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1.
Vision Res ; 176: 130-140, 2020 11.
Article in English | MEDLINE | ID: mdl-32882595

ABSTRACT

Eye movements are a functional signature of how the visual system effectively decodes and adapts to the environment. However, scientific knowledge in eye movements mostly arises from studies conducted in laboratories, with well-controlled stimuli presented in constrained unnatural settings. Only a few studies have attempted to directly compare and assess whether eye movement data acquired in the real world generalize with those in laboratory settings, with same visual inputs. However, none of these studies controlled for both the auditory signals typical of real-world settings and the top-down task effects across conditions, leaving this question unresolved. To minimize this inherent gap across conditions, we compared the eye movements recorded from observers during ecological spatial navigation in the wild (the Walkers) with those recorded in laboratory (the Watchers) on the same visual and auditory inputs, with both groups performing the very same active cognitive task. We derived robust data-driven statistical saliency and motion maps. The Walkers and Watchers differed in terms of eye movement characteristics: fixation number and duration, saccade amplitude. The Watchers relied significantly more on saliency and motion than the Walkers. Interestingly, both groups exhibited similar fixation patterns towards social agents and objects. Altogether, our data show that eye movements patterns obtained in laboratory do not fully generalize to real world, even when task and auditory information is controlled. These observations invite to caution when generalizing the eye movements obtained in laboratory with those of ecological spatial navigation.


Subject(s)
Eye Movements , Fixation, Ocular , Adaptation, Physiological , Humans , Saccades
2.
J Clin Ultrasound ; 42(2): 116-20, 2014 Feb.
Article in English | MEDLINE | ID: mdl-23657871

ABSTRACT

Atherosclerotic renal artery stenosis is a frequent cause of arterial hypertension and/or allograft dysfunction after kidney transplantation and is usually located at the iliac artery anastomosis. Fibromuscular dysplasia is a less frequent, nonatherosclerotic, vascular disease, inducing stenosis at the proximal/mid-distal part of the renal artery. We report the case of a 44-year-old woman, in whom serum creatinine concentration increased and arterial hypertension developed 3 months after renal transplantation. Color Doppler ultrasonography showed a low arterial resistance index and prolonged acceleration time in the interlobar arteries, and a significantly increased peak systolic velocity at the mid third of the renal artery, demonstrating hemodynamically significant stenosis. Percutaneous transluminal angioplasty allowed stenosis correction and was followed by creatinine concentration and arterial blood pressure normalization.


Subject(s)
Fibromuscular Dysplasia/diagnostic imaging , Kidney Transplantation , Postoperative Complications/diagnostic imaging , Renal Artery Obstruction/diagnostic imaging , Ultrasonography, Doppler, Color , Adult , Female , Fibromuscular Dysplasia/etiology , Humans , Renal Artery Obstruction/etiology , Tissue Donors
3.
Transplant Proc ; 42(6): 2068-70, 2010.
Article in English | MEDLINE | ID: mdl-20692410

ABSTRACT

CONTEXT: The use of pediatric donors can increase the number of donors available for pancreas transplantation. AIM: The aim of this study was to verify if pancreas transplantation from pediatric donors is as effective as transplantation from adult donors to restore metabolic control in type 1 diabetic patients. MATERIALS AND METHODS: From 2000 to April 2009 we performed 17 pancreas transplantations from pediatric donors: 9 simultaneous kidney-pancreas (SPK), 6 pancreas transplantation alone (PTA), and 2 pancreas after kidney (PAK). All subjects received whole organs with enteric diversion of exocrine secretions; 11 underwent systemic and 6 underwent portal venous graft drainage. The immunosuppressive therapy was as follows: prednisone, mycophenolate mofetil, anti-thymocyte globulin (ATG), and cyclosporine or tacrolimus. The pediatric donor population had a mean age of 15.3 years (range, 12-17), a mean weight of 60.1 kg (range, 42-75), and a mean body mass index (BMI) of 21 (range, 17.9-23.4). RESULTS: After 9 years the overall patient survival rate was 94.12%, whereas the graft survival rate was 63.35%. Normal glucose and insulin levels were maintained either fasting or during oral glucose tolerance test (OGTT). The group of recipients of pediatric organs was compared with patients receiving organs from adult donors (n = 125); the mean glucose values were lower in the pediatric group, whereas insulin production was higher in the adult patients. Early venous thrombosis was 17.6% in the pediatric group and 20% in adult recipients (Fisher exact test, P = not significant [NS]). CONCLUSION: Pediatric donors restored insulin independence in adult diabetic recipients, representing a valid source of organs for pancreas transplantation.


Subject(s)
Diabetes Mellitus, Type 1/surgery , Islets of Langerhans Transplantation/physiology , Pancreas Transplantation/physiology , Tissue Donors/statistics & numerical data , Adolescent , Adult , Blood Glucose/metabolism , Child , Diabetes Mellitus, Type 1/blood , Follow-Up Studies , Glucose Tolerance Test , Graft Survival , Humans , Immunosuppressive Agents/therapeutic use , Insulin/blood , Insulin/metabolism , Insulin Secretion , Islets of Langerhans Transplantation/immunology , Islets of Langerhans Transplantation/methods , Islets of Langerhans Transplantation/mortality , Mycophenolic Acid/analogs & derivatives , Mycophenolic Acid/therapeutic use , Pancreas Transplantation/immunology , Pancreas Transplantation/methods , Pancreas Transplantation/mortality , Survival Rate , Tacrolimus/therapeutic use , Time Factors
4.
G Ital Nefrol ; 25 Suppl 44: S64-7, 2008.
Article in Italian | MEDLINE | ID: mdl-19048588

ABSTRACT

The progression of diabetic nephropathy can be halted by keeping blood glucose levels close to normal values. Three therapeutic approaches can be considered: intensive insulin treatment, islet of Langerhans transplantation, and pancreas transplantation. 1) The Diabetes Control and Complication Trials, a clinical study conducted from 1983 to 1993, showed that intensive insulin treatment prevented the development and slowed the progression of diabetic kidney disease by 50%. 2) In 2003, P. Fiorina studied the potential effects of islet transplantation on the renal function of 36 patients with type 1 diabetes and kidney transplant. An improvement in kidney graft survival rate and functioning [Na(+)/K(+)-ATP activity] was observed when compared with 12 patients with unsuccessful islet transplant. 3) P. Fioretto et al, in 2006, confirmed that normoglycemia for 10 years following pancreas transplantation alone reversed diabetic glomerulopathy lesions in native kidneys. This study also demonstrated that interstitial expansion was reversible and atrophic tubules were reassorbed. 4) P. Fiorina, in 2007, confirmed that simultaneous kidney-pancreas transplantation was associated with a better high-energy phosphate metabolism (as assessed by 31P-magnetic resonance spectroscopy) than in kidney- alone transplanted diabetic patients, suggesting that restoration of Beta cell function positively affects kidney graft metabolism.


Subject(s)
Diabetic Nephropathies/surgery , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Islets of Langerhans Transplantation , Kidney Transplantation , Pancreas Transplantation , Clinical Trials as Topic , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 2/drug therapy , Diabetic Nephropathies/diagnosis , Diabetic Nephropathies/etiology , Evidence-Based Medicine , Humans , Treatment Outcome
5.
Am J Transplant ; 8(6): 1303-11, 2008 Jun.
Article in English | MEDLINE | ID: mdl-18444915

ABSTRACT

In this study we analyzed the role of CCL2, a member of the chemokine family, in early graft damage. Using simultaneous kidney-pancreas transplantation (SPK) as a model, we showed that brain death significantly increases circulating CCL2 levels in humans. We found that in such situations, high donor CCL2 levels (measured before organ recovery and at the onset of cold preservation) correlate with increased postreperfusion release of CCL2 by both the graft and recipient throughout the week following transplantation (n = 28). In a retrospective study of 77 SPK recipients, we found a significant negative association between high donor levels of CCL2 and graft survival. Decreased survival in these patients is related to early posttransplant complications, including a higher incidence of pancreas thrombosis and delayed kidney function. Taken together our data indicate that high CCL2 levels in the donor serum predict both an increase in graft/recipient CCL2 production and poor graft survival. This suggests that the severity of the inflammatory response induced by brain death influences the posttransplant inflammatory response, independent of subsequent ischemia and reperfusion.


Subject(s)
Brain Death/immunology , Chemokine CCL2/blood , Graft Survival/immunology , Kidney Transplantation/immunology , Pancreas Transplantation/immunology , Adult , Chemokine CCL2/immunology , Delayed Graft Function , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/surgery , Diabetic Nephropathies/etiology , Diabetic Nephropathies/surgery , Female , Humans , Kidney Failure, Chronic/etiology , Kidney Failure, Chronic/surgery , Male , Predictive Value of Tests , Retrospective Studies , Tissue Donors , Transplantation Tolerance
6.
Transplant Proc ; 39(6): 1830-2, 2007.
Article in English | MEDLINE | ID: mdl-17692624

ABSTRACT

BACKGROUND: The purpose of the study was to evaluate the impact of donor and recipient ages on patient and graft survival after kidney transplant. METHODS: Patients in a hospital database undergoing kidney transplant for end-stage renal disease (ESRD) during the period 1985 to May 2006 (n = 410; mean age 42 +/- 10 years; 61% men and 39% women) were divided into two groups: group A, patients of 60 years or older (6%, n = 24), and group B, those younger than 60 years (94, n = 386). In 204 patients (49.8%) the pancreas was transplanted simultaneously with the kidney. RESULTS: Overall 1-, 3-, 5-year patient survivals were 92%, 90%, 88% in group A and 95%, 90%, 87% in group B (P = .6, NS). Overall 1-, 3-, 5-year kidney graft was 92%, 75%, 65% in group A and 92%, 84%, 79% in group B (P = .7, NS). Donors were divided into two groups: group 1, 55 years or older (15%, n = 62), versus group 2, those younger than 55 years (85%, n = 348). Overall 1-, 3-, 5-year patient survivals were 91%, 86%, 76% in group 1 and 97%, 94%, 90% in group 2 (P = .0009). Overall 1-, 3-, 5-year kidney graft survivals were 87%, 82%, 76% in group 1 and 94%, 86%, 82% in group 2 (P = .02). CONCLUSIONS: Renal transplantation is an effective option for the treatment of ESRD in elderly patients. The overall rates of patient and kidney graft survival are comparable to those of younger patients. Donor age > or =55 years had a negative effect on patient and kidney graft survival.


Subject(s)
Kidney Failure, Chronic/surgery , Kidney Transplantation/physiology , Tissue Donors/statistics & numerical data , Adult , Female , Follow-Up Studies , Graft Survival , Humans , Kidney Transplantation/mortality , Male , Middle Aged , Retrospective Studies , Survival Analysis , Time Factors
7.
Neurology ; 69(12): 1285-92, 2007 Sep 18.
Article in English | MEDLINE | ID: mdl-17377071

ABSTRACT

BACKGROUND: Mutations in the LMNA gene, encoding human lamin A/C, have been associated with an increasing number of disorders often involving skeletal and cardiac muscle, but no clear genotype/phenotype correlation could be established to date. METHODS: We analyzed the LMNA gene in a large cohort of patients mainly affected by neuromuscular or cardiac disease and clustered mutated patients in two groups to unravel possible correlations. RESULTS: We identified 28 variants, 9 of which reported for the first time. The two groups of patients were characterized by clinical and genetic differences: 1) patients with childhood onset displayed skeletal muscle involvement with predominant scapuloperoneal and facial weakness associated with missense mutations; 2) patients with adult onset mainly showed cardiac disorders or myopathy with limb girdle distribution, often associated with frameshift mutations presumably leading to a truncated protein. CONCLUSIONS: Our findings, supported by meta-analysis of previous literature, suggest the presence of two different pathogenetic mechanisms: late onset phenotypes may arise through loss of function secondary to haploinsufficiency, while dominant negative or toxic gain of function mechanisms may explain the severity of early phenotypes. This model of patient stratification may help patient management and facilitate future studies aimed at deciphering lamin A/C pathogenesis.


Subject(s)
Genetic Predisposition to Disease/genetics , Heart Diseases/genetics , Lamins/genetics , Mutation/genetics , Neuromuscular Diseases/genetics , Adult , Age of Onset , Child , Child, Preschool , Cluster Analysis , Cohort Studies , DNA Mutational Analysis , Disease Progression , Frameshift Mutation/genetics , Genetic Markers/genetics , Haplotypes/genetics , Heart Diseases/metabolism , Heart Diseases/physiopathology , Humans , Lamin Type A/genetics , Muscle, Skeletal/metabolism , Muscle, Skeletal/pathology , Muscle, Skeletal/physiopathology , Mutation, Missense/genetics , Myocardium/metabolism , Myocardium/pathology , Neuromuscular Diseases/metabolism , Neuromuscular Diseases/physiopathology , Phenotype
8.
Transplant Proc ; 38(4): 1158-9, 2006 May.
Article in English | MEDLINE | ID: mdl-16757294

ABSTRACT

We assessed the effect on duodenal stump vascular supply of reconstruction of the gastroduodenal artery performed before pancreas transplantation. The median pancreas graft and patient survival times were 144 and 72 months for cases with or without gastrointestinal bleeding. Transmural blood flow values were significantly different between the donor duodenal stump and the recipient anastomosed jejunum (P < .01). The rate of gastrointestinal bleeding was lower in patients who received a pancreatic graft with back-table reconstruction of the gastroduodenal artery (P = .005).


Subject(s)
Arteries/surgery , Pancreas Transplantation/methods , Pancreas/blood supply , Plastic Surgery Procedures/methods , Adult , Duodenum/surgery , Female , Humans , Iliac Artery/surgery , Kidney Transplantation/mortality , Male , Pancreas Transplantation/mortality , Pancreatectomy , Retrospective Studies , Splenectomy , Survival Analysis , Treatment Outcome
9.
Transplant Proc ; 37(6): 2851-2, 2005.
Article in English | MEDLINE | ID: mdl-16182831

ABSTRACT

UNLABELLED: Simultaneous pancreas-kidney (SPK) transplantation has become a standard therapy for patients with type 1 diabetes and end-stage renal disease. We analyzed metabolic data in this clinical setting under tacrolimus- versus cyclosporine microemulsion (ME)-based immunosuppressive therapy. PATIENTS AND METHODS: We analyzed 205 patients enrolled in the Euro-SPK001 study for fasting blood glucose, fasting C peptide, glycated hemoglobin (HbA(1c)), blood lipids (total cholesterol and triglycerides), and pancreatic enzymes at regular intervals during the study. We compared blood pressure values with target levels for diabetic patients published by the European Society for Hypertension. RESULTS: Throughout the study, HbA(1c) and fasting C peptide levels were within the normal range in the two groups. Fasting blood glucose was higher during the first 2 months posttransplant in the tacrolimus group than in the cyclosporine-ME group, but no differences were seen thereafter. From month 2 posttransplant, mean levels of total cholesterol were significantly lower among patients receiving tacrolimus than those in the cyclosporine-ME group. In addition, patients receiving cyclosporine-ME showed serologic features of mild pancreatitis with elevated blood amylase and lipase levels during the first 6 months posttransplant. The two regimens were comparable with respect to hypertension, but target levels were reached in only 50% of the patients. CONCLUSION: Except for lipid profiles, no major differences in metabolic effects or blood pressure control were observed among SPK transplant patients receiving immunosuppression based on tacrolimus versus cyclosporine-ME. In view of the potential risk of hypertension, antihypertensive strategies should be implemented for all patients.


Subject(s)
Glycated Hemoglobin/analysis , Kidney Transplantation/physiology , Pancreas Transplantation/physiology , Amylases/blood , Blood Glucose/metabolism , C-Peptide/blood , Diabetes Mellitus, Type 1/surgery , Diabetic Nephropathies/surgery , Humans , Immunosuppressive Agents/therapeutic use , Kidney Failure, Chronic/etiology , Kidney Failure, Chronic/surgery , Lipids/blood
10.
G Ital Nefrol ; 22 Suppl 31: S30-5, 2005.
Article in Italian | MEDLINE | ID: mdl-15786399

ABSTRACT

Renal transplantation is an effective therapeutic tool for patients with end-stage renal diseases (ESRDs). Data reported in this article summarize the results obtained from 30 years' activity in the North Italy Transplant program (NITp), the first transplant organization in Italy that implemented a donor procurement and organ transplantation network. In the NITp kidney allocation is governed by a computerized algorithm, NITK3, put in place in 1997, aimed at ensuring equity, transparency and traceability during the stages of the allocation decision-making process. The NITp working group has recognized the NITK3 criteria and they are periodically reviewed following the results of the analysis of patients' transplantation odds. The results obtained with the use of the NITK3 algorithm have been very satisfactory: after 6 yrs, a significantly higher percentage of patients at immunological risk (sensitized or waiting for re-transplant), of patients waiting for >3 yrs and of patients with 0-1 HLA A,B,DR mismatches have been transplanted. Moreover, a higher percentage of kidneys were used locally (in a hospital within the procurement area), and this is known to stimulate donor procurement. Finally, we performed a preliminary statistical analysis of transplants carried out from 1998-2002 in 5/16 centers of the NITp area, demonstrating the quality of the NITp program in terms of patient and graft survival, and that donor and recipient age are the variables significantly impacting on transplant results.


Subject(s)
Kidney Transplantation/statistics & numerical data , Tissue and Organ Procurement , Adolescent , Adult , Female , Humans , Italy , Male , Middle Aged , Multivariate Analysis , Registries , Tissue and Organ Procurement/organization & administration
11.
Clin Neurophysiol ; 114(3): 515-28, 2003 Mar.
Article in English | MEDLINE | ID: mdl-12705432

ABSTRACT

OBJECTIVE: To investigate a modulation of the N170 face-sensitive component related to the perception of other-race (OR) and same-race (SR) faces, as well as differences in face and non-face object processing, by combining different methods of event-related potential (ERP) signal analysis. METHODS: Sixty-two channel ERPs were recorded in 12 Caucasian subjects presented with Caucasian and Asian faces along with non-face objects. Surface data were submitted to classical waveforms and ERP map topography analysis. Underlying brain sources were estimated with two inverse solutions (BESA and LORETA). RESULTS: The N170 face component was identical for both race faces. This component and its topography revealed a face specific pattern regardless of race. However, in this time period OR faces evoked significantly stronger medial occipital activity than SR faces. Moreover, in terms of maps, at around 170 ms face-specific activity significantly preceded non-face object activity by 25 ms. These ERP maps were followed by similar activation patterns across conditions around 190-300 ms, most likely reflecting the activation of visually derived semantic information. CONCLUSIONS: The N170 was not sensitive to the race of the faces. However, a possible pre-attentive process associated to the relatively stronger unfamiliarity for OR faces was found in medial occipital area. Moreover, our data provide further information on the time-course of face and non-face object processing.


Subject(s)
Brain Mapping , Evoked Potentials, Visual/physiology , Face , Pattern Recognition, Visual/physiology , Adult , Algorithms , Female , Humans , Male , Racial Groups
13.
Transplantation ; 71(11): 1560-5, 2001 Jun 15.
Article in English | MEDLINE | ID: mdl-11435965

ABSTRACT

BACKGROUND: Strategies to prevent the return to the diabetic state for graft loss or failure or any other cause after pancreas transplantation require the identification of the subjects at risk. This study evaluated whether daily glucose, insulin, and c-peptide profiles and studies of insulin sensitivity and secretion after transplantation predict pancreatic graft failure. METHODS: Fifty-three subjects with type 1 diabetes with end-stage renal failure who received a combined pancreas and kidney transplant underwent the following procedures 1 year after transplantation: 1-day metabolic profiles, sampling every 2 hours for plasma glucose, serum insulin, and c-peptide (n=51); an intravenous glucose tolerance test (IVGTT) to evaluate insulin secretion (n=48); and an euglycemic insulin clamp to evaluate insulin sensitivity (M value, n=14). The recipients were then followed up to 8 years (mean follow-up 4.8+/-0.3 years) to evaluate the return to the diabetic state. RESULTS: Survival analysis showed that plasma glucose in the profiles and insulin secretion in IVGTT were strongly related to the risk of returning to the diabetic state. A cutoff value of mean daily plasma glucose >127 mg/dL, corresponding to the top quartile of the mean plasma glucose distribution in the profiles, predicted the return to the diabetic state within 4 years from transplantation with a 93% specificity and a 100% sensitivity. A cutoff value of insulin delta peak <32 microU/ml in the IVGTT predicted the return to the diabetic state within 4 years from transplantation with a 75% specificity and a 75% sensitivity. In contrast, the M value in the clamp was devoid of predictive value. CONCLUSIONS: This study indicates that the mean 24-h plasma glucose 1 year after transplantation is the strongest predictor of the return to the diabetic state. The risk is related to defects in insulin secretion and not to insulin resistance. Metabolic profiles can be used to screen the subjects at risk to strictly monitor the graft function and to investigate early determinants of graft failure.


Subject(s)
Pancreas Transplantation , Pancreas/metabolism , Adult , Blood Glucose/analysis , Circadian Rhythm , Diabetes Mellitus, Type 1/surgery , Female , Glucose Tolerance Test , Humans , Insulin/blood , Male , Postoperative Period , Predictive Value of Tests , Prognosis , Recurrence , Survival Analysis , Time Factors
14.
Clin Neurophysiol ; 112(8): 1419-35, 2001 Aug.
Article in English | MEDLINE | ID: mdl-11459682

ABSTRACT

OBJECTIVE: To investigate the cortical activation during execution of unimanual and bimanual synchronous and asynchronous finger sequences, as well as during transitions between those sequences. METHODS: Task-related power (TRPow) analysis of multichannel surface EEG was used to examine the regional oscillatory brain activity in the lower (7.8-9.8 Hz) and upper (10.8-11.8 Hz) alpha band. Unimanual to bimanual, bimanual to unimanual, and unimanual to unimanual transitions, prompted by visual cues, were studied in 10 right handed subjects. RESULTS: (1) Execution of unimanual and bimanual movements was accompanied by a bilateral activation over the central regions. (2) The 7.8-9.8 Hz TRPow decrease was more prominent for left and bimanual movements, suggesting sensitivity of the lower alpha band to task difficulty. (3) No difference in alpha oscillatory activity was found between bimanual synchronous and asynchronous sequences. (4) Transitions between motor sequences were invariably accompanied by a mesioparietal TRPow decrease in the lower alpha band. (5) This mesioparietal activation was contingent to the change of motor program, and could not be accounted for by the change of visual cue, or related attentional processes. CONCLUSION: The 7.8-9.8 Hz mesioparietal activation most likely reflects a posterior parietal motor command initiating transition between motor programs.


Subject(s)
Movement/physiology , Parietal Lobe/physiology , Adult , Electroencephalography , Female , Fingers , Functional Laterality , Humans , Male
15.
Prensa méd. argent ; 86(8): 795-99, oct. 1999. tab
Article in Spanish | LILACS | ID: lil-294819

ABSTRACT

El propósito del siguiente trabajo es comparar a corto plazo, los resultados clínicos y radiológicos de las caderas operadas por médicos especialistas vs. médicos residentes. En el Servicio de Ortopedia y Traumatología se realizaron 85 hemiartroplastías entre los años 1994-97, el seguimiento de los mismos se realizó en el corto plazo (período de internación)Se trata de una cirugía de mediana complejidad con técnica reglada que en nuestro servicio los médicos residentes la realizan a partir de su 3er año de preparación. El objetivo final de eta cirugía es reinsertar rápidamente al paciente (generalmente añoso), a su actividad habitual


Subject(s)
Humans , Adult , Femoral Fractures/surgery , Hip Fractures/surgery , Hip Prosthesis , Orthopedics
16.
Prensa méd. argent ; 86(8): 795-99, oct. 1999. tab
Article in Spanish | BINACIS | ID: bin-9388

ABSTRACT

El propósito del siguiente trabajo es comparar a corto plazo, los resultados clínicos y radiológicos de las caderas operadas por médicos especialistas vs. médicos residentes. En el Servicio de Ortopedia y Traumatología se realizaron 85 hemiartroplastías entre los años 1994-97, el seguimiento de los mismos se realizó en el corto plazo (período de internación)Se trata de una cirugía de mediana complejidad con técnica reglada que en nuestro servicio los médicos residentes la realizan a partir de su 3er año de preparación. El objetivo final de eta cirugía es reinsertar rápidamente al paciente (generalmente añoso), a su actividad habitual


Subject(s)
Comparative Study , Humans , Adult , Hip Fractures/surgery , Femoral Fractures/surgery , Hip Prosthesis , Orthopedics
18.
J Mol Med (Berl) ; 77(1): 133-9, 1999 Jan.
Article in English | MEDLINE | ID: mdl-9930948

ABSTRACT

IDDM patients undergoing islet, segmental pancreas or whole pancreas allotransplantation were studied at regular intervals after surgery (3-6 months, 1, 2, 3 and 4 years) to evaluate glycometabolic control (24 h metabolic profile, OGTT) and serum free insulin response to insulinogenic stimuli (arginine, IVGTT). Patients received the same immunosuppressive therapy, based on cyclosporin, steroids and azathioprine. Islet transplanted patients showed: 1) an early peak of insulin secretion after arginine, that was maintained up to 4 years; 2) an early, but low peak of insulin secretion after IVGTT, which was lost at 3 years, despite evidence that islets were still functioning (insulin independence with normal HbAlc levels); 3) a diabetic-like response to OGTT at 3 months, which improved at 2 years (IGT response); 4) fasting euglycemia with mild and reversible post-prandial hyperglycemia during the 24 h metabolic profile, which was maintained for up to 2 years. Insulin secretory patterns of islet transplanted patients were similar to segmental pancreas transplanted patients, and lower than whole pancreas transplanted patients. The reduced beta cell mass transplanted and the functional denervation of the transplanted islets seem to be the major determinants of this behaviour.


Subject(s)
Blood Glucose/metabolism , Diabetes Mellitus, Type 1/surgery , Insulin/metabolism , Islets of Langerhans Transplantation , Pancreas Transplantation , Adult , Arginine , Diabetes Mellitus, Type 1/metabolism , Female , Glucose Tolerance Test , Humans , Insulin/blood , Insulin Secretion , Longitudinal Studies , Male , Transplantation, Homologous
19.
J Pediatr Endocrinol Metab ; 12 Suppl 3: 777-87, 1999.
Article in English | MEDLINE | ID: mdl-10626270

ABSTRACT

Pancreas transplantation has become an accepted therapeutic approach to treat insulin-dependent diabetes mellitus, successfully restoring normoglycemia. In contrast, islet transplantation is still in the experimental phase, only a few operations having being performed world-wide. The aim of this review is to analyze the effects of pancreas transplantation on the late complications of diabetes and to report the endocrino-metabolic effects of pancreas and islet transplantation.


Subject(s)
Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/surgery , Islets of Langerhans Transplantation , Pancreas Transplantation , Blood Glucose/metabolism , Diabetes Mellitus, Type 1/metabolism , Humans , Insulin/blood
20.
Diabet Med ; 15(12): 991-6, 1998 Dec.
Article in English | MEDLINE | ID: mdl-9868970

ABSTRACT

Hypoglycaemia is an important complication of insulin treatment in Type 1 diabetes mellitus (DM). Pancreas transplantation couples glucose sensing and insulin secretion, attaining a distinctive advantage over insulin treatment. We tested whether successful transplantation can avoid hypoglycaemia in Type 1 DM. Combined kidney and pancreas transplanted Type 1 DM who complied with good function criteria (KP-Tx, n = 55), and isolated kidney or liver transplanted non-diabetic subjects on the same immunosuppressive regimen (CON-Tx, n = 14), underwent 1-day metabolic profiles in the first 3 years after transplantation, sampling plasma glucose (PG) and pancreatic hormones every 2 hours. KP-Tx had lower PG than CON-Tx in the night and in the morning and higher insulin concentrations throughout the day. KP-Tx had lower PG nadirs than CON-Tx (4.40+/-0.05 vs 4.96+/-0.16 mmol l(-1), ANOVA p = 0.001). Nine per cent of KP-Tx had hypoglycaemic values (PG < or = 3.0 mmol l(-1)) in the profiles, both postprandial and postabsorptive, whereas none of CON-Tx did (p < 0.02). In conclusion, after pancreas transplantation, mild hypoglycaemia is frequent, although its clinical impact is limited. Compared to insulin treatment in Type 1 DM, pancreas transplantation improves but cannot eliminate hypoglycaemia.


Subject(s)
Blood Glucose/metabolism , Diabetes Mellitus, Type 1/surgery , Hypoglycemia/etiology , Insulin/blood , Pancreas Transplantation/physiology , Postoperative Complications , Adult , C-Peptide/blood , Diabetes Mellitus, Type 1/blood , Diabetic Nephropathies/surgery , Female , Humans , Kidney Failure, Chronic/surgery , Kidney Transplantation/physiology , Liver Transplantation/physiology , Male , Time Factors
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