간경변증 환자에서 Misoprostol의 치료 효과

오경석(Kyung Seok Oh),이영민(Young Min Lee),이상혁(Sang Hyuk Lee),설상영(Sang Yong Seol),정정명(Jung Myung Chung),최하진(Ha Jin Choi) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.6

N/A Background/Aims: The efficacy of misoprostol was evaluated in patients with esophageal varices bleeding or ascites caused by liver cirrhosis. Methods: The effects of misoprostol on portal hypertensive patients were observed in two groups, a group of 30 patients receiving misoprostol and a control group of 30 patients receiving conventional treatment. We detected ascites with abdominal ultrasonography and compared the misoprostol-diuretics group with the cluretics only group for ascites control. Hemodynamic condition after the administration of misoprostol was observed by measuring changes in volume and velocity of blood flow in portal vein using pulsed Doppler ultrasound. We also made comparisons between the misoprostol only group, EVL-misoprostol group and conservative group for esophageal varices rebleeding episodes during the follow up periods of 6-9 months. Results: In 14 of 18 cases (77.8%), the increase in the velocity and volume was observed and in the remaining 4 cases (22.2%), either a reduction or no change was observed. We observed the effect of misoprostol on ascites in two groups; one group receiving a combined treatment of misoprostol and diuretics, the other group receiving diuretics only. There was a statistically significant effect in the combined treatment group (P<0.05). The recurrence of bleeding after treatment was observed for 6 to 9 months. Rebleeding from esophageal varices occurred in 1 of 12 cases (8.3%) in the misoprostol group and 4 of 13 cases (30.7%) in the non-misoprostol group (P<0.05). However, there was no recurrence of bleeding in 10 patients who were treated with endoscopic variceal ligation and misoprostol during the follow up period. Conclusion: Misoprostol might be a very useful agent in the control of ascites and the prevention of rebleeding of esophageal varices caused by liver cirrhosis. (Korean J Gastroenterol 1996; 28:798-805)

초임부의 자궁경관 숙화에 있어 Misoprostol의 경구 및 경질 투여 용법의 비교

김경구 ( Kyung Koo Kim ),전경철 ( Kyung Chul Chun ),최형민 ( Hyung Min Choi ) 대한주산의학회 2006 大韓周産醫學會雜誌 Vol.17 No.3

목적: 미분만부의 유도분만 시 misoprostol의 경구투여 군과 경질투여 군 및 oxytocin만을 사용한 군에서 자궁경관 숙화와 유도분만 효과 및 안전성을 비교하고자 하였다. 방법: 2005년 11월부터 2006년 4월까지 인제대학교 일산 백병원 산부인과에 유도분만을 위하여 입원한 미분만부 중 자궁경관 점수 6점 이하인 산모를 무작위로 경구투여 군과 경질투여 군으로 각각 11명과 9명씩 나눈 후 경구투여 군은 misoprostol을 최초 50 ?g을 투여 후 100 ?g을 4시간 간격으로 최대 총 4차예 투여하였으며, 경질투여 군은 최초 25 ?g을 질후원개 부위에 도포후 같은 용량을 4시간 간격으로 최대 총 4차예 투여하였다. oxytocin만을 사용한 군은 같은 조건의 미분만부를 무작위로 추출하여 후향적으로 의무기록을 비교하였다. p<0.05인 경우를 통계적으로 유의한 상관관계가 있다고 보았다. 결과: 경구투여 군과 경질투여 군 및 oxytocin만을 사용한 군에서 연령, 임신주수, 분만력, 최초 자궁경관 점수 등은 통계적으로 유의한 차이를 보이지 않았다. 자궁경관 점수 8점 이상, 자궁경부 숙화60% 이상까지의 시간은 경구투여 군에서 짧게 관찰되었고 완전 숙화 및 총 분만시간은 경질투여 군에서 짧게 관찰되었지만, 약제 투여 횟수, 증대여부 및 질식분만 비율 등 산과적 결과와 함께 통계적 유의한 차이를 보이지는 않았고 산모 및 신생아에게 발생한 합병증 역시 세 군간에 통계적으로 유의한 차이를 보이지 않았다( p>0.05). 결론: 본 연구결과 misoprostol의 사용은 경구투여 군과 경질투여 군 모두에서 자궁경관의 숙화에 좋은 효과를 보였으며 또한 두 군에서 주산기 예후에는 통계학적으로 유의한 차이를 보이지 않았다. 초임부의 자궁경부 숙화를 위한 misoprostol의 사용은 현재 많은 연구에서 여러 가지 투여경로 및 용법이 시도되고 있으나 아직까지 표준화 되지 않았으며 앞으로 더 많은 연구 및 자료의 축적이 필요하다고 사료된다. Objective: To compare the safety and efficacy of oral misoprostol, vaginal misoprostol, and oxytocin-only users for cervix ripening and labor induction in nulliparous women. Methods: Randomly selected 11 patients were orally administered 50μg of misoprostol at first and then 100μg every 4 hours and the other 9 patients were vaginally administered 25μg of misoprostol at first after then the same doses every 4 hours. They all were nulliparous women with Bishop score 6 or less. Another 19 patients were oxytocin only users for cervical ripening and labor induction, who were nulliparous women with Bishop score 6 or less, and reviewed these medical records retrospectively. Results: There were no differences among these three groups in patient characteristics such as maternal age, gestational age, parity and initial Bishop score. In oral misoprostol group, it took shorter time to get Bishop score 8 or more and become effacement 60% or more than vaginal misoprostol group. On the contrary, in vaginal misoprostol group, it took shorter time to become full dilatation and deliver than oral misoprostol group. However there were no significant statistical differences between two groups in obstetric and neonatal outcomes. Conclusion: Oral and vaginal misoprostol are effective in cervical ripening but there were no significant statistical differences in perinatal outcomes. Among many regimens of misoprostol administration for cervix ripening in nulliparous women, there is no standardized method until now. More studies will be needed for safe application of this drug.

유도분만과 자궁경관 숙화에 있어 Misoprostol과 Dinoprostone 의 비교

이현행(Hyun Haing Lee),박원식(Won Sik Park),신승주(Seung Joo Shin) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.11

Objective: To compare the safety and efficacy of intravaginal misoprostol versus intracervical dinoprostone (prostaglandin E2 gel) for cervical ripening and labor induction. Methods: 60 patients with indication for labor induction and unfavorable cervices were randomly assigned to receive either intravaginal misoprostol or intracervical dinoprostone. 50 ㎍ tablets of misoprostol were placed in the posterior vaginal fornix every 4 hours for a maximum of 3 doses or dinoprostone 0.5mg was placed into the endocervix every 6 hours for a maximum of 2doses. No more medication was given after either spontaneous rupture of membranes or beginning of active labor. Results: Among 60 patients enrolled, 30 received misoprostol and 30 received dinoprostone. The average interval from start of induction to active labor was shorter in misoprostol group (6.5±3.2 hours) than in the dinoprostone group (10.7±7.3 hours) (p<0.05). Oxytocin augmentation of labor occurred more often in the dinoprostone group (36.7%) than in the misoprostol group (10.0%) (p<0.05). There was a higher prevalence of fetal distress (23.3% versus 3.3%) and tachysystole (16.6% versus 6.6%) in the misorprostol group than in the dinoprostone group(p<0.05). Conclusions: Vaginally administered misoprostol is an effective agent for cervical ripening and induction of labor. Furthermore, the cost of misoprostol ( 360/200㎍) is much less than that of dinoprostone ( 42,000/0.5mg). Cost benefits from administration of misoprostol are evident, especially in clinics under system of diagnosis-related group (DRG) : however when given at this dosage, it is associated with a higher prevalence of fetal distress and tachysystole than dinoprostone. Further studies to compare the safety of misoprostole to that of dinoprostone and to delineate an optimal dosing regimen for misoprostol are needed.

임신말기 유도분만에서 경질 misoprostol과 경구 dinoprostone의 비교

노현주(Hyun Ju Noh),김병철(Byung Cheol Kim),임연주(Yeon Ju Lim),이철우(Cheol Woo Lee),민정기(Jung Ki Min),양은영(En Young Yang),황운정(Woon Jeong Hwang),신용덕(Yong Duk Shin),김동진(Dong Jin Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.9

Objective: To compare the safety and efficacy of intravaginal misoprostol versus oral dinoprostone for labor induction at term. Methods: One hundred of patients at term were randomized to receive either 50㎍ of misoprostol vaginally every 4 hours or dinoprostone 0.5mg orally every 1 hour for the maximum of six doses. Intravenous infusion of oxytocin was administered under such circumferences as the patient did not go into active labor after maximum dose, SROM was developed without an adequate contraction pattern, or the patient had arrest of dilatation(no change in cervical dilatation for 2 hours). We compared the frequency of oxytocin augmentation, administration to delivery interval, vaginal delivery rate within 12 hours and 24 hours, intrapartum complications, induction failure, mode of delivery, neonatal outcomes, and maternal complications between two groups. Results: The average interval from administration to delivery was shorter in the misoprostol group(739.4±372.4min vs 1087.7±765.1min, p<0.05), but the interval from administration to vaginal delivery of each group was similar(724.3±375.4min vs 800.3±697.0min). Regarding the frequency of vaginal delivery within 24 hours, however, misoprostol group was higher than dinoprostone group(88% vs 56%, p<0.001). And oxytocin augmentation of labor occurred less commonly in misoprostol group than in dinoprostone group(20% vs 76%, p<0.05). Any statistically significant difference in intrapartum complications, mode of delivery, and neonatal or maternal adverse outcome was not appeared between these two group. Conclusion: Vaginal misoprostol is as effective and safe as oral dinoprostone for cervical ripening and induction of labor at term. In addition, vaginal misoprostol contributes the curtailment of labor induction expenditure due to its moderate price; misoprostol costs 100 won per 50㎍.

Development of a Novel Method of Misoprostol Detection on Filter Paper: Proof-of-Concept

Grace Wu,Muhammad H. Zaman,Hatice Imran Gungordu,Navaporn Tagontong,Peter Hall 대한의용생체공학회 2016 Biomedical Engineering Letters (BMEL) Vol.6 No.2

Purpose Uteronics are critical to managing and treating postpartum hemorrhaging (PPH), the global leading cause of maternal mortality that kills 800 women daily. While oxytocin is a widely used uteronic, misoprostol has been used in some low-resource countries as it is significantly cheaper, easier to administer, and not reliant on a cold chain. However, recent studies suggest that degradation of misoprostol tablets is accelerated if exposed to humidity at any point during manufacture. State-of-the-art means of assessing misoprostol quality involve high performance liquid chromatography (HPLC), which is expensive and requires high technical skill. Therefore, there is a need for a low-cost, light-weight, and easy-to-use alternative for quality testing. We investigated the use of enzymatic-based assays, which are widely used in point-of-care analysis but has not been studied for misoprostol. Methods We hypothesized that misoprostol, which contains a secondary alcohol, could be selectively metabolized by alcohol dehydrogenase. Two methods were developed to assess the feasibility to detect pure misoprostol in aqueous solution: a previously-developed amperometric assay on paper-screen printed electrodes, and a colorimetric test. Approximate binding constants were estimated and the accuracy of misoprostol quantification was compared to that measured by HPLC. Results Pure misoprostol in both a standard acetonitrile/ water mixture and aqueous solution was quantified with high sensitivity by HPLC. The accuracy of misoprostol detection by the amperometric method was 87.1 ± 2.3% (n = 3). Conclusions Based on this proof-of-concept study, enzymaticbased assays for misoprostol quantification can be considered as a novel method for low-cost and point-of-care quality testing. Further development is warranted to optimize the accuracy and sensitivity of this method for tablet products.

Preventive Efficacy and Safety of Rebamipide in Nonsteroidal Anti-Inflammatory Drug-Induced Mucosal Toxicity

( Jeong Ho Kim ),( A Soo Heon Park ),( Chul Soo Cho ),( Soo Teik Lee ),( Wan Hee Yoo ),( Sung Kook Kim ),( Young Mo Kang ),( Jong Sun Rew ),( Yong Wook Park ),( Soo Kon Lee ),( Yong Chan Lee ),( Won P 대한소화기학회 2014 Gut and Liver Vol.8 No.4

Background/Aims: The use of proton pump inhibitors or misoprostol is known to prevent the gastrointestinal complications of nonsteroidal anti-inflammatory drugs (NSAIDs). Rebamipide is known to increase the mucosal generation of prostaglandins and to eliminate free oxygen radicals, thus enhancing the protective function of the gastric mucosa. However, it is unknown whether rebamipide plays a role in preventing NSAID-induced gastropathy. The aim of this study was to determine the effectiveness of rebamipide compared to misoprostol in preventing NSAID-induced gastrointestinal complications in patients requiring continuous NSAID treatment. Methods: We studied 479 patients who required continuous NSAID treatment. The patients were randomly assigned to groups that received 100 mg of rebamipide three times per day or 200 μg of misoprostol three times per day for 12 weeks. The primary endpoint of the analysis was the occurrence rate of gastric ulcers, as determined by endoscopy after 12 weeks of therapy. Results: Of the 479 patients in the study, 242 received rebamipide, and 237 received misoprostol. Ultimately, 44 patients (18.6%) withdrew from the misoprostol group and 25 patients (10.3%) withdrew from the rebamipide group. There was a significant difference in withdrawal rate between the two groups (p=0.0103). The per protocol analysis set was not valid because of the dropout rate of the misoprostol group; thus, the intention to treat (ITT) analysis set is the main set for the efficacy analysis in this study. After 12 weeks, the occurrence rate of gastric ulcers was similar in the rebamipide and misoprostol groups (20.3% vs 21.9%, p=0.6497) according to ITT analysis. In addition, the therapeutic failure rate was similar in the rebamipide and misoprostol groups (13.6% vs 13.1%, p=0.8580). The total severity score of the gastrointestinal symptoms was significantly lower in the rebamipide group than in the misoprostol group (p=0.0002). The amount of antacid used was significantly lower in the rebamipide group than in the misoprostol group (p=0.0258). Conclusions: Rebamipide can prevent gastric ulcers when used with NSAIDs and can decrease the gastrointestinal symptoms associated with NSAID administration. When the possibility of poor compliance and the potential adverse effects of misoprostol are considered, rebamipide appears to be a clinically effective and safe alternative. (Gut Liver 2014;8:371-379)

만기임신에서 Misoprostol에 의한 자궁경부숙화 및 분만유도에 있어서 Prostaglandin E2 질정과의 비교연구

이경민(GM Lee),송태복(TB Song),김윤하(YH Kim),변지수(JS Pyun) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.4

Objective: The goal of this study is to compare the safety and efficacy of intravaginal misoprostol with that of intravaginal PGE2 for labor induction and cervical ripening in term pregnancy. Methods: Fifty nine patients with indications for induction of labor with unfavorable cervices were randomized to received either 50㎍ misoprostol or 3mg PGE2 intravaginally. Among 59 patients recuited, 30 received misoprostol and 29 received PGE2. The second dose was repeated 6 hours after first dose, if the cervices were unfavorable. At 6 hours after applying second dose, the cervices were reevaluated. Results: Regular uterine contraction and/or successful cervical ripening[Bishop score ≥7] after administration of one dose was statistically more often in the misoprostol group than that in the PGE2 group[60% vs 31%, p<0.05]. No difference was noted in successful induction rate after two doses administration between misoprostol group and PGE2 group[23.3% vs 27.6%]. Total 25[83.3%] in misoprostol group & 17[58.6%] in PGE2 group were achieved successful cervical ripening or labor induction by each drug[p<0.05]. There were no significant differences in the mean time to delivery, the need for oxytocin, delivery within 24hours. No significant differences were noted in cesarean section rate, frequency of tachysystole[20% vs 10.4%] and hyperstimulation[3.3% vs 6.9%], and neonatal outcomes between two groups. Conclusion: Intravaginal administration of misoprostol is an effective and inexpensive agent for cervical ripening and induction of labor. Misoprostol 50 ㎍ was acceptable as initial dosage for unfavorable cervices in term pregnancy compared with PGE2 3 mg. Complications were not statistically different between two groups.

만삭임신부의 유도분만에서 Misoprostol 경구투여와 Dinoprostone 경구투여의 비교

김우성(WS Kim),원영석(YS Won),방금화(KH Bang),이정례(JR Lee),임문환(MH Im),이병익(BI Lee),이우영(WY Lee) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.9

This study was to compare oral misoprostol with oral dinoprostone for induction of labor at term pregnancy. One hundred twenty patients at term were randomized to receive either 200μg of misoprostol orally or 0.5 mg dinoprostone 1 tablets orally every 1 hour for a maximum of six tablets. Labor was induced with intravenous oxytocin infusion 8 hours after the onset of oral medication if the patients did not go into labor. We compared the frequency of oxytocin augmentation, oral administration-to-delivery interval, vaginal delivery within 12 hours & 24 hours, intrapartum complications, induction failure, mode of delivery, neonatal outcomes, and maternal complications between two groups. There was a less frequency of oxytocin augmentation in the misoprostol group than in the dinoprostone group but there was no significant difference. The interval from oral administration to vaginal delivery was shorter in the misoprostol group (543.6 276.7 minutes) than in the dinoprostone group (864.4 272)(p<0.05). The frequency of vaginal delivery within 12 hours was higher in the misoprostol group (78.3%) than in the dinoprostone group (20.0%)(p<0.05) and the frequency of vaginal delivery within 12 hours to 24 hours was lower in the misoprostol group (6.7%) than in the dinoprostone group (53.3%)(p<0.05). There was no significant difference in intrapartum complications, the frequency of induction failure, mode of delivery, neonatal outcomes, maternal complications. Orally administered misoprostol is an effective than dinoprostone and safe agent for induction of labor at term pregnancy, however further studies are required to delineate an optimal dosing regimen for oral misoprostol.

Intravaginal isonicotinic acid hydrazide (INH) versus misoprostol for cervical ripening prior to hysteroscopy

( Ladan Haghighi ),( Zahra Najmi ),( Samaneh Rokhgireh ),( Yousef Moradi ),( Candidate ) 대한산부인과학회 2020 Obstetrics & Gynecology Science Vol.63 No.4

Objective The aim of the present study was to compare the efficacy of vaginal isoniazid (isonicotinic acid hydrazide [INH]) and vaginal misoprostol in cervical ripening before hysteroscopic surgery. Methods This randomized controlled trial included patients scheduled for hysteroscopic surgery during April 2016 and June 2017. The inclusion criteria were as follows: postmenopausal women or those at premenopausal age who had not had a vaginal delivery and candidate for diagnostic or operative hysteroscopy with closed cervix before intervention. The INH group (intervention group) received 900 mg of vaginal isoniazid (three 300-mg pills) 6-8 hours before hysteroscopic surgery. The misoprostol group (control group) received 400 micrograms of vaginal misoprostol 6-8 hours before hysteroscopic surgery. Finally, the efficacy of the 2 agents was comparatively analyzed. Results Baseline characteristics were comparable between the groups. In 67 cases in the INH group (95%) and 45 in the misoprostol group (50%), hysteroscopic entry was successful without additional mechanical dilation, and this difference was statistically significant (P=0.001). The odds ratio (OR) obtained in this study was 0.57 for both INH and misoprostol groups (OR, 0.57; 95% confidence interval, 0.43-0.75). Further, 19 cases in the INH group vs. 45 cases in the misoprostol group did not respond to the intervention, indicating statistically significance (P=0.001). Conclusion Vaginal INH is more effective than misoprostol in cervical ripening before hysteroscopic surgery and can be a good alternative to misoprostol.

Hepatorenal Syndrome에 대한 Prostaglandin E1 유사화합물인 Misoprostol의 치료 효과

정철헌(Chul Hun Jung),김지훈(Ji Hoon Kim),이오영(Oh Young Lee),김정호(Jeong Ho Kim),김호중(Ho J oong Kim),함준수(Joon Soon Hahm),박경남(Kyung Nam Park),기춘석(Choon Suhk Kee) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.3

N/A Hepatorenal syndrome is a functional renal impairrnent occuring mainly, but not exclusive- ly, in decompensated cirrhosis. Its pronosis is very poor. We studied to evaluate the effect of misoprostol (prostaglandin E, analogue) in patients with hepatorenal syndrome. We observed the therapeutic effect of oral misoprostol(0.4mg, four times per day) for 12 days in six pa- t.ients with hepatorenal syndrome who had oliguria and renal functional deterioration despite adequate supp)ement of fluid. The mean urinary output obtained over the 4 days preceding misoprostol administration was 263, 328, 275, 232, 265 and 356 ml per 24 hours, respectively, in the six patients, despite adequate volume expansion by plasma albumin and fresh frozen plasma. Diuresis increased t,o 906, 900, 625, 1085, 1495 and 1038 ml per 24hours, respectively, on day 1 12 after onset of therapy. In addition of diuresis, serum creatinine levels were 3.5, 2.6, 2.7, 4.5, 4.2 and 3.6mg/ dl before and changed to 2.0,1.9, 2.2, 5.0, 2.1 and 2.9mg/dl during treatment. Therefore, recov- ery of renal function in five patients were evident. Spot urine sodium concentration increased from average 30mEq/L to 40mEq/L in six cases before and during the treatment of misoprostol. In the present study, the oral administration of high dose of misoprostol in patients with hepatorenal syndrome seems to produce marked diuresis with recovery of renal failure, sug gesting again the role of prostaglandin in the pathogenesis of hepatorenal syndrome. There- fore, until further improvements in the management of hepatorenal syndrome in the future, administration of synthetic prostaglandin E,(misoprostol) may constitute an acceptable thera peutic intervention.(Korean J Gastroenterol 1994; 26: 498 505)