Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In order to hasten healing of pancreatic fistulas, we have treated 11 men and one woman with octreotide, a long-lasting somatostatin analog. This agent was administered subcutaneously in doses of 0.05-0.20 mg, two to three times per day. Fistulas were secondary to pancreatic biopsy (1), pancreatic abscess drainage (2), operative injury (3), and blunt abdominal trauma (4). The two patients with fistulas secondary to pancreatic biopsy had outputs of 1000 mL/d. The patient with blunt trauma had pancreatic ascites, with outputs of 750 mL/d. The remainder had outputs of 100-250 mL/d for periods ranging from 1 wk to 11 mo. After octreotide administration, fistula output decreased from 360 +/- 347 mL/d to 110 +/- 131 mL/d on the first day of therapy (p < 0.05) and to 44 +/- 72 mL/d on the seventh day (p < 0.05). Seven patients eventually closed their fistulas. Failure to achieve fistula closure with octreotide was secondary to pancreatic duct stenosis (4); pseudocyst (1) or recurrent sepsis (4); and patient noncompliance (4). Somatostatin analogs are useful in the management of pancreatic fistulas. They significantly decrease (p < 0.05) the volume of fistula output, and they seem to aid fistula healing. Somatostatin analogs are safe even for outpatient management of pancreatic fistulas.
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PMID:Somatostatin analog treatment of pancreatic fistulas. 828 81

We reviewed our experience of PAN cases operated for complications after a first laparotomy over the period 1992-1994. Over 29 PAN cases, 7 (24%) had been submitted to a second laparotomy or more. Total mortality rate of PAN was 10.3%, while mortality rate of relaparotomy was 14.2%. Haemorrhage and intra-abdominal sepsis were the main cause of relaparotomy (42.8% of the re-operations in both cases). Abdominal wall abscesses (14%) were treated locally; enteric or pancreatic fistulas (34%) were successful treated by drugs, such as somatostatin and octreotide, and / or by total parenteral nutrition. The main diagnostic tools to evaluate clinical course of the patients were computed tomography scan, that seems to gain serial staging of the necrosis and the septic collections. Arteriography is necessary to identify the bleeding source and to perform temporary embolization in the massive arterial haemorrhage before surgical treatment. Moreover, we need radiological exploration to explain fistulas pathways. According to circumstances, we can perform surgically the definitive hemostasis, the pancreatojejunostomy in pancreatic fistulas, and the digestive reconstruction in enteric fistulas. At all events the debridement of necrosis and septic collection is necessary. Up to date, there are not prognostic differences between "closed laparotomy" and "open laparotomy", and we think that the choice is determined only by individual believing of the surgeon.
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PMID:[Reoperation in necrotizing acute pancreatitis: evaluation of physiopathology and surgical treatment]. 876 86

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 X 100 micrograms/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 pancreatitis.
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PMID:Efficacy of somatostatin and its analogues in pancreatic surgery and pancreatic disorders. 881 84

Short-bowel syndrome is a rare problem in surgical practice and its prognosis depends on the length of intestinal remnants and/or the presence of a jejunostomy. In adults long-term total parenteral nutrition (TPN) can be avoided if the remaining small bowel is longer than 60-100 cm. In all, 50-60% of patients in the long-term follow-up are expected to be adequately nourished with oral feeding, 25% with enteral and parenteral feeding and less than 20% depend on long-term TPN alone. By using a modified diet (glutamine, growth hormone), intestinal absorption and overall prognosis could even be enhanced. The introduction of home TPN by specialized centres has resulted in a remarkable improvement in quality of life (> 80% good). The main complications of long-term TPN are sepsis, thrombosis and metabolic disorders. Medical therapy of diarrhoea consists of H2-receptor antagonists (hypergastrinaemia), loperamide and secretion inhibitors (somatostatin). Several surgical procedures have been performed, either to decelerate intestinal transit or to increase the area of intestinal absorption with overall unsatisfactory results. However, in the presence of small-bowel dilatation, promising surgical results (tapering, stricturoplasty, intestinal lengthening) have been achieved. There may be advances (immunosuppression) in the future that will make intestinal transplantation a good option for some patients; at present, the 1-year patient and graft survival in around 100 patients was 60% and 40%, respectively.
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PMID:[Pathophysiology, clinical aspects and therapy of short bowel syndrome]. 932 32

Digestive tract fistulas are a complex subject in terms both of classification and management. There is still a lack of firm epidemiological data regarding the their incidence, though the prognostic factors conditioning the prognosis of these patients are now well known. They are related mainly to the nutritional status of the patients and to the presence or otherwise of sepsis. Instrumental investigations should be aimed not merely at identifying the complication, but also at guiding clinicians in their choice of therapeutic management. According to the various situations arising, the treatment will be surgical, endoscopic or conservative medical. In the latter case, the clinician should establish first of all whether, as a result of the site of the fistula or the nutritional status, the patient requires total parenteral or enteral artificial nutrition, whenever possible. In those cases in which parenteral nutrition is indicated, the ideal drug with the best proven ability to shorten healing times and reduce the number of complications when used in combination with parenteral nutrition is naturally occurring somatostatin at the dose of 250 micrograms/h over 24 h. In all other cases, if the fistula is clinically important, its synthetic analogue, octreotide, should be the drug of choice and can be administered subcutaneously. The amount of octreotide administered ranges from 300 to 600 micrograms/day in 3 or 4 daily doses.
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PMID:Management of digestive tract fistulas. A review. 1056 89

The purpose of this study was to examine the effect of endogenous somatostatin hormone on bacterial translocation in obstructive jaundiced rats. Five groups of rats were studied: group I (n = 10), non-operated group (control); group II (n = 10), sham-operated group which underwent laparotomy and dissection of portal elements, while the common bile duct was not ligated and somatostatin was not injected; group III (n = 10), same as group II, plus injection of somatostatin; group IV (n = 10), common bile duct was ligated with laparotomy but somatostatin was not injected; group V (n = 10), same as group IV, plus somatostatin injection. The blood was analyzed for somatostatin, alkaline phosphatase, and bilirubin levels on the third and tenth days in all animals. At study termination (tenth day), peritoneal swab and blood cultures were taken, and liver, spleen, lung, and mesenteric lymph nodes were harvested for microbiological studies. Bacterial translocation levels were higher in groups III, IV, and V when compared with levels in groups I and II. Similar translocation levels were obtained when blood somatostatin levels were comparable. However, the highest translocation rate was found in groups IV and V in which the blood somatostatin level was also higher when compared with that in other groups. This finding shows that blood somatostatin level is increased in obstructive jaundice. This may explain the bacterial translocation and related sepsis found in obstructive jaundice.
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PMID:Somatostatin: possible cause of bacterial translocation in obstructive jaundiced rats. 1066 91

Endotoxin (LPS), a membrane component of gram-negative bacteria produces multiple endocrine and metabolic effects that mimic those seen in acute sepsis. It induces species-dependent alterations of the growth hormone (GH) axis that may participate in the shift of the metabolism towards catabolic events. Humans and sheep show increased GH secretion in response to LPS, as opposed to rats, which have been the most studied. The purpose of our work was to evaluate the effects in intact rams of an acute intravenous administration of a high dose of LPS on the insulin-like growth factor (IGF)-I/IGF-binding proteins (IGFBPs) system and to analyse the temporal relationship of GH axis changes with those of several hormonal and metabolic parameters such as somatostatin, cortisol, insulin, and glucose. LPS induced a late moderate decrease of total IGF-I plasma levels following a 5-h steady-state period (-26.6+/-4. 2%, P<0.05, 9 h after LPS), despite a biphasic and sustained increase of GH secretion in the same animals (2.48+/-0.39 ng/ml 2 h after LPS and 2.7+/-0.37 ng/ml 5 h after LPS vs 0.77+/-0.10 before LPS; Briard et al. 1998a). Western ligand blot analysis in IGFBPs showed an early short-lasting increase in IGFBP-1 (188.8+/-39% P<0. 05, 3 h after LPS). No significant change was seen for either IGFBP-2, -3 or -4. We observed a marked and sustained increase in cortisol (128.18+/-7.21 ng/ml 3 h after LPS, vs 21.17+/-4.22 before LPS). Insulin also increased (27.69+/-3.90 microU/ml 3 h after LPS, vs 13.48+/-1.69 before LPS) and its burst coincided with that of IGFBP-1. Moderately decreased IGF-I and increased IGFBP-1 plasma levels contrasted with the sustained increase in GH secretion that we recently described, thereby suggesting that endotoxin causes a state of resistance to GH. This may be exacerbated by reduced IGF-I bioavailability and/or action, and which may participate in the pathophysiology of the catabolic state seen in sepsis. The temporal analysis of hormone responses suggests that endotoxin-induced alterations of the IGF-I/IGFBPs system may involve the prolonged and substantial somatostatin rise that we recently demonstrated, together with an increase in glucocorticoid and cytokine as more generally assumed.
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PMID:IGF-I/IGFBPs system response to endotoxin challenge in sheep. 1069 76

Enterocutaneous fistulas (ECFs) are a complex topic in terms of classification. ECF-related morbidity and mortality can be high due to fluid loss and electrolyte imbalance, sepsis, and malnutrition. Most prognostic factors influencing the outcome of ECF are now well-known. ECF treatment is complex; and, based on various situations, it can be surgical or conservative/ medical. Depending on fistula site and nutritional status, clinicians have to decide whether total parenteral or enteral nutrition should be established. In cases where total parenteral nutrition alone for 7 days has failed to influence the high output fistulas, overall data support the use of adjuvant drug, somatostatin, or its synthetic analogue, octreotide. Somatostatin 250 microg/d and octreotide 300-600 microg/d have been tried along with total parenteral nutrition to decrease the healing time of ECFs and to reduce the number of complications.
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PMID:Nutrition and enterocutaneous fistulas. 1103 97

We report a case of a female neonate with Beckwith-Wiedemann syndrome who manifested upper airway obstruction soon after birth and suffered from intractable hypoglycemia and abdominal distention caused by nephromegaly. She was delivered at 31 weeks of gestation with 2480 g and was diagnosed as Beckwith-Wiedeman syndrome, manifesting macroglossia, hepatomegaly, nephromegaly and omphalocele. Her trachea was intubated 30 minutes after birth due to upper airway obstruction. At 12 days of life, glossopexy was performed to relieve the airway obstruction. Although tracheal extubation was successfully accomplished 12 days later, 21 days after the glossopexy she manifested apnea and hypoxia and required tracheal intubation and mechanical ventilation again. We suspected hypoglycemia or central apnea to be the cause of apnea and started the administration of somatostatin analog as a treatment for hypoglycemia. In addition to the apnea, abdominal distention caused by nephromegaly exacerbated her respiratory condition. At 69 days of life she died of sepsis complicated with disseminated intravascular coagulation and renal failure. A needle biopsy at autopsy revealed nephroblastomatosis.
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PMID:[A neonate with Beckwith-Wiedemann syndrome who developed upper airway obstruction after glossopexy]. 1184 Jun 63

Somatostatin (SRIF) is a well-known neuroendocrine secretion product. SRIF expression and secretion are induced after inflammation in murine macrophages and in endotoxin-injected sheep and pigs. Because adipocytes have been demonstrated to produce numerous cytokines and peptide hormones, we investigated the expression of SRIF and its receptors (SSTR1-5) in human adipose tissue after inflammatory stimulation in vitro and in tissues from patients with septic disease.Preadipocyte-derived adipocytes, mesenchymal stem cell-derived adipocytes, and mature explanted adipocytes expressed SRIF-mRNA after endotoxin [lipopolysaccharide (LPS)] or IL-1beta treatments. LPS- and IL-1beta-mediated SRIF-mRNA induction was blocked by pretreatment with dexamethasone. Using cocultures and quantitative real-time PCR, we demonstrate adipocyte SRIF induction by secretion factors from activated peripheral blood mononuclear cell-derived macrophages. In contrast to basal adipocytes, SRIF protein was detected in culture supernatants of LPS-treated and of combined TNFalpha/IL-1beta/LPS-treated adipocytes. SRIF protein was visualized by immunohistochemistry in explanted minced adipose tissue after overnight incubation in culture medium supplemented with combined IL-1beta and LPS. In septic patients, expression of SRIF-mRNA and SRIF protein was found in visceral, but not in sc, adipose tissue. Adipocyte mRNA abundance of SSTR 1-5 was differentially regulated by inflammatory treatments.Thus, human visceral adipose tissue secretes SRIF during inflammation and sepsis and expresses several SSTRs. It is tempting to speculate that visceral adipose tissue-derived SRIF plays a modulatory role in the immunological and metabolic response to inflammation.
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PMID:Somatostatin is expressed and secreted by human adipose tissue upon infection and inflammation. 1547 72


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