The role of octreotide in preventing complications after pancreatoduodenectomy for cancer

Background Although the mortality rate of pancreatoduodenectomy has fallen sharply over the last two decades, there is still a risk of serious complications resulting from leakage at the site of anastomosis between the pancreatic remnant and the gastrointestinal tract. Numerous techniques have been described to minimise the risk of these anastomotic leaks, but they can be difficult to avoid if the distal pancreas is unobstructed with a soft parenchyma and a non-dilated duct. The risk of leakage is largely dependent upon the presence of activated pancreatic enzymes, and this fact provides a rationale for the perioperative use of the somatostatin analogue octreotide to inhibit exocrine pancreatic secretion. Discussion Six prospective randomised controlled trials have been published on the use of prophylactic octreotide in pancreatic surgery, five from Europe and one from the USA. The five (multicentre) European studies have consistently shown that octreotide reduces the postoperative complication rate, but the American study does not confirm this benefit. Methodological differences may explain the discrepancy, notably the fact that most of the US patients had received preoperative chemoradiation which is likely to have reduced enzyme secretion. A meta-analysis of four of these studies showed that octreotide lowered the rate of postoperative complications from 37 to 21%, chiefly by reducing the risk of pancreatic fistula. Prophylactic octreotide therapy is cost effective and should be used at least in patients with normal pancreatic parenchyma

Head injury triage in a sub Saharan African urban population

AbstractBackgroundInjuries are the ninth leading cause of death in the world and disproportionately affect low- and middle-income countries. Head injury is the leading cause of trauma death. This study examines the epidemiology and outcomes of traumatic head injury presenting to a tertiary hospital in Malawi, in order to determine effective triage in a resource limited setting.MethodsThe study was conducted at Kamuzu Central Hospital (KCH) in Lilongwe Malawi during a three-month period. Vital signs and Glasgow Coma Score (GCS) were prospectively collected for all patients that presented to the casualty department secondary to head injury. All head injury admissions were followed until death or discharge.ResultsDuring the three-month study period, 4411 patients presented to KCH secondary to trauma and 841 (19%) had a head injury. A multivariate logistic regression model revealed that GCS and heart rate changes correlated strongly with mortality. There is a four-fold increase in the odds of mortality in moderate versus mild head injury based on GCS.ConclusionIn a resource limited setting, basic trauma tools such as GCS and heart rate can effectively triage head injury patients, who comprise the most critically ill trauma patients. Improvements in head injury outcome require multifaceted efforts including the development of a trauma system to improve pre-hospital care

Clinical Highlights in the Treatment of Pancreatic Diseases

Despite advances in the treatment of pancreatic diseases, they remain clinical challenges. In this review article, the author summarized the key abstracts presented at 9th Congress of the European Hepato-Pancreato-Biliary Association, held in Cape Town, South Africa, from April 12th to 16th, 2011. These studies include the endoscopy, surgery, complications, and other clinical points of the pancreatic treatment

Pancreatic endocrine tumors

Pancreatic endocrine tumours are rare tumours, and arise from the types of pancreatic cells that produce hormones. These tumours may or may not secrete hormones themselves and may or may not be cancerous (malignant). Functioning tumours secrete a particular hormones which may cause various syndromes. The present article reviews the latest reports on the pancreatic endocrine tumour

Chronic pancreatitis

The abstract is available at the Clinical pancreatic disorder I: Acute pancreatitis. North Am J Med Sci 2011; 3: 316-319. doi: 10.4297/najms.2011.331

Pancreatic cancer: chemotherapy and radiotherapy

Pancreatic cancer in many cases appears in a non-curatively resectable stage when the diagnosis is made. Palliative treatment become an option in the patients with advanced stage. The present article reviewed chemotherapy and radiotherapy in various advanced stage of pancreatic cancer

Tumors of the body and tail of the pancreas

The abstract is available at the Clinical pancreatic disorder I: Acute pancreatitis. North Am J Med Sci 2011; 3: 316-319. doi: 10.4297/najms.2011.331

Non-pancreatic cancer tumors in the pancreatic region

Most of tumors found in the pancreas are adenocarcinoma of the pancreas. A small number of tumors in the pancreas, such as islet cell tumors or neuroendocrine tumors, papillary cystic neoplasms, lymphoma, acinar cell tumors, metastatic tumors to the pancreas often, have a far better prognosis, and the majority of these tumors are non-malignant or benign. The author reviewed the recent literatures, and summarized where the tumor comes originally in the pancreas, what is the type of the tumor, and how to treat the tumor

Organization of Care for Pancreatic Cancer

The abstract is available at the Clinical pancreatic disorder I: Acute pancreatitis. North Am J Med Sci 2011; 3: 316-319. doi: 10.4297/najms.2011.331