Meropenem 동시 사용으로 인한 Valproic acid의 혈중농도 감소 3예

노은경,김혜경,이명진,안보숙,송영구,김정호 대한화학요법학회 2002 대한화학요법학회지 Vol.20 No.4

서울에 위치한 일개 대학병원에서 광범위 항생제인 meropenem을 사용하기 시작한 2000년 4월부터 2001년 5월까지, valproic acid의 약동학 서비스가 의뢰된 432건 중 meropenem을 동시에 사용했던 3명의 환자에서 모두 valproic acid의 현저한 혈중농도저하를 관찰하였다. 이 급격한 혈중농도 변화기간에 3명의 환자에서 valporic acid와 동시에 사용된 공통 약물은 meropenem 뿐이었다. Meropenem을 사용하기 시작한 시점에서 7일 전후로 valproic acid의 혈중농도는 측정 한계치인 15㎍/㎖ 전후의 수준으로 급격히 감소되었으며, meropenem을 중단한지 1-2일 이내에 valproic acid의 농도는 meropenem을 사용하기 이전 수준으로 빠르게 회복되었다. 이들 환자중 1명은 meropenem을 사용하는 동안 발작을 경험하였다. Meropenem이 valproic acid의 혈중 농도를 감소시키는 기전은 아직 명확하지 않으나, 이들 두 약제의 동시 투여가 요구되는 상황에서는 valproic acid의 혈중농도 모니터링이 더 자주 필요하며, 가능한 다른 항경련제로의 일시적 교체를 고려하여야 할 것이다. Meropenem, a carbapenemn, has a broad spectrum of activity that includes β-lactamase-producing organisms, and are used frequently in treating various infections. Compared with imipenem/cilastatin, meropenem has a lower affinity for the γ-butyric acid (GABA) receptor and thus a lower potential for inducing seizures. This makes meropenern, even at higher dosages and costs, suitable for the treatment of patients with infections of the central nervous system and for the treatment of infections in patients with high risk of seizure attack. In 3 neurosurgical patients using valproic acid to control seizure, however, we experienced significant decrease of serum valproic acid concentration during concomitant use of meropenem. We report here our observations of decreases in the serum concentrations of valproic acid to sub-therapeutic levels in three adult neurosurgical patients during concomitant therapy with meropenem.

한국인에서 Vancomycin의 치료적 약물농도 평가

송영구,김혜경,노은경,이서영,안보숙,김정호,박민수,윤희정,김준명 대한감염학회 2004 감염과 화학요법 Vol.36 No.5

목적 : 상용화된 PK simulation software를 이용하여 vancomycin의 치료적 약물농도 측정(Therapeutic Drug Monitoring, 이하 TDM)이 의뢰된 환자에서, 측정된 vancomycin 혈청농도와 평균 약동학 지표를 이용하여 계산된 예측농도를 비교하고, 실측 농도와 예측 농도 사이에 차이를 나타내는 요인이 무엇인지를 알아보고자 하였다. 재료 및 방법 : 2001년 3월부터 2002년 9월까지 188명으로부터 vancomycin TDM이 의뢰된 239건의 결과를 분석하였다. Vancomycin을 투여하기 30분 전에 측정된 최저 농도로 CAPCIL^(R) (Simkin Inc.) 프로그램에서 single-point linear 방법으로 약동학 지표(분포용적 : Vd_(m), 청소율: Cl_(m), 반감기 : T_(1/2m))와 이에 따른 실측 농도(ECm, 이하 실측치)를 구하였다. 또한 CAPCIL^(R) 프로그램에서 이들 환자의 평균 약동학 지표(Vd_(p), Cl_(p), T_(1/2p))를 이용한 예측 농도(EC_(p), 이하 예측치)를 계산하였다. 먼저 전체에서 실측치와 예측치의 평균에 차이가 있는지 비교하였으며 신기능 및 체중에 따라 실측치와 예측치의 차이가 있는지 알아보았다. 다음으로 예측 최저 농도를 기준으로 실측 최저 농도와 차이(%dEC=(EC_(m)-EC_(p))/EC_(p))를 세 그룹으로 나누어서 각 그룹 간에 차이를 나타내는 요인이 무엇인지 알아보았다. 통계는 SAS 프로그램을 이용하여paired t-test, ANOVA, multiple regression 등으로 처리하였으며 P<0.05를 유의한 것으로 간주하였다. 결과 : Vancomycin TDM이 의뢰된 188명중 남자 1ll명, 여자 77명이었다. 총 239건에서 실측 최저 농도는 예측 최저 농도보다 유의하게 낮았고(11.9±9.9 ㎍/ml vs. 19.2±19.5 ㎍/ml), 약동학 지표 중 청소율과 분포용적은 예측한 값보다 유의하게 높았다. 신기능 및 체중에 따른 각각의 군에서도 비슷한 양상을 보였다. 예측 최저 농도와 실측 최저 농도의 차이에 따라 구분한 세 군간에 농도 차이를 나타낸 요인으로는 몸무게, 나이, 키, IBW, BUN, Ccr이었으며, 이중 다변량 분석에서 나이, 몸무게, BUN이 실측치와 예측치의 차이에 영향을 주는 요인으로 나타났다. 결론 : 신기능이 저하되었을 경우와 저체중, 고령인 경우 실측 농도에 비해 더 높은 농도로 예측하는 경향으로 나타나 최적의 치료 농도를 유지하기 위해서는 이와 같은 환자에서 특히 vancomycin TDM이 필요하다고 생각된다. Background : We measured plasma vancomycin concentrations as a part of therapeutic drug monitoring (TDM) consultation and compared and analyzed the estimated plasma steady-state therapeutic drug levels of vancomycin obtained on the basis of measured concentrations and by population PK parameters using a PK simulation software in Korean patients to find the factors influencing the discrepancies that lie between these estimates. Materials and Methods : We analyzed the PK parameters of the 188 patients for whom vancomycin TDM was done for 239 episodes between March, 2001 and September, 2002. The trough vancomycin plasma concentrations were measured from plasma samples that were drawn 30 minutes before a vancomycin dose. Based on the measured concentrations, we estimated the steady-state therapeutic levels (EC_(m)) and PK parameters (apparent volumes of distribution, Vd_(m); clearance, Cl_(m); and half life, T_(1/2m)) using the single-point linear method utilized in CAPCIL (Simkin, Inc.) software program. We compared these with the steady-state levels and PK parameters estimated based on population PK database supplied by the software (EC_(p), Vd_(p), Cl_(p), and T_(1/2p)). We stratified and compared the values based on the patients' renal functions, body weights relative to ideal body weights, the magnitude of differences between EC_(m) and EC_(p). Multiple logistic regression using SAS software package was done to analyze factors that significantly influence the discrepancies. Results:One hundred and eleven were males, and 77 were females. The mean ECm were significantly lower than the mean ECp (11.9±9.9 μg/ml vs. 19.2±19.5 μg/ml). Clm and Vdm were higher than Cl_(p) and Vd_(p), respectively. The same patterns could be applied to the subclasses of patients based on renal functions and body weights. The factors that contribute to the differences in EC_(m) and EC_(p) were body weight, age, height, IBW, BUN, and Clcr, of which age, body weight, and BUN were found to be most significant by multiple regression analysis. Conclusions : Significant sizes of discrepancies between the estimated plasma steady-state therapeutic drug levels of vancomycin obtained on the basis of measured concentrations and by population PK parameters using a PK simulation software in Korean patients necessitate adjustment of dosage and confirmation of steady-state levels by follow-up TDM. We emphasize the need for obtaining vancomycin population PK database in Korean patients.

입원전담전문의 진료지원시스템의 설계 및 도입과 병원정보시스템과의 통합 방안

정윤빈,신형식,우가희,정혜경,정진경,고미영,김진수,김소원,이강영 건강보험심사평가원 2021 HIRA RESEARCH Vol.1 No.2

The difference in the urine D-chiro-inositol Level according to the characteristics of type 2 diabetes mellitus patients

( Hye Won Jang,),( Min Kyeong Kim ),( Kyong Hye Jeong ),( Koon Soon Kim ),( Hyun Jin Kim ),( Young Suk Jo ),( Minho Shong ),( Bon Jeong Ku ) 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.-

A Prospective Randomized Trial of Either Famotidine or Pantoprazole for the Prevention of Bleeding after Endoscopic Submucosal Dissection

Hye Kyong Jeong,박창환,Chung Hwan Jun,Gi Hoon Lee,Hyung Il Kim,김현수,최성규,유종선 대한의학회 2007 Journal of Korean medical science Vol.22 No.6

Endoscopic submucosal dissection (ESD) has been reported to have a higher bleeding rate than conventional methods. However, there are few reports on whether a proton pump inhibitor or a histamine2-receptor antagonist is the more effective treatment for preventing bleeding after ESD. In a prospective trial, patients undergoing ESD due to gastric adenoma or adenocarcinoma were randomly assigned to pantoprazole or famotidine. Both drugs were given intravenously for the first 2 days, thereafter by mouth. Eighty-five in the pantoprazole group and 79 in the famotidine group were included for analysis. Primary outcome measure was the delayed bleeding rate. Clinical characteristics were not different between the two groups. The delayed bleeding rate was significantly lower in the pantoprazole group compared with the famotidine group (3.5% vs. 12.7%, p=0.031). On multivariate analysis, the preventive use of pantoprazole (relative hazard: 0.220, 95% CI: 0.051- 0.827, p=0.026) and the specimen size (≥34 mm, relative hazard: 4.178, 95% CI: 1.229-14.197, p=0.022) were two independent factors predictive of delayed bleeding. There were no significant differences in en bloc and complete resection rate between the two groups. In conclusion, pantoprazole is more effective than famotidine for the prevention of delayed bleeding after ESD.

The difference in the urine D-chiro-inositol level according to the characteristics of type 2 diabetes mellitus patients

( Hye Won Jang ),( Min Kyeong Kim ),( Kyong Hye Jeong ),( Koon Soon Kim ),( Hyun Jin Kim ),( Young Suk Jo ),( Minho Shong ),( Bon Jeong Ku ) 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

Background/Aims: D-chiro-inositol is known as a mediator of insulin`s action and it has been shown to lower the blood glucose concentration in type 2 diabetes mellitus patient. This study aims to compare the urine D-chiro-inositol levels between normal controls and type 2 diabetes mellitus patients and we also searched for the relationship between the clinical characteristics of diabetes mellitus patients and the urine D-chiro-inositol concentration. Methods: 103 normal controls and 111 type 2 diabetes mellitus patients were recruited. Urine D-chiro-inositol was measured by the high performance liquid chromatography/mass spectrometry method. Results: Excretion of urinary D-chiro-inositol was increased in the diabetic subjects (p=0.000). In the diabetic group, the D-chiro-inositol level demonstrated a statistically significant positive correlation with HbA1c(r=0.264, p=0.007), microalbumin (r=0.252, p=0.021) and blood urea nitrogen (r=0.259, p=0.008) and it showed an inverse correlation with albumin (r=-0.198, p=0.045), ALT (r=-0.237, p=0.019) and the GFR (r=-0.200, p=0.043)(Table 2). Only the fasting plasma glucose level (ß=0.003, p=0.043) and the total cholesterol (ß=0.008, p=0.024) were found to be significant variables on the multiple regression analysis. When diabetic subjects were divided into two groups according to the HbA1c level, the subjects with a HbA1c level more than 8% presented a higher level of urinary D-chiro-inositol (p=0.019). Conclusions: The urinary D-chiro-inositol excretion of the diabetic subjects was increased. For the subjects whose HbA1c level exceeded more than 8%, the urinary excretion level of D-chiro-inositol was also increased. So we can expect more effectiveness of pinitol treatment in this poor glucose control group.

Case Report : Autoamputation of a Giant Colonic Lipoma

( Hye Kyong Jeong ),( Sung Bum Cho ),( Tae Jin Seo ),( Kyoung Rok Lee ),( Wan Sik Lee ),( Hyun Soo Kim ),( Young Eun Joo ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2011 Gut and Liver Vol.5 No.3

Most colonic lipomas are asymptomatic and need no treatment, whereas lesions larger than 2 cm can cause acute abdominal pain, changes in bowel habits, gastrointestinal bleeding, intussusception or bowel obstruction. Autoamputation of polypoid lesions in the gastrointestinal tract is indeed a rare phenomenon, and its precise mechanism remains unknown. It presumably occurs due to ischemic necrosis of the polyp by peristalsis-induced torsion or tension. Here, we report a case of autoamputation of a giant colonic lipoma in a 48-year-old man. In our case, colonoscopic examination showed a huge autoamputated mass in the rectum and a remnant long stalk in the transverse colon. The autoamputated mass in the rectum was completely removed after fragmentation using an electrosurgical snare, and the remnant long stalk located in the transverse colon was also resected safely by endoscopic snare polypectomy. To our knowledge, these endoscopic treatments for removal of an autoamputated mass and a remnant long stalk of colonic lipoma have not been reported previously. (Gut Liver 2011;5:380-382)

물벼룩의 체장 관측 도중 산화 스트레스와 대안적 성장 파라미터 개발

정주안 ( Ju An Jeong ),김은혜 ( Eun Hye Kim ),최은경 ( Eun Kyong Choi ),문서연 ( Seo Yeon Moon ),배현정 ( Hyun Jeong Bae ),정태용 ( Tae-yong Jeong ) 한국물환경학회 2021 한국물환경학회·대한상하수도학회 공동 춘계학술발표회 Vol.2021 No.-

Long-term outcomes of abdominal paraganglioma

Hye Ryeon Choi,Zeng Yap,Soon Min Choi,Sun Hyung Choi,Jin Kyong Kim,Cho Rok Lee,Jandee Lee,Jong Ju Jeong,Kee-Hyun Nam,Woong Youn Chung,Sang-Wook Kang 대한외과학회 2020 Annals of Surgical Treatment and Research(ASRT) Vol.99 No.6

Purpose: Paragangliomas (PGL) are rare neuroendocrine tumors derived from chromaffin cells of the autonomic nervous system. We aim to describe our experience and the long-term outcome of abdominal PGL over the last decade. Methods: A retrospective review of patients diagnosed with PGL in our hospital between November 2005 and June 2017 was conducted. All nonabdominal PGL were excluded and the clinicopathological features and long-term outcomes of the patients were analyzed. Results: A total of 46 patients were diagnosed with abdominal PGL. The average age of diagnosis was 55.4 years and there was no sex predilection. The average tumor size was 5.85 cm and they were predominantly located in the infrarenal position (50%). The mean follow-up period was 42 months (range, 1.8–252 months). All patients with metastases had Pheochromocytoma of the Adrenal Gland Scaled Score (PASS) of ≥4. One patient presented with synchronous metastases while 2 developed local recurrence and distant metastases. One presented with only local recurrence. One patient died 5 years after diagnosis. Conclusion: Abdominal PGL is a rare tumor with excellent long-term prognosis. Recurrence although uncommon, can occur decades after initial diagnosis. Long-term follow-up is therefore recommended for all patients with PGL, especially in patients with PASS of ≥4

Features of atherosclerosis in hemodialysis patients

( Kyong Ah Park ),( Hye Min Jo ),( Ji Soo Han ),( Min Jin Kim ),( Do Hyung Kwun ),( Moo Yong Park ),( Soo Jeong Choi ),( Jin Kuk Kim ),( Seung Duk Hwang ) 대한신장학회 2013 Kidney Research and Clinical Practice Vol.32 No.4

Background: Cardiovascular disease is the main cause of mortality in dialysis patients. Carotid intima-media thickness (CIMT) is used as a surrogate marker of early atherosclerosis. Atherosclerosis can cause vascular access failure. The purpose of this study was to define the clinical features of atherosclerosis in hemodialysis patients based on CIMT and to define the relationship between CIMT and access failure. Methods: In this cross-sectional study, the CIMT of 60 patients on hemodialysis was examined using B-mode Doppler ultrasonography between May 2012 and November 2012. Carotid atherosclerosis was defined as a CIMTZ0.9 mm or the incidence of atherosclerotic plaques. Results: The patients` mean age was 54.5710.6 years, and 60% of the patients were male. The CIMT was 0.8170.47 mm (range, 0.35-2.50 mm). The group with atherosclerosis was characterized by older age compared with those without atherosclerosis. Patients with atherosclerosis showed much shorter durations of access patency than their counterparts in the nonatherosclerosis group (hazard ratio, 2.822; 95% confidence interval, 1.113-7.156; P¼0.029). Moreover, being overweight was associated with a 2.47-fold (95% confidence interval, 1.101-5.548) increased primary access failure. Conclusion: This study shows that atherosclerosis is associated with older age. Patients who are overweight and have atherosclerosis may have shortened access patency.