were analyzed using chi-squared test, Fisher's Exact test, and unpaired Student t-test. Mean amount of warfarin before and after surgery was 4.0 mg, 4.1 mg in Group A and was 5.1 mg, 4.6 mg in Group B, respectively. Average duration of warfarin doing before ablation was 73.7 days in Group A, 129.9 days in B with no significant difference (p = 0.312). The duration time of warfarin on groups after ablation lasted several months. The number of checking INRs was 4.1 and 7.6, respectively. Inter-individual variability of INR fluctuations were $2.1{\pm}0.6$ in Group A and $2.2{\pm}0.7$ in B which were not significantly different (p = 0.062). 164 cases of decreased INR were: 'omission in taking medication, stressfulness and headache, 'increased intake of high vitamin K foods', 'lifestyle change of increased physical activities', and 'increase of food-intakes'. To the contrary, 36 cases of increased INR were: 'reduce of food-intake', 'use of non-prescription drugs', 'reduction in physical activities', and 'excessive restriction on food-intake', consecutively. In conclusion, the study validated therapeutic outcomes of RA patients who we treated with standard guideline and demonstrated 9 factors of INR fluctuations in the patient. A well-trained, pharmacist-monitored anticoagulation service could reduce the risk of adverse effects and prevent complications in patients with AF around RA operation.

• Korean Journal of Biological Psychiatry
• /
• v.4 no.2
• /
• pp.198-210
• /
• 1997

To examine the double-faced thymoleptic(antidepressant and antimanic) effects of risperidone in mood disorders, this article reviews the psychotropic-induced mania, thymoleptic effects of antipsychotics, therapeutic effects of risperidone and risperidone(RIS)-induced mania(RIM) in mood disorders, risk factors of RIM, possible neurochemical mechanism of these thymoleptic effects, pathophysiological and clinical significance of thymoleptic effects, and suggestive clinical guideline of RIS in mood disorders. RIS appeared effective for bipolar disorder at a lower dose than that recommended for schizophrenia, especially in the cases of maintenance of mood stabilizers, and gradual titration from low doses. Manic induction/exacerbation can occur by chance during RIS treatment in mood disorders, schizoaffective disorders, and schizophrenias. The possible risk factors for RIM are refractory mood disorder, especially in bipolar I disorder with poor initial response ; refractory schizoaffective disorders, especially in bipolar type with poor initial response ; refractory chronic schizophrenias, especially with initial responses ; psychotic features ; higher initial doses ; rapid titration ; combined therapy with antidepressants in refractory depression ; and RIS monotherapy in mania/hypomania. RIS is a drug that preferentially block 5-HT2 receptors. The effects of low dose are due mainly to the blockade of 5-HT2 receptors. There are more gradual increase in D2 blockade with increasing dose and this D2 blocking properties become apparent at higher doses. This may be related to a modulation of dopaminergic transmission by 5-HT2 antagonism at lower doses with the direct action of RIS on DA receptors coming into play at higher dose. The serotonergic antagonistic effect may be important for its effects on depressive symptoms. This, together with adequate blo-ckade of D2 receptors, may not necessarily lead to destabilization of mood disorder, but rather to more therapeutic effects. Therefore, this dose-receptor affinity relationship with both antidepressant and antimanic effects according to treatment duration can explain a continuum of antidepressant effect, antimanic effect, behavioral stimulation, and manic/hypomanic induction/exacerbation. It was the recognition of a useful psychiatric side effects by a thoughtful observer with fertile minds that led to their ultimate utilization as psychotropic drugs, i.e., phenothiazine, MAOI, TCA, and lithium. And, in vivo pharmacological challenge by novel psychotropics, as a neurochemical probe, with more specific actions is a useful tool to select pharmacologically homogeneous subgroup of the same phenotypical(clinical) condition, to further study the unknown underlying pathogenesis of various mental illnesses. Finally, RIS may be a useful alternative or adjunctive drug for patients with mood disorders without psychotic features or refractory to treatment with standard antipsychotic drugs. The more conservative doses(tirated slowly from 1-3 mg/d) of RIS, and maintenance of mood stabilizer in the cases with risk factors of RIM are recommended in mood disorder.

• Journal of Trauma and Injury
• /
• v.22 no.1
• /
• pp.77-86
• /
• 2009

Purpose: The appropriate management of traumatic truncal arterial injury is often difficult to determine, particularly if the injury is associated with severe additional truncal lesions. The timing of repair is controversial when patients arrive alive at the hospital. Also, there is an argument about surgery versus stent-graft repair. This study's objective was to evaluate the appropriate method and the timing for treatment in cases of truncal abdominal injury associated with other abdominal lesions. Methods: The medical records at Ajou University Medical Center were reviewed for an 8-year period from January 1, 2001, to December 31, 2008. Twelve consecutive patients, who were diagnosed as having had a traumatic truncal arterial injury, were enrolled in our study. Patients who were dead before arriving at the hospital or were not associated with abdominal organ injury, were excluded. All patients involved were managed by using the ATLS (Advanced Trauma Life Support) guideline. Data on injury site, the timing and treatment method of repair, the overall complications, and the survival rate were collected and analyzed. Results: Every case showed a severe injury of more than 15 point on the ISS (injury severity score) scale. The male-to-female ratio was 9:3, and patients were 41 years old on the average. Sites of associated organ injury were the lung, spleen, bowel, liver, pelvic bone, kidney, heart, vertebra, pancreas, and diaphragm ordered from high frequency to lower frequency. There were 11 cases of surgery, and one case of conservative treatment. Two of the patients died after surgery for truncal organ injury: one from excessive bleeding after surgery and the other from multiple organ failure. Arterial injuries were diagnosed by using computed tomography in every case and 9 patients were treated by using an angiographic stent-graft repair. There were 3 patients whose vessels were normal on admission. Several weeks later, they were diagnosed as having a truncal arterial injury. Conclusion: In stable rupture of the truncal artery, initial conservative management is safe and allows management of the major associated lesions. Stent grafting of the truncal artery is a valuable therapeutic alternative to surgical repair, especially in patients considered to be a high risk for a conventional thoracotomy.

• Radiation Oncology Journal
• /
• v.12 no.1
• /
• pp.109-115
• /
• 1994

The purpose of this paper is to develop an efficient method for the quick determination of multiple isocenters plans to provide optimal dose distribution in sterotactic radiosurgery. A Spherical dose model was developed through the use of fit to the exact dose data calculated in a 18cm diameter of spherical head phantom. It computes dose quickly for each spherical part and is useful to estimate dose distribution for multiple isocenters. An automatic computer search algorithm was developed using the relationship between the isocenter move and the change of dose shape, and adapted with a spherical dose model to determine isocenter separation and cellimator sizes quickly and automatically. A spheric81 dose model shows a comparable isodose distribution with exact dose data and permits rapid calculations of 3-D isodoses. the computer search can provide reasonable isocenter settings more quickly than trial and error types of plans, while producing steep dose gradient around target boundary. A spherical dose model can be used for the quick determination of the multiple isocenter plans with 3 computer automatic search. Our guideline is useful to determine the initial multiple isocenter plans.

• Journal of the Korean Institute of Landscape Architecture
• /
• v.44 no.5
• /
• pp.26-37
• /
• 2016

As activities and convenience of residents in outdoor spaces in apartment houses have been considered important, strategies for making outdoor spaces in apartment houses healing spaces have emerged as a major interest. The purpose of this study is to draw elements for planning healing to create healing spaces in collective housing areas and to present design guidelines. The findings of this study are as follows. Functional elements of a healing environment were classified into safe environment, therapeutic environment, ancillary environment, orientation-reinforcing environment, amenities, and social environment. Outdoor spaces in collective housing areas were divided into collective housing entrance areas, internal and external spread areas, outdoor activity areas, and areas by theme. First, collective housing entrance areas should be planned in such a manner that residents can feel the area is private and easy to recognize. Second, internal and external spread areas should be planned in such a manner that they are easy to access and communicate with neighbors. Third, outdoor activity areas should be divided into an open space, resting space, playing space, and sports space. Open spaces should be planned in such a manner that they can command a fine view and respect the privacy of nearby residents. Resting spaces should be equipped with a shelter that protects users from direct sunlight, rain, and snow as well as include a movable bench. Playing spaces should be built considering development of children's curiosity, adventurous spirit, character, stimulation, and physical health. Playing spaces should be designed in such a manner that roadways and sidewalks can be separated for safe traffic. Sport spaces should be planned in such a manner that they can be associated with a pavilion and trail that provide residents with an opportunity to communicate with each other and rest. Fourth, spaces by theme are classified into sense garden, therapeutic garden, experiential garden, and learning garden. Sense gardens are a small garden based on the five senses. Sense gardens should be designed in such a manner that they can improve users' mental and physical health through programs that stimulate the sense of sight, auditory sense, and olfactory sense. Therapeutic gardens should be designed in such a manner that they can provide a comfortable and relaxing space by minimizing noise. It is advisable for therapeutic gardens to be equipped with a medicinal herb garden, meditation garden, and sense garden. Experiential and learning gardens should be designed in such a manner that they can provide users with a space in which they can enjoy nature and leisure activities. It is advisable for experiential and learning gardens to be equipped with a tea garden, vegetable garden, and camping garden. Healing programs should be designed in such a manner that users can feel relaxed by providing a healing environment, making the most of the natural environment. Further research on evaluating whether the findings of this study are effective in healing in a qualitative and quantitative manner is needed.

• Tuberculosis and Respiratory Diseases
• /
• v.73 no.5
• /
• pp.282-287
• /
• 2012

Broncholiths are defined as calcified materials that occur in a tracheobronchial tree or in a cavity communicating with that. Broncholith has variable clinical features. The therapeutic options to remove broncholiths are so variable that clinicians need to select the most safe and effective methods by mass size, mobility, and location. As yet, there is no consistent guideline removing a broncholith. We report 2 successful cases of removing a fixed broncholith by flexible bronchoscopy guided cryoadhesion. With repeated technique of thawing and freezing with cryoprobe, we could extract the fixed broncholith safely. This method is promising as a way to remove broncholith in the future.

• Annals of Clinical Neurophysiology
• /
• v.12 no.1
• /
• pp.3-6
• /
• 2010

The British guideline for early management of persistent low back pain, published in 2009, indicated that physicians should offer exercise or medication, rather than radiological interventions or injections, as first choice of treatment in the patients with chronic low back pain (CLBP). However, there had been great controversies regarding the effectiveness of interventional treatment of patients with CLBP. Both somatic (discogenic, instability, etc) and psychosocial factors contribute to the pathophysiology of chronic low back pain (CLBP). Although it can be difficult in many occasions, thorough interview with the patients and specific diagnostic approaches can help us to identify which is the main etiology in individual patient. With the recent progress in medical radiology and development of new therapeutic modalities, some subgroups of patients of CLBP caused by somatic factors appear to be good candidates of interventional therapy. Interventional therapy can be considered in patients with CLBP caused by annulus rupture, facet joint degeneration, disc degeneration, and vertebral column instability. Among other subgroups of CLBP, carefully selected patients with disc degeneration show the most favorable result by interventional therapy. In this regard, discogenic pain, either as a form of CLBP or acute discogenic radiculopathy, seems to be a good indication of interventional therapy. Because many spine specialists generally consider those with radiculopathy are easier to be treated, patients with CLBP tend to be subjects of conventional conservative therapy. For these reasons, clinicians should make their best effort to identify every possible somatic cause in patients with CLBP before regarding them as hypochondriacs. In this review, some of the recent evidence on the role of interventional treatment in patients with CLBP will be discussed, and some of our cases who showed favorable results by interventional therapy will be presented.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
• /
• v.13 no.1
• /
• pp.47-66
• /
• 2002

Sexual abuse is emerging as one of the major form of child abuse. In the late 1990s, official reports of sexual abuse began to mushroom at a much more rapid rate than reports of other forms of abuse in Korea. In addition, sexual abuse can cause the most serious emotional-cognitive-behavioral sequelae to victims. Although child & adolescent psychiatrists meet many sexual abuse victims who are referred from many types of child protective services, the psychiatrists may not be likely to give them sufficient and appropriate treatment and guideline for victims and their parents. In this article, the historical concepts, pathophysiological processes, shortterm & longterm sequelae of sexual abuse are reviewed and summarized. And I summarize the intervention and outcome studies for sexual abuse victims. In the close future, the active participation of psychiatrists who help the child and adolescents will be expected in the development of nationwide preventive and therapeutic projects for victims and families of sexual abuse.

• IMMUNE NETWORK
• /
• v.4 no.4
• /
• pp.250-254
• /
• 2004

Background: It is necessary for human beings to uptake vitamin C through diet or supplements. It is also well-known that vitamin C plays an important role in the prevention of scurvy, enhancement of collagen synthesis and anti-tumor immune response. In addition, there are several recent reports regarding the effective role of vitamin C on the regulation of allergic responses, such as atopic dermatitis and asthma. However, the effective therapeutic and preventive measures using vitamin C are not established yet, since vitamin C is seriously unstable in aqueous solution. Therefore, we have investigated the best way to maintain the stability of vitamin C. Methods: After we making a mixture of polyphenol (0.001, 0.01, 0.1%) and vitamin C (1 mM), the mixtures were placed at room temperature both with/without light protection. And then the concentration of ascorbic acid was measured with HPLC. To analyze the in vivo effect of vitamin C on the regulation of skin allergic reaction, polyphenol (0.1%)-vitamin C (1 mM) mixture was applied to the skin and the production of histamine from mast cell was analyzed by Evans blue dye staining. Results: We have found that the polyphenol has preventive power of oxidation of vitamin C. In addition, the production of histamine was suppressed by the polyphenol (0.1%)-vitamin C (1 mM) mixture. Conclusion: We have reached the conclusion that our study suggests the research guideline for the therapy of atopic dermatitis through vitamin C.

• Toxicological Research
• /
• v.33 no.1
• /
• pp.71-77
• /
• 2017

Hormone replacement therapy (HRT) consists of highly effective prescription medications for treating menopausal symptoms; however, these agents have exhibited side effects including the risk of estrogen-induced carcinogenesis. Therefore, interest in phytotherapy-based materials as a natural source of alternatives to estrogen therapy has increased. However, some of these herbal medicines have been reported to increase the risk of estrogen-induced cancer. Herbal formulations composed of a combination of Cynanchum wilfordii Hemsley (CW), Phlomis umbrosa Turczaninow (PU), and Angelica gigas Nakai (AG) extracts (CPAE) have been used for treating menopausal symptoms. Therefore, in this study, we aimed to examine the safety of CPAE by determining its potential adverse estrogenic activity using the Organization for Economic Cooperation and Development (OECD) test guideline 455 (TG455) in a stably transfected transcriptionally activated human estrogen receptor ${\alpha}$ ($hER{\alpha}$)-HeLa9903 cell model. We found that CPAE did not how any estrogenic activity or stimulate promoters containing estrogen response elements in MCF-7 cells. In addition, CPAE showed no significant selective activity against $hER{\alpha}$ and $hER{\beta}$, non-selective activity against the ER, or effects on ER target gene expression. Furthermore, CPAE did not significantly induce MCF-7 cell proliferation and uterine weight increase in ovariectomized rats. These results demonstrate that CPAE can be used as beneficial herbal drug for prevention and therapeutic intervention of estrogen carcinogenesis in menopausal women.