Objective: We conducted a retrospective study to evaluate the use of total parenteral nutrition (TPN) and octreotide (OC), in comparison to standard treatment for the management of external digestive tract fistulas (EDTF) at a major tertiary referral University Hospital.Patients: We analyzed the clinical course of 112 patients with EDTF treated from 1978 to 2001. Thirty-nine patients admitted during the period 1978-1990 (group A) and 73 patients admitted during the period 1991-2001 (group B) were studied. Group A received standard supportive treatment while group B received standard supportive treatment in combination with TPN and OC. The main outcome measures were the duration of hospitalization, the fistula spontaneous closure time, the mortality rate and complications of treatment.Results: A dramatic reduction (81 +/- 4.5%) in fistula output was observed within 48 hours after administration of TPN and OC in group B compared to group A (p < 0.05). The incidence of spontaneous fistula closure was increased from 64% in group A to 81% in group B (p < 0.05) and the mean fistula closure time decreased from 38 +/- 2.7 in group A to 17 +/- 1.8 days in group B (p < 0.05). Complications occurred in 61.5% of group A patients and in 45% of patient group B respectively (p< 0.05). The direct fistula related mortality was 7.5% and 2% respectively (p < 0.05).Conclusions: The introduction of TPN and OC in EDTF ameliorated in a statistically significant way all the parameters of EDTF healing that were studied. Although fistula related direct mortality was decreased, further studies with well-designed comparative prospective trials are needed.This abstract was accepted and was be presented as a poster at Digestive Disease Week, Chicago, IL, May 14-19, 2005

Although swallowing difficulties have been described in patients with Kearns-Sayre syndrome (KSS), the spectrum of manometric characteristics of dysphagia is not yet well known. Moreover, it is conceivable that a combination of various degrees of swallowing difficulties with different patterns in manometric studies exist, each playing a major role in the prognosis, natural history, and quality of life of KSS patients. An 18-year-old girl diagnosed at the age of 5 years with KSS (muscle biopsy) was admitted to our department with an upper respiratory tract infection and dysphagia. Clinical examination revealed growth retardation, external ophthalmoplegia, pigmentary retinopathy, impaired hearing, and ataxia. An electrocardiogram revealed cardiac conduction defects (long Q-T), and brain magnetic resonance imaging showed abnormalities in the cerebellar hemispheres. A manometric and motility study for dysphagia was conducted and the pharynx and upper esophageal sphincter (UES) resting pressures were similar to control group values, but the swallowing peak contraction pressure of the pharynx and the closing pressure of the UES were very low and could not promote effective peristaltic waves. Relaxation and coordination of the UES were not affected although pharyngeal and upper esophagus peristaltic waves proved to be very low and, consequently, were practically ineffective. The patient was started on treatment comprising a diet rich in potassium, magnesium, and calcium, and oral administration of vitamin D and co-enzyme Q10 100 mg daily; she was discharged 6 days later with apparent clinical improvement.

BACKGROUNDSmall intestinal canine submucosa has been used in previous studies as a large diameter arterial graft and has shown acceptable patency rates. The aim of our experimental study was to assess its effectiveness when it is used as an autogenous medium-sized diameter arterial graft (5-7 mm).METHODSFifteen mongrel dogs were included and underwent laparotomy under general anaesthesia. The mucosa, tunica muscularis and serosa were removed from a resected intestinal segment. The remaining tube, which consisted of the submucosa and the basilar tunica mucosa, represented the experimental graft which was used to replace a proportional gap of the canine infrarenal aorta. Ascertainment of peripheral pulses, measurement of the intra-aortic pressures, aortography and in vivo/in situ observation before the sacrifice of the animals, were the procedures used for verification of the graft's patency.RESULTSThe resistance to thrombogenicity of the graft was considered satisfactory: nine out of 10 grafts remained patent for postoperative intervals ranging from one day to one year; one graft showed partial obstruction due to a technical perioperative error. The grafts showed also excellent physical characteristics (ease of handling and suturing, blood impermeability and durability), resistance to infection and showed no tendency to develop myointimal hyperplasia.CONCLUSIONSSmall intestinal canine submucosa showed satisfactory haemodynamic properties, long-term patency and resistance to infection, when used as a medium-diameter arterial substitute.