Comparison of the effects and complications of combined therapies using endoscopic variceal ligation with octreotide or terlipressin in the control of acute esophageal variceal bleeding / 대한내과학회지

BACKGROUND: In patients with liver cirrhosis, acute esophageal variceal bleeding is a life-threatening event with high mortality and subsequent recurrent bleeding despite of endoscopic therapy. So the effect of vasoactive agents used in combination with endoscopic therapy has been studied. The aim of this study was to compare the effects and complications of octreotide or terlipressin with endoscopic variceal ligation in the management of acute esophageal variceal bleeding. METHODS: From January, 1999 to February, 2001, 73 cirrhotic patients admitted to the Soonchunhyang University Chonan Hospital because of acute esophageal variceal bleeding were included in this study. The patients were randomized to receive either octreotide (37 patients) or terlipressin (36 patients) in combination with endoscopic variceal ligation. RESULTS: Initial control of bleeding was achieved in 35 (94.6%) patients receiving octreotide and in 33 (91.7%) patients receiving terlipressin. In the octreotide group, three patients with two cases of early rebleeding and one case of late rebleeding had rebleeding events, but in the terlipressin group, two patients with only early rebleeding bled again after initial control of bleeding. Two cases of myocardial ischemia were observed in terlipressin group, but there were no serious complications in octreotide group. CONCLUSION: This study suggests that both octreotide and terlipressin in combination with endoscopic therapy, are efficious in the initial control and the prevention of subsequent rebleeding. Octreotide showed a relatively lower risk of severe adverse reactions than terlipressin.

Toxic Hepatitis Induced by Occupational Dimethylacetamide Exposure / 대한산업의학회지

Dimethylacetamide is widely used in the production of plastics, resins, synthetic fibers, and gums and in purification and crystallization processes. Inhalation of the vapor or skin absorption of the liquid of dimethylacetamide(DMAC) can cause liver damage. Toxic hepatitis possibly attributable to DMAC exposure occurred in seven works among 178 employees who had worked on a new spandex-fiber production line. A large amount of DMAC is used as a spinning solvent for synthetic fibers in the factory. The patients were aged 23-47 years old and composed of five males and two females. They were involved in the process of polymerization(1 patient), spinning(1), take-up(4) and packaging(1). The mean duration of exposure was 10 weeks. They experienced fatigue, dizziness and jaundice. The patients showed elavated total bilirubin, alanine aminotransferase(ALT), and aspartate aminotransferase(AST) levels. The serologic test for viral hepatitis A, B and C were negative, as were the abdominal ultrasonographic scans. Based on the presumptive diagnosis of DMAC-induced toxic hepatitis, they were removed from the workplaces. One or two months after removal from the work, the transaminase levels returned to normal. The patients had no history of significant alcohol use, blood transfusion, recent medication, and drug abuse. As a result, authors could not find any attributable cause of toxic hepatitis but the toxicity by DMAC exposure.