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Medical Treatment of the Benign Prostatic Hyperplasia.

Journal of the Korean Medical Association.2004;47(2):163-172. doi:10.5124/jkma.2004.47.2.163

The search for nonhormonal pharmacological agents capable of reducing out flow obstruction caused by benign prostatic hyperplasia (BPH) began in the 1970s when alpha adrenergic receptors were demonstrated within the smooth muscle element of prostatic adenomas, the prostatic capsule, and the bladder neck. Recently, many studies have confirmed that the alpha adrenoceptor blockade sub-jectively and objectively reduces symptoms and urodynamic parameters in bladder outflow obstruction. Very longterm effects of the alpha blockade upon the pro-state are not yet known. There is no direct evidence of a decrease in the stromal smooth muscle bulk or in the total prostate volume after longterm treatment with alpha adrenoceptor blockers in man. The endocrinebased therapies, such as stilbestrol, luteinizing hormonereleasing hormone analogues, antiandrogens flutamide, and cyproterone acetate, have sometimes been used to treat BPH, but with a limited efficacy and prominent sideeffects such as loss of libido, impotence, hot flushes, and gynecomastia. Although it has been shown that some of these therapies may shrink the prostate, the sideeffects are intolerable to most patient. On the other hand, new 5 alpha reductaseinhibiting agents are able to block the effects of androgen within the prostate without a systemic antiandrogen activity. Since the effects of androgens are particularly directed at the glandular element of the prostate rather than at the smooth muscle, the combined use of alphaadrenoceptor blockers and 5 alphareductase inhibitors could theoretically produce an additive effect in the treatment of BPH. The indications of medical treatment for BPH include patients with mild to moderate symptoms, especially if they are reluctant to undergo surgery, and those who are not medically eligible to surgery.
Androgen Antagonists ; Androgens ; Cyproterone Acetate ; Diethylstilbestrol ; Erectile Dysfunction ; Flutamide ; Gynecomastia ; Hand ; Humans ; Libido ; Lutein ; Male ; Muscle, Smooth ; Neck ; Prostate ; Prostatic Hyperplasia* ; Receptors, Adrenergic, alpha ; Urinary Bladder ; Urodynamics

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Drug Utilization Review.

Sang Cheol BAE

Journal of the Korean Medical Association.2004;47(2):156-162. doi:10.5124/jkma.2004.47.2.156

Drug utilization review (DUR) is one of the approaches to improve quality of health care and reduce its costs. DUR programs have been defined as "structured, ongoing initiatives that interpret patterns of drug use in relation to predetermined criteria, attempting to prevent or to minimize inappropriate prescribing while maximizing the effectiveness of drug therapy to save costs." There have been a limited number of papers to evaluate the economic consequences of DUR programs, and they provide no definite evidence regarding the cost saving or costeffectiveness of the programs. A possible explanation for this would be that DUR might not be awarded a high priority, resulting in reduced opportunities for financing to DUR including development of a good program and its evaluation study. However, despite these problems, in Korea simple descriptive studies of drug utilization and the development of effective intervention strategies must start and continue in order to optimize drug therapy and to save costs in health care. Pharmacoeconomic studies are employed to measure drug efficiencies, through comparison of the costs and effects of alternative therapies. Theses studies can uncover the economics repercussions of inappropriate prescribing and quantify the cost effectiveness of various DUR interventions. The use of DUR in conjunction with pharmacoeconomic analysis will result in more costeffective and rational utilization of medicines. Both methods could be used in a complementary fashion. In conclusion, DUR processes will lead to the better utilization of drugs, based on improved economic and social performance.
Awards and Prizes ; Complementary Therapies ; Cost Savings ; Cost-Benefit Analysis ; Delivery of Health Care ; Drug Therapy ; Drug Utilization Review* ; Drug Utilization* ; Economics, Pharmaceutical ; Inappropriate Prescribing ; Korea ; Quality of Health Care

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The Development of Korean Medication Algorithm for Major Psychiatric Disorder.

Jun Soo KWON ; Won Myong BAHK

Journal of the Korean Medical Association.2004;47(2):150-155. doi:10.5124/jkma.2004.47.2.150

Recently the clinical practice guideline and medication algorithm for several disorders have been developed and distributed for an optimal treatment as evidencebased medicine. The Korean Medication Algorithm Project for Major Psychiatric Disorders was initiated by the 'Korean College of Neuropsychopharmacolgy' in fall 2000, and later the 'Korean Academy of Schizophrenia' joined the project. This article reviews the advantages and limitations of the guideline and the algorithm in general, and specifically reviews the design, process and method of development of the 'Korean Medication Algorithm Project for Major Psychiatric Disorders'.
Bipolar Disorder ; Methods* ; Practice Guidelines as Topic ; Schizophrenia

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eEfforts to Improve Physicians Prescription in Developed Countries.

Jong Myon BAE

Journal of the Korean Medical Association.2004;47(2):144-149. doi:10.5124/jkma.2004.47.2.144

S +nce errors in prescription potentially result in serious outcomes but can be prevented by multiple interventions, it is very important to update the knowledge on medicines and to improve physicians' prescription for medication safety. The aim of this article is to review useful interventions to improve prescription in developed countries. The passive dissemination of drug information or clinical practice guide-lines alone is an insufficient method for improving most pre-scribing behaviors, although necessary. While the concurrent drug utilization review (DUR) could reduce inappropriate drug prescription and help physicians' prescribing decisions, retrospective DUR and penalties should not be operated in order to hold down the cost of medication.
Developed Countries* ; Drug Prescriptions ; Drug Utilization Review ; Prescriptions* ; Retrospective Studies

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Gene Therapy and Molecular Imaging.

Hesson CHUNG ; Ick Chan KWON ; Seo Young JEONG

Journal of the Korean Medical Association.2004;47(2):139-143. doi:10.5124/jkma.2004.47.2.139

No abstract available.
Genetic Therapy* ; Molecular Imaging*

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Molecular MR Imaging.

Woo Kyung MOON

Journal of the Korean Medical Association.2004;47(2):133-138. doi:10.5124/jkma.2004.47.2.133

Magnetic resonance (MR) imaging has emerged as a leading technique in molecular imaging science be-cause it provides highresolution threedimension maps of the living subject. Differential contrast in soft tissues depends on endogenous differences in water content, relaxation times, and diffusion characteristics of the tissue of interest. To increase the intrinsic contrast generated in an MR image, paramagnetic or superparamagnetic complexes are used to develop new contrast agents that can target the specific molecular marker of the cells or can be activated to report on the physiological status or metabolic activity of biological systems. The future of molecular MR imaging is promising as advancements in hardware, contrast agents, and image acquisition methods coalesce to bring high resolution in vivo imaging to the biochemical sciences and to patient care.
Contrast Media ; Diffusion ; Magnetic Resonance Imaging* ; Molecular Imaging ; Patient Care ; Relaxation ; Water

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Optical Imaging in the Field of Molecular Imaging.

Jae Kyu ROH ; Dong Eog KIM

Journal of the Korean Medical Association.2004;47(2):127-132. doi:10.5124/jkma.2004.47.2.127

Molecular imaging is leading an important role in the era of molecular medicine. Optical imaging, a rising star in the filed of molecular imaging, largely consists of fluorescent imaging and bioluminescent imaging. In the fluorescence imaging, an illuminating light excites fluorescent reporters in the living subject, and a charged coupled device (CCD) camera collects an emission light of shifted wavelength. In the bioluminescent imaging, reporter genes code for the luciferase that is responsible for fireflies' glow. After the injection of the substrate iuciferin, animals carrying the luciferase gene are imaged with a supersensitive CCD camera to pick up the small number of photons transmitted through tissues. It has been shown that well aimed and creatively built reporters let researchers explore and answer a lot of biologically important questions in living subjects. Despite its relatively short history, optical imaging is rapidly being implemented in various clinical areas as well as research fields.
Animals ; Genes, Reporter ; Linear Energy Transfer ; Luciferases ; Molecular Imaging* ; Molecular Medicine ; Optical Imaging* ; Photons

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Nuclear Medicine Techniques.

Kyung Han LEE

Journal of the Korean Medical Association.2004;47(2):119-126. doi:10.5124/jkma.2004.47.2.119

Molecular imaging is emerging as an exciting new discipline that deals with imaging of disease on a cellular or genetic level. Nuclear medicine has tra6 tionally focused on noninvasive imaging of in vivo physiology using radiolabeled tracers. As such, molecular imaging has its roots in nuclear medicine and in many ways is a direct extension of this field. The myriad of biological processes that may be targeted for molecular nuclear imaging can be grouped into direct and indirect strategies, depending on the type of imaging probe. The direct strategy uses de novo synthesis of molecular probes targeted to a specific molecular marker such as a receptor, transporter, or enzyme. For each novel target, new radiolabeled compounds are required as well as characterization of their detection sensitivity, interaction specificity, pharmacokinetics of delivery, and signaltonoise ratio. The indirect strategy entails the use of a pretargeting molecule that is subsequently activated upon occurrence of a specific molecular event, which in turn is targeted by a specific molecular radioprobe. Reporter gene imaging falls into this category and provides a rapid and convenient tool to monitor gene expression by yielding a phenotype that is readily imaged upon expression. The remarkable efforts currently focused on the molecular nuclear technology signify its importance and wide range of application. With continued improvements in instrumentation, identification of novel targets, and design of better radioprobes, molecular nuclear imaging promises to play an increasingly important role in disease diagnosis and therapy.
Biological Processes ; Diagnosis ; Gene Expression ; Genes, Reporter ; Molecular Imaging ; Molecular Probes ; Nuclear Medicine* ; Pharmacokinetics ; Phenotype ; Physiology ; Sensitivity and Specificity

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General Perspectives on Molecular Imaging.

June Key CHUNG ; Joo Hyun KANG

Journal of the Korean Medical Association.2004;47(2):112-118. doi:10.5124/jkma.2004.47.2.112

Motecular imaging provides a visualization of normal as well as abnormal cellular processes at a molecular or genetic level rather than at the anatomical level. Molecular imaging is rapidly emerging and a multidisciplinary field coordinating medicine, molecular cell biology, chemistry, pharmacology, genetics, biomedical engineering, and physics. Conventional medical imaging methods utilize the imaging signals produced by nonspecific physico chemical interaction. However, molecular imaging methods utilize the imaging signals derived from specific cellular or molecular events. Because molecular and genetic changes precede anatomical change in the course of disease development, molecular imaging can detect early events in disease progression. Molecular imaging includes images of proteomics, metabolism, cellular biologic processes as well as genetics. In a narrow sense, molecular imaging means genetic imaging using imaging reporter genes. We can image diverse cellular processes including gene expression, proteinprotein interaction, signal transduction pathway, and monitoring of target cell distribution (cancer cells, immune cells, and stem cells) by imaging reporter gene. Molecular imaging methods are classified as optical imaging, nuclear imaging and magnetic resonance imaging. Each imaging modalities have their advantages and weaknesses. In the near future, through molecular imaging we can understand basic mechanisms of disease, and diagnose earlier and, subsequently, treat earlier intractable diseases such as cancer, neuro degenerative diseases, and immunologic disorders.
Biomedical Engineering ; Chemistry ; Diagnostic Imaging ; Disease Progression ; Gene Expression ; Genes, Reporter ; Genetics ; Magnetic Resonance Imaging ; Metabolism ; Molecular Imaging* ; Molecular Medicine ; Optical Imaging ; Pharmacology ; Proteomics ; Signal Transduction

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Implementation of DUR System and Participation of Clinicians.

Byung Joo PARK

Journal of the Korean Medical Association.2004;47(2):108-110. doi:10.5124/jkma.2004.47.2.108

No abstract available.

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