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Understanding the Drug-Drug Interaction.

Journal of the Korean Medical Association.2006;49(1):78-85. doi:10.5124/jkma.2006.49.1.78

Drug-drug interaction (DDI) is defined as a change in effect or safety of a drug by another co-administered drug. The fact that more than half of the market withdrawal cases for the past ten years was caused by potentially fatal DDI's demonstrates its clinical importance. The mechanism of DDI can be categorized into pharmacokinetic and pharmacodynamic interactions. Most of the clinically important drug interactions are caused by inhibition or induction of oxidative metabolism by cytochrome P450 (CYP) isozymes. Recent researches are also focusing on drug transporter interactions as another significant factor underlying DDI's. It is hard to prevent unexpected or rare DDI's. However, most of the cases of DDI occur from an erroneous prescription of drugs that are already known to result in deleterious interactions. To avoid such well-established DDI's, physicians are first recommended to utilize hands-on summary tables for CYP substrates before prescribing. It should also be remembered that old age, polypharmacy and damaged hepatic or renal function are risk factors of DDI as well as adverse drug reactions. Moreover, patients treated with drugs with a narrow therapeutic index (immunosuppressants, antiarrhythmics, anticoagulants, digoxin, theophylline etc) deserve a special consideration when their prescriptions are changed. In Korea, the clinical significance of DDI has been underemphasized. The fundamental prescription to this old prescription habit is to teach medical students and physicians clinical pharmacology and therapeutics, which have long been neglected in Korea.
Anticoagulants ; Cytochrome P-450 Enzyme System ; Digoxin ; Drug Interactions ; Drug-Related Side Effects and Adverse Reactions ; Humans ; Isoenzymes ; Korea ; Metabolism ; Pharmacology, Clinical ; Polypharmacy ; Prescriptions ; Product Recalls and Withdrawals ; Risk Factors ; Students, Medical ; Theophylline

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A Recent Overview of Varicose Vein in the Legs.

Kwang Jo CHO

Journal of the Korean Medical Association.2006;49(1):70-77. doi:10.5124/jkma.2006.49.1.70

Varicose vein is one of the ancient diseases, which has its evidence in Greek sculpture. Nowadays varicose vein has become a popular disease because of the media, so that many people want to treat their varicose vein and many medical doctors from a variety of fields seek a varicose clinic, accordingly. Since the introduction of the great saphenous vein stripping, the treatment of varicose vein has not been changed very much for about 100 years. Recently, however, many doctors in the outpatient varicose clinic prefer less invasive treatment and some innovative techniques that have become available recently. Endovascular treatment or transilluminated powered phlebectomy is one of them. Some dermatologists try to treat all kinds of varicose vein with sclerotherapy. But the long-term results of the treatment reveal that the gold standard of the treatment of typical varicose vein is a groin-to-knee inversion stripping of the great saphenous vein with stab avulsion of the varicose cluster. The application of the color Doppler duplex ultrasonogram to the leg vein has made it possible to evaluate the reflux of axial veins and perforator veins more thoroughly and less invasively. Therefore ultrasonography is the method of choice for the diagnosis of varicose vein preoperatively and postoperative follow-up studies for recurrent cases. The recurrence of varicose vein after treatment is mostly from the remnant reflux in the saphenofemoral junction and its tributary. Thus more meticulous treatment of the tributaries of saphenofemoral junction is needed.
Diagnosis ; Follow-Up Studies ; Humans ; Leg* ; Outpatients ; Recurrence ; Saphenous Vein ; Sclerotherapy ; Sculpture ; Ultrasonography ; Varicose Veins* ; Veins

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Treatment of Acne.

Kyu Uang WHANG

Journal of the Korean Medical Association.2006;49(1):63-69. doi:10.5124/jkma.2006.49.1.63

Acne vulgaris is a self-limited disease, seen primarily in adolescents. Most cases of acne are pleomorphic, presenting various lesions consisting of comedones, pustules, and nodules. Although it has been traditionally classified as a disease of the sebaceous gland, it actually involves the pilosebaceous unit. There are four major principles in the treatment of acne: (1) correct the altered pattern of follicular keratinization; (2) decrease the sebaceous gland activity; (3) decrease the follicular bacterial population; and (4) produce anti-inflammatory effect. The natural course of acne varies greatly, and therefore, the determination of the therapeutic efficacy of medications for the treatment of acne is far from being simple.
Acne Vulgaris* ; Adolescent ; Humans ; Sebaceous Glands

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Nocturnal Enuresis.

Kyung Do KIM

Journal of the Korean Medical Association.2006;49(1):53-60. doi:10.5124/jkma.2006.49.1.53

Nocturnal enuresis is the second most common chronic health problem in children following allergy. The prevalence of nocturnal enuresis in different age groups is about the same in all parts of the world. It can be stated that nocturnal enuresis is a clinical problem for the child and the family as well when the child is wetting the bed at least one night every month. With this definition, about 10% of 7-year-old children have nocturnal enuresis. Historically, a remarkable progress has been made in the mid-eighties. Previously, bedwetting was looked upon as a trivial condition, hardly worthy of serious medical assessment and management. In 1985, however, a study from Aarhus in Denmark drew a strong attention to bedwetting in the medical community worldwide by suggesting that nocturnal enuresis may be caused by nocturnal polyuria, which in turn depends on an insufficient production of antidiuretic hormone (vasopressin) during the sleeping hours. Since then, nocturnal enuresis has turned out to be an unexpectedly fruitful area for research, producing hundreds of scientific reports. Regarding its pathophysiology, it is becoming clear that two thirds of children with nocturnal enuresis have nocturnal polyuria due to an inadequate vasopressin secretion during sleep. In addition, ongoing studies suggest that there may be bladder problems (unstable bladder) or arousal disorder underlying nocturnal enuresis. Nocturnal enuresis should be taken seriously by physicians and needs intervention when the child expresses a desire to sleep dry, usually around 5 years of age.
Arousal ; Child ; Denmark ; Fruit ; Humans ; Hypersensitivity ; Nocturnal Enuresis* ; Polyuria ; Prevalence ; Urinary Bladder ; Vasopressins

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Management of Late-onset Hypogonadism.

Ju Tae SEO

Journal of the Korean Medical Association.2006;49(1):48-52. doi:10.5124/jkma.2006.49.1.48

There has been a great deal of recent interests in the topic of low testosterone in elderly men, a condition referred to as andropause, ADAM (androgen decline of aging male), or PADAM (partial androgen deficiency of the aging male), or LOH (late onset hypogonadism). Age-related decreases in androgen levels occur gradually and vary considerably among individuals. A low level of testosterone has been implicated as a cause of changes in sexual, physical and behavioral capacity in aging men. Although several observational and interventional studies have demonstrated that androgens have important beneficial functions in the body composition, muscle mass and strength, fat distribution, erythropoiesis, cognition, mood and bone density, and play a key role in male sexual function, a considerable controversy exists regarding the indications of testosterone supplementation in aging male.The objective of this article is to discuss what is known and not known regarding the benefits and risks of testosterone-replacement therapy and the monitoring of men receiving testosterone treatment.
Aged ; Aging ; Androgens ; Andropause ; Body Composition ; Bone Density ; Cognition ; Erythropoiesis ; Humans ; Hypogonadism* ; Male ; Risk Assessment ; Testosterone

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Surgical Treatment of Fragility Fracture During Menopause.

Kyu Hyun YANG

Journal of the Korean Medical Association.2006;49(1):41-47. doi:10.5124/jkma.2006.49.1.41

Estrogen deficiency causes a severe dysfunction in the bone homeostasis and bone resorption. Because of the wide surface area of cancellous bone, the primary bone loss occurs at the bony trabeculae of cancellous bone. Resorption pits on the surface of the trabeculae also play an important role in the development of fragility fracture as a stress riser. Since the vertebral body and distal radius have a high proportion of cancellous bone, fragility fractures during menopause are usually vertebral fracture and Colles' fracture. Surgical correction of these fractures is sometimes indicated in this age group. When surgical intervention is indicated, an anatomical restoration of the fracture is essential because of the high social activity and long life expectancy in these patients. A collapse of the vertebral body causes bending of the spinal column and shifting of the weight bearing line. It also causes abnormal stress on the adjacent vertebral body and subsequent vertebral fracture. The rationale of the surgical treatment is to control the acute pain from the fracture and to restore the mechanical axis of the spinal column. Stretching of the hand is a protective mechanism of the fall, which decreases the impacting force on the hip joint, while it frequently causes Colles' fracture on the wrist. During the past few decades, it has been thought as a benign injury, which does not cause any dysfunction. Now orthopaedic surgeons are requested to restore the function of the upper extremity as well as the anatomy of the joint.
Acute Pain ; Axis, Cervical Vertebra ; Bone Resorption ; Colles' Fracture ; Estrogens ; Female ; Hand ; Hip Joint ; Homeostasis ; Humans ; Joints ; Life Expectancy ; Menopause* ; Osteoporosis, Postmenopausal ; Radius ; Spine ; Upper Extremity ; Weight-Bearing ; Wrist

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Pharmacological Therapy for Postmenopausal Osteoporosis.

Chan Soo SHIN

Journal of the Korean Medical Association.2006;49(1):30-40. doi:10.5124/jkma.2006.49.1.30

Osteoporosis, now defined as a disease characterized by a low bone mass and a microarchitectural deterioration of bone tissue leading to an enhanced bone fragility and fracture risk, is a major public health problem, affecting 200 million individuals worldwide. Optimal treatment and prevention of osteoporosis require modification of risk factors, particularly smoking cessation, adequate physical activity, and attention to diet, in addition to pharmacologic intervention. A number of pharmacologic options are now available to health care providers. The estrogens and raloxifene both prevent bone loss in postmenopausal women, and the estrogens probably also decrease the risk of first fracture. There is a good evidence that raloxifene prevents further fractures in postmenopausal women who already have had fractures and some evidence that estrogen does as well. Bisphosphonate alendronate prevents bone loss and reduces fractures in healthy and osteoporotic postmenopausal women, and in osteoporotic men as well. Risedronate is more potent and has fewer upper gastrointestinal side effects than alendronate, and reduces the incidence of fractures in osteoporotic women. An intermittent use of potent bisphosphonate zoledronate also increases bone mineral density and may become an alternative in the prevention and treatment of osteoporosis. Calcitonin increases bone mineral density in early postmenopausal women and men with idiopathic osteoporosis, and also reduces the risk of new fractures in osteoporotic women. All of the agents discussed above prevent bone resorption, whereas teriparatide increases bone formation and is effective in the treatment of osteoporotic women and men. Bisphosphonates are also effective in the treatment of secondary osteoporosis associated with the use of glucocorticoids to treat inflammation or prevent rejection after transplantation. New avenues for targeting osteoporosis will emerge as our knowledge of the regulatory mechanisms of bone remodelling increases, although issues of tissue specificity may remain to be solved.
Alendronate ; Bone and Bones ; Bone Density ; Bone Resorption ; Calcitonin ; Diet ; Diphosphonates ; Estrogens ; Female ; Glucocorticoids ; Health Personnel ; Humans ; Incidence ; Inflammation ; Male ; Motor Activity ; Organ Specificity ; Osteogenesis ; Osteoporosis ; Osteoporosis, Postmenopausal* ; Public Health ; Raloxifene Hydrochloride ; Risedronate Sodium ; Risk Factors ; Smoking Cessation ; Teriparatide

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Climacteric Symptoms and Hormone Therapy.

Hyoung Moo PARK

Journal of the Korean Medical Association.2006;49(1):11-29. doi:10.5124/jkma.2006.49.1.11

After menopause, estrogen deficiency from the loss of ovarian function results in various symptoms and metabolic changes, which lead to an increased risk of chronic diseases. Troublesome menopausal symptoms, vasomotor and/or psychological, are the first to develop, and various kinds of disorders related to estrogen deficiency such as genitourinary atrophy, involutional osteoporosis, cardiovascular, and Alzheimer's diseases follow. Among these, two major long-term consequences of ovarian failure are osteoporosis and cardiovascular disease, which are also the major causes of morbidity, mortality and financial costs. Hormone therapy by using estrogen with or without progesterone, is most consistently effective for the treatment of acute and some intermediate menopause-related symptoms such as vasomotor symptoms and vaginal dryness, and therefore has been recommended as the first-line measure to prevent and treat the acute symptoms of estrogen deficiency. It also has been reported that hormone therapy reduces the risks of some long-term sequelaes, suggesting both therapeutic and preventive roles in postmenopausal women. However, it is clear that hormone therapy is not a panacea and is not suitable for all postmenopausal women because of side effects and some concerns about cancer risks. The rate of long-term compliance is also low at present. Recent RCTs showed that hormone therapy does not seem to be effective in improving cognition and preventing CHD and dementia. However, there is a growing consensus that the early initiation of hormone therapy provides protection from CVS and CNS, the two most important areas, whereas RCTs have disagreed with observational data. This means that in young women at early menopause, "a window of therapeutic opportunity" exists for hormone therapy, since treatment during this period may provide cardio- and neuroprotection. More studies are urgently needed on this controversy. Current recommendations suggest treatment with the lowest effective dose for the shortest period of time and individualized treatment based on patient's risk and benefit ratio.
Atrophy ; Cardiovascular Diseases ; Chronic Disease ; Climacteric* ; Cognition ; Compliance ; Consensus ; Dementia ; Estrogens ; Female ; Humans ; Menopause ; Mortality ; Osteoporosis ; Progesterone

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Perspectives for Managing Menopause: General Introduction.

Han Jin OH

Journal of the Korean Medical Association.2006;49(1):4-10. doi:10.5124/jkma.2006.49.1.4

Menopause is very important for women causes of many health problems are related. Hormone Replacement Therapy (HRT) is so common to treat symptoms of menopause. It is important that benefits and harms of HRT based on scientific evidence should be considered when prescribing HRT. The health care workers should prepare themselves for a better dialogue with women including information about alternative treatment. Beneficial effects of HRT on vasomotor symptoms have been supported by various studies, but HRT to treat negative mood is not recommended. Estrogens and androgens have significant beneficial effects on skin collagen, but do not prevent the effect of aging on elastic tissue and have limited use in the prevention and treatment of skin changes of menopause. Short-term benefits have been shown for urogenital atrophy. Recent evidences suggest that benefits of HRT include prevention of osteoporotic fractures, and colorectal cancer while prevention of dementia is uncertain. Harms include Coronary Heart Disease (CHD), stroke, thromboembolic events, and breast cancer, with 5 or more years of use. Active living, alternative therapies and consumption of food rich in phytoestrogens are some areas, which need to be explored in more detail. Patient preferences as well as evidence are important to initiate and/or continue HRT. Treatment choice should be based on up-to-date information and targeted to individual women's needs. HRT still offers the potential for benefit to outweigh harm, providing the appropriate regimen has been instigated in terms of dose, route and combination.
Aging ; Androgens ; Atrophy ; Breast Neoplasms ; Collagen ; Colorectal Neoplasms ; Complementary Therapies ; Coronary Disease ; Delivery of Health Care ; Dementia ; Elastic Tissue ; Estrogens ; Female ; Hormone Replacement Therapy ; Humans ; Menopause* ; Osteoporotic Fractures ; Patient Preference ; Phytoestrogens ; Skin ; Stroke

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A New Year's Greeting Message.

Jae Jung KIM

Journal of the Korean Medical Association.2006;49(1):2-2. doi:10.5124/jkma.2006.49.1.2

No abstract available.

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