A Multicenter, Randomized, Controlled Trial to Evaluate the Effect of Prophylactic Octreotide on ERCP-Induced Pancreatitis

Eight-four patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) were randomized to receive 100 micrograms of octreotide intravenously immediately prior to ERCP, and 100 micrograms subcutaneously 45 min after the initial dose, or placebo. Amylase, lipase, and glucose were measured and clinical assessment was performed before, and 2 and 24 h after, ERCP. We define clinical pancreatitis as the combination of elevated amylase or lipase with abdominal pain and tenderness. Interim analysis in 84 patients revealed an 11% incidence of clinical pancreatitis in the control group and 35% in the treatment group (p < 0.01). There were no differences in either group with respect to sphincterotomy, gender, age, duration of ERCP, number of cannulations of the pancreatic duct, degree of duct injection, or the volume of contrast injected. Analysis of group differences stratified by sphincterotomy revealed the following: 1) In patients who did not undergo a sphincterotomy, there was a significantly higher rate of pancreatitis in the treatment group [10/17 (59%) versus 1/17 (6%) RR 10.0 (95% CI 1.4-69.8)]. 2) Sphincterotomy reduced the rate of pancreatitis in patients who received octreotide from 10/17 (59% no sphincterotomy), to 3/20 (15% sphincterotomy) (p = 0.01), which equals the rate in patients who received placebo and underwent sphincterotomy [4/25 (16%)]. 3) Although the incidence of pancreatitis was higher in the treatment group, octreotide may reduce the severity of pancreatitis measured by the number of days NPO (Wilcoxon rank sum, p = 0.02), length of stay after ERCP (p = 0.13), the number of days of pain (p = 0.11), and the degree of amylase elevation (p = 0.04). We conclude that: 1) Octreotide appears to increase the incidence of pancreatitis when given prophylactically for diagnostic ERCP. 2) Although pancreatitis was more common in the octreotide group, it was less severe than the placebo group. 3) Sphincterotomy may afford protection against pancreatitis in patients who received octreotide. 4) We cannot recommend the use of prophylactic octreotide during diagnostic or therapeutic ERCP.     

Association of achalasia and pulmonary Mycobacterium fortuitum infection

A case of achalasia complicated by Mycobacterium fortuitum pulmonary infection and empyema is reported. This association has been documented in the medical literature. Possible mechanisms explaining this association are discussed.     

Chronic beryllium disease: diagnosis, radiographic findings, and correlation with pulmonary function tests

Patients with suspected chronic beryllium disease underwent bronchoscopy and bronchoalveolar lavage. Their bronchoalveolar lymphocytes were incubated with beryllium salts, and quantitative lymphocyte transformation was measured. Seventeen patients with a positive lymphocyte proliferation test were evaluated radiographically with the International Labour Office classification. The most common radiographic abnormalities included diffuse small round and reticular opacities. Hilar adenopathy, linear scars, lung distortion, bullae, and pleural thickening were found less commonly. Specific radiographic findings were compared with pulmonary function abnormalities. The extent of radiographic profusion of small opacities and the presence of linear scars did not correlate with pulmonary function abnormalities. There was, however, a significant correlation between extensive pleural disease and reduced vital capacity in this small group of patients.     

Chronic beryllium disease.

Chronic beryllium disease is a multisystem granulomatous disease caused by industrial exposure to beryllium dust or fumes. It is thought to represent a hypersensitivity disorder rather than a true pneumoconiosis. The lung is the primary organ of involvement, and many of the radiographic features resemble sarcoid.