Prolonged improvement of total pancreatic allograft function by previous intrathymic bone marrow cell injection in rats.

Donor-specific induction of tolerance was previously achieved in the diabetic rat by intrathymic injection of pancreatic islets. It allowed a secondary islet graft in any site without immunosuppression. Since total pancreatic graft in man is metabolically more proficient than islet graft, we attempted tolerance induction for total vascularized pancreas transplantation in diabetic BN recipient rats by an intrathymic bone marrow cell (BMC) injection from Lewis donor rats, associated to an antilymphocyte antibody (ALS) administration. Control groups consisted of isogenic grafts, allogenic grafts without tolerance induction and allogenic grafts with ALS alone. In all grafted groups, mean blood glucose and plasma insulin were normalised within 24 h. Graft rejection (clinically suggested by diabetes recurrence and later confirmed by histology) appeared at 18 +/- 2 postoperative days in the absence of intrathymic BMC injection and at 36 +/- 8 days in the group with BMC injection (p < 0.05). Intrathymic bone marrow graft was successful in delaying rejection in our study.

Adjustable gastric banding in a public university hospital: prospective analysis of 400 patients.

BACKGROUND: Laparoscopic application of an adjustable gastric band (LAGB) is considered the least invasive surgical option for morbid obesity. It has the advantage of being potentially reversible and can improve quality of life. METHOD: Between April 1997 and January 2001, 400 patients underwent LAGB. There were 352 women and 48 men with mean age 40.2 years (16-66). Preoperative mean body weight was 119 kg (85-195) and mean body mass index (BMI) was 43.8 kg/m2 (35.1-65.8). RESULTS: Mean operative time was 116 minutes (30-380), and mean hospital stay was 4.55 days (3-42). There was no death. There were 12 conversions (3%). 40 complications required an abdominal reoperation (10%), for perforation (n = 2), gastric necrosis (n = 1), slippage (n = 31), incisional hernia (n = 2) and reconnection of the tube (n = 4). We noticed 7 pulmonary complications (2 ARDS, 5 atelectasis) and 30 minor problems related to the access port. At 2 years, mean BMI had fallen from 43.8 to 32.7 kg/m2 and mean excess weight loss (EWL) was 52.7% (12-94). CONCLUSION: LAGB is a very beneficial operation with an acceptable complication rate. EWL is 50% at 2 years if multidisciplinary follow-up remains assiduous. Surveillance for late anterior stomach slippage within the band is essential.

A prospective 2-year clinical evaluation of overdentures attached to nonsplinted implants utilizing ERA attachments.

Edentulism is a major oral healthcare issue for an ever-increasing older population in the United States. Most previous studies examined the success of overdentures supported by splinted implants utilizing clip bars and other types of attachments. This longitudinal study of 10 consecutive patients involves mandibular overdentures supported by nonsplinted implants with ERA attachments. Two-year results indicate that nonsplinted implants can be successfully used with ERA attachments to support overdentures. Each patient reported increased satisfaction with comfort, chewing, retention, and phonetics with the implant-assisted ERA-retained overdenture.

Total pancreatico-duodenal transplantation with portal venous drainage: metabolic assessments in diabetic rats.

A perfect metabolic correction of diabetes is essential to completely eradicate long-term chronic complications. Only a total pancreatic graft with portal venous drainage enables such an achievement. Isogenic Lewis rats were used for donors, recipients and controls. Pancreatico-duodenal transplantation was either heterotopic with systemic venous drainage (n = 12) or paratopic with portal drainage (n = 11). All animals were regularly monitored for non-fasting plasma glucose and insulin. Both techniques promptly restored the non-fasting plasma glucose to normal values (p<0.003). Normo-insulinemia (47.4+/-6.4 microU/ml) was obtained in the paratopic group, while the heterotopic group showed hyperinsulinism (132.0+/-15.2 microU/ml). Perfect metabolic control justifies the additional technical difficulties of total paratopic pancreatic transplantation with portal venous drainage.

The outcome of advanced chronic nephropathy in type 1 and type 2 diabetic and non-diabetic patients: a prospective study.

To compare end-stage progression of nephropathy in type 1 and type 2 diabetic patients and non-diabetic subjects, we prospectively studied 92 patients with advanced uraemia not yet on dialysis (mean age 57.2 +/- 15.0 years), with a serum creatinine level above 200 mumol/L. The study included monthly serum creatinine (SC) measurements and quarterly outpatient follow-up (mean 10.8 +/- 7.1 months, range 1-21). Sixty subjects (65.2%) were diabetic (28 type 1 and 32 type 2). At inclusion, 95.6% of patients had anti-hypertensive medications. Drug category, dosage and combination were similar for both groups. Blood pressure (< or = 130/85 mmHg) and glucose level targets (fasting < or = 7.5 mmol/L and postprandial < or = 10 mmol/L) were obtained in all patients. Initial SC was not significantly different between diabetic and non-diabetic patients (426.5 +/- 189.4 mumol/L vs. 405.1 +/- 201.9 mumol/L). SC increased significantly faster in diabetic than non-diabetic patients (respectively 3.9 +/- 6.1% and 1.5 +/- 4.6% monthly, p < 0.05), with no difference between type 1 and type 2 diabetes. One-third (33.7%) of all patients started dialysis during follow-up (40% diabetic and 22% non-diabetic). Their weight, body mass index, age, sex ratio, treatment and aetiology were similar. During follow-up, the patients (29.4%) who sustained a major vascular event differed only in age (62.1 years vs. 55.2 years; p < 0.001). In this study, diabetic renal disease worsened significantly faster than other nephropathies, in spite of proper normalisation of blood pressure and glucose level. Therefore, it is essential to diagnose and manage Type 2 diabetes early to avoid encumbering dialysis centres with older patients.

[Electrical injuries during laparoscopy]. / Les accidents électriques en coelioscopie.

Electrical injury is uncommon during surgical laparoscopy, but may be serious. Following a comprehensive literature review, we describe five mechanisms of burn injuries: direct contact, electric arc, insulation failure, direct or capacitive coupling. We discuss these mechanisms and suggest simple preventive measures designed to ensure optimal safety.

No increase of hypoglycaemia upon transfer of aged longstanding type 1 diabetic patients to human insulin: a prospective randomized study. The Investigators of the Transfert Study.

To assess the frequency and severity of hypoglycaemia following transfer to human insulin, 94 aged Type 1 diabetic patients on animal insulin were randomly assigned either to continue their usual insulin (group A, n = 48) or convert to equivalent preparations of human insulin (group B, n = 46). At inclusion, the two groups showed no differences in age (58.1 +/- 2.2 vs. 54.4 +/- 2.3 years), duration of diabetes (20.8 +/- 1.4 vs. 19.6 +/- 1.6 years) (mean +/- SEM), and glycosylated haemoglobin (HbA1c) values (9.1 +/- 0.2% vs. 8.9 +/- 0.2%). There were 43 eligible patients in group A and 41 in group B. After three months of treatment, HbA1c values were not significantly different between the two groups (8.6 +/- 0.2% vs. 8.5 +/- 0.2%), and there was no difference in the frequency and intensity of hypoglycaemic episodes. Quality of life, as assessed by a questionnaire, was similar at inclusion and after three months. However, the anxiety level was significantly lower in group B. Type 1 diabetic patients were efficiently and safely switched from animal to human insulin without aggravating the incidence of hypoglycaemia, in spite of two major risk factors, i.e. advanced age and diabetes of long duration.

Grafted immunoisolated human benign insulinoma reduces the incidence of diabetes in young NOD mice without abolishing the auto-immunity.

Exogenous insulin may prevent the auto-immunity of diabetes in rodents. We studied the preventive effect of a safe endogenous insulin delivery in the diabetes-prone NOD mouse by immuno-protected human insulinoma grafts. Perm-selective macrocapsules seeded with human insulinoma were implanted in 34 young NOD mice, 4 and 8 weeks old. The animals were observed 18 months and compared to 34 NOD mice grafted with empty fibers and 25 simply observed. Before grafting, the capacity of the macrocapsules to release insulin was assessed in vitro by perifusion studies and by implantation to 12 diabetic NOD mice. At perifusion, the insulin release of the macrocapsules responded to step changes in glucose. During the in vivo study, the capsules reduced the glycemia of diabetic mice from 18+/-3.5 to 7.3+/-2.1 mmol/L. In the study groups, the survival rate without diabetes (50-70%) was statistically different from controls (10-20%). Recipient's splenocytes transplanted to irradiated male NOD mice transferred the autoimmunity in 75-83% of grafted mice and 86-100% of controls. Insulitis was persistent in all, although milder in the grafted mice. Encapsulated insulinoma prevents diabetes in the NOD mouse without abolishing the auto-immunity. The quantity and quality of the tissues needed and the best moment to graft them have to be determined. The prevention of diabetes by encapsulated pancreatic tissue is appealing because of its simplicity and safety.

Efficacy of double gloving with a coloured inner pair for immediate detection of operative glove perforations.

OBJECTIVE: To compare the efficacy of double gloving with an inner coloured pair of gloves and double gloving with classic gloves, for prompt detection of perforation during a single standard operation. DESIGN: Prospective, randomised study. SETTING: Teaching hospital, France. SUBJECTS: 100 Consecutive patients with haematological malignancy or AIDS, who were referred for implantation of a vascular access port. INTERVENTIONS: Insertion of a central line with an implantable chamber under local anaesthesia. The use of double gloving with an inner coloured pair or with classic gloves was decided preoperatively by random allocation. MAIN OUTCOME MEASURES: Visual detection of one or more perforations on one or more gloves during operation, localisation of the perforation(s), and post-operative evaluation of the water tightness of the gloves. RESULTS: There were a total of 14 perforations of the outer gloves, 9 were detected during operation in the coloured inner pair group compared with none in the standard gloves group. Postoperative testing showed that there were no undetected perforations in the coloured inner pair group compared with 5 in the standard gloves group. CONCLUSIONS: Double gloving with a coloured inner pair is effective in the peroperative detection of accidental perforations in surgical gloves.

[Is there a role for pancreas transplantation in the treatment of type II diabetes mellitus? Experimental study]. / Y a-t-il une place pour la transplantation pancréatique dans le traitement du diabète du type II? Etude expérimentale.

There is no experimental basis for transplantation of the pancreas in patients with non-insulin-dependent diabetes mellitus. We compared results in normal and grafted non-insulino-dependent Lewis rats. A heterotopic pancreatico-duodenal graft was implanted with end-to-side anastomosis of the coeliac artery and the portal vein of the donner on the infrarenal aorta and inferior vena cava of the recipient. The diabetic rats showed weight loss, high blood glucose levels (3.30 +/- 1.25 milligrams), moderate insulinopenia and significantly elevated liver production of glucose. Glycaemia, weight and liver production of glucose were the same as those in the group of normal animals. We concluded that transplantation of the pancreas in an isogenic model without immunosuppression can correct glucose levels and insulino-resistance. It could be suggested in man.