Angioedema is a disorder characterized by well-demarcated nonpitting edema involving the tongue, floor of the mouth, larynx, lips, and face. The incidence of angiotensin converting enzyme(ACE) inhibitor related angioedema has been reported to be about 0.1% to 0.2%, and the time of onset is usually during the first week of therapy. These ACE inhibitors include captopril, enalapril, and lisinopril. A 53-year old man with an 8 month history of hypertension previously controlled with atenolol, was presented to the dermatologic department with angioedema of the face and tongue. He had begun therapy with captopril one day before this episode. Even though he was treated with epinephrine and methylprednisolone sodium succinate, the edema gradually progressed and finally dyspnea developed. He was urgently intubated and treated with steroids and pheniramine maleate in the intensive care unit. The edema resolved after 24 hours.
Angioedema* ; Angiotensin-Converting Enzyme Inhibitors ; Angiotensins ; Atenolol ; Captopril* ; Dyspnea ; Edema ; Enalapril ; Epinephrine ; Humans ; Hypertension ; Incidence ; Intensive Care Units ; Larynx ; Lip ; Lisinopril ; Methylprednisolone Hemisuccinate ; Middle Aged ; Mouth ; Pheniramine ; Steroids ; Tongue

To present a case of unusual dorsal epidural gas (EG) accumulation after a simple lumbar microdiskectomy (MD), treated with computed tomography (CT)-guided needle aspiration.A 78-year-old woman underwent simple lumbar MD at the L3–4 level. One week after the operation, the patient complained of severe back pain radiating to the right thigh. Follow-up magnetic resonance imaging (MRI) and CT revealed huge EG formation at the dorsal L3–4 epidural space. Conservative treatment did not resolve the patient's pain. We performed CT-guided needle aspiration after 1 week of conservative treatment. The patient's pain fully resolved after aspiration, but it recurred 1 week later. Follow-up MRI and CT revealed reaccumulation of the dorsal EG at the L3–4 level. CT-guided needle aspiration was repeated, again leading to full pain resolution. Follow-up CT 6 months after the second aspiration showed no recurrent dorsal EG. The patient has been symptom-free for 1 year since the second aspiration. CT-guided needle aspiration is a safe and effective alternative to reoperation in the context of dorsal EG formation after MD.

BACKGROUND: South Korea is rapidly being an aging-society and the demand of long-term care insurance services for elderly patients is rising. In addition, because the elderly taking multiple medicines, the adherence is lowered and the adverse events are easily occurred. Therefore, many are interested in introducing the geriatric pharmacy specialist to manage this situation. PURPOSE: By applying a similar program such as the geriatric pharmacy specialist working in nursing home, we conducted this study to evaluate the potential contribution to both the health insurance services and financial savings for the elderly patients. METHODS: We conducted a trial in an elderly nursing home to collaborate between doctor and pharmacist making a checklist for improving medication adherence and establish a consultation system. Also we applied a smart phone application in the pharmaceutical care processes. RESULTS: Thereby completing the drug therapy related checklist apply to nursing facilities in South Korea. And we got a performance that improves medication adherence when used in the clinical practice settings. CONCLUSION: By introducing a training program of pharmacy care managers and geriatric professionals such as the United States and Japan, we revealed the elderly nursing home residents and vulnerable elderly people living alone were improved the medication adherence and it will contributed to the health and quality of life of the patients.
Aged* ; Checklist ; Drug Therapy ; Education ; Humans ; Income ; Insurance, Health ; Insurance, Long-Term Care ; Japan ; Korea ; Long-Term Care ; Medication Adherence* ; Nursing Homes* ; Nursing* ; Pharmaceutical Services ; Pharmacists ; Pharmacy ; Quality of Life ; Specialization ; United States ; Smartphone

OBJECTIVES: The root barks of Periploca sepium Bge. (P. sepium) has been used in traditional Chinese medicine for healing wounds and treating rheumatoid arthritis. However, toxicity in high-doses was often diagnosed by the presence of many glycosides. The potential mutagenicity of P. sepium was investigated both in vitro and in vivo. METHODS: This was examined by the bacterial reverse mutation (Ames) test using Escherichia coli WP2uvrA and Salmonella typhimurium strains, such as TA98, TA100, TA1535, and TA1537. Chromosomal aberrations were investigated using Chinese hamster lung cells, and the micronucleus test using mice. RESULTS: P. sepium did not induce mutagenicity in the bacterial test or chromosomal aberrations in Chinese hamster lung cells, although metabolic activation and micronucleated polychromatic erythrocytes were seen in the mice bone marrow cells. CONCLUSIONS: Considering these results, it is suggested that P. sepium does not have mutagenic potential under the conditions examined in each study.
Animals ; Arthritis, Rheumatoid ; Biotransformation ; Bone Marrow ; Chromosome Aberrations ; Cricetinae ; Cricetulus ; Erythrocytes ; Escherichia coli ; Glycosides ; Lung ; Medicine, Chinese Traditional ; Mice ; Micronucleus Tests ; Periploca ; Salmonella typhimurium

BACKGROUND: 8,000 children in North Korea died before they reached the 1 year after births in 2013. The high mortality rate of children under five years of age is mainly caused by infectious diseases and malnutrition. The need for national pediatric immunization and supply of vaccines will be vital when the abrupt reunification occurs. OBJECTIVE: The purpose of this study is to scrutinize the pediatric immunization coverage of North Korea. Additionally it is to estimate the amount and the costs needed to vaccinate. METHODS: The target population is the children of North Korea. The method is based on a pre-survey and an interview of North Korea defectors. The target interviewees searched for are as follows; doctors, teachers, and others. The interview includes questions on mortality rates and immunization coverage. The analysis is largely based on the statements of the health care providers within the selected group. RESULTS: The interviewees are 8; 7 female and 1 male. The birth years range from 1956 to 1982. 3 out of 8 are former health care providers; a doctor, a pharmacist, and a nurse. The morbidity rate of infectious diseases exceeds the data from WHO. The immunization coverage is nearly 0% after 1980s. In order to ensure the welfare of North Korean children, at least 8,234,000 vaccine doses, requiring over 105 million U.S. dollars, are needed. CONCLUSION: The morbidity rate of infectious disease in North Korea is conspicuous. The preparation for supply and expenditure of vaccines is vital.
Child ; Communicable Diseases ; Democratic People's Republic of Korea* ; Female ; Health Expenditures ; Health Personnel ; Health Services Needs and Demand ; Humans ; Immunization* ; Male ; Malnutrition ; Mortality ; Parturition ; Pharmacists ; Vaccines

No abstract available.
Connective Tissue Diseases* ; Connective Tissue* ; Diagnosis*

Hydrochlorothiazide is a diuretic drug used in the treatement of edema and hypertension. We report a case of hydrochlorothiazide induced photosensitivity in a 54 year old woman who had taken hydrochlorothiazide for 3 years for hypertension. She complained of itching and burning sensation with erythematous papules and lichenified plaques on light-exposed areas. Fhototest showed marked decrease of the minimal erythema dose(MED) for UVA. The symptoms subsided after the use of topical steroid and the substitution atenolol for hydrochlorothiazide.
Atenolol ; Burns ; Edema ; Erythema ; Female ; Humans ; Hydrochlorothiazide* ; Hypertension ; Middle Aged ; Pruritus ; Sensation

OBJECTIVE: We conducted a survey to understand the current state of pharmacy services and pharmacists' thoughts in the future of the community pharmacy setting. METHODS: A questionnaire was distributed to 229 pharmacists and gathered from 95 respondents. RESULTS: We asked to pharmacists about what the ideal pharmacy duty should be in the next 10 years at the community pharmacy setting in Korea. For this question, the respondents said drug counselling (19.4%), dispensing (13.8%), longterm care of chronic disease and healthcare education (12.8%), and OTC counselling (11.5%). When asked about how much time they were spending doing certain tasks in the pharmacy, the main tasks were dispensing (23.5%), counselling (17.1%), prescription review (10.1%), and OTC counselling (5.5%). When asked about what the most important duty of a pharmacist was, medication counselling (45.4%) was the most important task that they identified and the reasons for not being able to fulfill this role properly was time shortage (78.9%) followed by the lack of counselling spaces, up-to-date knowledges, and focus on financial gains over patient counselling. CONCLUSION: Korean pharmacists are mainly focusing on dispensing in their daily work. Their basic responsibilities can be easily mechanized over the next few years, but the social expectations of disease-prevention and public health promotion both in current and future can not be replaced by such mechanical measures. Therefore, pharmaceutical services in Korea should be developed in more diverse and professional ways.

Although urine cytology has been used as a useful diagnostic and followup procedure for bladder tumors, it has difficulties in diagnosing low grade and superficial bladder tumors. Recently, flow cytometric DNA analysis is developing an increasing role in the evaluation of patients with possible urothelial malignancy. We evaluated the value of urine cytology and flow cytometry in the diagnosis and the followup of 91 patients with superficial bladder carcinoma between January 1989 and December l992. Positive cytology was detected in 37.4 percent of 91 patients. Among the 74 patients who were examined by urine cytology and flow cytometry, the detection rate was 39.2 percent by cytology, 47.3 percent by flow cytometry and 60.8 percent when both modalities were used. In the 33 recurrences, the detection rate was 63.6 percent by cytology, 57.6 percent by flow cytometry and 75.8 percent by both modalities. The results of this study indicated that urine cytology and flow cytometry have relatively low sensitivity in the diagnosis of superficial bladder tumors, but have higher sensitivity in recurrent tumors. A combination of urine cytology and flow cytometry increased diagnostic accuracy. In conclusion, the combination of urine cytology and flow cytometry is a useful adjunct procedure for the diagnosis and followup of patients with superficial bladder tumors.
Diagnosis ; DNA ; Flow Cytometry* ; Follow-Up Studies ; Humans ; Recurrence ; Urinary Bladder Neoplasms* ; Urinary Bladder*

Nefazodone, a newer antidepressant is a phenylpiperazine derivative that inhibits the reuptake of both norepinephrine and serotonin, and antagonizes 5-HT2A and alpha1 adrenergic receptors. Compared with SSRIs nefazodone caused the fewer activating symptoms, adverse gastrointestinal effects(nausea, diarrhea, anorexia) and adverse effects of sexual function, but is associated with the more dizziness, dry mouth, constipation, visual disturbances and confusion. We report on 4 cases of visual disturbances and hallucinations in patients taking nefazodone. 1) Nefazodone, as a 5-HT2A antagonist, might induce visual disturbances. 2) mCPP, metabolite of nefazodone might contribute to the hallucination through action on 5-HT receptor. 3) Dopaminergic enhancing activity of nefazodone might cause hallucination. The case report raises the possibility that dose-related perceptual disturbances may exist with nefazodone. The fact emphasizes the need to pay close attention to all possible drug interactions, particularly in patients treated with multiple psychoactive agents, older patients, and patients with decreased hepatic function.
Constipation ; Diarrhea ; Dizziness ; Drug Interactions ; Hallucinations ; Humans ; Mouth ; Norepinephrine ; Psychotropic Drugs ; Receptors, Adrenergic ; Serotonin ; Serotonin 5-HT2 Receptor Antagonists