• Asian Pacific Journal of Cancer Prevention
• /
• v.15 no.19
• /
• pp.8259-8263
• /
• 2014

Aims: To determine the clinical characteristics, pathological features, local and distant failure patterns in patients with carcinoma of major salivary glands treated with surgery and postoperative radiotherapy (PORT). Materials and Methods: We retrospectively reviewed 106 cases of major salivary gland tumor seen at our centre (1998-2008). Sixty five cases of major salivary gland carcinoma were selected for analysis (exclusions: benign, palliative, non-carcinomas). The patient population treated by surgery and PORT was divided into two groups: 1) Patients who underwent surgery and immediate PORT (Primary PORT); 2) Patients with recurrent carcinoma who underwent at least two surgeries and received PORT in the immediate post-operative period of the last performed surgery (Recurrent PORT). Recurrence free survival (RFS) was assessed using the Kaplan-Meier method. Results: Median age was 35 years with a male: female ratio of 1.3:1. The majority of cancers were located in the parotid gland (86.2%) and the most common histology was mucoepidermoid carcinoma (43%). Thirty nine cases (60%) were primary while 26 (40%) were recurrent. Optimal surgery was performed in 59/65 patients (90.8%). 43 patients (66.2%) underwent neck dissection, of which 14 (32.5%) had nodal metastasis. Overall, 61 (93.8%) patients complied with the prescribed radiotherapy. Median dose of PORT was 60 Gy. Median follow-up was 13.1 months (range 2-70). Relapse free survival was 50.4% at 60 months. Some 12 cases (18.5%) recurred with a median time to recurrence of 16.9 months. Conclusions: Surgery and PORT is an effective treatment for major salivary gland carcinoma with over 90% compliance and <20% recurrence. Early treatment with postoperative radiotherapy may increase the survival rate in major salivary gland carcinoma patients.

• Journal of The Korean Society of Clinical Toxicology
• /
• v.14 no.2
• /
• pp.92-99
• /
• 2016

Purpose: The use of flumazenil administration in the emergency department is still controversial because of concerns about adverse effects. The present study was conducted to re-evaluate the risk-benefit ratio associated with flumazenil administration to patients suspected of having acute hypnotics and sedatives poisoning in the emergency department. Methods: A retrospective chart review study was conducted for patients whose final diagnoses were "poisoning" and "benzodiazepine" or "sedatives-hypnotics" from Mar. 2006 to Feb. 2015. The basal characteristics of the patients, including past medical history, ingredients and dose of ingested drug and co-ingested drugs were investigated. For patients administered flumazenil, responsiveness and time from admission to flumazenil administration were investigated with supplement. All collected data were analyzed in aspect terms of risk/benefit. Results: A total of 678 patients were included in our study. Benzodiazepine was the most common sedative/hypnotic drug prescribed, and the frequency of prescription continuously increased. The proportion of TCA as co-ingestion decreased from 13.1% to 3.9% in patients with acute sedative/hypnotic poisoning. Flumazenil was administered to 55 patients (8.1%), of which 29 patients (52.7%) were applied to contraindications. Fifty-three patients (96.4%) showed positive responsiveness, including partial responsiveness after flumazenil administration. No severe adverse events were identified. Conclusion: Based on the current trends in prescription patterns for sedative/hypnotic drugs, increased use of non-TCA antidepressants, and responsiveness to administration of flumazenil, benefit seemed weighted more in this study, although the observed benefits were based on limited results. Further prospective multicenter studies will be needed to optimize benefit-risk ratio.

• IMMUNE NETWORK
• /
• v.13 no.4
• /
• pp.123-132
• /
• 2013

Obesity is consistently increasing in prevalence and can trigger insulin resistance and type 2 diabetes. Many lines of evidence have shown that macrophages play a major role in inflammation associated with obesity. This study was conducted to determine metformin, a widely prescribed drug for type 2 diabetes, would regulate inflammation through down-regulation of scavenger receptors in macrophages from obesity-induced type 2 diabetes. RAW 264.7 cells and peritoneal macrophages were stimulated with LPS to induce inflammation, and C57BL/6N mice were fed a high-fat diet to generate obesity-induced type 2 diabetes mice. Metformin reduced the production of NO, $PGE_2$ and pro-inflammatory cytokines ($IL-1{\beta}$, IL-6 and $TNF-{\alpha}$) through down-regulation of $NF-{\kappa}B$ translocation in macrophages in a dose-dependent manner. On the other hand, the protein expressions of anti-inflammatory cytokines, IL-4 and IL-10, were enhanced or maintained by metformin. Also, metformin suppressed secretion of $TNF-{\alpha}$ and reduced the protein and mRNA expression of $TNF-{\alpha}$ in obese mice as well as in macrophages. The expression of scavenger receptors, CD36 and SR-A, were attenuated by metformin in macrophages and obese mice. These results suggest that metformin may attenuate inflammatory responses by suppressing the production of $TNF-{\alpha}$ and the expressions of scavenger receptors.

• Journal of The Korean Society of Clinical Toxicology
• /
• v.1 no.1
• /
• pp.34-39
• /
• 2003

Carisoprodol (CSP) is commonly prescribed as a skeletal muscle relaxant. Recently, we encountered 7 suicidal cases in which carisoprodol was detected. We developed a rugged, sensitive, and specific method for the determination of CSP and meprobamate (MPB) by GC and GC/MS. Postmortem blood concentrations of CSP and MPB ranged 22.9-124.4 ,$\mu$g/ml and its metabolite, 26.8-144.5 ,$\mu$g/ml respectively. Among 7 cases studied, Only CSP was ingested in 4 cases and combination of CSP and dextromethorphan was ingested in 2 cases according to the case history and one case was with ethanol. The order of the tissue concentration of CSP and MPB was liver> kidney > brain, and the concentration of MPB was higher than that of CSP in all tissues. The MPB /CSP concentration ratios of urine, bile juice, liver, kidney, brain and blood were 15.7, 4.0, 1.2, 1.4, 1.4 and 1.0 respectively. There was a big difference in concentration of CSP and MPB in 7 cases due to differences in the amount of dose administered and time to death after dosing.

• Journal of Korean Neurosurgical Society
• /
• v.40 no.3
• /
• pp.148-153
• /
• 2006

Objective : The authors conducted this study to present the long-term treatment outcomes [minimum 2 years] of Gamma knife radiosurgery[GKS] for trigeminal neuralgia[TN] and to demonstrate the correlation of treatment outcomes and the anatomical characteristics of TN. Methods : From 1997 to 2003, 44 consecutive patients suffering from medically intractable pain underwent GKS for TN. A single 4mm collimator was used with a median maximum dose of 80Gy [range $75{\sim}80Gy$] prescribed to the root entry zone of the trigeminal nerve. Median follow up duration was 30 months [range $24{\sim}78\;months$]. Anatomical measurements of trigeminal nerve in magnetic resonance images during GKS planning were correlated with clinical outcome. Results : Twenty-two patients [50%] achieved an excellent outcome [BNI grade I & II], 20 patients [45.5%] a good outcome [grade IIIa & IIIb], and only 2 patients [4.5%] a poor outcome [grade IV & V]. Eleven patients [25.0%] experienced pain recurrence after initial pain relief. Smaller volume of trigeminal nerve area irradiated more than 40Gy was significantly correlated with excellent outcome in both univariate and multivariate analyses respectively [P=0.033 and 0.040]. Conclusion : Anatomical considerations during the planning of GKS would be helpful for predicting clinical outcome in TN.

• Advances in Traditional Medicine
• /
• v.6 no.4
• /
• pp.274-285
• /
• 2006

Allium sativum (Family Amaryllidaceae or Liliaceae) is used worldwide for various clinical uses like hypertension, cholesterol lowering effect, antiplatelets and fibrinolytic activity etc. Due to these common house hold uses of Allium sativum, as a herbal supplements, and failure of patients to inform their physician of the over-the-counter supplements they consume leads to drugnutrient interactions with components in herbal supplements. Today these types of interactions between a herbal supplement and clinically prescribed drugs are an increasing concern. In vitro studies indicated that garlic constituents modulated various CYP (cytochrome P450) enzymes. CYP 3A4 is abundantly present in human liver and small intestine and contributes to the metabolism of more than 50% of commonly used drugs including nifedipine, cyclosporine, erythromycin, midazolam, alprazolam, and triazolam. Extracts from fresh and aged garlic inhibited CYP 3A4 in human liver microsomes. The in vivo effects of garlic constituents are found to be species depended and the dosing regimen of garlic constituents appeared to influence the modulation of various CYP isoforms. Studies have indicated that the inhibition of various CYPs by organosulfur compounds from garlic was related to their structure also. Studies using in vitro, in vivo, animal and human models have indicated that various garlic constituents can be the substrates, inhibitors and or inducers of various CYP enzymes. The modulation of CYP enzyme activity and expression are dependent on the type and chemical structure of garlic constituents, dose regime, animal species and tissue, and source of garlic thus this review throws light on the possible herb drug interaction with the use of garlic.

• Korean Journal of Clinical Pharmacy
• /
• v.20 no.3
• /
• pp.193-199
• /
• 2010

Tacrolimus, an immunosuppressant prescribed against graft-versus-host disease (GVHD) in patients with allogeneichematopoietic stem cell transplantation (HSCT), is affected to change its pharmacokinetic properties by various factors. For this reason, it is needed a close monitoring to adjust dosage amount in order to optimize the blood concentration of tacrolimus is located within the effective range. According to our in-house study, 62% of HSCT-patients were needed dosage-adjustment and it is necessary to optimize the current immunosuppressive regimen in clinical settings. A retrospective study was designed to evaluate the dosing regimen (converting ratio of IV:PO=1:4) of tacrolimus in HSCT patients (n=62). After collecting data from patient's profile and medical record, pharmacokinetic parameters were calculate and compared between the estimated and the actual values in the selected subjects (n=58). It was found that the bioavailabilty (BA) of oral tacrolimus was 40.5% very much different from that is known as 25%. It implies that the current protocol has a potent risk causes dose-related toxicities to the patients. Furthermore, analyses among factors demonstrated that there was no statistical significance between BA of tacrolimus and the variable factors. In the clinical perspectives, the current converting ratio of tacrolimus in patients with HSCT to be re-considered and an appropriate and optimal alternative regimen should be adopted to prevent GVHD and to increase the quality of life of patients.

• Research in Community and Public Health Nursing
• /
• v.18 no.1
• /
• pp.5-13
• /
• 2007

Purpose: The purpose of this study is to investigate compliance with prescribed medication in the elderly visiting public health centers. Method: Data were collected from 665 elders living in Seoul and the Gyeonggi Province during the period from February 21 to June 30 in 2006. The data were collected through individual interviews and were analyzed using correlation and multiple regression analysis with the SAS 9.1 program. Results: The mean of medication compliance was 2.97(${\pm}.68$) on a 5-point Likert scale. Specifically, compliance 3.14(${\pm}.70$) for medication dose, 2.94(${\pm}.77$) for medication frequency, and 2.84(${\pm}.79$) for medication time. The elderly with a higher level of education (${\beta}=.095$, p<.001), with health insurance (${\beta}=.208$, p=.0009) and with a higher level of family support (${\beta}=.040$, p=.0306) showed a higher level of mediation compliance. Female elders (${\beta}=.142$, p<.001) kept higher medication compliance than male ones. Conclusion: These findings suggest that people with low education, low socioeconomic status and less family support need more education before medication. The evaluation of medication compliance needs to be encouraged before starting medication to distinguish those who may not comply with medical prescription. Predictive factors identified in this study must be considered when designing interventions, program development and education for appropriate medication management for the elderly.

• Korean Journal of Pharmacognosy
• /
• v.11 no.2
• /
• pp.85-94
• /
• 1980

In this paper, we studied what the drug name of Sang-Baik-Pi(桑白皮) Mori Cortex Radicis) is, how to collect it; and how the chief symptoms had changed in the chinese medical references and herbological literatures and formularies. Also we bibliographically analyzed in the herbological way the drugs combinated with Sang-Baik-Pi and their active principles among the prescriptions in the famous medical book; 'Dong-Ui-Bo-Gam', (東醫寶鑑) of our country. Finally, we concluded as foolow. Numerous names of botainical origin were described, but it was not recorded that San-Keun-Baik-Pi(桑根白皮) in old days is different from root bark of Morus sp. in this times. Sang-Baik-Pi has been a common designation since Ming dynasty (AD 1500). Collections of it were independent of seasons, it could effect perfectly over 10 years old. And its cork layer should be removed after collections, it was especially emphacised that root bark on ground was poisonous. The chiefly cured symptoms with Sang-Baik-Pi were constantly not different from the contents of 'Shin-Nong-Bon-Chau-Kyung'(神農本草經) in ancient times, but it has been developed since Ming dynasty. Its uses are widely extended to a surgical and dermatologic desease; rheumatis, beriberi and diabetes in this times. and its efficacies depend upon curing. Prescriptions on Sang-Baik-Pi that were prescribed in 'Dong-Ui-Bo-Gam' are there, 177 drugs combinated with it. Glycyrrhizae Radix is most frequently combinated with Sang-Baik-Pi(frequently 68%). It is proved that Armeniacae Semen, Platycodi Radix etc, in the order take strong effects on anti-tussive, anti-phlogistic, diuretic, anti-pyretic etc. It is expressed 34 times, frequently, that a dose is 3.75g, and it shows that a usual doses is 2-4g. As the above prescriptions are classified, the results is as follows, respiratory tract desease is most frequently in 69 prescriptions, the next gastrointestinal tract 13 times, diuretic 12 times, and antipyretic 11 times. Therefore, Sang-Baik-Pi contains a good remedial value chiefly of the effects upon the respiratory diseases.

• Korean Journal of Clinical Pharmacy
• /
• v.24 no.1
• /
• pp.1-8
• /
• 2014

Objective: Currently, rivaroxaban is widely used clinically for thromboprophylaxis after surgery. However, there are concerns on effectiveness and safety of rivaroxaban for its proper use. We aimed to evaluate the effectiveness and safety of rivaroxaban in orthopaedic patients after total hip replacement surgery in a large medical centre after the preferred formulary was switched from enoxaparin to rivaroxaban. Methods: The study was conducted on the patients who underwent hip arthroplasty surgery at the department of Orthopaedic Surgery at Seoul St. Mary's Hospital, South Korea. Electronic medical records were retrospectively reviewed to identify patients treated with rivaroxaban following total hip replacement between February 2011 and March 2012. Evaluation criteria included indications for use, dose, initiation and duration of therapy, drug interactions, adverse reactions, and status of health care reimbursement. The patients who were on enoxaparin were also reviewed as a reference. Results: We identified 57 patients who received rivaroxaban and 50 who received enoxaparin. All patients were prescribed the drugs for Korean Food and Drug Administration-approved indications. No thromboembolic or bleeding events were observed in either group. However, only 5.3% of rivaroxaban- treated patients had an appropriate length of prophylaxis and only 3.5% began rivaroxaban treatment at the recommended time. Surprisingly, 47.4% of rivaroxaban-treated patients received rivaroxaban despite being ineligible for reimbursement benefits. Conclusion: Rivaroxaban was generally well tolerated clinically. However, the duration of treatment, the time of initiation and patient eligibility for reimbursement require improvements, emphasising the need for education which indicates the area of pharmacists' involvement.