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      • Rosuvastatin을 중심으로 본 HMG-CoA Reductase Inhibitor간 처방 변경 사유의 분석에 관한 연구

        변정인,홍주희,김미경,이재연,조윤희,한현주,손인자 한국병원약사회 2008 病院藥師會誌 Vol.25 No.4

        Rosuvastatin is the latest developed HMG-CoA reductase inhibitor. It has the most potent lipid-lowering effect and its cost is comparatively high with atorvastatin. In Seoul National University Hospital(SNUH), the number of its prescription has been increasing monthly since the introduction on February 2005. In spite of rosuvastatin’s strong lipid-lowering effect, physicians sometimes change the antilipidemic medication from rosuvastatin to another HMGCoA reductase inhibitor. Focusing on rosuvastatin, we tried to find out the reasons why the medical physicians changed the prescription of the antilipidemic drug. And we evaluated whether the antilipidemic pharmacotherapy was accomplished effectively and safely. In this study, we investigated the cases of the antilipidemic medication conversion in SNUH between March 1, 2005 and March 31, 2006. We reviewed the medical records and the laboratory data of the patients retrospectively. 296 cases were changed from one of the HMG-CoA reductase inhibitors to rosuvastatin. 165 cases(55.7%) of them were changed in order to achieve rapid-lipid lowering effect and 4 cases(1.4%) of them were changed to avoid adverse drug reactions and to obtain safe pharmacotherapy. In 127 cases(42.9%), we could not find out the factors influencing the medication change. On the other hand, the total number of cases to change one of the other HMG-CoA reductase inhibitors from rosuvastatin was 65. In the 11 cases(55.7%), the patients were refractory to rosuvastatin, so the antilipidemic medication were changed. 21 cases(32.3%) of them were changed to avoid adverse drug reactions and to obtain safe pharmacotherapy. In the 7 cases(10.8%), the patient’s LDL-C level was reached within the target LDL-C range according to National Cholesterol Education Program. Of the remaining 26 cases, we could not figure out the reasons why the physicians changed the antilipidemic medication. It is necessary to follow up the patients in order to evaluate whether the purpose of the medication change will be obtained.

      • 관상동맥 석회화 침착 정량화 CT검사를 위한 제조사별 소프트웨어의 재현성 평가

        변정인(Joog In Byun),남윤철(Yoon Chol Nam),조원홍(Won Hong Cho),김문찬(Moon Chan Kim) 대한CT영상기술학회 2006 대한CT영상기술학회지 Vol.8 No.1

        '스콜라' 이용 시 소속기관이 구독 중이 아닌 경우, 오후 4시부터 익일 오전 9시까지 원문보기가 가능합니다.

        Purpose The main purpose of coronary calcification quantifiable test is to prognose the progress of arteriosclerosis, to screen the group and to prevent exacerbation. Like, the test is performed by periodic pursuit test. However, the numerical value outputted newly is difficult to compare with the former value, in case a new tomography was replaced or a patientwas transferred to another hospital. It is because test methods and the softwares for quantifiable test are not standardized yet. Hereupon, this study was performed on purpose to compare the calcification values, outputted by a company’s, with other companies’. Materials and Methods The 30cases, sampled 10cases respectively from 3companies, were subjected to this study. Likewise, LightSpeed 16 and Advantage workstation 4.1(GE), Brilliance 40 and Extended Brilliance Workspace 2.0(Philips) and Somatom Sensation 16 and Wizard Workstation 3D Card(VB10B Siemens) were subjected to this study. In order that clear images can be secured, GE’s testers were operated under the condition of 0.5 rotation time, 120kVp and 350mA, through axial prospective gating. In case of Philips’ products, the exposure condition was composed of 0.42 rotation time, 120kVp and 196mAs(effective mAs), through axial prospective gating. In case of Siemens’, the condition was composed of 0.42 rotation time, 120kVp and 150mAs (effectivemAs), through helical retroprospective gating. While 25cm DFOV-2.5mm tomographic images were outputted in GE’s and Philips’, 18m DFOV-3mm tomographic images were outputted in Siemens’. AJ-130 and AJ volume were calculated through analyzing the images, outputted from a company’s product, on 3companies’, and the numerical difference among the companies were ascertained through the values. Results 1. The 10 data outputted from ‘P’ Company was respectively analyzed on the softwares of P, S and G Company respectively. As a result of ascertaining the numerical difference between P and S Company, the variation of AJ-130 was from 0 to 16.9%, based on P Company. On this occasion, 2 data were correctly tallied with each other, and 0.1~5% and 15.1~20% were one of each. AJ volume indicated the variation between 8 and 119%, and 0.1~50%, 50.1~100% and 100.1~150% were 4, 3 and 3 cases respectively. Likewise, the numericaldifference between P and G Company was ascertained on the basis of P Company. As a result, the variation was from 0.3 to 20.9% in case of P Company; 0.1~5%, 5.1~10%, 10.1~15% were 1, 1 and 2 cases respectively. In case of AJ volume, the variation indicated the range between 0.2 and 169.8%. Enumerating respective variations, 0.1~50% were 4 cases, 50.1~100% were 3 cases, 100.1~150% was 1 case and 150.1~200% were 2 cases. 2. The 10 data outputted from ‘S’ Company were respectivelyanalyzed on the softwares of P, S and G Company. In consequence, AJ-130 indicated the variation between 0 and 3.5%, based on S Company, and the cases where numerical value was correctly tallied were 3 parts; the remnant 7 cases showed the variation from0.1 to 5%. AJ volume indicated the variation between 1.9 and 10.5%, and 0.1~5%, 5.1~10% and 10.1~15% were 7, 1 and 1 case respectively. In the numerical difference between S and G Company, AJ-130 showed the variation from 0 to 16.2%, based on S Company. One case were correctly tallied, and 0.1~5%, 10.1~15% and 15.1~20% were 7, 1 and 1 case respectively. In case of AJ volume, the variation was from 0.1 to 22.8% and 0.1~5%, 5.1~10% and 20.1~25% were 5, 4 and 1 case of each. 3. The 10 data outputted from ‘G’ Company were respectively analyzed on the softwaresof G and P Company. In consequence of ascertaining the numerical difference between G and P Company, AJ-130 indicated the variation range from 0.1 to 11.8%, based on G Company, and 0.1~5%, 5.1~10% and 10.1~15% were 7, 2 and 1 case respectively. In case of AJ volume, 10 differences were observed between 0.1 and 3.3%. Conclusion In case coronary calcification was analyze

      • 두개부와 흉부 CT 검사시 Bismuth 차폐재를 이용한 안구의 렌즈와 유방의 선량감소에 대한 평가

        변정인(Jung in Byun),남윤철(Yoon chul Nam),이홍(Hong Lee),신상보(Sang bo Shin),한동균(Dong kyoon Han) 대한CT영상기술학회 2008 대한CT영상기술학회지 Vol.10 No.1

        '스콜라' 이용 시 소속기관이 구독 중이 아닌 경우, 오후 4시부터 익일 오전 9시까지 원문보기가 가능합니다.

        Purpose Bismuth shield can filter twice in that penetrates X-ray, which is essential in diagnosis, and it also partially decreases skin dose. Hence, it is necessary to study the effects in reduction of absorbed dose on highly sensitive organs, which are included in the regions of cranial and chest CT exams. Materials and methods All exams were proceeded on LlghtSpeed 16MDCT (GE Medical System, Milwaukee, U.S.A.), Rando phantom (Model RAN-110, Churchin associate LID., USA) and Glass dosimetry system(GD-351,8.5mm, FGD-1000) for the measurement of radiation dose. In addition, AttenuRad radiation protection devices of eyeballs & breast (F&L Medical Products Co.) are used for protection of sensitive organs. In cranial examination, the brain CT protocols was used for the examinations, and the summary of it is as followed: The glass radiation elements were put on left and right lens of phantom eyeballs, and the radiation before and after the use of Bismuth shield were measured twice when 120kVp of current were changed into 150mAs, 200mAs, and 200mAs, and when 250mAs were changed into 100kVp, 120kVp, and 140kVp. In chest examination, low-dose protocol and chest routine protocol are used for the examination. The conditions of low-dose protocol are as followed:120kVp, noise index 11.57(10~50mA), tube rotation time 0.8sec, pitch 1.375, and table speed 13.75mm/sec. Also, the conditions of chest routine CT protocol are 120kVp, noise index 15.86(160~250mA), tube rotation time 0.8sec, pitch 1.35, and table speed 13.5mm/sec. The glass elements were put on the both nipples of phantom and the radiation before and after the use of bismuth shield were measured twice. When the shield is used, rubber-made spacer(1cm) should be on the breasts, followed by bismuth shield, because it decreases not only the scattering ray absorption into breast wall caused by bismuth shield but image artifact potentially. Results The result of the measurement of orbit shielding during cranial examination. The results of measurements of the radiation(from 120kVp to 150, 200, 250 and 300mAs) before and after the use of bismuth shield are as followed: from 18.4±0.3mGy to 10.25±0.5rnGy(44.3% decrease) at 150mAs; from 23.9±0.9mGy to 13.9±0.1mGy(41.5% decrease) at 200mAs; from 37.3±0.3mGy to 19.8±0.9mGy(47.1% decrease) at 250mAs; and from 47.8±3.4mGy to 24.4±1.4mGy(46.8% decrease) at 300mAs. On the other hand, the measurements of radiation(from 250mAs to 100, 120, and 140 kVp) before and after the use of bismuth shield are as followed: from 22.9±0.2mGy to 22.9±0.2mGy(51.2% decrease) at 100kVp; from 34.4±0.9mGy to 19.5±0.2mGy(43.3% decrease) at 120kVp; and from 49.5 ±4.4mGy to 29±1.2mGy(41.4% decrease) at 140kVp. The result of the measurement of orbit shielding during breast examination. In low-dose protocol, the results of measurements of the radiation before and after the use of bismuth shield are 3.16±0.02mGy and 2.44±0.03mGy(22.78% decrease), respectively, and in chest routine protocol, the results were 14.45±1.08mGy and 11.93±0.21mGy(17.43% decrease), respectively. Conclusion In cranial examination, there was not much change in the radiation dose of eye lens with an application of bismuth shield, even increases of mAs with constant kVp. On the other hand, the rate of reduction of radiation dose by bismuth shield is seen with constant mAs and increase of kVp. Due to the use of bismuth shield, radiation dose has been decreased about 22.8%in low-dose study, and 17.4% in chest routine study. In our hospital, the use of bismuth shield of orbit is not applied to adults, but applied to some infants only when brain CT exam was operated to them. The breast shield is applied, as a test, to women under 50 years old. According to this study, the results show obviously that the use of the bismuth shield can reduce radiation dose of highly radiation-sensitive organs. As mentioned before, the amount of radiation that eye balls received at 250mAs(at

      • KCI등재후보

        암환자의 마약성 진통제 유발성 변비에 대한 예방적 완하제 사용 및 복약순응도 평가

        박지언,변정인,정선회,손인자,이혜숙 한국병원약사회 2011 病院藥師會誌 Vol.28 No.2

        Constipation is the most common adverse effect occurring with chronic opioid use. Constipation resulting from opioids is dose-related, and patients do not develop tolerance to this symptom. Prophylaxis is crucial because opioid-induced constipation is much easier to prevent than to treat. This study was undertaken to estimate how often laxatives were started concurrently with opiates and to describe the compliance of laxatives and patient’s awareness about the side effect. We identified all outpatients who received a first prescription for oral opioid analgesics for a year from the the January 2007 in Cancer Center, Seoul National University Hospital. And we surveyed by telephone patients who received opioid analgesics more than 4 weeks through a questionnaire about medication compliance and patient’s awareness of the side effect for two months from the 16 August 2008. Overall, 45% of the patients received laxatives simultaneously with opioids. The 50 patients participated in the survey. 55% of patients for whom laxatives are prescribed took a laxative regularly. Of these patients 35% experienced opoioid-induced constipation. 45% of patients took a laxative irregularly, and of these patients 74% experienced constipation. The risk of developing constipation was significantly higher in irregularly taking laxative group [odds ratio 5.3(95% CI 1.4-19.9)]. The laxative compliance was higher with recognition of the reason for taking laxatives [odds ratio 3.9(95% CI 1.1-14.2)]. This study shows that prophylactic treatments are essential to minimize opioid-induced constipation. In addition, it is important to educate patients to raise their compliance and understanding of the reason for taking medication and necessity.

      • 고강도 열연강판의 구멍확장 시험 시 균열의 전파거동에 미치는 미세조직의 영향

        박세호(Seho Park),정국(Jungkuk Byun),도형협(Hyeonghyeop Do),정인상(Insang Chung) 한국자동차공학회 2011 한국자동차공학회 부문종합 학술대회 Vol.2011 No.5

        Recently, advanced vehicle concepts and light-weight design of automobiles require improved steel grades with increased strength and formability. Especially, high strength hot-rolled steel sheets applied to chassis such as wheel, lower arm require high hole expansion ratio because of their complicated shapes in cold press processing. Aim of this study is to analyze the effects of microstructures on the crack propagation behavior during hole expansion which is used to estimate stretch-flangeability for steel sheets. For high strength steel sheets which had various microstructures and different components, hole expansion test were carried out and than analyzed the differences of the crack propagation behavior. As the result, it was conclusioned that formation of the 2nd fracture surface, low difference in hardness between the matrix and 2nd phase, excellent uniformity of the microstructures and a small number of the micro-voids led to excellent hole expansion ratio (HER).

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