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  • 1
    Electronic Resource
    Electronic Resource
    Basal and nutrient-stimulated pancreatic and gastrointestinal hormone concentrations in type-l-diabetic patients after successful combined pancreas and kidney transplantation (1992)
    Springer
    Journal of molecular medicine 70 (1992), S. 40-48 
    Details
    ISSN: 1432-1440
    Keywords: Pancreas transplantation ; Insulin secretion ; Pancreatic hormones ; Gastrointestinal peptide hormones ; Rènal elimination (clearance) ; Systemic venous pancreas drainage
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The secretion of pancreatic and gastrointestinal hormones in the basal state and after nutrient stimuli (50 g glucose, 50 g protein, or 30 g triglyceride administered on separate occasions) was assessed in ten previously type-1-diabetic patients after successful combined kidney and pancreas transplantation (systemic venous drainage). Fasting values were compared to matched non-diabetic kidney-transplanted patients and related to kidney function (endogenous creatinine clearance) and to the type and dosage of immunosuppressive medication. In the fasting state, only IR insulin concentrations were higher in pancreas-kidney-transplanted patients (by 88%; P=0.001) than in the kidney graft recipients. There were significant inverse correlations of plasma C-peptide, GIP, and gastrin immunoreactivity to endogenous creatinine clearance (kidney function). In response to nutrients, insulin secretion (IR insulin, C-peptide) was significantly stimulated by glucose, and — to a lesser degree — also by protein. Pancreatic glucagon was suppressed by glucose and stimulated by protein ingestion. GIP was raised after glucose and triglyceride more than after protein (P=0.0003). GLP-1 immunoreactivity was stimulated by all nutrients, with a tendency towards higher responses to protein and fat (P=0.06). Gastrin was mainly raised by protein. In conclusion, the overall pattern of pancreatic and gastrointestinal hormone release is normal in patients after combined pancreas-kidney-transplantation, but there are some peculiarities due to (a) systemic venous drainage of the pancreas graft (elevated fasting IR insulin) and (b) impaired kidney function (negative correlation of fasting plasma values to endogenous creatinine clearance for C-peptide, GIP, and gastrin). The plasma levels of these important regulatory peptides and their responses to nutrient stimulation are compatible with and may contribute to the well-preserved endocrine function of the pancreatic grafts (normal or slightly impaired glucose tolerance, preserved incretin effect).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00422937
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  • 2
    Electronic Resource
    Electronic Resource
    The bladder drainage technique in pancreas transplantation — the Tübingen experience (1991)
    Springer
    Diabetologia 34 (1991), S. S24 
    Details
    ISSN: 1432-0428
    Keywords: Pancreas transplantation ; Bladder drainage technique ; Immunosuppression ; Complications ; Graft function rate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Starting in 1987 renal- and pancreaticoduodenal — transplantations were performed simultaneously in a consecutive series of 40 patients with Type 1 diabetes mellitus and end-stage renal disease. Exocrine secretion of the pancreatic graft does not seem to be a crucial problem anymore when using the bladder drainage technique. No pancreatic fistulae were seen. No graft lost its function due to early post-operative graft thrombosis. Early post-operative graft pancreatitis and recurrent urinary tract infections remain the drawbacks of the bladder drainage technique. Despite a strong immunestimulation of the recipient by the combined pancreaticoduodenal/ renal allograft all but two rejection episodes could be reversed by using different monoclonal/ polyclonal antibodies. Actuarial 1-year-graft survival rate reaches 85 % for the pancreas as well as the kidney. Thus, simultaneous pancreas-kidney transplantation can be performed with a high success rate when using the technique described.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00587614
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  • 3
    Electronic Resource
    Electronic Resource
    Consequences of systemic venous drainage and denervation of heterotopic pancreatic transplants for insulin/C-peptide profiles in the basal state and after oral glucose (1991)
    Springer
    Diabetologia 34 (1991), S. S81 
    Details
    ISSN: 1432-0428
    Keywords: Pancreas transplantation ; Insulin secretion ; C-peptide ; Systemic venous drainage ; Insulin metabolic clearance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Plasma glucose, immunoreactive insulin and C-peptide concentrations were compared in nine pancreas-kidney-transplanted patients (systemic venous drainage) and in ten non-diabetic kidney-transplanted patients with similar kidney function. In the basal state, C-peptide (insulin secretion) was similar, but immunoreactive insulin was higher and glucose concentrations were slightly, but significantly lower in pancreas-transplanted patients. After 50 g oral glucose, the plasma glucose and IR-insulin profiles were similar in both groups. The circumvention of first-pass hepatic insulin extraction (decreased endogenous insulin clearance) was compensated for by a significant reduction in insulin secretion (C-peptide; p=0.036). In conclusion, hyperinsulinaemia in pancreas-transplanted patients with systemic venous drainage is significant only in the basal state. Insulin delivered into the portal and peripheral circulation, when leading to similar insulin profiles, maintains comparable degrees of glucose tolerance.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00587626
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  • 4
    Electronic Resource
    Electronic Resource
    Determinants of a normal (versus impaired) oral glucose tolerance after combined pancreas-kidney transplantation in IDDM patients (1996)
    Springer
    Diabetologia 39 (1996), S. 462-468 
    Details
    ISSN: 1432-0428
    Keywords: Pancreas transplantation ; insulin secretion ; pancreatic hormones ; oral glucose tolerance ; glucagon stimulation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary After successful pancreas transplantation, insulin-dependent diabetic patients are characterized by a normal or at worst impaired oral glucose tolerance (World Health Organisation criteria). It is not known which pathophysiological mechanisms cause the difference between normal and impaired oral glucose tolerance. Therefore, we studied 41 patients after successful combined pancreas-kidney transplantation using stimulation in the fasting state with oral glucose (75 g), intravenous glucose (0.33 g/kg) and glucagon bolus injection (1 mg i.v.). Glucose (glucose oxidase), insulin and C-peptide (immunoassay) were measured. Repeated-measures analysis of variance and multiple regression analysis were used to analyse the results which showed: 28 patients had a normal, and 13 patients had an impaired oral glucose tolerance. Impaired oral glucose tolerance was associated with a greatly reduced early phase insulin secretory response (insulin p〈0.0001; C-peptide p=0.037). Age (p=0.65), body mass index (p=0.94), immunosuppressive therapy (cyclosporin A p=0.84; predniso(lo)ne p=0.91; azathioprine p=0.60) and additional clinical parameters were not different. Reduced insulin secretory responses in patients with impaired oral glucose tolerance were also found with intravenous glucose or glucagon stimulations. Exocrine secretion (α-amylase in 24-h urine collections) also demonstrated reduced pancreatic function in these patients (−46%; p=0.04). Multiple regression analysis showed a significant correlation of 120-min glucose with ischaemia time (p=0.003) and the number of HLA-DR mismatches (p=0.026), but not with HLA-AB-mismatches (p=0.084). In conclusion, the pathophysiological basis of impaired oral glucose tolerance after pancreas transplantation is a reduced insulin secretory capacity. Transplant damage is most likely caused by perioperative influences (ischaemia) and by the extent of rejection damage related, for example, to DR-mismatches.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00400678
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    Experimental laparoscopic cholecystotomy (1991)
    Springer
    Surgical endoscopy and other interventional techniques 5 (1991), S. 51-56 
    Details
    ISSN: 1432-2218
    Keywords: Cholelithiasis ; Cholecystotomy ; Interventional technique ; Minimally invasive surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary This instrument set for a single puncture technique of laparoscopic cholecystotomy was developed in 100 phantom tests with pig gallbladders and was later evaluated in 12 animal experiments. No complications were observed. After clinical development, treatment on an outpatient basis under local anaesthesia seems possible. For the patient this would mean avoiding general anaesthesia, shorter hospitalization, pain reduction and good cosmetic results, while reducing expenditure for the public health authorities at the same time. To avoid recurrent stones, diet and low-dose drug therapy should be considered. Because the procedure is minimally invasive, repetition of the laparoscopic procedure seems justified if stones recur.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00316835
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  • 6
    Electronic Resource
    Electronic Resource
    Die laparoskopische cholezystotomie: Neubewertung einer operationsmethode im licht endoskopischer techniken (1991)
    Springer
    Langenbeck's archives of surgery 376 (1991), S. 302-307 
    Details
    ISSN: 1435-2451
    Keywords: Cholecystotomy ; Minimally invasive surgery ; Laparoscopy ; Interventional technique
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Als Ergänzung von konservativen und interventionellen Verfahren zur Entfernung von Gallensteinen unter Erhaltung einer funktionsfähigen Gallenblase wurde die laparoskopische Cholezystotomie von einem Zugang aus entwickelt. Dazu wurden 120 Phantomversuche an Schweinegallenblasen durchgeführt. In 20 Tierexperimenten mit Schweinen wurden keine wesentlichen Komplikationen beobachtet. Als Vorteile des Verfahrens im Vergleich zu einigen konkurrierenden Methoden sind sofortige Steinfreiheit, Entfernung auch kalkhaltiger Steine and definitiver Verschluß der Gallenblase zu nennen. Ein ambulanter Eingriff in Lokalanäs-thesie erscheint nach Einführung in die Kliniksroutine möglich. Die wesentliche Indikation dürften Patienten mit hohem Operationsrisiko darstellen. Die Cholezystotomie ist als Alternative zur perkutanen Litholyse und zur ESWL anzusehen.
    Notes: Summary The laparoscopic cholecystotomy was developed to remove calculi while preserving a functioning gallbladder. 120 phantom tests on pig's gallbladders were performed. No major complications were observed in 20 animal experiments with pigs. Compared with competing conservative and interventional methods the laparoscopic cholecystotomy provides immediate removal of stones and a definite closure of the gallbladder by a clip. Calcified stones are no contraindication for the procedure. After introduction into the clinical routine, an outpatient treatment in local anaesthesia seems to be possible. Patients with a high operative risk should be treated by this method. The laparoscopic cholecystotomy represents an alternative to the percutaneous transhepatic litholysis and the ESWL.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00188272
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    Paper (German National Licenses)
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