摘要:

Neuroendocrine tumours of the gastroenteropancreatic system represent a therapeutic challenge. Current therapeutic strategies will be presented and discussed with especial consideration given to biotherapeutic regimens in metastatic tumour disease.

ISSN:0012-2823    

DOI:10.1159/000201404

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

64 consecutive patients with disseminated midgut carcinoids were treated over 8 years by active intervention. Their 5-year survival was 57.5%. 14 (22%) attained anatomical and biochemical cure by surgery alone. Their mean 5-hydroxindoleacetic acid (5-HIAA) levels were still normal after 69 ± 6.2 months of follow-up. Subclinical disease was diagnosed in 7/14 patients using somatostatin receptor scintigraphy; subsequent re-exploration of 6 led to scintigraphically proven cure in 5. 40 patients with bilobar hepatic disease underwent embolisation in combination with octreotide; their 5-HIAA levels were still reduced by 55% after 71 ± 10 months of follow-up and their estimated 5-year survival was 56%. More specifically, those with good radiological response on computerised tomography ( > 50%) had a pronounced reduction of 5-HIAA levels (81 %) and low mortality, while those with poor radiological volume reduction had a limited reduction of 5-HIAA levels (28%) and a much higher mortality (death by tumour or cardiovascular disease). 10 patients were not embolised due to complicating diseases and had a very poor 5-year survival. The increased risk of cardiovascular death underlines the importance of total survival analysis in patients suffering from a disease with multiple hormonal effect

ISSN:0012-2823    

DOI:10.1159/000201405

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

We evaluated a hand-held scintillation detector for intra-operative localisation of somatostatin-receptor-positive tumours in situ, and after excision, as an addition to preoperative scintigraphy with [111In-DTPA-Phe1]octreotide. Using the hand-held detector, the suspect tumour/normal tissue ratio Rin Situ between measurements was calculated for 23 patients with neuroendocrine tumours. The count rates of excised tumour and normal tissue were also measured ex vivo and their ratio Rex vivo was calculated. In midgut carcinoid (MC) patients (all scintigraphy positive), 4/29 macroscopically identified tumours gave false Rin Situ. Tumour/blood 111In activity (T/B) ratios measured in a γ counter were all high (27-650). In patients with medullary thyroid carcinoma (8/10 scintigraphy positive), misleading Rin Situ were found in 4/37 macroscopically identified tumours. T/B ratios were lower (3-39) than those seen in MC patients. 2/4 patients with endocrine pancreatic tumours (EPTs) had positive scintigraphy, reliable intra-operative measurements, and very high T/B ratios (910-1,500). 1 patient with a gastric carcinoid had correct Rin situ and Rex vivo, with high T/B ratios (71-210). 1 patient with sporadic insulinoma had negative scintigraphy and 1 patient with neuroendocrine carcinoma of the uterus also had low T/B ratios. In most cases, in situ measurements added little information to preoperative scintigraphy and surgical findings. The very high T/B ratios seen in MC tumours and some EPTs seem promising for future radiotherapy via somatostatin receptors

ISSN:0012-2823    

DOI:10.1159/000201406

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

This paper summarises the effects of somatostatin analogues on gastric and small bowel motility patterns in transit and health, and discusses the literature on the application of these medications to the treatment of human diseases such as small bowel scleroderma, dumping syndrome, and rapid-transit diarrhoea including carcinoid diarrhoea.

ISSN:0012-2823    

DOI:10.1159/000201407

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Subcutaneous injection of 50 μg octreotide before a meal can almost totally prevent the increase in exocrine pancreatic secretions caused by the meal. Octreotide inhibits plasma amino acid uptake by pancreatic acinar cells, and thus synthesis of pancreatic enzymes. This effect has clinical potential

ISSN:0012-2823    

DOI:10.1159/000201408

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Consideration is given to the characterisation of pancreatic fistulas (PFs), the rationale for their treatment, and supportive and specific treatment measures. Choice of treatment should be based not only on the percentage of closures achieved, but also on their time and cost. The combined use of parenteral nutrition (TPN) and somatostatin inhibits pancreatic secretion well; no therapy can inhibit it completely. Presumptive use of octreotide, a subcutaneous formulation of somatostatin, in patients undergoing elective pancreatic surgery, reduced postoperative complications, mainly PFs, in about 500 patients in two controlled double-blind clinical studies, confirming the use of octreotide both in prophylaxis and treatment. Octreotide has been tested on outpatients after a brief hospitalisation period, at a dose of 100 mg three times a day. Home treatment does not involve co-administration of TPN, thus lowering not only costs but also risks. Optimal doses and the types of fistula amenable to this therapy need to be established and we only use out-patient treatment for chronic low-output fistulas.

ISSN:0012-2823    

DOI:10.1159/000201409

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Major pancreatic resection is still accompanied by considerable morbidity (35%) and mortality (10%). Typical complications, such as pancreatic fistula and abscess, are chiefly associated with exocrine pancreatic secretion. The hormone somatostatin and its analogue octreotide are well known as potent inhibitors of exocrine pancreatic secretion. In two randomised, double-blind, placebo-controlled, multicentre trials we assessed the prophylactic effect of the perioperative inhibition of exocrine pancreatic secretion by octreotide to prevent postoperative complications. Each patient received 3 × 100 μg/day octreotide or placebo subcutaneously. A significant reduction in fistula, abscess, fluid collection, sepsis and postoperative pancreatitis occurred with patients undergoing pancreatic resection for cancer. Results were similar in a second study, using the same protocol but recruiting only patients with chronic pancreatitis. A new randomised, controlled multicentre trial is also described, in which 300 patients with severe acute pancreatitis are being treated with or without octreotide in double-blind fashion. The results will clarify the influence of inhibition of exocrine pancreatic secretion by octreotide on the course of acute pancreatitis, and hence its potential, through inhibition of digestive enzyme secretion, as a treatment for acute pancreatiti

ISSN:0012-2823    

DOI:10.1159/000201410

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The available pharmacological treatments for portal hypertension are reviewed. Vasoconstrictor treatments include vasopressin (VP), the synthetic VP analogue tGLVP, combined nitroglycerin (NTG)-VP, somatostatin (SRIF), SRIF analogues and non-selective beta-blockers. Vasodilator treatments include short- and long-acting organic nitrates. Infusions of VP > 1.0 U/min can cause severe side-effects. tGLVP can control variceal bleeding and improve survival and causes fewer complications than VP. SRIF is as effective as tGLVP in controlling bleeding and improving survival and has minimal side effects. Beta-blockers are effective in preventing the first variceal haemorrhage and are well tolerated.

ISSN:0012-2823    

DOI:10.1159/000201411

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Octreotide inhibits intestinal motility and secretions of the gastro-intestinal tract and pancreas and mediators of diarrhoea and so is very useful in managing refractory diarrhoea. It is safe and effective in 75-80% of the 10-20% of cancer chemotherapy patients who develop severe diarrhoea, and is useful in the management of persistent diarrhoea associated with neuroendocrine tumours, particularly VIPoma and carcinoid tumours, congenital microvillus atrophy, some patients with the short bowel syndrome (giving them a reduced need for intravenous fluids), and AIDS-related diarrhoea that does not respond to antibiotics or conventional anti-diarrhoeal drugs. Some studies suggest a 50% effectiveness in graft-versus-host disease. Preliminary studies suggest that octreotide is also of value in persistent diarrhoea caused by neuromuscular disorders of the gut, particularly diabetes mellitus and systemic sclerosis, suggesting that it may have wider application in the future. Octreotide may prove useful as a tool for studying the pathogenesis of diarrhoea of diverse aetiologies, particularly those associated with disturbances of intestinal motility, such as irritable bowel syndrome.

ISSN:0012-2823    

DOI:10.1159/000201412

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Following gastric surgery, 25-50% of patients experience dumping symptoms. Early dumping usually involves both gastro-intestinal and vasomotor complaints, while late dumping involves mainly the latter. Management is mainly achieved by dietary modification. Drug therapy has been investigated, without consistent success. However, the somatostatin analogue octreotide alleviates dumping by slowing gastric emptying, inhibiting insulin release, decreasing enteric peptide secretion and intestinal absorption of water and sodium, slowing monosaccharide absorption, increasing gut transit time and preventing haemodynamic changes. The short-term efficacy of octreotide has been confirmed in five randomised, controlled trials. Promising results are also available from long-term studies on a limited number of patients.

ISSN:0012-2823    

DOI:10.1159/000201413

出版商:S. Karger AG    

年代:1996

数据来源: Karger