Octreotide therapy of large-volume refractory AIDS-associated diarrhea: a randomized controlled trial.

OBJECTIVE: To compare the effect of octreotide (a long-acting somatostatin analog) to that of antidiarrheal therapy plus placebo on large-volume refractory AIDS-associated diarrhea. DESIGN: A randomized controlled trial. SETTING: Referral-based clinic and hospital in a tertiary care center. PATIENTS: Twenty male patients with AIDS and refractory diarrhea, with stool volume > 1000 ml/day who failed to improve after initial supportive management. All patients finished the study. INTERVENTIONS: Patients were randomly given either octreotide in doses of 100, 200 and 300 micrograms subcutaneously every 8 h, or high doses of loperamide and diphenoxylate orally plus placebo subcutaneously for 10 days. MAIN OUTCOME MEASURES: Bowel movements and stool volume were registered before and every day after treatment by the patients themselves and the nursing personnel. RESULTS: Patients from both groups were similar for age, time of AIDS diagnosis, duration of diarrhea and etiology. Baseline mean bowel movements per day (9.4 +/- 2.8 in the octreotide group versus 10 +/- 3.1 in controls) and baseline mean stool volume (2753 +/- 840 versus 2630 +/- 630 ml/day, respectively) were similar in both groups before therapy (P < 0.05). Mean bowel movements per day after 10 days of therapy was 2.1 +/- 1.6 in the octreotide group versus 7 +/- 3 in controls (P < 0.05). Mean stool volume after 10 days of therapy was 485 +/- 480 in the octreotide group versus 1080 +/- 420 ml/day in controls (P < 0.05). Complete response (stool volume < 250 ml/day) was observed in two patients from the octreotide group and none from controls; partial response (decrease > 50% in stool volume) in four and two; and no response (decrease < 50% or no change) in four and eight (P < 0.05), respectively. Side-effects occurred in eight out of 10 octreotide patients and three out of 10 controls (P < 0.05), but none were significant to result in discontinuation of medication. CONCLUSION: Octreotide proved to be superior to conventional therapy in this short-term treatment of large-volume refractory AIDS-associated diarrhea.

[Primary liver cancer. Its epidemiological, clinical and biochemical characteristics]. / Cáncer hepático primario. Características epidemiológicas, clínicas y bioquímicas.

Epidemiological, clinical, biochemical and topographic features of primary hepatic cancer (PHC) were reviewed retrospective and prospectively in this study. This review consisted of 76 patients from 1971 to 1990. Forty nine males and 27 females. The mean age was 66.1 +/- 11.7 years. Hepatocellular carcinoma (HC) was the most frequent histological type (84.1%), followed by cholangiocarcinoma (87.7%). Mixed carcinoma and hepatoblastoma were 4.3 and 2.9% respectively. The prevalence af PHC among 1485 autopsies was 0.74%. The most frequent sites af metastasis were the lungs (66%) and portal vein (50%). Hepatocellular carcinoma was associated to cirrhosis in 80% of the cases. A syndrome including asthenia, weight loss, hepatomegaly and cholestasis was identified in most of the patients, and alkaline phosphatase was the most frequently disturbed laboratory test. 60% of tumors were bilateral and none of the solitary tumors had less than 5 cms in diameter. 20% of HC showed normal serum levels of AFP (< 20 ng/ml). 40% had at least one of the markers of B virus hepatitis in serum.

Total therapeutic paracentesis (TTP) with and without intravenous albumin in the treatment of cirrhotic tense ascites: a randomized controlled trial.

We studied 35 cirrhotic patients with tense ascites assigned at random into two groups: Group I consisted of 17 patients treated by total therapeutic paracentesis (TTP) (6-15 l) plus i.v. albumin (5 g/l of fluid) and Group II consisted of 18 patients treated by TTP (5.5-15.5 l) without albumin. On 19 patients we performed a sequential assessment of cardiac output (CO), plasma renin activity (PRA) and plasma aldosterone (PA). Both groups were similar in age, sex, and etiology of cirrhosis. CO, PRA and PA values were expressed as mean changes occurring in relation to their respective baseline values. CO changes after TTP (l/min): Group I: 2.5 after 6 h and 2.2 after 12 h; Group II: 2.2 after 6 h and -0.4 after 12 h, (p < 0.05 comparing values after 12 h between the two groups). PRA changes after TTP (ng/dl/h): Group I: -7.4 after 1 h, -7.8 after 6 h and -3.2 after 24 h; Group II: -2.4 after 1 h, -0.8 after 6 h and 3.9 after 24 h (p < 0.05 comparing values between both groups after 6 and 24 h). PA changes after TTP (ng/dl): Group I: -50.5 after 1 h, -36.7 after 6 h and -34.6 after 24 h; Group II: -18.2 after 1 h, -2.2 after 6 h and 20 after 24 h, (p < 0.05 comparing values between both groups after 1 and 6 h). Complications were minimal in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Severe diarrhea in AIDS treated with a somatostatin analog. Report of a case]. / Diarrea grave en el síndrome de inmunodeficiencia adquirida, tratada con un análogo de somatostatina. Reporte de un caso.

We herein report a 30 years old male patient with AIDS and Cryptosporidium diarrhea diagnosed by intestinal biopsy. After some days of unsuccessful conventional anti-diarrheal treatment, an analog of somatostatin (octreotide acetate) Sandostatin was started. The stool volume and the bowel movements decreased dramatically and in spite of some collateral effects the patient could be clinically improved and discharged from the hospital.

[Therapeutic paracentesis with albumin infusion for the treatment of tension ascites in cirrhotic patients. Preliminary report]. / La paracentesis terapéutica con infusión de albúmina en el tratamiento de la ascitis a tensión del paciente cirrótico. Informe preliminar.

UNLABELLED: It has been recently reported that repeated large volume paracentesis (LVP) is a safe and efficacious procedure to treat cirrhotics with tense ascitis. In this paper we present the results of our experience with the use of this method. We studied 10 cirrhotics with tense ascites. The criteria for exclusion are described in the text. During LVP, iv albumin infusion was given (25 g each tap). Patients were followed during 3-4 months after discharge from the hospital. RESULTS: Eighteen LVP were made in 10 patients. The mean age was 56 years (range 37-77). Six had peripheral edema. The mean volume of ascitic removed was 6.75 L (range 5-12) per tap. No clinic or hemodynamic complications were observed. With exception of serum cholesterol, which showed a decrease after LVP, laboratory tests did not show any significant modification. Two patients died 3 and 6 weeks after LVP due to hepatic failure and digestive hemorrhage. The procedure was well tolerated. Two were readmitted to the hospital after three months because of ascites. We conclude that LVP plus 25 g of i.v. albumin infusion is a safe and efficacious method to treat cirrhotic tense ascites. After three months no renal function impairment was observed. LVP decrease serum cholesterol.

[Pathogenesis of portal systemic encephalopathy]. / Conceptos actuales sobre la fisiopatogenia de la encefalopatía hepática.

Hepatic encephalopathy is a neuropsyquiatric syndrome associated to multifactorial metabolic disruptions. Several physiopathogenic theories have been proposed. In this review authors explain and analyze most of theses theories which include ammonia, mercaptans, false neurotransmitters, gamma aminobutiric acid, endogenous benzodiazepins, and zinc deficiency as well as some of the new biochemical concepts of neurotransmission.