Disease relevance of Pancreatic Fistula

• In fasting dogs with gastric fistulas and modified Herrera's pancreatic fistulas, intraduodenal administration of 1-phenyl-1-hydroxy-N-pentane (pH 6.7) in three different doses (25, 50, and 100 mg/kg) resulted in significant increases in both plasma secretin concentration and bicarbonate output [1].
• Sandostatin has made a major impact on the conservative treatment of pancreatic ascites and is an important adjunct to the management of external pancreatic fistulas [2].
• The gastric carcinoids appeared to diminish in size in response to a octreotide acetate (Sandostatin, Sandoz Pharmaceuticals; Hanover, NJ) administered to promote closure of a low-volume postoperative pancreatic fistula [3].
• Common complications in the octreotide group were pancreatic leak (18%), pancreatic fistula (13%), intra-abdominal abscess (7%), and arrhythmia or myocardial infarction (7%) [4].
• Both sepsis and GI bleeding significantly decreased mean survival (P < or = 0.05, ANOVA), but pneumonia, pancreatic fistula, or wound problems did not [5].

High impact information on Pancreatic Fistula

• METHODS: In conscious rats, plasma PYY was determined in response to oral ingestion of a 6-mL meal and intravenous infusion of PYY; small intestinal transit time was measured by phenol red as a nonabsorbable marker, and pancreatic secretory studies were performed in rats with pancreatic fistulas and jugular vein catheters [6].
• To characterize this relationship, we measured incremental responses of protein, bicarbonate, and PP to graded doses of intravenous secretin, caerulein, CCK8, CCK33, bethanechol, and intraduodenally perfused HCl, sodium oleate, and L-phenylalanine in dogs with gastric and pancreatic fistulas and compared them with average postprandial values [7].
• In dogs with gastric and pancreatic fistulas, 168 pmol kg-1 h-1 of CCK produced maximal pancreatic protein output and slightly stimulated gastric acid secretion [8].
• Each trial reported significant decreases in overall complication rates, and two of the four reported significantly lowered rates of pancreatic fistula in patients receiving prophylactic octreotide [9].
• Urethane anaesthetised rats with pancreatic fistulas pretreated with 3-0-methyl-glucopyranose (500 mg/kg/h) were stimulated with an intravenous bolus of 2-deoxyglucose (2-DG) (75 mg/kg) [10].

Chemical compound and disease context of Pancreatic Fistula

• The effect of graded doses of intravenously infused secretin and intestinally perfused sodium oleate and HCl on pancreatic exocrine secretion and plasma secretin was determined in cats and dogs prepared with pancreatic fistulas [11].
• 1. Pancreatic bicarbonate and protein secretion as well as immuno-reactive plasma secretin concentration in response to a meal, duodenal acidification and exogenous secretin or octapeptide of cholecystokinin (OP-CCK) have been measured following administration of methionine-enkephalin in chronic pancreatic fistula dogs [12].
• Endoscopic sealing of pancreatic fistula by using N-butyl-2-cyanoacrylate [13].
• We have studied this problem in fasted dogs with chronic pancreatic fistulas by means of a specific cholecystokinin antagonist, proglumide, to inhibit the effect of cholecystokinin [14].
• The effects of etorphine, a potent opiate agonist without preferential affinity for mu, delta or kappa receptors, on exocrine pancreatic secretion were studied in rats fitted with chronic or acute pancreatic fistulas and compared to those of methadone, a well-documented mu agonist [15].

Anatomical context of Pancreatic Fistula

• A patient with a pancreatic fistula, with a defunctionalized duodenum (subsequent to a previously performed Billroth II gastrectomy for cancer and choledochojejunostomy for metastatic infiltration in the bile duct) was submitted to prolonged synthetic somatostatin infusion (48 h) [16].
• This study, carried out on conscious rats with large gastric (GF) and pancreatic fistulas, confirms that diversion of pancreatic juice in rats with the GF closed results in the progressive stimulation of pancreatic secretion reaching the maximum similar to that induced by exogenous CCK [17].
• BACKGROUND: Optimal treatment strategies for patients with external pancreatic fistulas have evolved with improved radiographic imaging and the development of transpapillary pancreatic duct stents [18].
• Hydrochloric acid (0.1 N), pepton (5%) and olive oil were introduced into the small intestine of conscious chickens with chronic pancreatic fistula and caused the volume and protein output to increase slightly in about two-thirds of the chickens tested [19].

Gene context of Pancreatic Fistula

• Somatostatin and its analogs diminish pancreatic secretion of water and electrolytes and have been effective in treating pancreatic fistulas and pseudocysts [20].
• The incidence of clinical pancreatic fistula (two of 38 versus eight of 37; P < 0.05) and total pancreatic stump-related complications (five of 38 versus 12 of 37; P < 0.05) was lower in patients treated with S-14 [21].
• To investigate the possible exocrine pancreatic inhibitory actions of amino acids and fat, pancreatic fistula outputs and plasma concentrations of glucagon, somatostatin, and pancreatic polypeptide were measured for response to intravenous (IV) and intraduodenal nutrient administration in six dogs submaximally stimulated with cholecystokinin [22].
• We report our experience with eight patients with severe persistent pancreatitis associated with peripancreatic fluid collections requiring placement of drainage catheters who subsequently developed pancreatic fistula [23].
• Human pancreatic polypeptide (HPP) and its C-terminal hexapeptide (HP-PP) were infused intravenously in graded doses into healthy human subjects and dogs with chronic pancreatic fistula during submaximal stimulation with secretin [24].

Analytical, diagnostic and therapeutic context of Pancreatic Fistula

• Prospective, randomized trial of octreotide to prevent pancreatic fistula after pancreaticoduodenectomy for malignant disease [25].
• In five dogs with chronic pancreatic fistulas, plasma CCK concentrations and pancreatic protein secretion in response to an intestinal stimulant (intraduodenal oleate) and to two exogenous peptides (bombesin and CCK-33) were compared before and after bilateral truncal vagotomy [26].
• The pancreatic fistula rates were 9% in the control group and 11% in the octreotide group [9].
• The treatment includes (1) synchronous EUS-guided multiple transmural and/or transpapillary drainage procedures followed by balloon dilation of the cystogastrostoma or cystoduodenostoma, (2) daily endoscopic necrosectomy and saline solution lavage, and (3) sealing of pancreatic fistula by N-butyl-2-cyanoacrylate [27].
• The aim of this study was to determine the role of NO in the control of endocrine and exocrine pancreatic secretion in response to sham feeding (SF), ordinary meat feeding (F), duodenal perfusion with nutrients and i.v. infusion of gastrin releasing peptide (GRP) or urecholine in conscious dogs with chronic pancreatic fistulas [28].

References