Treatment of external gastrointestinal fistulas by a combination of total parenteral nutrition and somatostatin.

Thirty-seven patients with external gastrointestinal fistulas were treated with a combination of total parenteral nutrition (TPN) and somatostatin (ST). There was a significant fall in fistula output within the first day of treatment (p less than 0.001). On the first day of combined therapy, the reduction of fistula output was 70%, and in 68% of the cases, the fistula output fell to less than 50% of the initial level. Spontaneous closure was observed in 82% of the cases, and the time taken to close the fistula ranged between 1 and 14 days of starting therapy [5.4 +/- 0.7 days (mean +/- SEM)]. The response to TPN-ST treatment occurred, irrespective of age and sex of patients, duration and daily output of the fistulas before ST use, and their location in the gastrointestinal tract. Infection of fistula output was a factor of adverse prognosis. In all cases, and in the absence of mechanical obstacles, treatment that combines TPN and ST could be tried and continued up to 14 days in cases in which the fistula output falls more than 50% on the first day of treatment.

Inhibition of testosterone metabolism and lipogenesis in animal sebaceous glands by progesterone.

The effect of progesterone on 14C-testosterone metabolism and on 14C-lipid synthesis was studied in two animal sebaceous gland models, hamster flank organ and rat ear skin. Unilateral topical application of progesterone to the female hamster flank organ topically treated with testosterone propionate resulted in localized inhibition of both in vitro 14C-lipogenesis and in vitro conversion of 14C-testosterone to 5 alpha-reduced radio-metabolites. Topical progesterone did not inhibit in vitro 14C-lipogenesis in the male hamster flank organ. Progesterone added in vitro inhibited 14-C-lipogenesis and 14C-testosterone metabolism in male rat ear sebaceous glands. These results lend support to the hypothesis that inhibition of sebaceous gland lipogenesis by progesterone is a consequence of its inhibitory effect on testosterone metabolism. Such a rationale provides a valid explanation for the clinical findings with progesterone reported by other investigators.

[Influence of the stratum corneum on transepidermal water loss and Bioavailability of a new topical steroid, difluprednate: clinical implications (author's transl)]. / Influence du stratum corneum sur la perspiration insensible et sur la biodisponibilité d'un nouveau stéroïde topique, le difluprednate. Implications thérapeutiques.

Comparative study of experimental and theoretical curves obtained by plotting transepidermal water loss against stratum corneum thickness in man, shows that every layer in the stratum corneum acts as part of the epidermal barrier to water loss. Another function of the stratum corneum is to decrease the cutaneous penetration of topical corticosteroids like difluprednate and to modify their bioavailability ('corticosteroid reservoir'). Our data suggest that variations in stratum corneum thickness between subjects explain variation of transepidermal water loss and sensitivity difluprednate, as there is a close relationship between these two parameters. It is then conceivable than the phototype has clinical implications is there really exists a relationship between phototype, stratum corneum thickness and sensitivity to steroids.

[Phototoxicity of Bergamot oil. Comparison between humans and guinea pigs]. / Etude expérimentale de la phototoxicité de l'essence de Bergamote. Corrélations entre l'homme et le cobaye.

Phototoxicity of bergamot oil in solar simulating radiation (SSR greater than or equal to 290 nm) and in long ultraviolet radiation (LUV greater than or equal to 320 nm) has been compared by studying photoaugmentation of erythema in the guinea pig after 24 h and pigmentary photoaugmentation in man on the 8th day. The results show that a close relationship exists between guinea pig and human responses, with both radiations used, and that man seems to be slightly more sensitive to phototoxic effects of bergamot oil than the guinea pig. This difference of sensitivity necessarily implies the participation of UVA (320--400 nm) in the phototoxic reaction of bergamot oil with solar radiation. This UVA participation is particularly obvious in the guinea pig; in man, the results are less clear and a certain synergy of UVB rays (290--320 nm) may be involved in the phototoxic UVA-induced reaction of bergamot oil. Despite these slight differences, the erythematous reaction in the guinea pig appears to be a remarkable experimental model to show out potential phototoxic reactions of products containing psoralens in man.