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      Successful Treatment of Enterocutaneous Fistula in a Hemodialysis Patient with Somatostatin

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          Abstract

          Although cysticercosis is the most common parasitic disease affecting the central nervous system, spinal cysticercosis is rare. A rare form of spinal cysticercosis involving the whole spinal canal is presented. A 45-year-old Korean male had a history of intracranial cysticercosis and showed progressive paraparesis. Spinal magnetic resonance scan showed multiple cysts compressing the spinal cord from C1 to L1. Three different levels (C1-2, T1-3, and T11-L1) required operation. Histopathological examination confirmed cysticercosis. The patient improved markedly after surgery.

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          Complicated enterocutaneous fistulas: failure of octreotide to improve healing.

          Elida Alvarez, H Reber, James McFadden (2000)
          Octreotide has been promoted as a potential aid during closure of enterocutaneous fistulas (ECFs) on the basis of clinical and experimental evidence that it can reduce gastrointestinal secretions. We retrospectively reviewed the records of patients admitted with ECF to our tertiary referral center to ascertain whether use of octreotide affected fistula duration, length of hospitalization, closure rate, and morbidity. Of 60 patients diagnosed and treated for ECF over a 4-year period, 13 underwent a therapeutic trial with octreotide. Thirteen patients from the group who did not receive octreotide were matched by cause, location, and output of the fistula, age, and primary diagnosis to the treatment group. Octreotide was administered in therapeutic dosage for a mean course of 57 +/- 29 days, resulting in a substantial acute decrease (84.7 +/- 4.8%) in fistula output. Prolonged therapy nevertheless failed to affect the outcome parameters studied, particularly fistula duration, spontaneous closure rate, and length of hospitalization. There was a significantly higher incidence of septic and thrombotic complications associated with octreotide use. In this patient population with complicated ECFs, use of octreotide showed no benefit and was associated with increased morbidity.
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            Chronic renal failure: effect of hemodialysis on gastrointestinal hormones.

            T O'Dorisio, B Levine, H Gaskill … (1984)
            Fifteen patients with chronic renal failure (serum creatinine level greater than 5 mg/dl) of long duration (more than 2 years) requiring hemodialysis were studied. Blood samples before and after 4 hours of hemodialysis were assayed for creatinine, blood urea nitrogen, potassium, calcium, glucose, insulin, gastrin, gastric inhibitory polypeptide, vasoactive intestinal polypeptide, pancreatic polypeptide, somatostatin, motilin, and neurotensin levels. Before dialysis, serum gastrin was minimally increased whereas gastric inhibitory polypeptide and pancreatic polypeptide were grossly increased compared with normal fasting values. Hemodialysis produced no changes in serum gastric inhibitory polypeptide, vasoactive intestinal polypeptide, pancreatic polypeptide, somatostatin, motilin, and neurotensin. Slight increases in serum insulin and gastrin levels may have occurred secondary to a dialysis-induced increase in the serum calcium level. The kidneys appear to be a major site of inactivation of insulin, gastrin, gastric inhibitory polypeptide, and pancreatic polypeptide. The gastrin level, although elevated in renal failure patients, may be suppressed by very high circulating levels of gastric inhibitory polypeptide.
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              Treatment of enterocutaneous fistulas with TPN and somatostatin, compared with patients who received TPN only.

              K Panagopoulos, K Vagenas, J. Spiliotis … (1990)
              Eighteen patients with post-operative enterocutaneous fistulas were treated with total parenteral nutrition (TPN), skin care, infection control and intravenous somatostatin (SMS) 250 micrograms/h. This group was compared with 30 patients treated with standard medical treatment (total parenteral nutrition (TPN), skin care and infection control). In the SMS group the fistula output was reduced to 50% in three days and spontaneous closure was observed in 14 patients after a mean of 6.1 +/- 3.1 days of treatment with SMS, and in 18.2 +/- 6.3 days after the TPN administration. In the control group the fistula output was reduced by up to 50% after a week and spontaneous closure occurred in 20 patients in a mean of 27.4 +/- 8.7 days after the start of treatment. These results are statistically significant. There was one (5.5%) death in the SMS group compared with three (10%) deaths in the other, and glucose intolerance was observed in two (11%) patients in the SMS group. Somatostatin has been shown to be useful in the conservative treatment of enterocutaneous fistulas because of its ability to reduce output and accelerate closure.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Yonsei Med J
                Journal ID (publisher-id): YMJ
                Title: Yonsei Medical Journal
                Publisher: Yonsei University College of Medicine
                ISSN (Print): 0513-5796
                ISSN (Electronic): 1976-2437
                Publication date (Print): 31 December 2009
                Publication date (Electronic): 18 December 2009
                Volume: 50
                Issue: 6
                Pages: 865-866
                Affiliations
                [1 ]Department of Nephrology, Faculty of Medicine, University of Mersin, Mersin, Turkey.
                [2 ]Department of Internal Medicine, Faculty of Medicine, University of Mersin, Mersin, Turkey.
                [3 ]Department of Surgery, Faculty of Medicine, University of Mersin, Mersin, Turkey.
                [4 ]Department of Radiology, Faculty of Medicine, University of Mersin, Mersin, Turkey.
                Author notes
                Corresponding author: Dr. Ahmet Alper Kiykim, Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Mersin University, 33190 Mersin, Turkey. Tel: 90-324-3374300, Fax: 90-324-3374305, ahmetkiykim@ 123456mersin.edu.tr
                Article
                DOI: 10.3349/ymj.2009.50.6.865
                PMC ID: 2796420
                PubMed ID: 20046434
                SO-VID: 1f2ee08b-efdf-439a-9a3f-649b5415d8b5
                Copyright © © Copyright: Yonsei University College of Medicine 2009
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 22 December 2003
                Date revision received : 03 April 2004
                Date accepted : 03 April 2004
                Categories
                Subject: Letter to the Editor

                ScienceOpen disciplines: Medicine
                Keywords: neurocysticercosis,subarachnoid space,central nervous system parasitici infections,spine
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: neurocysticercosis, subarachnoid space, central nervous system parasitici infections, spine

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