The politics of health in Europe

Somatostatin is a tetradecapeptide with potent inhibitory actions on several endocrine systems; it blocks the release of growth hormone, follicle stimulating hormone and thyrotropin from the pituitary gland (Krulich et al., 1968; Brazeau et al., 1973; Hall et al., 1978; Reichlin, 1983) and several peptide hormones from the endocrine gut and pancreas (Cohen et al., 1978; Gerich, 1981). It also affects exocrine and other functions of the gut, i.e. inhibits motility and absorption and decreases gut blood flow (cf. Arnold & Lankisch, 1980). Somatostatin also inhibits flushing in the carcinoid syndrome by reducing peripheral serotonin (5-HT) levels (Frolich et al., 1978). Recently synthetic somatostatin analogues have become available. Such compounds have been used both chronically and acutely to relieve symptoms caused by excessive secretion of tumour products (biogenic amines, peptide hormones) from carcinoid lesions of the gastrointestinal tract (cf. Bloom & Greenwood, 1985; Kvols et al., 1985). Such analogues may act at several levels, i.e. impaired release of tumour products, interaction with released peptides, blockade or desensitation of tumour receptors. With clinical experience of one somatostatin analogue (SMS 201-995) in the chronic management of patients with carcinoid tumours (Ahlman & Tisell, 1987) we evaluated the usefulness of this drug in combination with peripheral blockade of 5-HT2-receptors in a patient who had reacted with a carcinoid crisis (flushing and profound hypotension) at a previous attempt at anaesthesia.