Lanreotide Autogel (Ipsen) is a long-acting somatostatin analogue (SA) in a new galenic formulation suitable for subcutaneous (s.c.) injection. In our department, 11 patients with therapy-resistant acromegaly were treated with Lanreotide Autogel for 48 months. 10/11 patients had previously undergone transsphenoidal surgery. For a median duration of 1.4 years prior to Lanreotide Autogel, the patients received Lanreotide PR 30 mg every 7, 10, or 14 days. 60, 90, or 120 mg of Lanreotide Autogel was administered by deep s.c. injection every 28 days, with the higher dosage being given to those with the previously shortest injection interval under Lanreotide PR. Dose was adjusted on the basis of Growth Hormone (GH) level after 4, 8, and 12 months with a minimum dose of 60 mg and a maximum dose of 120 mg. The efficacy of Lanreotide Autogel treatment was evaluated by measuring GH concentrations (4 hour profiles) and IGF-I levels. Before switching to Lanreotide Autogel, the multiple of the upper limit of normal (xULN) of IGF-I levels was 1.2 (median) and the median GH level was 1.3 microg/l. 3 out of 11 patients had an IGF-I within the age- and sex-adjusted normal range. After 48 months of treatment with Lanreotide Autogel, six patients had an IGF-I within the normal range. Median GH levels were at 1.3 microg/l and xULN of IGF-I was at 1.0 compared to Lanreotide PR 30 mg treatment (p < 0.001). At the end of the study, 8 patients received 120 mg Lanreotide Autogel, 2 patients 90 mg and 1 patient 60 mg, respectively. There was slight but significant deterioration of glucose metabolism with an increase of HbA1c. In conclusion, the new galenic formulation of Lanreotide improves not only the control of biochemical markers of acromegaly compared to the conventional PR formulation, but is also easier to administer given its deep s.c. method of administration. Glucose metabolism has to be followed carefully in patients on high-dose Lanreotide Autogel.
The endothelial cell (EC) response during the first 2 h after traumatic hemorrhagic shock (THS) was analyzed in the rat mesentery by electron microscopy. Using a computer-assisted image analysis system, we interactively measured THS-induced changes of the area and the mean height of EC as well as the number of swollen EC occluding the capillary lumen. Analysis distinguished between capillaries presenting with the lumen blocked by corpuscular blood cells and capillaries with an open lumen. THS resulted in a significant increase in EC height of capillaries with an open lumen, but not of capillaries with lumen blocked by blood cells when compared with the control group (p < 0.05). This phenomenon was found to be most prominent 60 min after THS. In addition, THS was accompanied by a significantly increased number of swollen EC which occluded capillaries with an open lumen. From these results we conclude that swelling of EC contributes to THS-induced microvascular injury. Occlusion of the capillary lumen by EC swelling may be regarded as the morphological correlate of the THS-induced ‘no-reflow’ phenomenon.
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