BACKGROUND: Therapeutic drug monitoring (TDM) has been shown to be effective in minimizing the risk for toxicity and maximizing the efficacy of the drugs. The application of pharmacokinetics principles to indiviualization and optimization of dosage is necessary. We evolved interpretative report system of digoxin determination in a view of individual's pharmacokinetics. The alto of the present study is to validate the effectiveness of the interpretative report system in digoxin therapeutic monitoring service. METHODS: We reviewed 125 inpatients of two groups. 4 group, before interpretative reporting, had 86 inpatients from February 1996 to March 1996. B group included 39 inpatients from September 1996 to October 1996 after the practice of the sytem. Digoxin concentrations were measured in serum by TDxFlex (Abbott Laboratories, U.S.A.). Each patient's digoxin pharmacokinetics was determined by using the Abbott-base Pharmacokinetics system (Abbott Laboratories, U.S.A.) . The interpretation for the assayed digoxin level, the recommendation of maintenance dosage and the simulation graph with predicted serum levels were included in the report. The effectiveness of the reporting system was evaluated by comparing the appropriateness of digoxin level measurement between both groups. RESULTS: It revealed that appropriate measurements of digoxin level were 59.5 % of the tests in A group and 77.1% of those in B group (p=0.006). Evaluation of serum digoxin concentrations stratified by digoxin concentration showed also significant difference among the percentage of tests in each concentration range between both groups (p=0.011). CONCLUSIONS: Interpretative report system for the assayed results caused to increase in the appropriateness of digoxin measurement. The report system with some improvement which is achieved through the active approach to physician helps us use TDM effectively. The system can be applied to the other TDM drugs.
Digoxin ; Drug Monitoring* ; Humans ; Inpatients ; Pharmacokinetics

BACKGROUND: Therapeutic drug monitoring (TDM) has been shown to be effective in minimizing the risk for toxicity and maximizing the efficacy of the drugs. The application of pharmacokinetics principles to indiviualization and optimization of dosage is necessary. We evolved interpretative report system of digoxin determination in a view of individual's pharmacokinetics. The alto of the present study is to validate the effectiveness of the interpretative report system in digoxin therapeutic monitoring service. METHODS: We reviewed 125 inpatients of two groups. 4 group, before interpretative reporting, had 86 inpatients from February 1996 to March 1996. B group included 39 inpatients from September 1996 to October 1996 after the practice of the sytem. Digoxin concentrations were measured in serum by TDxFlex (Abbott Laboratories, U.S.A.). Each patient's digoxin pharmacokinetics was determined by using the Abbott-base Pharmacokinetics system (Abbott Laboratories, U.S.A.) . The interpretation for the assayed digoxin level, the recommendation of maintenance dosage and the simulation graph with predicted serum levels were included in the report. The effectiveness of the reporting system was evaluated by comparing the appropriateness of digoxin level measurement between both groups. RESULTS: It revealed that appropriate measurements of digoxin level were 59.5 % of the tests in A group and 77.1% of those in B group (p=0.006). Evaluation of serum digoxin concentrations stratified by digoxin concentration showed also significant difference among the percentage of tests in each concentration range between both groups (p=0.011). CONCLUSIONS: Interpretative report system for the assayed results caused to increase in the appropriateness of digoxin measurement. The report system with some improvement which is achieved through the active approach to physician helps us use TDM effectively. The system can be applied to the other TDM drugs.
Digoxin ; Drug Monitoring* ; Humans ; Inpatients ; Pharmacokinetics

BACKGROUND: Methylmalonic aciduria can be caused by inherited defects in the methylmalonyl-CoA mutase enzyme, Inherited defects in the metabolism of vitamin Bl2 and acquired or inherited vitamin Bl2 deficiency. Quantitation of urinary methylmalonic acid (MMA) is very useful In diagnosis of methylmalonic acidemia and cobalamin deficiency. We evaluated a quantitation method of urinary MMA and determined reference values. METHODS: The method involved stable isotope dilution gas chromatographymass spectrometry (GC-MS) with (methyl 2H3)-MMA as the internal standard. We determined the detection limit, linearity and periodic variations of the assay. Urinary MMA levels were measured in 70 individuals of ages newborn to 58 years with no metabolic disorders. RESULTS: The lower limit of detection calculated from blank runs (mean+/-3SD) was 2.62nmo1/m1. One control urine tramp)e analyzed 23 times within 3 weeks game results of 7.83+/-1.09 (mean+/-SD, CV=13.8%) nmol/mL. The linearity at four different concentrations of MMA was acceptable (R2=0.9992). The concentration of urinary MMA in 70 individuals was 2.33+/-2.19 mmol/mol creatinine (mean+/-SD). Age related reference values which decreased with age were also reported (p=1.23x10-9). CONCLUSIONS: The described method is sensitive, specific and noninvasive, which is considered the gold standard method for measuring MMA. The method could be used as a screening test for cobalamin deficiency and inherited methyl malonic acidemia. On the basis of the narrow range of normal concentration, it is expected that the method would readily detect mild cobalamin deficiency.
Chromatography, Gas* ; Creatinine ; Diagnosis ; Gas Chromatography-Mass Spectrometry* ; Humans ; Infant, Newborn ; Limit of Detection ; Mass Screening ; Metabolism ; Methylmalonic Acid* ; Methylmalonyl-CoA Mutase ; Reference Values ; Spectrum Analysis ; Vitamin B 12 ; Vitamins

This study is performed to evaluate usefulness of dermal measurement of benzidine and benzidine based dye as one of the occupational exposure assessment method for these compounds. We selected one benzidine manufacturing factory and one dye manufacturing factory in Incheon area. Eleven workers were for benzidine manufacturing factory and twenty four for dye. We analyzed relationships among air level, amount on skin and concentration of urinary metabolites for these compounds. Airborne levels of benzidine and dye were measured by NIOSH 5509, 5013 methods. Amount of these compounds on skin was measured with skin wipe method. Concentration of benzidine metabolites in urine was measured by High Performance Liquid Chromatography after alkaline hydrolysis. The amount of benzidine on hand skin was 25.05( - 233.2) ng/ur, and the amount of the neck was 2.01 ( - 11.9) ng/cm2 in the benzidine dihydrochloride manufacturing factory. The amount of benzidine on hand and neck skin has positive correlation with concentration of urinary monoacetyl benzidine (r=0.644, p < 0.05) . The amount of benzidine based dye on hand skin was 55.75( - 457.7) ng/cm2, and the amount of the neck skin was 18( - 284.7) ng/cm in benzidine based dye manufacturing factory The amount of dye on hand and neck skin has positive correlation with concentration of urinary benzidine for dye workers (r=0.467, p < 0.05). When assessing the exposure of workers who deal with benzidine, the amount of benzidine on skin should be measured for an accurate exposure assessment.
Chromatography, Liquid ; Hand ; Hydrolysis ; Incheon ; National Institute for Occupational Safety and Health (U.S.) ; Neck ; Occupational Exposure ; Skin

PURPOSE: Perinatal asphyxia occurring in newborn is one of the major causes of acute mortality and chronic neurological disability in survivors. We have studied the relationship between early electroencephalography(EEG) findings and clinical course and neurologic outcome in severe asphyxiated neonates. METHODS: Between the period of July 1999 and June 2002, 25 neonates who were diagnosed with severe perinatal asphyxia(1-minute Apgar score of < or =3 and initial pH is less than 7.2) at NICU in Dongsan Medical Center were enrolled. An EEG was recorded and analyzed within three days of life and divided into two groups - group 1(normal or focal change on EEG) and group 2(generalized abnormal EEG). Between the two groups, clinical courses and neurologic outcomes were compared. RESULTS: Fifteen infants(60%) were group 1 and ten infants(40%) were group 2(polyspikes, burst- suppression, generalized low voltage). Associated maternal disease, days of hospitalization, need for ventilator support, delay of oral feeding and convulsion duration are significantly higher and longer in group 2. Also, poor neurologic outcome(expire, developmental delay) was significantly higher in group 2(60%) than group 1(13.3%). CONCLUSION: Thus, the early neonatal EEG in asphyxiated newborn can be a predictable diagnostic tool in assessment of neurologic outcome.
Apgar Score ; Asphyxia ; Electroencephalography ; Hospitalization ; Humans ; Hydrogen-Ion Concentration ; Infant, Newborn* ; Mortality ; Seizures ; Survivors ; Ventilators, Mechanical

The purpose of this study was to discuss the history of, and concerns regarding, the newly amended criteria of occupational cerebrovascular or cardiovascular diseases (CCVDs). Since the early 1990s, CCVDs have been the second most common occupational disease, despite fluctuations in their criteria. The first issue was the deletion of cerebral hemorrhage on duty as a recognized occupational disease in 2008. The second issue was the obscurity regarding definitions of an acute stressful event (within 24 hr before disease occurrence), short-term overwork (within 1 week), and chronic overwork (for 3 or more months). In this amendment, chronic overwork was defined as work exceeding 60 hr per week. If the average number of weekly working hours does not exceed 60 hr, night work, physical or psychological workload, or other risk factors should be considered for the recognition of occupational CCVDs. However, these newly amended criteria still have a few limitations, considering that there is research evidence for the occurrence of disease in those working fewer than 60 hr per week, and other risk factors, particularly night work, are underestimated in these criteria. Thus, we suggest that these concerns be actively considered during future amendment and approval processes.
Cardiovascular Diseases/*economics ; Cerebrovascular Disorders/*economics ; Humans ; Insurance, Health/economics ; Occupational Diseases/*economics ; Organization and Administration ; Republic of Korea ; Work Capacity Evaluation ; Workers' Compensation/*economics ; *Workload

BACKGROUND: It has been known that arterial carbon dioxide tension is 4~5 mmHg higher than end-tidal carbon dioxide tension in healthy adults during general anesthesia. But negative arterial to end-tidal PCO2 difference was reported in pregnant patients undergoing cesarean section. The purpose of this study was to elucidate the difference between arterial and end-tidal PCO2 in anesthetized patients with reduced functional residual capacity. METHODS: 90 patients were divided into 3 groups i.e. control group (n=30), obese group (n=20, body weight more than 20% greater than ideal weight), pregnant group (n=40). All patients had no cardiac or respiratory abnormalities and never smoked. Arterial blood gas analysis and measurement of end-tidal PCO2 were done 20 minutes after induction of anesthesia in control and obese group and just before uterine incision and 20 minutes after fetal delivery in pregnant group. RESULTS: There were significant correlations between arterial and end-tidal PCO2 in all groups. The incidences of negative arterial to end-tidal PCO2 difference were 10% in control group, 40% in obese group, 42.5% in pregnant group (p<0.05). CONCLUSION: From this study, it is concluded that patients with reduced functional residual capacity have more incidences of negativity than normal patients in the values of arterial to end-tidal PCO2 difference during general anesthesia. So when the tight control of PaCO2 is required in patients with reduced FRC, we recommend to measure PaCO2 for better anesthetic management.
Adult ; Anesthesia ; Anesthesia, General ; Blood Gas Analysis ; Body Weight ; Carbon Dioxide* ; Carbon* ; Cesarean Section ; Female ; Functional Residual Capacity* ; Humans ; Incidence ; Pregnancy ; Smoke

Healthcare workers are exposed to a variety of chemical agents used in many different areas and purposes. The chemicals could cause health problems to healthcare workers using them. Glutaraldehyde is a kind of disinfectant and used for endoscopes, catheters, and many kinds of operating apparatus. It may cause allergic contact dermatitis. Formaldehyde is another disinfectant and can be used for fixing tissues. Formaldehyde was classified to a Group 1 carcinogen by IARC and it may cause lung or nasal cancer. Ethylene Oxide gas is the most popular disinfectant these days and may be applied to many health care sets or linens. EO gas may cause allergic contact dermatitis and breast cancer or leukemia. It is also classified as Group 1 carcinogen despite limited evidence for human cancers. Anesthetics are related to genotoxicities, sister chromatid exchange, and might be related to spontaneous abortion, stillbirth or birth defects. Some of the anti-neoplastic drugs such as Busulfan, Chlorambucil, cyclophosphamide, melphalan are Group 1 carcinogens. They could cause nausea, pruritus, or decreasing leukocytes or platelets. Other miscellaneous chemical agents are heavy metals such as elementary mercury or lead and organic solvents such as toluene, xylene and acetone. Although some of these chemical agents including EO gas have occasionally exceeded to permissible level, air levels of most above chemicals in Korean hospitals were relatively low. However, we have to make every effort to reduce the exposure level of these chemicals.
Abortion, Spontaneous ; Acetone ; Anesthetics ; Bedding and Linens ; Blood Platelets ; Breast Neoplasms ; Busulfan ; Carcinogens ; Catheters ; Chlorambucil ; Congenital Abnormalities ; Cyclophosphamide ; Delivery of Health Care ; Dermatitis, Allergic Contact ; Endoscopes ; Ethylene Oxide ; Ethylenes ; Female ; Formaldehyde ; Glutaral ; Humans ; Leukemia ; Leukocytes ; Lung ; Melphalan ; Metals, Heavy ; Nausea ; Nose Neoplasms ; Pregnancy ; Pruritus ; Sister Chromatid Exchange ; Solvents ; Stillbirth ; Toluene ; Xylenes

OBJECTIVES: This study was performed to investigate the effectiveness of the questionnaire. METHODS: Workers'health examination records, work environment record, and questionnaires of selected industries as samples were analysed using logistic regression analysis and discrimination analysis Results'Cases of bearing impairment (Dl+C) as dependent variables, and age, work duration and level of environmental noise as independent variables were selected for multiple unconditional logistic regression analysis. Odds ratio was 4.04 in hearing difficulty, 2.78 in tlnnitus and 1.08 in age. In the second analysis Noise induced hearing loss is selected as dependent variable. The OR in hearing difficulty was 3.67(95 % C.1. : 1.61 8.61), and was 1.09(95 % C.1. : 1.05-1.14) in age. Conditionnal multlple logistic regression analysis was performed. In hearing impairment as dependent variable, the OR of age was 1.02(95 % C.1. : 1.00-1.04) and other variables were not significant. However, NIHL as dependent, the OR of hearing difficulty was 4.57(95 % C.1. : 1.43-14.67). According to multiple logistic regression adopting each items of questionnaire as dependent variable, the only item of hearing difficulty showed significant difference with hearing ability. The discrimination analysis was performed with the class variable of hearing impairment, and discrimination variables of age, work duration, and environment noise level. The sensitivity of 59 %, and specificity of 88 %, and average error count of 23 % were obtained. When the numbers of items answered in questionnaire were assumed as the parameter of judgement for noise induced hearing loss (NIHL), the highest sensitivity and specificity were 33.5% and 49.0% in cases of more than two items answered. CONCLUSIONS: The development of items that is simple and discriminative mainly consisted of chronic and specific diseases related items is needed. Computerization for newly developed items might be needed to establish effective surveillance system for NIHL in the future.
Discrimination (Psychology) ; Hearing Loss* ; Hearing* ; Logistic Models ; Mass Screening* ; Noise* ; Odds Ratio ; Questionnaires* ; Sensitivity and Specificity

Osteoid osteoma is a relatively common benign tumor that most commonly affect the cortex of the long bone, Adolescent and young adult males are most frequently affected. It causes aching pain that worsens at night and commonly is relieved by aspirin. The typical radiographic appearance is a lucent nidus with surrounding dense cortical thickening. If the lesion is located in intra-articular cancellous bone, an osteoid osteoma may present with clinical findings that are more indicative of an inflammatory synovitis, and with atypical radiographic findings such as lack of both surrounding sclerosis and a lucent nidus. Therefore intra-articular osteoid osteoma may pose a diagnostic difficulty. Recently, we experienced 3 cases of intra-articular osteoid osteoma(2 humeral haed, 1 femoral head) and present them in detail.
Adolescent ; Aspirin ; Humans ; Male ; Osteoma, Osteoid ; Sclerosis ; Synovitis ; Young Adult