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Suh, Hyeon Jeong,Kim, Inho,Cho, Joo-Youn,Park, Sang-In,Yoon, Seo Hyun,Hwang, Joo-Hee,Bae, Ji Yun,Lee, Jeong-Ok,Koh, Youngil,Song, Kyoung-Ho,Choe, Pyoeng Gyun,Yu, Kyung-Sang,Kim, Eu Suk,Kim, Hong Bin,B Raven Press 2018 Therapeutic drug monitoring Vol.40 No.1
BACKGROUND:: Therapeutic drug monitoring (TDM) of posaconazole is usually performed 1 week after starting the drug because of its long half-life. However, previous studies showed that measuring the posaconazole plasma concentration (PPC) on day 3 is effective for predicting steady-state levels. The purpose of this study was to evaluate the relevance of early TDM (day 3) of posaconazole for achieving an optimal PPC. METHODS:: This prospective study was conducted from September 2014 to August 2016. A total of 148 patients with acute myeloid leukemia or myelodysplastic syndromes received a 200 mg posaconazole oral suspension 3 times daily for fungal prophylaxis. During the period from September 2014 to December 2015 (control group), no dose adjustment was performed on day 3. During the period from January 2016 to Aug 2016 (early TDM group), the frequency of posaconazole 200-mg administration was increased to 4 times daily in patients whose PPC on day 3 was <400 ng/mL. The cutoff value for optimal PPC on day 8 was defined as 500 ng/mL. RESULTS:: In 21 of 107 patients (20%) in the control group, PPC was <400 ng/mL on day 3. In 15 (71%) of these 21 patients, the PPC was suboptimal on day 8. In the early TDM group, the PPC was <400 ng/mL on day 3 in 4 of 41 patients (10%). After increasing the posaconazole administration frequency in these 4 patients, PPC was suboptimal on day 8 in 1 patient (25%). In both groups, 104 patients had a PPC of ≥500 ng/mL on day 3, but 7% (7/104) of these had a suboptimal level on day 8. CONCLUSIONS:: Early TDM on day 3 for posaconazole suspension may help more patients achieve optimal drug levels on day 8, although TDM on day 8 is needed even in patients with optimal levels on day 3.
Suh, Hyeon Jeong,Yoon, Seo Hyun,Yu, Kyung-Sang,Cho, Joo-Youn,Park, Sang-In,Lee, Eunyoung,Lee, Jeong-Ok,Koh, Youngil,Song, Kyoung-Ho,Choe, Pyoeng Gyun,Kim, Eu Suk,Bang, Soo-Mee,Kim, Hong Bin,Kim, Inho American Society for Microbiology 2018 Antimicrobial Agents and Chemotherapy Vol.62 No.7
<P>The metabolism of posaconazole is mediated mainly by uridine 5'diphospho-glucuronosyltransferase (UGT) enzymes, especially UGT1A4. The aim of this study was to investigate the effects of genetic polymorphisms on the posaconazole plasma concentration (PPC). This prospective study was conducted from September 2014 to August 2016. We enrolled patients with acute myeloid leukemia or myelodysplastic syndrome treated with posaconazole oral suspension (200 mg) three times daily for fungal prophylaxis. The patients were examined for the multidrug resistance gene 1 3435C>T and 2677G>T/A variations and the UGT1A4*3 allele by direct sequencing of DNA from peripheral whole-blood samples. We defined poor absorbers to be those with PPCs of <200 ng/ml and the optimal PPC to be >= 700 ng/ml on day 8. The associations between genetic polymorphisms and the PPC were evaluated using multivariate logistic regression analysis including clinical variables. During the study period, 132 patients were enrolled. Six patients (4.5%) were defined as poor absorbers, and 49 patients (37.1%) did not reach the optimal PPC on day 8. In multivariate analysis, the independent risk factors for a poor absorber were at least one UGT1A4*3 allele (adjusted odds ratio (aOR], 18.81; 95% confidence interval [Cl], 1.09 to 324.44; P = 0.043) and poor oral food intake (aOR per -100 kcal, 1.44; 95% Cl, 1.04 to 1.99; P = 0.029). There was no statistically significant association between the genetic polymorphisms and achievement of the optimal PPC on day 8. The UGT1A4*3 polymorphism is an independent risk factor for being a poor absorber of posaconazole oral suspension in patients with hematological malignancies.</P>
최정현 ( Choe Jeong Hyeon ),김민철 ( Kim Min Cheol ),임승관 ( Im Seung Gwan ),조숙경 ( Jo Sug Gyeong ),신승수 ( Sin Seung Su ),오윤정 ( O Yun Jeong ),최영화 ( Choe Yeong Hwa ),박광주 ( Park Gwang Ju ),황성철 ( Hwang Seong Cheol 대한내과학회 2003 대한내과학회지 Vol.65 No.3
목적 : 요근 농양은 드물게 발생하는 치명적인 질환으로 비특이적인 임상 양상으로 나타나 진단과 치료가 지연되는 경우가 많다. 이에 저자들은 지난 5년동안 아주대학교 병원에서 진단된 요근 농양 24예의 임상 양상 및 특징, 원인 균주 및 치료 결과에 대해 알아보고자 하였다. 방법 : 1996년 3월부터 2001년 5월까지 아주대학교 병원에서 방사선학적 진단 및 균 배양 검사를 통해 요근 농양으로 진단 후 입원 치료한 24명의 환자를 대상으로 후향적 검토를 Background : Psoas abscess is a rare condition with vague clinical presentations, therefore misdiagnosis or delayed diagnosis is often made. We have reviewed the characteristics of the clinical presentation, microbiology, and treatment of 24 patients with
4 Dipyridamole (99m)Tc-MIBI SPECT의 육안 분석과 정량적 분석
최진현 ( Choe Jin Hyeon ),도문홍 ( Do Mun Hong ),이근우 ( Lee Geun U ),신원호 ( Sin Won Ho ),최성란 ( Choe Seong Lan ),함종열 ( Ham Jong Yeol ),최동주 ( Choe Dong Ju ),염명걸 ( Yeom Myeong Geol ),정순일 ( Jeong Sun Il ),최진학 ( C 대한내과학회 1993 대한내과학회지 Vol.44 No.4
연구배경 : 관상동맥 질환을 진단하고 병소의 위치를 결정하거나 그 기능적 의의를 평가하는 비관혈적인 검사법으로 심근 SPECT의 유용성이 널리 인정되고 있다. 저자들은 심근 SPECT의 육안 분석과 정량적 분석방법의 진단적 우위를 비교하기 위하여 본 연구를 시행하였다. 방법 : 허혈성 심장 질환을 의심하여 심근 SPECT와 관상동맥 조영술을 모두 실시한 126명의 환자를 연구 대상으로 하였다. Dipyrdamole 0.56mg/kg을 정주하고 ^(99m)Tc-MIBI 15mCi를 투여한 후 rotating gamma camera를 이용하여 부하 스캔을 구하였고, 4시간 후 ^(99m)Tc-MIBI 25mCi를 다시 투여한 후 재분포 스캔을 시행하였다. 단층 영상을 3방향으로 재배치하여 육안적으로 분석하였다. Technetium 흡수의 분포도로부터 전체 좌심실을 대표하는 2차원의 극지도를 그리고, CSMC에 의해 개발된 정상치와 비교함으로써 최종적인 병변 극지도를 구하여 정량적으로 분석하였다. 관류 결손의 재관류 여부를 육안분석으로 완전 재관류, 부분 재관류, 무 재관류군으로 구분하였고, 각 군에서의 정량적 관류 정도를 비교하였다. 결과 : 관상동맥 질환 진단의 전체적인 민감도는 육안 분석으로 91%, 정량적 분석으로는 94%로서 유의한 차이가 없었으며, 특이도는 각각 76% 및 71%로 역시 유의한 차이가 없었다. 개개의 관상동맥 분지의 병변을 육안 및 정량적 분석으로 발견할 수 있는 민감도는 좌전하행지가 각각 89% 및 92%, 우관상 동맥이 84% 및 93%, 좌회선지가 71% 및 77%로 모든 혈관에서 육안 분석보다 정량적 분석이 높았으나 유의한 차이는 없었다. 육안 및 정량적 분석의 특이도는 좌전하행지가 각각 79% 및 70%, 우관상 동맥이 77% 및 82%, 좌회선지가 96% 및 92%로 유의한 차이는 없었다. 육안 분석에 관류 결손의 완전 재관류는 협심증군에서 심근경색증군보다 유의하게 높았다. 육안분석에 의하여 분류된 각 군의 정량적 분포 정도는 완전 재관류군과 무재관류군 사이나, 부분재관류군과 무재관류군 사이에서는 유의한 차이가 있었으나, 완전 재관류군과 부분재관류군 사이에서는 유의한 차이가 없었다. 결론 : Dipyridamole 정주 후 ^(99m)Tc-MIBI SPECT검사의 정량적 분석이 육안 분석보다 더욱 정확한 분석 방법은 아닌 것으로 생각되며, 재관류 평가의 임상적 중요성에 비추어 볼 때 병변의 심한 정도와 재관류의 정도를 정량화 하는 방법에 대한 연구가 더욱 진행되어야 할 것으로 사료된다. Background: The usefulness of myocardial SPECT in diagnosing coronary artery disease, & assessing the functional significance of the coronary stenosis is confirmed by many investigators. To determine the superiority of the quantitative analysis method over the visual analysis method in assessing myocardial SPECT this study was performed. Methods: One hundred & twenty six patients with suspicious coronary artery disease had both intravenous dipyridamole ^(99m)Tc-MIBI SPECT and coronary angiougraphy within an interval of 5 days. The scintigraphic findings were assessed visually and quantitatively using two dimensional polar map. The results of visual and quantitative assessments were compared to the coronary angiographic findings. In 85 patients who showed perfusion defect on stress scintigraphy, the reversibility of the defect was evaluated by visual analysis. Results: For detection of coronary artery disease, the overall sensitivity of the visual and quantitative analyses was 91% & 94% respectively (p>0.05). The overall specificity was 76% by visual and 71% by quantitative analyses(p>0.05). For detection of individual coronary branch diseases, the quantitative analysis was higher than visual analysis in the sensitivity(LAD: 89% vs. 92%, RCAl 84% vs.93%, LCx: 71% vs. 77%), but the differences were not statistically significant. The specificities of both visual and quantitative analyses were similary high(LAD: 79% vs. 70%, RCA: 77% vs. 82%, LCx: 96% vs. 92%), but there were no significant differences also. The reversibility of perfusion defect was assessed by visual analysis. Of the 144 abnormal vascular territories in 85 patients, 49 vascular territories showed complete redistribution and 30 territories showed partial redistribution. The patients with angina had significantly higher percentage of complete redistribution (angina: 50% vs. MI: 15%, P<0.05). Conclusion: Our results showed that quantitative analysis of ^(99m)Tc-MIBI tomography may not be more accurate technique than visual analysis for detection of coronary artery disease and for localization of individual coronary stenoses.