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Dosage Adjustment before and after Warfarin - Rifampin Combination Therapy (와파린-리팜핀 병용 시 용량 조절)

  • Kim, Dong-Hyun;Kim, Kyung-Hwan;Choi, Kyung-Hee;Lee, Kwang-Ja;Lee, Hye-Suk;Son, In-Ja;Kim, Ki-Bong;Lee, Jae-Woong;Ahn, Hyuk
    • Journal of Chest Surgery
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    • v.41 no.3
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    • pp.354-359
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    • 2008
  • Background: Warfarin is used as an anticoagulant and it is mainly excreted by the liver metabolism (the R-form is mainly metabolized by cytochrome p450 3A4, and the S form by cytochrome p450 2C9). Rifampin is usually used for tuberculosis or endocarditis, and it is a representative drug that induces the CYP families, including 3A4 and 2C9. The anticoagulation effect of warfarin decreases through the increased metabolism that's due to the induction of enzymes, and this iscaused by rifampin when patients take these two medicines together. No one has suggested appropriate guidelines regarding this drug interaction even though an appropriate adjustment of warfarin's dosage is needed. We examined the drug interaction in patients who received warfarin-rifampin combination therapy according to the time interval, and the factors affecting drug interaction were analyzed. Based on the data, we tried to determine the clinically available warfarin dosage guidelines before and after taking this drug combination. Material and Method: We reviewed the OO University Hospital anticoagulation service team's follow up sheets that were filled out from Jan '1998 to Sep 2006 for the patient who took warfarin - rifampin combination therapy (n=15). Result: The average INR of all the patient before rifampin administration was $2.25{\pm}0.52$ $(mean{\pm}SD)$, and that value for the first 100 days after rifampin administration was $1.98{\pm}0.28$. The p value for these two sets of data showed no correlation (paired t-test, p>0.05). The average INR of all the patient before rifampin cessation was $2.19{\pm}0.34$, and the value after rifampin cessation was $2.49{\pm}0.43$. The p value of these two showed correlation (paired t-test, p<0.05) but the average INR falls between the therapeutic INR range. Conclusion: The warfarin dose adjustment equation of before and after warfarin-rifampin combination therapy was derived based on this study's results because the warfarin dosage adjustment of the anticoagulation service team was considered appropriate.

Ceftriaxone Associated Biliary Pseudolithiasis (Ceftriaxone 사용후 발생된 Pseudolithiasis)

  • Kim, Jae-Young;Ko, Jae-Sung;Lee, Hwan-Jong;Ko, Young-Ryul;Seo, Jeong-Kee
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.1 no.1
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    • pp.100-106
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    • 1998
  • Purpose: Ceftriaxone, a potent parenteral third-generation semisynthetic cephalosporin is widely used for the treatment of a variety of bacterial infections in both children and adult. Review of recent data indicates that ceftriaxone treatment has been associated with the development of reversible biliary pseudolithiasis and that is thought by many to be a benign process. Despite, several reports describe patients with ceftriaxone pseudolithiasis who required cholecystectomy for presumed acute cholecystitis. In this study we evaluated the incidence, risk factors, and prognosis of gallbladder pseudolithiasis after ceftriaxone treatment. Methods: Between march, 1997 and January, 1998, any child admitted to the Children's hospital of National University of Seoul and prescribed ceftriaxone for probable or definite bacterial infection were eligible for the study. 21 of them had ultrasound examination on the 2~12 days later after the start of ceftriaxone treatment, 8 of whom documented gallbladder precipitates or pseudolithiasis during treatment by serial abdominal ultrasound. Repeat abdominal ultrasound was performed 10~80 days later after the end of ceftriaxone treatment. The children with underlying liver disease or decreased renal function were excluded in this study. Results: 1) 21 children had ultrasound examinations of gallbladder during ceftriaxone treatment and 8 (38%) of them acquired pseudolithiasis. 2) The patients who developed gallbladder pseudolithiasis were significantly older ($6.3{\pm}2.9$ yr. vs $2.2{\pm}3.1$ yr.)(p<0.05), and older than 24 months were probably the significant risk associated with this phenomenon (p<0.05). However, no significant differences in sex, type of infection, fasting, and ceftriaxone treatment regimen (dose, duration of therapy). 3) The abnormality found on gallbladder ultrasonography was a strikingly hyperechogenic material with post-acoustic shadowing in 5 patients without post-acoustic shadowing in 3 patients 4) Follow up of gallbladder ultrasound was performed in 6 patients after cessation of ceftriaxone treatment. Sonographic abnormalities completely resolved within 14 days post cessation of therapy in 2 patients; 30 days, 1 patient; 80 days, 3 patients. Conclusions: We suggest that routine abdominal ultrasound should be considered in all children who received high dose ceftriaxone in more than 24 months of age and developed hepatobiliary symptoms during or just after ceftriaxone treatment.

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Optimal Time to Localize Bleeding Focus and the Usefulness of Flexible Bronchoscopy in Hemoptysis (객혈에서 굴곡성 기관지경의 출혈부위 결정을 위한 적절한 시행시기 및 그 유용성)

  • Lee, Jae-Ho;Koh, Won-Joong;Lee, Chan-Ju;Chung, Hee-Soon
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.3
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    • pp.353-364
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    • 2000
  • Background : Bronchoscopy is a useful diagnostic tool, for accurate localization of the bleeding site and the management of hemoptysis. However, there is some controversy about the optimal timing of bronchoscopy. Method : To determine the optimal timing of bronchoscopy in hemoptysis, we reviewed the medical records of 118 patients and analyzed the following relationships amongst simple chest PA findings, namely, the duration and amount of hemoptysis, and the timing of bronchoscopy retrospectively. Results : The major causes of hemoptysis were active tuberculosis(28.8%), inactive tuberculosis(10.2%), bronchiectasis(17.0%), lung cancer(7.6%), and aspergilloma(7.6%). Localization of the bleeding focus by bronchoscopy was possible in 87.5% (21/24 cases) during active bleeding, and it was possible in 40.4% after bleeding had stopped(p<0.05). The localization rate of bleeding focus was 59.8% when the chest PA showed certain abnormalities, but it decreased to 27.8% when the chest PA finding was normal(p<0.05). When chest PA showed diffuse abnormalities or its finding was normal, the localization rate of bleeding focus significantly increased if bronchoscopy was performed during bleeding or within 48 hours of the cessation of active bleeding. The localization rate was higher as the amount of hemoptysis became larger(p<0.05). The localization rate of early bronchoscopy(during bleeding or within 48 hours of the cessation of active bleeding) was significantly higher when the duration of hemoptysis was less than 1 week, but there was no advantage if the duration was 1 week or longer. Early bronchoscopy was also necessary to localize the bleeding focus for surgical resection in 4 patients, and the bronchoscopy itself was therapeutic in 1 patient whose bleeding was successfully managed with thrombin-application via bronchoscope. Conclusion : It is concluded that flexible bronchoscopy is useful at not only localizing the bleeding focus but also in preparing a therapeutic plan, and early bronchoscopy is more favorable in hemoptysis.

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Effect of Sand Extraction on Meiobenthic Community of Jangbong-do in the Eastern Yellow Sea of Korea (서해 주문도 연안 사질 조하대에서의 해사채취가 중형저서동물 군집에 미치는 영향 연구)

  • Kang, Teawook;Min, Won-Gi;Hong, Jae-Sang;Kim, Dongsung
    • Korean Journal of Environmental Biology
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    • v.32 no.2
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    • pp.138-152
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    • 2014
  • The objective of the study survey was to determine the effect of marine sand extraction on community composition and rate of recolonization of the meiobenthos following cessation of mining activities. Because of meiobenthic distribution in nature, high abundance, intimate association with sediments, fast reproduction, benthic larva period, sensitivity to pollution and rapid life histories, meiobenthos are widely regarded as ideal organisms to study the potential ecological indicator of natural and anthropogenic stresses. The community structure of meiobenthos was studied at seven stations within sandy tidal and sub tidal zones in Jangbongdo in the Yellow Sea, Korea from Aug. 2006 to Dec. 2007. Meiobenthic samples were collected by three core samples, with a 3.6 cm in diameter, from each sediment sample taken with a Smith-McIntyre Grab. It was found that sand mining often causes complete removal of the sediment and the damage to the habitats of meiobenthos. This study in the effect showed that sand mining resulted in a reduction in total abundance and biomass of meiobenthos in mining area. The finding of this study further showed that initial restoration of abundance and biomass within one year of the cessation of sand mining.

Changes in Organic and Inorganic Nutrients in Terminal Shoots of 'Fuyu' Persimmon during Spring Growth (감나무 정단신초의 봄 생장 동안 유기 및 무기 양분의 변화)

  • Yoon, Young-Whang;Choi, Seong-Tae;Park, Doo-Sang;Rho, Chi-Woong;Kim, Dae-Ho;Kang, Seong-Mo
    • Horticultural Science & Technology
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    • v.32 no.3
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    • pp.279-288
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    • 2014
  • To understand changes in composition and distribution of nutrients during early shoot growth of persimmon, organic compounds and inorganic elements of terminal shoots were analyzed for about 40 days from the time of foliation. Sample shoots were collected from mature 'Fuyu' trees for this three-year experiment and they were divided to stem, leaves, and the fruits including flower buds at the earliest stage. During shoot growth, concentration of soluble sugars increased in both leaves and fruits, but that of starch increased only in leaves. Those of amino acids tended to decrease in all the parts but there was no consistent change in proteins. As shoots grew, contents of all the organic compounds in a shoot increased, and they were especially higher in May leaves accounting for more than 60% of the shoot total for each nutrient. Along with shoot growth, concentrations of N and P gradually decreased in all three parts, while K decreased only in stem. However, those of Ca and Mg did not show notable changes in all the parts with wide variations depending on the year. Due to the quantitative increase in growth, contents of inorganic elements in a shoot increased in all the parts and the leaves accounted for 54-82% of the shoot total. At the cessation time of extension growth, a shoot contained 526-768 mg of soluble sugars, 245-844 mg of starch, 26-31 mg of amino acids, and 66-103 mg of proteins for three years. On the other hand, a shoot contained 203-388 mg of K, the greatest among the inorganic elements, followed by 132-159 mg of N. Changes of the nutrients in a shoot were much greater during the earlier stage of growth after foliation than during the later stage toward growth cessation, suggesting the importance of mobilizing reserve nutrients for the early growth of the shoots. The results of this study also suggested that the rate of nutrient changes, especially during the earlier stage of shoot growth, could be affected by environmental and cultural conditions.

Hypofractionated Radiotherapy for Small-sized Hepatocellular Carcinoma as Salvage Therapy: Sustained Local Control and Safety (작은 크기의 재발성 간세포암에 대한 구제치료로 소분할 방사선치료: 국소 제어율과 안전성)

  • Bae, Sun-Hyun;Park, Hee-Chul;Lim, Do-Hoon;Lee, Jung-Ae;Choi, Moon-Seok;Lee, Joon-Hyoek;Koh, Kwang-Cheol;Paik, Seung-Woon;Yoo, Byung-Chul
    • Radiation Oncology Journal
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    • v.28 no.2
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    • pp.85-90
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    • 2010
  • Purpose: To evaluate the rate of tumor response, local control, and treatment-related complications after hypofractionated radiotherapy for recurrent hepatocelluar carcinoma (HCC) less than 5 cm in size. Materials and Methods: Among the HCC patients who were treated by radiotherapy (RT) between 2006 and 2007 after the failure of previous treatment, a total of 12 patients were treated with hypofractionated RT. The criteria for hypofractionated RT was as follows: 1) HCC less than 5 cm, 2) HCC not adjacent to a critical organ, 3) HCC without portal vein tumor thrombosis, and 4) less than 15% of normal liver volume that irradiated 50% of the prescribed dose. Hypofractionated RT was performed with 50 Gy delivered in 10 fractions, at a rate of 5 fractions per week. The evaluation of tumor response was determined by CT scans performed at 3 months after the cessation of RT, followed by the evaluation of toxicity by Common Terminology Criteria for Adverse Events version 3.0. The median follow-up period after radiotherapy was 18 months. Results: A complete response (CR) was achieved in 5 of 12 lesions (41.7%) at CT performed at 3 months after the cessation, whereas the overall complete response was observed in 7 of 12 cases (58.3%). In-field local control rate was sustained in 83.3% of patients. All patients developed intra-hepatic metastases except for 2 patients. The overall survival rate was 90.0% at 1 year and 67.5% at 2 years, respectively. Three patients developed Grade 1 nausea during RT and 1 patient showed a progression of ascites after RT. There was no grade 3 or greater treatment-related toxicities. Conclusion: Hypofractionated RT for small-sized HCC as a salvage therapy showed a 58.3% CR rate and 83.3% of local control. Fifty Gy administered in 10 fractions of partial liver irradiation is considered as a tolerable dose that does not cause severe complications.

Factors associated with Electronic Cigarettes Use in Korean Adults (한국 성인의 전자담배 사용 관련요인)

  • Park, Eui-Cheol;Bae, Seok-Hwan;Lee, Moo-Sik
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.20 no.8
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    • pp.47-55
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    • 2019
  • This study was conducted to investigate the factors associated with electronic cigarette use by Korean adults. To accomplish this, data collected from 228,477 individuals during a community health survey conducted by the Korean Centers for Disease Control and Prevention in 2015 were analyzed by descriptive analysis, the Chi-squared test, and logistic regression analysis. The lifetime prevalence of electronic cigarette smoking was 11.1% for men and 0.8% for women. The current prevalence for electronic cigarettes smoking was 24.2% for men and 26.1% for women among lifetime users of electronic cigarettes. The lifetime experience rate of electronic cigarette smoking was significantly associated with age, educational attainment, occupation, income status and current smoking status, respectively. The current universal smoking e-cigarette is significantly related to the current smoking status, which shows a significantly higher number of current smokers than groups that have smoked in the past. The preference for electronic cigarette smoking was high. E-cigarettes were perceived by those who aimed to quit smoking as having a smoking cessation effect compared to regular cigarettes while also providing the pleasure of smoking and addressing the addiction. Therefore, e-cigarettes were highly favored because they were reflected as a solution to the dilemma of smoking. In 2014, electronic cigarette imports tripled from the previous year, and interest in electronic cigarettes is increasing worldwide. Accordingly, measures related to the prevention and discontinuation of e-cigarettes should be considered. Strengthening anti-smoking education and active promotion of anti-smoking risks is needed to improve smokers' wrong perception of smoking-related health. The WHO also reports that there is a lack of grounds to ensure or acknowledge that e-cigarettes are effective. Accordingly, it is important to identify environmental factors influencing the use of electronic cigarettes and explore the relationship between electronic cigarette recognition and use.

Effect of Smoking and Drinking Habits on the Nutrient Intakes and Health of Middle and High School Boy Students (남자 중.고생의 흡연과 음주습관이 영양소 섭취 및 건강상태에 미치는 영향)

  • Shin, Kyung-Ok;An, Chang-Hun;Hwang, Hyo-Jeong;Choi, Kyung-Soon;Chung, Keun-Hee
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.38 no.6
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    • pp.694-708
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    • 2009
  • The principal objective of this study was to determine the effects of smoking & drinking on the diet, nutrient intake, and overall health. A sample of 262 youths, aged 16 to 18 year-old, was randomly selected from Seoul and its vicinity. The subjects participated by answering survey questions including general questions, questions regarding health, smoking & drinking habits, dietary habits, nutrient intake, physical characteristics, and smoking cessation plans. The average height, weight, and BMI of the subjects were $173.5{\pm}6.8\;cm$, $64.8{\pm}11.8\;kg$, and $21.4{\pm}3.7\;kg/m^2$, respectively. Among the subjects, 88% appeared to be interested in health and 43.5% of youth asserted that the best way to keep healthy was to engage in regular exercise. Among 63 smokers, 52 students (82.5%) used alcoholic beverages while 11 students (17.5%) did not use alcoholic beverages, meaning that smoking was a causative factor in drinking. 55.6% of youth reported beginning to smoke in middle school, and 38.1% of them asserted that curiosity was the motive for smoking. The youth reported that the craving for smoking was highest when hungry, and the best place to smoke was the restroom. 20 students (69.0%) answered that the only way to quit smoking was just to stop. 12 students (44.4%) reported that the main reason for failures in smoking cessation attempts was a lack of intention or willpower. 87.1% of all subjects answered that they were inclined to quit smoking, and 56.7% of them would be interested in attending a smoking cessation program if they had the opportunity. Among the smoking and drinking group, 50% of drinkers began to drink in high school, and the reason for drinking given was peer pressure-40% of drinkers answered that they wished to quit drinking. 34.4% of students appeared to have breakfast everyday, but 16.4% of students answered that they had quit eating breakfast. 52.5% of all students reported that the principal reason for overeating was the presence of one's favorite food, and the smoking and drinking group reported overeating more frequently than other groups (p<0.05). 72.6% of all subjects reported eating interim meals $1{\sim}2$ times daily, 36.4% of smokers ate carbonated beverages, 38.5% ate ice cream as a interim meal, and 38.5% of the drinking and smoking groups ate fruits, 26.9% of them ate fried foods, and some of them ate fast foods as a interim meal. Among smokers, the ratio of eating fat-rich foods, and meats such as kalbi and samgyupsal more than two times per week was higher, and 54.3% of smokers ate ice cream, cookies, and carbonated beverages more than two times per week (p<0.05). The total nutrient intake of the $15{\sim}19$-year youth group was much higher than the standard value. The energy intake of the smoking group and the drinking and smoking group was significantly higher than that of the normal group (p<0.05). Intakes of phosphorus (p<0.05), cholesterol (p<0.05), and sodium (p<0.05) were the highest among all groups. Accordingly, it is recommended that practical education programs be implemented to teach young students to resist peer pressures to smoke and drink. Additionally, education that acknowledges the importance of nutrition is necessary to avoid preferential eating and overeating due to smoking and drinking.such education can also teach students to eat a balanced diet and improve their physical development.

The Status of Health Education Program and the Needs of Restriction on Drinking and Smoking (대학생의 음주.흡연 예방교육 및 규제기준 마련을 위한 요구도 조사)

  • Bang, Hyeong-Ae;Rhim, Kook-Hwan
    • The Journal of Korean Society for School & Community Health Education
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    • v.9 no.1
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    • pp.143-156
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    • 2008
  • Objectives: This study was performed to examine the effective health education measures and health education programs for college students and also investigated the demands of restriction on drinking and smoking behavior in public area at the school level. Methods: The data were collected from 446 students of five universities located in Seoul and analyzed with SPSS WIN 10.0 program. Results: 1) Current drinkers were average 87.7% (male 90.1%, female 85.3%) and binge drinker was 68.4% (male 76.5%, female 60.2%). Among all drinkers, 19.4% drank more than eight times per month. As for the rate of smoking, 50.9% among the male student, and 12.1% among females were smokers. Among all smokers. the largest group (41.5%) smoked between >$11{\sim}20$ cigarettes per day. Many of the students started smoking in their middle schools (male 29.8%, female 51.5%). It implies that smoking prevention programs need to be emphasized in these schools. 2) The analysis of the correlation between drinking and smoking shows that no smoking students who drank were 66.2%, but abstainer who is smoker were only 5.7%(p=0.004). Alcohol consumption frequency and amount of smokers were higher than those of nonsmokers (p=0.000). The rate of attempts to reduce drinking was 38.1%, mainly for health reason. More than 34.5% of smoking student had made attempts to quit smoking, but succeeded only 16.9%. 3) As for the needs of moderate drinking and smoking cessation education, 67.8% among female students and 53.6% among male demand special education programs. About effective health education measures on drinking and smoking, 49.3% of drinkers and 35.2% of smokers had an inclination for health educator, and the next were video, campaign and pamphlet. 4) The largest group (45.0%) of respondents had agreed to regulate on drinking behavior, and especially 74.5% of them wants to ban the practice in most public area in school. 35.7% among female students and 27.0% among male desired to extend the non-smoking area on whole campus. The health policy for college students, through various ways, such as education, counseling service, and special program on orientation, should be employed. For public health perspectives, university and college community had to institute the detailed enforcement regulation on drinking and smoking.

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A Systematic Review and Meta-analysis of Acupuncture Trials in Republic of Korea that Used Sham Acupuncture as a Control Group (거짓침을 대조군으로 사용한 국내 침 임상시험에 대한 체계적 고찰과 메타분석)

  • Kim, Jung-Eun;Kang, Kyung-Won;Kim, Tae-Hun;Lee, Seung-Hoon;Kim, Joo-Hee;Baek, Seung-Min;Choi, Sun-Mi
    • Journal of Acupuncture Research
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    • v.28 no.6
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    • pp.1-17
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    • 2011
  • Objectives : This study aimed to review randomized controlled trials of acupuncture performed in South Korea that used sham acupuncture as a control group. Methods : The following databases were searched through the end of September 2011: Koreanstudies information service system (KISS), Korean medical database (KMbase), national discovery OR science leaders (NDSL), oriental medicine advance searching integrated system (OASIS), and research information service system (RISS). The following search terms were used: acupuncture AND (sham or placebo). The reference lists of searched articles and Korea institute of oriental medicine (KIOM) reports(2005~2009) were identified. The following data were extracted: year/first author, disease, number of participants, blinding, intervention, outcome, and result. Where appropriate, we performed meta-analysis. The methodological quality was assessed according to the Jadad scale and 'risk of bias' by Cochrane Handbook procedure. Results : Twenty-nine studies were included in this review. In eighteen studies, penetrating sham controls were used as the control intervention, whereas the remaining eleven studies adopted non-penetrating sham controls such as the Park Sham Device or blunt auricular acupuncture. Nine studies showed statistically significant difference in outcomes. Twelve studies concerning insomnia after stroke, chronic tension-type headache, idiopathic Parkinson's disease, Hwa-Byung, and smoking cessation were included in meta-analysis. A meta-analysis of insomnia after stroke only found significant difference(MD -4.31, 95% Cl -6.19 to -2.42, $p$<0.00001). In general, all of the studies showed low methodological quality(Jadad score: mean 2.1). Risk of bias by Cochrane Handbook procedure varied. Conclusions : The results of this study could not suggest conclusive evidence that acupuncture is more effective than sham acupuncture in several diseases. In the future, more studies with rigorous acupuncture trials using sham controls should be conducted.