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  • 1
    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: 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. [Diabetologia (1996) 39: 462–468]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00400678
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  • 2
    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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  • 3
    Electronic Resource
    Electronic Resource
    The anterolateral intertubercular approach to the shoulder with osteotomy of the lesser tubercle of the humerus (1999)
    Springer
    European journal of orthopaedic surgery & traumatology 9 (1999), S. 35-39 
    Details
    ISSN: 1432-1068
    Keywords: Shoulder ; Approach ; Épaule ; Voie d’abord
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Les auteurs proposent une voie d’abord d’épaule originale qui permet d’accéder directement á cette articulation. Grâce à cette voie, peuvent être traitées les fractures complexes de l’extrémité proximale de l’humérus par ostéosynthése ou par prothése, les omarthroses excentrées ou non par prothése. Deux moyens techniques sont employés, tout d’abord la création d’un digastrique trapézo-deltoïdien antérieur et, en cas de chirurgie prothétique réglée, l’ostéotomie du trochin pour ouvrir l’articulation et accéder directement à la tête humérale ainsi qu’à la glène. Le patient est installé en position demi-assise, le moignon de l’épaule dépasse largement de la table opératoire. L’incision est antéro-externe dans le sens des fibres du deltoïde, elle mesure 8 à 10 cm à l’aplomb de l’angle antéro-externe de l’acromion (AAEA) qui constitue un repré chirurgical facile. Un tiers de l’incision est proximal, les deux tiers restants sont distaux. Le digastrique trapézo-deltoïdien est créé: le deltoïde est divisé dans le sens des fibres entre le faisceau antérieur et moyen et cela à cheval sur l’AAEA. Le périoste acromial est incisé verticalement, l’incision est prolongée vers le haut sur le trapèze. Le digastrique ainsi créé est récliné vers l’avant emportant le ligament acromio-coracoïdien. Une acromioplastie peut être effectuée. Cet abord permet à lui seul l’accès à l’extrémité supérieure de l’humérus dans les fractures complexes et permet l’ostéosynthèse le cas échéant. En cas de chirurgie prothétique réglée et si la coiffe des rotateurs est intacte, l’abord complet de l’articulation est réalisé par l’ostéotomie du trochin (petite tubérosité) dans un plan parallèle à la palette humérale. Cela permet d’emporter avec le fragment de trochin le muscle sous-scapulaire et d’ouvrir l’articulation. La mise en rétropulsion du coude et la rotation externe font apparaître la tête humérale qui est ostéotomisée et, de cette manière, l’accès à la glène est immédiat. Les différents temps de chirurgie prothétique peuvent être rêalisés. La fermeture se fait le plus simplement par rénsertion du trochin au fil non résorbable de gros diamètre en trans-osseux. Le digastrique trapézo-deltoïdien est fermé par des points séparés sans tension.
    Notes: Summary The authors propose an original route of approach to the shoulder that allows direct access to this articulation. Thanks to this route, complex fractures of the proximal end of the humerus can be treated by ostosynthesis or prosthesis, and shoulder arthroses, whether centered or not by prosthesis. Two technical methods are used: first, the creation of an anterior digastric trapezio-deltoid muscle flap, and then, in cases of elective prosthetic surgery, osteotomy of the lesser tubercle to open the articulation and provide direct access to the humeral head and the glenoid. The patient is installed in the semiseated position, with the apex of the shoulder projecting widely from the operating table. The incision is anterolateral, in the direction of the fibers of the deltoid and measures 8–10 cm from the anterolateral angle of the acromion (ALAA), which constitutes a convenient surgical landmark. One third of the incision is proximal; the other two-thirds are distal. The trapezio-deltoid digastric muscle flap is created: the deltoid is divided in the direction of its fibers between the anterior and middle bundles, straddling the ALAA. The acromial periosteum is incised vertically. The incision is extended upwards into the trapezius. The digastric muscle flap thus created is reflected forward together with the coracoacromial ligament. An acromioplasty can be performed. This approach by itself allows access to the upper end of the humerus in complex fractures and allows osteosynthesis if called for. In cases of elective prosthetic surgery, and if the rotator cuff is intact, complete access to the articulation is obtained by osteotomy of the lesser tubercle in a plane parallel to its humeral base. This allows reflection of the subscapularis muscle with the tubercular fragment and opening of the articulation. Retropulsion of the elbow and lateral rotation displays the humeral head, which is osteotomized, and in this way access to the glenoid is immediate. The different stages of prosthetic surgery can then be performed. Closure is made most simply by reattachment of the lesser tubercle with a stout transosseous suture. The trapezio-deltoid digastric flap is closed by interrupted sutures without tension.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02427770
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  • 4
    Electronic Resource
    Electronic Resource
    Eurocer® in the filling of bone defects, especially in addition osteotomies of the knee: a preliminary study (1999)
    Springer
    European journal of orthopaedic surgery & traumatology 9 (1999), S. 175-177 
    Details
    ISSN: 1432-1068
    Keywords: Eurocer® ; Bone defects ; Oteotomies ; Knee ; Substituts osseux ; Genou ; Ostéotomies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé L'Eurocer®, à un an, paraît tout-à-fait correspondre à ce que l'on peut souhaiter dans le cas des ostéotomies d'addition de la TTA et son usage est poursuivi dans le service. Nous avons utilisé l'Eurocer, dans d'autres applications : une ostéotomie d'addition fémorale inférieure de varisation, des comblements de perte de substance osseuse traumatique (10 fois), un comblement de perte de substance osseuse tumorale (1 fois), des reprises de prothèse totale de hanche descellée, aseptiques (3 fois), septique (1 fois) et des pseudarthroses de jambe (fig. 2 et fig. 3), etc... Il n'y a plus strictement aucun problème dans l'utilisation de ce biomatériel, aucune image de séquestration n'est apparue dans notre expérience et aucun signe de mauvaise tolérance. A chaque fois, l'étude radiologique attentive depuis environ un an fait apparaître des zones nettes de jonction entre Pos environnant et l'Eurocer,. Il n'y a aucune image de liseré et il semble, sous toutes réserves, qu'une disparition progressive de cet Eurocer, au plan radiographique est en train de se réaliser. La figure 1 montre un Eurocer, à six mois après mise en place au niveau d'un tibia et cette radiographie montre tout à fait l'absence de séquestration du produit ainsi que la lyse progressive et l'émoussement des fragments d'Eurocer, sur leurs contours. Il apparaît donc qu'il s'agit d'une expérience variée et multiple. Aucun élément aujourd'hui ne nous permet de douter de l'intérêt de l'usage de ce produit.
    Notes: Summary After one year, Eurocer® appears to satisfy all requirements in the case of addition osteotomies of the anterior tibial crest (ATT) and its use continues in the department. We have used Eurocer® in other applications: an addition varisation osteotomy of the lower end of the femur, the packing of traumatic losses of bone substance (10 cases), packing for bone defects of tumoral origin (1 case), revisions for loosened total hip prostheses (3 aseptic cases, 1 septic case) and for pseudarthroses of the tibia (Figs. a and 3), etc. Strictly speaking, there is no longer a problem in the use of this biomaterial; no image of sequestration has appeared in our series and no evidence of poor tolerance. In each case careful radiologic study for about one year has shown sharp lines of junction between the surrounding bone and the Eurocer®. There was no image of a demarcating sclerotic marg-in and it seems, subject to reservations, that progressive disappearance of the Eurocer® is in process of taking place. Fig. 1 shows the Eurocer® six months after insertion in a tibia and- this radiograph shows complete absence of sequestration of the product, as well the progressive lysis and smoothing-off of the contours of the Eurocer® fragments. Thus it seems that the findings are varied and multiple. Currently, no factor suggests any doubt as to the value of the use of this product.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00542587
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  • 5
    Electronic Resource
    Electronic Resource
    Distal femoral fractures following total knee replacement: A series of 37 cases (2000)
    Springer
    European journal of orthopaedic surgery & traumatology 10 (2000), S. 249-256 
    Details
    ISSN: 1432-1068
    Keywords: Knee arthroplasty ; Distal femoral fracture
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Distal femoral fractures following knee arthroplasty are uncommon. The reported frequency ranges from 0.3 to 2.5%. Treatment of such fractures remains controversial. Both operative and nonoperative methods have been proposed Conservative treatment (used for undisplaced fractures) is very demanding for patient and surgeon. Open reduction and fixation is often preferred in displaced and unstable fractures but complications are not rare and may be very severe. Good clinical results have been recently reported with intramedullary nailing in both anterograde and retrograde manner. Revision arthroplasty is also a possible treatment if there is component loosening. The purpose of this study is to report our experience with the management of distal femoral fractures after knee arthroplasty in 37 cases. We stress the difficulty of treating these fractures and the poor results obtained in terms of knee function.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01682138
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  • 6
    Electronic Resource
    Electronic Resource
    Impairment of pancreatic microcirculation in the early reperfusion period during simultaneous pancreas-kidney transplantation (1998)
    Springer
    Transplant international 11 (1998), S. S433 
    Details
    ISSN: 1432-2277
    Keywords: Key words Pancreas transplantation ; Microcirculation ; Graft pancreatitis ; Oxymetry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The most likely cause of graft pancreatitis is the ischemia/reperfusion injury which can be a major problem in simultaneous pancreas-kidney transplantation. Animal experiments suggest the important role in this process of an impaired microcirculation after reperfusion. We have investigated pancreatic microcirculation in the early reperfusion period during clinical pancreas-kidney transplantation. Tissue P O2 (P O2ti) was monitored by a P O2-sensitive electrode. After reperfusion (a. r.) samples were taken from the venous effluent of the pancreas and simultaneously from the radial artery. After an initial peak a transient fall of P O2 was found. Total blood flow and hemoglobin oxygen saturation (sHbO2) in the venous effluent increased until 90 min a. r. (107 ml/min, 97.1 %) High venous sHbO2 and high P O2ti correlated with good graft outcome. These findings can be explained by an impairment of capillary perfusion (no reflow) and concomitant shunt perfusion. The data suggest the considerable relevance of pancreatic microcirculation in the early reperfusion period during clinical pancreas transplantation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001470050515
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  • 7
    Electronic Resource
    Electronic Resource
    Critical islet mass for successful porcine islet autotrasplantation (1999)
    Springer
    Journal of molecular medicine 77 (1999), S. 126-129 
    Details
    ISSN: 1432-1440
    Keywords: Key words Pancreatectomy ; Porcine islets ; Autotransplantation ; Glucose tolerance test
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A major reason for the failure of clinical islet transplantations may be a limited islet mass. The aim of this study was to determine the critical islet mass necessary for normalization of glucose metabolism in a porcine model. Diabetes was induced by total pancreatectomy. The splenic lobe of the pancreas was intraductally distended with UW-solution containing 2.67–3.33 mg/ml collagenase, and the distended pancreas was digested in a continuous digestion filtration device. The islets were purified on a isoosmotic Ficoll-sodium-diatrizoate gradient. The survival period of the diabetic recipients in group 2 and 3 receiving, respectively, a low (2.14±0.39 µL/kg body weight) and a high (4.99±0.83 µL/kg body weight) islet mass was significantly prolonged compared to that of diabetic recipients in group 1 receiving no islet transplantation. However, the survival period of the recipients in group 2 was not significantly different to that in group 3. Three recipients of an islet mass of 〉5 µl/kg body weight became normoglycemic (fasting blood glucose 〈100 mg/dl) for more than two months. Furthermore, the glucose and insulin release reactions to the glucose challenge were comparable to that before pancreatectomy. Contrarily, another five diabetic recipients of an islet mass of 〈4 µL/kg body weight became a fasting blood glucose level of 〈200 mg/dl. The glucose and insulin release reactions to the glucose challenge were improved only, but not normalized compared to that before pancreatectomy. The data presented in this study demonstrate that metabolic normalization in pancreatectomized diabetic minipigs can be established by autotransplantation of an islet mass of 〉5 µl/kg body weight.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001090050319
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