Clinical Analysis of Octreotide in Varix Bleeding

PURPOSE: This study was conducted to confirm the effects of octreotide in patients with variceal bleeding. METHODS: We performed a retrospective analysis of 26 patients with variceal bleeding, who visited the Emergency Center of Seoul National University Hospital from January 1st to June 31st, 1996, the control group, and a prospective analysis of 28 patients with variceal bleeding, who visited the Emergency Center of Seoul National University Hospital from March 1st to August 31st, 1999, for the octreotideinfused group. The octreotide-infused group recieved a continuous infusion of octreotide, 25 microgram/hr, for 5 days after an initial bolus of 50 microgram. When active bleeding continued over 1 hour, over 5 pints of packed-RBC were needed for transfusion within 24 hours, or when the systolic blood pressure was under 90 mmHg, a ballon tamponade with Sengstaken-Blackemore tube was used. T-test and X2 test were used for statistical analysis(p<0.05). RESULTS: Forty-one patients were male(octreotide-infused group 22, control group 19) and 13 were female(octreotide-infused group 6, control group 7). The mean age was 55 years(octreotide-infused group 56 years, control group 52 years). There were no significant differences in vital signs, hemoglobin/hematocrit levels, and Child-Pugh's classifications between the octreotide-infused group and the control group initially. There was a significant difference in the rates of early bleeding control within 24 hours(p<0.05), but there were no significant differences in the rates of rebleeding, mortality within 1 week, and use of a balloon tamponade. CONCLUSION: Variceal bleeding is a serious complication of liver cirrhosis and has a high mortality rate. Octreotide is an effective vasoactive agent for control of early bleeding. Thus, octreotide should be used first before endoscopic definitive therapies, to stabilize the vital signs of patients and to secure a field for endoscopic procedures.

Clinical Analysis of Phalloides Syndrome

BACKGROUND: To review the important features and treatment modalities of phalloides syndrome. METHOD: We performed a retrospective analysis of 16 patients with phalloides syndrome who visited the Emergency Center of Seoul National University ospital, Uijongbu St. Mary 's Hospital, Gachon Medical College Hospital, and Kyungpook National University Hospital from July 1st to August 31st, 1998. Mann-Whitney U test was used for statistical analysis(p < 0.05). RESULTS: 9 were male and 7 were female. The mean age was 54 years(men 46 years, women 65 years). Fourteen cases(88%) occurred in Kyungpook area. All cases of phalloides syndrome RESULT:ed from mistaking toxic mushrooms for edible mushrooms. The doses of ingestion of mushroom were not available because the patient could not remember the exact amounts. The identification of mushrooms in 4 cases was confirmed by mycologist, 6 cases by mushroom photoatlas, and remained 6 cases were not confirmed. The initial symptoms of mushroom poisoning were abdominal pain, nausea, and watery diarrhea. The time intervals from the ingestion of mushroom to the onset of symptom were from 6 to 13 hours(mean 11.3 +/-2.68 hours). The laboratory data showed the increased GOT and GPT, prolonged prothrombin time, elevated serum creatinine level, and decreased platelet count. The initial management of phalloides mushroom poisoning was done conservatively, but the early specific treatments such as gastrointestinal decontamination, administration of activated charcoal, IV penicillin or silymarin were not perfomed in all cases. The mortality rate was 18.8%. There were significant differences in total bilirubin, prothrombin time, platelet count, and serum creatinine between survival and non-survival group(p<0.05). CONCLUSION: It is important to know the morphological differences between edible and toxic mushroom for prevention of phalloides syndrome. If the patient with acute gastroenteritis has a history of mushroom ingestion, the emergency physician should suspect phalloides syndrome and start early proper treatment. For the identification of mushroom, it is desirable to contact a mycologist.