Portal-endocrine and gastric-exocrine drainage technique in pancreatic transplantation

Pancreas transplant [PTx] is an established treatment for patients with diabetes mellitus. Diagnosis of rejection has continued to be problematic. In 2007, a new technique of PTx with portal-endocrine and gastric exocrine [P-G] drainage was first performed at our institution. This technique facilitates access to pancreas allograft. To report our experience with the first 30 patients who underwent PTx using P-G technique. The first 30 patients who underwent PTx between 2007 and 2009 were studied. In these patients, arterial and venous anastomosis was similar to standard portal-enteric [P-E] technique, though contrary to other techniques of enteric drainage, the end of allograft jejunum was anastomosed to the anterior aspect of the stomach. Donor and recipient demographic data, number of antigen matches and immunosuppressant were collected. All patients achieved euglycemia. 3 patients underwent pancreatectomy: 2 due to vessel thrombosis and 1 due to chronic rejection. 3 patients died-2 with functioning pancreatic and renal allografts. 7 patients with CMV and 4 patients with rejection were diagnosed with endoscopy of allograft duodenum and treated. 1-year patient and graft survival was 94% and 85%, respectively. This novel technique of PTx has proven to be safe with good patient and allograft survival. Access to donor duodenum and pancreas allograft via endoscopy is unique to this technique and provides the added advantage of life-long easy access to allograft

Isolation and identification of Malassezia spp. in pytiriasis versicolor in Kashan, Iran

Pityriasis versicolor [PV] is a chronic superficial fungal disease caused by Malassezia spp. The incidence is as high as 30-40% in tropical climates. Epidemiological data suggest geographical variations in the rate of the isolated species from PV. Our aim was to identify Malassezia spp. from PV patients in Kashan, Iran. Isolates of Malassezia were collected from 118 PV patients [75 males and 43 females]. A direct microscopy with KOH and methylene blue was carried out. Cultures were made in modified Dixon agar medium and the isolates were identified by macroscopic and microscopic features, physiological characteristics [catalase test] and biochemical criteria [esculin and lipid assimilation tests]. Data were analyzed statistically by software SPSS [version 11] and Fischer's exact and descriptive statistical tests. The average age of 118 patients in this study was 28.42 +/- 8.53 years. The percentages of patients in this study were 64.4 and 35.6 for men and women respectively. Hyperhydrosis was reported as the most important finding with 58.1%. Back [42.2%] and extremities [7.4%] were the highest and the lowest involved parts respectively. The isolates found were M. globosa [43.8%], Malassezia furfur [38.4%], M. obtusa [9.8%], M. sympodialis [6.3%], and M. slooffiae [1.7%]. From these findings it was suggested that M. globosa presents the main species implicated in the pathogenicity of PV and M. furfur as the second agent of importance