Fluoxetine-induced Acute Toxic Hepatitis / 대한간학회지

Fluoxetine (Prozac ) is a antidepressant that inhibits the reuptake of serotonin in central nervous system, and has lesser adverse effects than the tricyclic antidepressants. The adverse effects of this drug are various, and the most common side effects are headache and nausea. The hepatic injury caused by fluoxetine is reported but very rare and not well known. Literature review has shown only 3 cases of hepatotoxicity from fluoxetine. We regard our case as the first of the hepatotoxicity from fluoxetine in Korea. The patient that we experienced showed normal aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values before fluoxetine administration. 15 days after she took fluoxetine, AST and ALT values were increased and gradually increased as she took fluoxetine daily. We studied about viral hepatitis, metabolic liver disease, and autoimmune liver disease, but the cause of hepatic injury was not established. After the patient stopped to take fluoxetine, AST and ALT values decreased. A liver biopsy showed a moderate infiltration within the portal tracts with lymphocytes and ballooning degeneration of hepatocytes. We concluded fluoxetine-induced acute toxic hepatitis had occured. We must keep in mind that fluoxetine may cause hepatitis without cholestasis and suggest taking liver function tests regularly.

Expression of p53, bcl-2 Protein in Small Cell Lung Cancer (SCLC) Cell Lines in Relation to Sensitivity to Chemotherapy / 대한암학회지

PURPOSE: Sensitivity of tumor cells to chemotherapeutic regimen may be accentuated by their abnormal expression of oncogene. p53 is required for the efficient activation of apoptosis following irradiation or treatment with chemotherapeutic agents. The aim of this study was to evaluate the relationship between chemosensitivity and apoptosis related proteins such as p53, bcl-2 in small cell lung cancer cell lines. MATERIAL AND METHODS: Six human small cell lung cancer cell lines, NCI-H69, NCI-H128, NCI-H1436, NCI-H1092, derived from untreated and treated patients were tested for chemo sensitivity and the expression of the p53, bcl-2 genes were examined in each cell lines with western blot analysis. We used 4 drugs including adriamycin, cisplatin, vincristine and VP-16. RESULTS: NCI-H128 was the most sensitive cell line to four drugs. NCI-H82 and NCI-H1092 were highly resistant to VP-16, adriamycin and vincristine and determination of an IC50 was not possible. In western blot analysis, NCI-H128 alone was strong positive to p53 monoclonal antibody and the rest of cell lines were negative. All but NCI-H128 were positive to bcl-2 monoclonal antibody. NCI-H128 which was strong positive to p53 and negative to bcl-2. NCI-H1092 was strong positive to bcl-2 and negative to p53 monoclonal antibody. CONCLUSION: We were not able to explain the expression of p53 in small cell lung cancer cell lines in relation to senitivity to anti-cancer chemotherapeutic agents. But the expression of bcl-2 in small cell lung cancer cell lines was correlated with the chemosensitivity well.

The influence of maturation period of arteriovenous fistula on its survival in patients undergoing maintenance hemodialysis / 대한내과학회지

BACKGROUND: Arteriovenous fistula(AVF) has been the most important, primary mode of achieving vascular access for chronic hemodialysis by this time. In general, maturation period over 4 to 8 weeks after operation for the formation of AVF has been recommended for the long-term survival of AVF, and so insertion of central venous catheter without using AVF being matured has been primarily recommended whenever hemodialysis is needed. But not infrequently, serious complications have been reported in association with the insertion and the use of central venous catheter. So earlier use of AVF is regarded as a good method of avoiding serious complications with regard to the insertion and the use of central venous catheter. But early use of AVF has not been generally recommended, for early use of AVF has been regarded to be associated with early failure of AVF. But few studies have reported the correlation between maturation period and AVF survival. And in practice, early use of AVF has already been performed frequently by not a few nephrologists or nurses of dialysis units. So authors tried to examine the correlation between maturation period and AVF survival rate, and to find the validity of early use of AVF if it is regarded usable for the hemodialysis by experienced hemodialysis nurses and nephrologists. METHODS: A retrospective analysis using 88 AVF cases which had been created in 85 patients from Oct. 1986 through June 1996, and from which authors could get enough information for this study was done. Authors compared one year survival rates of AVF according to the maturation period, the presence of DM, and condition of AVF assessed clinically by doctors and experienced nurses in hemodialysis units. Also from the cases with AVF obstruction, authors examined the 1st, 2nd, and 3rd year survival rate of AVF according to the maturation period. RESULTS: One year survival rate of AVF with maturation period less than 4 weeks was higher than that with maturation period more than 4 weeks, but there was no statistical significance. One year survival rate, irrespective of the length of maturation period for AVFs, of AVF regarded to be usable and good for hemodialysis was higher than that of AVF regarded to be usable but not good for hemodialysis. In the study with the AVF obstruction group only, one year survival rate of AVF with maturation period less than 4 weeks was higher than that of AVF with maturation period more than 4 weeks but there was no statistical significance. And one year AVF survival rate was higher in non DM group(94.1%) than DM group(60%) regardless of maturation period of AVF(p<0.05). CONCLUSION: On the contrary to the views that longer maturation period of more than 4 weeks will be necessary for the long-term survival of AVF, our results suggest that shorter maturation period for AVF less than 4 weeks does not necessarily mean early failure of AVF once AVF is regarded to be usable for hemodialysis. So it is suggested that early use of AVF instead of inserting central venous catheter is a reasonable approach for getting an adequate vascular access for hemodialysis in chronic renal failure patients who were subjected to receive hemodialysis on waiting peroid of AVF maturation.