[Organ donation by living donors in isolated pancreas and simultaneous pancreas-kidney transplantation]. / Die Lebend-Organspende in der isolierten Pankreas- und simultanen Pankreas-Nieren-Transplantation.

We studied retrospectively 106 pancreas transplants from living donors. Of these, 83 were solitary pancreas transplants, done between June 1979 and December 1997 (51 pancreas transplants alone for non-uremic recipients as well as 32 pancreas-after-kidney transplants for previously uremic recipients with a functioning kidney graft), and 23 were simultaneous pancreas-kidney transplants (SPK), done between March 1994 and December 1997. In all, 105 (99%) donors were genetically related to the recipients. Perioperative donor mortality was 0%. Donor complications included 9 splenectomies as well as 4 operatively drained and 7 percutaneously managed peripancreatic fluid collections. We noted hyperglycemia in 3 (3%) donors (all among the initial cases in this series). The 1-year survival rate was 50% for solitary pancreas recipients and 78% (pancreas) and 100% (kidney) for SPK recipients. Of the 5 pancreas graft losses which occurred after SPK, 3 were due to thrombosis, 1 to pancreatitis and infection, and 1 to chronic rejection. Currently, all kidney grafts and 18 pancreas grafts are functioning in these 23 dual organ recipients (with 0% recipient mortality). Living donor pancreas and SPK grafting is associated with low donor morbidity and good graft outcome. With stringent donor criteria and appropriate counseling of the prospective donor/recipient pairs, living donor pancreas transplants may become a more widely applied therapeutic alternative for selected non-uremic and uremic patients with Type I diabetes.

[Metabolic and immunologic sequelae of pancreas transplantation in the pig]. / Metabolische und immunologische Konsequenzen der Pankreastransplantation beim Schwein.

After induction of a Streptozotocin-induced diabetes mellitus solitary pancreas transplants were performed in 31 Yorkshire-Landrace pigs. Exocrine pancreatic secretions were bladder drained (duodenocystostomy). Postoperatively all animals were subject to a standardized immunosuppression. The purpose of the study was both to examine the intensity of rejection episodes within a certain time period and to correlate laboratory with histology data. Cystoscopic transduodenal pancreas biopsies in defined intervals were obtained by intraoperative ultrasound control; this technique reduces the complication rate and should be used clinically. The biopsy results showed that severe rejection episodes despite high dose triple-immunosuppression for induction therapy were noted histologically and immunohistochemically as early as postoperative day 6. Morphological changes significantly preceded functional changes. Due to the distinct immunogenicity of pancreas transplants and in order to decrease incidence and severity of rejection episodes, quadruple-immunosuppression (including T-cell-antibodies) is imperative for induction therapy and anti-rejection treatment. Our results demonstrate that solitary pancreas transplantation is clinically indicated only in patients with extremely labile diabetes mellitus due to the high immunosuppression required. This animal model should be utilized for further studies to improve the result of solitary pancreas transplantation.

Streptozotocin-induced diabetes mellitus in pigs.

We induced, as a precondition for a pancreas transplant, insulin-dependent diabetes mellitus in 67 Yorkshire Landrace pigs by administering streptozotocin. A dosage of 150 mg/kg body weight gave rise to a long-lasting diabetes mellitus that persisted with time (follow-up period: 26 weeks). Consecutive measurements of serum glucose and plasma insulin, before and up to 30 hours after administering streptozotocin, revealed triphasic behavior: initial hyperglycemia (1st to 3rd hour), pronounced hypoglycemia (12th to 18th hour), then hyperglycemia (22nd hour on). IVGTTs done 1 to 7 days after administering streptozotocin revealed a reduction of the K-value (glucose disappearance rate) from 0.3 (day 2) to 0.07 (day 4). Immunohistochemical studies revealed a complete loss of all beta-cells, concomitantly with a relative increase in glucagon- and somatostatin-positive cells. We also observed a complete loss of pp (pancreatic polypeptide)-positive cells. Diabetes induced by streptozotocin at 150 mg/kg body weight is complete and permanent; our mortality rate was 0%. Given the high morbidity rate after pancreatectomy, streptozotocin should be the method of choice for inducing diabetes mellitus in pigs.

Mathematical modeling of fetal limb growth.

Using ultrasound measurements of the femur, tibia, humerus, radius (N = 515), and fibula and ulna (N = 385) from normal fetuses between 12 and 40 completed weeks of gestation, growth models were determined for each bone by computer analysis. On the basis of residual analysis, growth of fetal limb bones could best be expressed as a function of tangens hyperbolicus. Growth profiles and growth data are shown with 5th, 10th, 50th, 90th, and 95th percentiles. These results are compared with previous investigations of limb bone measurements.

[Stomach cancer in patients under 40]. / Das Magenkarzinom bei Patienten unter 40 Jahren.

Fifty-one patients below the age of forty were treated for stomach carcinoma at the Surgical Hospital of Mainz University, between 1970 and 1986. They accounted for 5.2 per cent of all patients with stomach carcinoma. Diagnosis had been delayed under the following characteristic circumstances: The interval between onset of symptoms and diagnosis had been more than a year in 34 per cent of all cases. Fifty per cent of the patients had been originally hospitalised, following false suspicious diagnosis. Primary examination for gastro-intestinal passage produced falsely negative results in 43 per cent. The same falsely negative outcome was recorded from 24 per cent, following gastroscopy, and from twelve per cent, following gastroscopy combined with tissue sampling. The percentage of early stomach carcinomas was twice as high as that recorded from patients over forty. Undifferentiated carcinomas, on the other hand, were predominant in patients below forty, whereas adenocarcinomas were primarily recorded from patients over forty. Curative resection was successful in 55 per cent of the over-forties and 44 per cent of the under-forties. No-recurrence intervals were longer among the over-forties. However, five-year survival rates in Stages I, II, and III were better among the under-forties. Hence, the conclusion has been drawn from these findings that stomach carcinoma prognosis of patients below forty is better than that in higher age groups. This, however, is contradictory to other investigations reported in the literature.

[Development of a growth model for fetal head and body measurements]. / Entwicklung eines Wachstumsmodells für fetale Kopf- und Rumpfmasse.

Head parameters BPD, FOD and HC and abdomen parameters ATD, APD and AC have been ascertained in a prospective cross-sectional study in 515 healthy single fetuses between 13 and 40 weeks of gestation by ultrasound. In all cases ultrasound velocity was 1540 m/sec. From these data, a growth model was achieved for each parameter and corresponding growth curves with 5%, 10%, 50%, 90% and 95% percentiles were established.