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Journal of the Korean Medical Association.2002;45(1):90-99. doi:10.5124/jkma.2002.45.1.90

The pharmacological therapy of cardiac arrhythmias is still challenging. As is well known, antiarrhythmic drugs have a narrow therapeutic-toxic window and can induce lethal proarrhythmia (antiarrhythmic drug-induced arrhythmia). The harmful effect of antiarrhythmic drug was proven by CAST and so many clinical trials. Thus we need strict indications for prescription and objective parameters for monitoring of the drug action and side effects. The cardiac arrhythmias are classified as ectopic beats, bradyarrhythmia, and tachyarrhythmia. The main target of antiarrhythmic drugs is tachyarrhythmia. The clinical role of antiarrhythmic drugs is the acute conversion of arrhythmia to sinus rhythm and the chronic suppression/prevention of tachycardia. The cardiac arrhythmia (arrhythmogenesis) occurs in harmony of 3 components, namely, substrate, precipitating (modulating) factors, and trigger. The acute modification of arrhythmogenic environment by drug may be efficient, but the chronic suppression of arrhythmia only by the drug may not be complete. Recently, the clinical role of chronic drug therapy is replaced by RFCA (in patients with SVT except atrial fibrillation) and ICD (VT/SCD). The antiarrhythmic drugs are usually classified into Class I (sodium channel blocker), Class II (beta-blocker), Class III (potassium channel blocker), Class IV (calcium channel blocker), and others (digoxin and adenosine), according to Vaughn-Williams suggestion. Nowadays, the clinical electrophysiologist reclassified the agents into calcium channel-dependent drug (Class II, IV, digoxin, and adenosine) and sodium/potassium channel-dependent drug (Class I and III). The drug is effective only when the concentration in blood or tissue is sufficient to modify the arrhythmogenic substrate. We need to know the pharmacokinetic and pharmacodynamic properties of antiarrhythmic drugs exactly. We can expect the blood concentration of a drug if we know the elimination half-life and the dosing schedule of the drug because most drugs (including antiarrhythmic agents) have the first-order (elimination) kinetic. For a new steady-state of drug concentration, we should wait for 3 to 4 times of the half-life after changing the dosage (prescription). Finally, the consideration and management of the underlying heart disease and precipitating/modulating factors are needed for the effective antiarrhythmic drug therapy.
Anti-Arrhythmia Agents ; Appointments and Schedules ; Arrhythmias, Cardiac ; Bradycardia ; Calcium ; Digoxin ; Drug Therapy ; Half-Life ; Heart Diseases ; Humans ; Prescriptions ; Tachycardia

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A Case of Intramural Pregnancy.

Jun Yong HUR

Journal of the Korean Medical Association.2002;45(1):85-89. doi:10.5124/jkma.2002.45.1.85

Intramural pregnancy is a rare variant of ectopic pregnancy, which was first reported in 1924 by Perli, and only 21 cases have been reported in the literature. The pathologic diagnosis of an intramural pregnancy can be made by the myometrium surrounding the products of conception that separate it from the endometrial cavity or fallopian tubes. Recent development of radiologic ultrasonography and radioimmunoassay of the beta-subunit of human chorionic gonadotropin has markedly enhanced the ability to diagnose intramural pregnancy during very early gestation. Many reports have noted that there would be possible relationships between the intramural pregnancy and prior uterine traumatic factor-curettage, cesarean section, myomectomy, salpingectomy, and manual removal of the placenta. We experienced a 28-year-old female patient with amenorrhea for 7 weeks and sudden vaginal spotting. She underwent dilatation and curettage at 4 weeks of gestation. We report this case with a brief review of the literature.
Adult ; Amenorrhea ; Animals ; Cesarean Section ; Chorionic Gonadotropin ; Curettage ; Diagnosis ; Dilatation and Curettage ; Fallopian Tubes ; Female ; Fertilization ; Humans ; Metrorrhagia ; Mice ; Myometrium ; Placenta ; Pregnancy* ; Pregnancy, Ectopic ; Radioimmunoassay ; Salpingectomy ; Ultrasonography

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Prevention and Management of Fractures with Seasonal Prevalence in Winter.

Dong Wook KIM

Journal of the Korean Medical Association.2002;45(1):73-84. doi:10.5124/jkma.2002.45.1.73

Seasonal variations of fractures are concerned with seasonal sports injuries and pathologic fractures in elderly osteoporotic patients. Despite various attempts at prevention, injuries in downhill skiing especially free style, snowboarding, snowmobile, and tobogganing continue to be seasonal recreational problem. Knee injuries in skiing can be prevented by health education as well as self-releasing test for the binder. Injury of the upper extremity in snowboarding and of the spine in snowmobile also can be reduced by education program. Another aspect of seasonal variation of fractures is related to the osteoporosis in elderly patients. Distal radius fractures, hip fractures, and compression fractures of the spine are common problems in winter. The high incidences these fractures in winter are not only due to ice and snow but also related to the daylight hours and level of vitamin D. So we can reduce the incidence of these fractures by snow clearing, sand and salt spreading in strategic areas, slip-preventive aids on shoes, sometimes padding for older women, and most of all, early detection and treatment of osteoporosis in elderly people.
Aged ; Athletic Injuries ; Education ; Female ; Fractures, Compression ; Fractures, Spontaneous ; Health Education ; Hip Fractures ; Humans ; Ice ; Incidence ; Knee Injuries ; Off-Road Motor Vehicles ; Osteoporosis ; Prevalence* ; Radius Fractures ; Seasons* ; Shoes ; Skiing ; Snow ; Spine ; Upper Extremity ; Vitamin D

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Bioequivalence Test and Its Significance.

Kyung Hwan KIM

Journal of the Korean Medical Association.2002;45(1):65-72. doi:10.5124/jkma.2002.45.1.65

Bioequivalence is defined as the absence of a significant difference in the rate and extent to which the active ingredient or active moiety in pharmaceutical equivalents or pharmaceutical alternatives becomes available at the site of drug action when administered at the same molar dose under similar experimental conditions in either a single dose or multiple doses in an appropriately designed study. If a drug is to be bioequivalent to the reference drug, the confidence interval for both pharmacokinetic parameters, AUC(area under the plasma concentration-time curve) and Cmax(maximal plasma concentration), must be entirely within the 80% to 125% of those of the reference drug. Underlying the concept of bioequivalence is the thesis that, if a drug product contains a drug substance that is chemically identical and is delivered to the site of action at the same rate and extent as another drug product, then it is equivalent and can be substituted for that drug product. The primary concern from the regulatory point of view is the protection of the patient against approval of products that are not bioequivalent. In this paper the general concept and the practical significance of the bioequivalence is described. The recently revised Korean guideline for bioequivalence test is also discussed.
Drug Substitution ; Humans ; Molar ; Plasma ; Therapeutic Equivalency*

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Objections to Professional School of Medicine.

Chang Jin SONG

Journal of the Korean Medical Association.2002;45(1):56-64. doi:10.5124/jkma.2002.45.1.56

No abstract available.
Humans

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Introduction of the Graduate School of Medicine - Affirmative Aspect.

Soo Hun CHO

Journal of the Korean Medical Association.2002;45(1):51-55. doi:10.5124/jkma.2002.45.1.51

No abstract available.
Humans

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Current Status and Vision of e-Care.

Tai Woo YOO

Journal of the Korean Medical Association.2002;45(1):41-50. doi:10.5124/jkma.2002.45.1.41

Internet is changing almost every facet of our daily lives and the health care is not the exception. About half of the Korean population are using Internet and Korea has the highest rate of high bandwidth Internet use such as ADSL, Cable TV, and so on. E-health has been around health information, e-commerce, and connectivity. Now it migrates toward patient care, so called, e-care. E-care tries to improve the quality of care and reduce the health care costs like the traditional health care. The examples are health risk assessment, information and support, disease management, and interactive medical channel. Health risk assessment provides a comprehensive appraisal of risk factors, summarized by the health age. Information and support sites are specified for special age groups and special diseases. Many medical institutions such as hospitals or HMOs are providing medical channels as a part of their health care services. Many chronic diseases such as diabetes mellitus and congestive heart failure are managed on-line supplementing the traditional doctors' care and management of such diseases. For the first time in Korea, an e-care system, named "Lifetime Health Clinic" is introduced. It provides health information for 80~90% of health problems occurring in a typical home. It also provides a lifetime cancer screening guideline and guidelines to manage registered members' health risks such as smoking, exercise, stress, nutrition, and weight. Clients select their own family physicians and their questions are answered by them on a one-to-one basis. It will improve the quality of medical care supplementing the traditional doctor's role.
Chronic Disease ; Delivery of Health Care ; Diabetes Mellitus ; Disease Management ; Early Detection of Cancer ; Health Care Costs ; Health Maintenance Organizations ; Heart Failure ; Humans ; Internet ; Korea ; Patient Care ; Physicians, Family ; Risk Assessment ; Risk Factors ; Smoke ; Smoking

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Internet Healthcare Delivery System.

Suk Il KIM ; Kwang Jum KIM

Journal of the Korean Medical Association.2002;45(1):33-40. doi:10.5124/jkma.2002.45.1.33

The healthcare laws and healthcare system, which includes healthcare delivery system and network hospital and attending hospital system etc., have much influence on the application of Internet. Whereas government-driven healthcare delivery system had little desirable effects including increased efficiency in patient care and balanced development of various types of medical service facilities, the private hospital network was successful with the help of information interchange. The network hospital is a kind of private hospital network for patient delivery preparing for the current healthcare management issues such as the separation of pharmacy and clinic and expansion of DRG. Network hospitals has been used the internet to transfer the information of patients. Internet is not the main success factor of the network, but the it may not be successful without Internet. The attending hospital system is in it's early stage in Korea. As the number of participating physician increases, the need of information interchange will be increased. The future of the internet healthcare delivery system would be composed of web application and databases, ASP, team approach to assist physicians. The major obstacle of the system is the technical level of information system in medium and small sized hospitals. The governmental financial assistance is needed in that hospitals. The most important issue is the standardization of information. The participation of KMA in standardization is needed.
Delivery of Health Care* ; Diagnosis-Related Groups ; Hospitals, Private ; Humans ; Information Systems ; Internet* ; Jurisprudence ; Korea ; Patient Care ; Pharmacy ; Viperidae

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Medical Consultation and Telemedicine Using the Internet.

Sang Woo OU

Journal of the Korean Medical Association.2002;45(1):24-32. doi:10.5124/jkma.2002.45.1.24

The number of Internet users is rapidly increasing in Korea. Because of the busy modern life style, demands for the convenient medical services using the Internet are also increased. There are about 10,000 medical Internet sites in Korea. However, several surveys on the Internet medical information in Korea have shown disapointing results. As in other nations medical information is often inappropriate for the questions and some might be even harmful. Somewhat insufficient role of the Internet medical consultation do not satisfy the people' needs. There are eseveral movements for the improving medical Internet information system in Korea but are still at the beginning state. By using the Internet technology, telemedicne for the remote area, for the dementia patients, for the emergency care, and for the elderaly have been tried in Korea. But legal problems, insufficient evidence for its efficiency, and several other drawback make telemedicine be still remaining at the experimental state. However, increasing demands for the better medical services, developing inforamtion technology, expanding high-velocity network system, and fucure capacity mobile communication systems will obviate these problems in the near future.
Dementia ; Emergency Medical Services ; Humans ; Information Systems ; Internet* ; Korea ; Life Style ; Telemedicine*

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Legal Approach in Internet Medical Counseling.

Hyun Ho SHIN

Journal of the Korean Medical Association.2002;45(1):17-23. doi:10.5124/jkma.2002.45.1.17

Internet medical counseling is increasing through the recent diffusion of super-high speed network. It provides not only medical information but also substantial Internet counseling(home medical care or telemedicine) that may rander definite diagnosis and treatment on line. But Internet medical counseling is still prohibited since Korean medical law stipulates the principle of facing treatment. Soon if will be possible to deliver Internet medical counseling under the revised bill of Korean medical law on telemedicine and electronic medical record. Therefore, I would like to give some legal information and advice that merit attention when medical personnel deliver Internet medical counseling. First, in case of substantial Internet medical counseling, it would be desirable to allow Internet counseling as the second treatment with the trust between doctor and patient being the first. Internet counseling should replace facing treatment only when the latter is practically not possible. It should be initiated not by physicians??soliutation but by requests from patients themselves. Of course, full explanation about the practice, including any potential disadvantages to the patients, should be provided. Second, counseling contents should be recorded and the hard copies of the Q-and-A should be kept with signature on. Patients privacy should not be infringed. Third, in case of Internet medical counseling, medical personnel has the same responsibility as that in the facing treatment. And it is stipulated in the revised bill of Korean medical law that if there is no definite evidence that acknowledges remote doctor's fault, resident doctor has the responsibility. But this could make a resident doctor hesitate to practice telemedicine, and enough discussion should follow on this. Internet medical counseiling gives a big opportunity to provide highly developed medical techniques overcoming the geographic barrier of distance, but it also might be dangerous enough to threaten patient's life by providing wrong information and cause effluence of private inforamtion. Therefore, it is necessary to facilitate public opinion regarding the Internet medical counseling on its limit and regulation.
Counseling* ; Diagnosis ; Diffusion ; Electronic Health Records ; Humans ; Internet* ; Jurisprudence ; Privacy ; Public Opinion ; Telemedicine

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