Remission of symptoms during long term treatment of metastatic pancreatic endocrine tumours with long acting somatostatin analogue.

Abstract

were employed in manufacturing and non-manufacturing work had almost identical rates ofabortion, and this relativity was not affected after logistic regression had accounted for differences in age, parity, history of abortion, education, and smoking. Thus there were no important differences between the two groups in these respects.This study thus provides support for the findings of Clarke and Mason that leatherwork in pregnancy may be associated with an increased risk of stillbirth.' The excess was entirely in the previous pregnancies, for which our data were complete and, we believe, reliable. In current pregnancies, in which stillbirths were incompletely ascertained, the absence ofexcess (one observed against 0-95 expected) is based on numbers too small to be interpreted. The difference between the ratio ofobserved to expected cases in current and previous pregnancies is no more than can be explained by chance. We did not, however, find any convincing evidence of an increase in fetal malformations. The only type of congenital defect on which Clarke and Mason commented were the three cases of trisomy 18 in an estimated 1200 births, or one in 400. As we had only 346 term pregnancies in leatherworkers and no case oftrisomy 18 we are not able to confirm or refute their finding.There is not necessarily any contradiction in finding a hazard that causes stillbirth and not malformation. A toxic agent acting later in pregnancy even over a short period could kill a fetus, whereas our knowledge of teratology suggests that only an agent acting at the right time in the first trimester might cause a malformation.The findings of Clarke and Mason and our own suggest that leatherwork may possibly expose women to a fetotoxic agent. We examined the work histories of the eight women in our study whose infants were stillborn; all operated sewing machines, three manufacturing shoes, three bags, and one belts. Five of the eight described exposure to glues (or cements, or both), one to paint, and one to silicone. It seems desirable to investigate the possible fetotoxicity ofmaterials used in the manufacture ofleather products. Four patients showed a significant reduction in tumour related hormone concentrations but in none did values return to normal. All five patients, however, noted definite symptomatic improvement and in one this was dramatic (disappearance of life threatening diarrhoea and correction of metabolic acidosis and hypokalaemia within 48 hours). Mild worsening ofsymptoms and increasing fasting tumour related hormone concentrations after three to six months of treatment were reversed by doubling the 12 hourly dose. The treatment was well tolerated and had no deleterious effect on fasting blood glucose concentrations.This somatostatin analogue seems a promising non-invasive treatment for metastatic pancreatic endocrine tumours.

Octreotide (SMS 201–995) for hematopoietic support-dependent high-dose chemotherapy (HSD-HDC)-related diarrhoea: dose finding study and evaluation of efficacy

“…Seven patients efficacy and tolerance of octreotide in the control of severe (50%) had less than 500 ANC/mm 3 (grade 4 diarrhoea in patients treated with HSD-HDC. neutropenia) simultaneously with the diarrhoea.…”

“…The clinical activity of octreotide in the management of symptoms associated with a number of secretory diarrhoeal disorders is well documented. [4][5][6][7]14 Although the exact Table 3 Relation between dose/cumulative response/treatment duration mechanism of action is unknown, a reduction of luminal fluids, the inhibition of chloride secretion with a stimulation contents and the mucosal surface. 16 In watery diarrhoea produced by peptides released by tumors (vipoma, carci- rrhoea, octreotide has been used to treat chemotherapyrelated diarrhoea.…”

Hormonal and Volumetric Long Term Control of a Growth Hormone-Releasing Hormone-Producing Carcinoid Tumor

“…In two patients with an intermediate biochemical response there was even progression of tumor volume, with evidence of new metastases during treatment (4,15). In one patient with excellent biochemical response von Werder described some evidence of tumor shrinkage of a hepatic metastasis (18), although clear evidence of tumor shrinkage was demonstrated in only one patient in the literature (12).…”

“…An intermediate response, with clinical improvement of acromegalic features and a major reduction in GH and IGF-I levels, has been described in 7 patients. GH decreased by 40 -90%, and IGF-I decreased by 47-75%, accompanied by GHRH reductions of 54 -70% from baseline (4,6,7,(15)(16)(17). Treatment failure was described in 2 of 14 patients (2, 3).…”

Treatment of secretory diarrhea in AIDS with the somatostatin analogue SMS 201-995

“…Somatostatin has been useful in the treatment of secretory diarrhea related to various diseases such as Zollinger-Ellison syndrome [2], VernerMorrison syndrome [3,12], the carcinoid syndrome [5], glucagonomas [3], and ileostomy [18]. However, the native form of somatostatin has the disadvantage of a short half-life, necessitating intravenous administration [15].…”