Neonatal chylothorax

Chylothorax is the most common form of pleural effusion encountered in neonates. It is defined as abnormal accumulation of lymphatic fluid in the pleural space. It may be either congenital or an acquired condition. It causes respiratory and nutritional problems and significant mortality rate. Neonatal chylothorax respond to octreotide treatment. Octreotide is a long-acting somatostatin analog that can reduce lymphatic fluid production and has been used as a new strategy in the treatment of chylothorax.'' Initial management may include restriction of enteral feedings. Authors report a case of newborn baby born to gravida 2 mother at 32'2 weeks of gestation with left sided pleural effusion subsequently confirmed to be a congenital chylothorax with patent ductus arteriosus. USG guided tap was done, and milky fluid was aspirated.

Radionuclide therapy for pancreatic neuroendocrine neoplasms / 中国实用外科杂志

Pancreatic neuroendocrine neoplasms(pNENs)are the most common neuroendocrine tumors.For early local pNENs,surgery is the main therapeutic strategy and the tumor can be removed completely.But for those pNENs that cannot be surgically removed or have undergone distant metastasis,peptide receptor radionuclide therapy(PRRT)can be chosen as a first-line therapeutic strategy as pNENs overexpress somatostatin receptors.In recent years,clinical trials and studies on the use of PRRT in pNENs have been increasing rapidly.Many reports have confirmed the efficacy of 90 Y and 177 Lu-labeled somatostatin analogue in pNENs patients.

Outcome of Endoscopic Transsphenoidal Surgery in Combination with Somatostatin Analogues in Patients with Growth Hormone Producing Pituitary Adenoma

OBJECTIVE: To determine the efficacy of endoscopic surgery in combination with long-acting somatostatin analogues (SSAs) in treating patients with growth hormone (GH)-secreting pituitary tumor. METHODS: We performed retrospective analysis of 133 patients with GH producing pituitary adenoma who underwent pure endoscopic transsphenoidal surgery in our center from January 2007 to July 2012. Patients were followed up for a range of 3-48 months. The radiological remission, biochemical remission and complication were evaluated. RESULTS: A total of 110 (82.7%) patients achieved radiological complete resection, 11 (8.2%) subtotal resection, and 12 (9.0%) partial resection. Eighty-eight (66.2%) patients showed nadir GH level less than 1 ng/mL after oral glucose administration. No mortality or severe disability was observed during follow up. Preoperative long-acting SSA successfully improved left ventricle ejection fraction (LVEF) and blood glucose in three patients who subsequently underwent success operation. Long-acting SSA (20 mg every 30 days) achieved biochemical remission in 19 out 23 (82.6%) patients who showed persistent high GH level after surgery. CONCLUSION: Endoscopic transsphenoidal surgery can biochemically cure the majority of GH producing pituitary adenoma. Post-operative use of SSA can improve biochemical remission.

Naloxone or Vagotomy Does Not Influence Centrally Octreotide-induced Inhibition of Gastric Acid Secretion in Rats / 华中科技大学学报（医学）（英德文版）

To investigate the effect of preceding naloxone injection into the third cerebroventricle or acute subdiaphragmatic vagotomy on the gastric acid secretion inhibited by the somatostatin analogue octreotide given by intracerebroventricular (icv) injection. The third ventricles were cannulated in male Wistar rats anesthetized with sodium pentobarbital. One week later, acute gastric lumen perfusion was carried out. The gastric perfusion samples were collected every 10 min and were fitrated by 0.01 mol/L NaOH to neuter. On the basis of subcutaneous injection of pentagastrin (G-5, 160 μ g/kg), icv injection of physiological saline (group A, n=20), icv injection of octreotide (0.05 μ g)(group B, n=20), icv injection of naloxone (2.5 μ g)+octreotide (0.05 μ g) (group C, n=20), acute subdiaphragmatic vagotomy+ icv injection of physiological saline (group D, n=20), or acute subdiaphragmatic vagotomy+icv injection of octreotide (0.05 μ g) (group E, n=20) were conducted. Before and after icy injection, 1-h total acid output (TAO) was determined and compared. The experimental data were expressed in change rate (%) of TAO. The change rates (%) of TAO were 4.60 % in group A, -20.35 % in group B, -18.06 % in group C, 5.01% in group D and -21.59 % in group E, respectively. Comparison of group B or C versus group A showed that P＜0.01 and comparison between the group E versus group D showed that P＜0.01. Whereas the differences between group C and group B, group E and group B were not statistically significant (P＞0.05 for all). The results indicate that the central inhibition of gastric acid secretion by octreotide may not be mediated by the endogenous opiate substance or its receptor and the peripheral pathway for icv injection of octreotide to suppress gastric acid secretion is via extra-vagus route.

Efficacy of Octreotide LAR in Acromegalic Patients / 대한내분비학회지

BACKGROUND: Octreotide(OC)-LAR is a long-acting preparation of octreotide which has been effectively used to suppress GH/IGF-1 hypersecretion in acromegalic patients. The clinical response, biochemical outcomes, and safety of OC-LAR were evaluated in 27 active acromegalic patients. METHOD: 27patients with an active disease status (according to the clinical picture, GH >5microgram/L and elevated age-matched IGF-1), and previously treated with bromocriptine after surgery, comprised the study population. OC-LAR was given(20mg, i.m., every 4 week for 3 injections, then the doses were titrated individually) and the acromegalic symptoms and adverse reactions recorded. The serum levels of GH and IGF-1 were evaluated every 12 week. The acromegalic symptoms including headache, fatigue and arthralgia, improved in all patients. RESULTS: Gastrointestinal side effects were transient and mild. The levels of GH significantly decreased, from 8.9+/-3.5 to 2.9+/-2.2 microgram/L at 12 weeks(P<0.001, vs. baseline), to 2.9+/-2.1microgram/L after 24 weeks(P<0.001) and to 2.5 +/-1.3microgram/L at 48 weeks(P<0.001). The levels of IGF-1 significantly decreased, from 753.7+/-213.6 to 429.7+/-253.4 microgram/L at 12 weeks(P<0.001, vs. at baseline), to 405.7+/-213.3microgram/L at 24 weeks(P <0.001) and to 348.9+/-144.7microgram/L at 48 weeks(P<0.001). The safelevel of GH is less than 2.5microgram/L and normal age-matched IGF-1 levels were achieved in 63 and 52% of the patients, respectively. CONCLUSION: Octreotide-LAR was well tolerated and effective as an adjuvant treatment in lowering the levels of GH and IGF-1 in active acromegalic patients.

Octreotide Inhibits the Growth of Hepatocellular Carcinoma Through Down-Regulation of cMet / 中国普外基础与临床杂志

Objective To investigate the inhibitory effects and the mechanisms of octreotide(OCT) on the growth of hepatocellular carcinoma(HCC).Methods Bel7402 HCC cells were studied for proliferative ability by MTT assay,morphology by light microscopy,adhesive and invasive ability by cell adhesion and "wound strack" experiments.Immunofluorescence flow cytometry was used for study of cMet expression and cell cycle as well. Furthermore,the effects of OCT on tumor growth metastasis were investigated in nude mice with implanted HCC.The expression of cMet in implanted tumor cells was studied by immunohistochemistry.Results With OCT treatment,the proliferative ability of Bel7402 cells and cell morphology didn't change.The adhesive and invasive ability decreased compared with no OCT treatment cells(P

Effects of Somatostatin Analogue Pretreatment on Ovarian Response to Ovulation Induction in Patients with Polycystic Ovarian Syndrome / 대한산부인과학회잡지

OBJECTIVE: To determine whether the somatostain analogue, octreotide, pretreatment before ovulation induction with human menopausal gonadotropin (hMG) affects ovarian response, and ovulation induction outcome in infertile patients with polycystic ovarian syndrome (PCOS) resistant to clomiphene citrate (CC) METHODS: From November 1998 to June 1999, 30 infertile patients with PCOS unresponsive to CC were randomly allocated either octreotide pretreatment (treatment group) (n = 15) or hMG alone (control group) (n = 15) groups. In the treatment group, 100 g of octreotide were administered daily for 7 days after progesterone injection for withdrawal bleeding, and then hMG was administered for ovulation induction. RESULTS: There were no differences in the total number of hMG ampules required and the duration of hMG administration between the two groups. The number of follicles of 10-14 mm diameter on the day of hCG injection was significantly less in the treatment group than that in the control group (4.3 +/- 2.5 vs. 9.6 +/- 4.4, p < 0.001). The serum estradiol (E2) level on the day of hCG injection was significantly lower in the treatment group, with 1579.2 +/- 421.0 pg/ml compared with 2120.3 +/- 512.7 pg/ml in the control group (p < 0.001). The hematocrit level on the day of hCG injection was also significantly lower in the treatment group than that in the control group (36.9 +/- 2.1% vs. 40.8 +/- 2.9%, p < 0.05). The incidence of severe ovarian hyperstimulation syndrome (OHSS) seemed to be lower in the treatment group, but the difference did not achieve significance (6.7% vs 20.0%). CONCLUSION: This study suggests that octreotide pretreatment before ovulation induction could improve hormonal milieu compared to hMG alone, and therefore may be effective in ovulation induction for patients with PCOS resistant to CC.

The Effect of Slow Release Lanreotide in Korean Acromegalic Ratients / 대한내분비학회지

BACKGROUND: Previous studies have shown that somatostatin analogues such as octreotide are effective in suppressing GH and IGF-I levels in acromegaly. The recent availability of slow release lanreotide could avoid the inconveniences associated with either repeated subcutaneous injections or continuous infusions. We investigated the effects of the SR-lanreotide on clinical, biochemical and safety responses in five patients with acromegaly. And we investigated whether the response of the GH level to acute adrninistration of octreotide predicts the response after 12 weeks of treatment with the SR-lanreotide and whether the identification of gsp oncogene could be used as a therapeutic and prognostic clue in treatment with the SR-lanreotide. METHODS: We studied the effects of SR-lanreotide 30 mg administered intramuscularly biweekly for 12 weeks in five Korean acromegalic patients. Subjective improvements in the clinical symptoms of acromegaly and adverse reactions were recorded. During SR-lanreotide treatment, serum GH, IGF-I and IGFBP-3 concentrations were evaluated just before the next injection of the SR-lanreotide. Before the start of SR-lanreotide therapy the sensitivity of GH secretion to the octreotide was tested by measuring the effect of the acute response to 0.1 mg intravenously on plasma GH levels followed until 6 hours after administration of octreotide. Direct polymerase chain reaction sequencing of the gsp oncogene were performed. We compared the responses to SR-lanreotide in patients harboring gsp-positive and gsp-negative somatotroph adenomas. RESULTS: The treatment with SR-lanreotide for 12 weeks could suppress the GH level by more than 50% in four of five patients and normalize the IGF-I in two patients. No correlation was found between the GH level and IGF-I level at the end of the study. The IGFBP-3 level correlated with the IGF-I level in three of five patients. Although the initial GH response to octreotide tended to correlate with the IGF-I response after SR-lanreotide treatment, the results were statistically insignificant. The patients with gsp-positive tumor tended to show a better response to SR-lanreotide. During treatment, there was a reduction in the percentage of patients complaining of joint pain, fatigue, digital paresthesia, and hyperhydrosis. Changes in soft tissue swelling were documented by decreases in finger circumference. The common adverse events were abdominal discomfort, loose stool, and diarrhea. These events were decreased progressively. No patients discontinued the treatment of SR-lanreotide due to adverse events. CONCLUSION: This study showed that SR-lanreotide is effective in controlling acromegalic symptoms as well as GH and IGF-I hypersecretion. This treatment was well tolerated and more convenient for the patients. Further studies are required for clinical outcome of long-term SR-lanreotide treatment and cost-effective analysis.

The Effects of Somatostatin Analogue on Ovarian Response to Ovulation Induction in Patients with Polycystic Ovarian Syndrome / 대한산부인과학회잡지

OBJECTIVE: To determine whether the somatostatin analogue, octreotide, given concunently with human menopausal gonadotropin (HMG) affects ovarian response, ovulation induction outcome, and serum levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) in infertile patients with polycystic ovarian syndrome (PCOS) resistant to clomiphene citrate (CC). METHODS: From August 1996 to June 1998, 42 infertile patients with PCOS urresponsive to CC were enrolled in the present study. Women who had other infertility factors were excluded from this study. Patients were randomly allocated either to combined HMG and octreotide treatment (treatment group) (n=21) or HMG alone (control group) (n=21). In the treatment group, 100 micrograms of octreotide were administered daily concomitantly with HMG from the 3rd day of menstrual cycle to the preceding day of human chorionic gonadotropin (HCG) injection. RESULTS: Patient's characteristics were comparable in both groups. One cycle in the control group was abandoned because of excessive follicular development. However, none of the cycles in the treatment group was abandoned. There were no differences in the number of HMG ampules required and the duration of HMG administration between the two groups. The number of follicles > 14mm diameter on the day of HCG injection was significantly less in the treatment group than that in the control group (p<0.01). The serum estradiol level on the day of HCG injection was also significantly lower in the treatment group, with 1391.0 +/- 695.5 pg/ml compared with 2217.5 +/- 811.6pg/ml in the control group (p<0.001). The incidence of severe ovarian hyperstimulation syndrome seemed to be lower in the treatment group, but the difference did not achieve significance (4.9% vs 23.8%). There were no differences in the clinical pregnancy rate, miscarriage rate and multiple pregnancy rate between the two groups. Although serum GH levels were comparable between the two groups, serum IGF-1 level on the day of HCG injection was significantly higher in the treatment gmup than that in the control group (p<0.001). CONCLUSION: This study suggests that the combined octreotide and HMG treatment could improve hormonal milieu and folliculogenesis compared to HMG alone, and therefore may be effective in ovulation induction for patients with PCOS resistant to CC.

The Role of SMS201-995 in the Prevention and Treatment of Pulmonary Edema Caused by Acute Pancreatitis in Rats / 第二军医大学学报

Pulmonary edema is associated with pancreatic enzymes released into the blood stream during acute pancreatitis.Acute hemorrhagic pancreatitis in rats was established by injecting 5%sodium taurocholate into the pancreatic duct.Before and at the time of induction,SMS201-995 2?g/kg was injected subcutaneously,and followed by 3 h continuous I.V.infusion of NS solution containing SMS201-995 5?g?kg-1?h-1 at a rate of 6ml?kg-1?h-1.The results of this experiment showed that SMS201-995 could:(1) decrease the serum levels of amylase and lipase effectively;(2)reduce lung index and lung extravascular water volume siginficantly;(3)ameliorate the pathologic changs of lung and pancreas evidently.These results also suggested that SMS201-995 could both prevent and treat acute pancreatitis and pulmonary edema induced by it in rats.Therefore,it is theoretically sound that evidence can be proviede by the results obtained in this experiment for the application of SMS201-995,a long acting analogue of somatostatin,to treat clinical acute pancreatitis by its inhibitory effect towards pancreatic exocrine secretion.