Internal assessment of a novel islet isolation facility in Spain.

UNLABELLED: Islet transplantation is a promising therapy in the treatment of diabetes mellitus. Herein we present the result from the first series of islet isolations carried out in our new islet isolation facility. The aims of study were to analyze the influence of various donor characteristics on the success of islet isolation and compare these outcomes with other European and American groups. Data from 22 completed islet isolation were used to compare donor and isolation variables among successful (>300,000 IEQs) versus unsuccessful isolations. The successful isolation rate from our laboratory was 31.8%. We did not see any significant differences between successful and unsuccessful groups according to donor characteristics, although age was close to significance (38.57 +/- 10.29 versus 48.33 +/- 12.39; P = .08). Donor age (1.12 [1.23; 0.99]) and body mass index (0.065 [1.32; 3.08]) were associated with isolation success in a logistic regression model. We did not find differences among intraprocedure variables with the exception of IEQ prepurification (409,073 +/- 115,041 versus 263,776 +/- 128,988; P < .05). IEQpre and IEQpost were positively correlated (P < .05). In comparison with other groups, we observed differences in some cases related to islet yield prepurification (P < .05) but not postpurification. Purity from our islet preparations was the highest from all considered groups (P < .05). Recovery was similar in all groups. CONCLUSIONS: In our experience, donor characteristics have no influence on the success rate. The digestion step is a critical factor for success. Our results with respect to IE yield were close to that of experienced groups.

Unidad de trastornos de identidad de género de Andalucía. Experiencia del primer año de funcionamiento / Sexual identy unit of Andalucía

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Incidencia de amputaciones de extremidades inferiores en la población con diabetes mellitus de Málaga (1996-1997)

Objetivo. Conocer la frecuencia de amputaciones de miembros inferiores (AMI) para el diseño de un programa preventivo de AMI en personas con diabetes mellitus (DM).Diseño. Estudio observacional, retrospectivo.Emplazamiento. Estudio poblacional en Málaga y provincia. Pacientes. Se revisaron las historias clínicas de todas las personas con AMI de hospitales públicos o concertados de la provincia de Málaga entre el 1 de enero de 1996 y el 31 de diciembre de 1997. Se excluyeron las AMI traumáticas o tumorales. Se calculó la incidencia acumulada, el riesgo relativo (RR) de AMI y la tasa de mortalidad en personas con DM.Resultados. Se realizaron 449 AMI durante el período estudiado, 316 (70,3 por ciento) en personas con DM y 133 (29,6 por ciento) en población sin DM. La incidencia de AMI por 100.000 personas y año fue de 6,3 (IC, 4,7-7,8) en población sin DM y de 136,1 (IC, 114,9-157,3) en personas con DM. El RR de AMI fue 21,6 (IC, 17,6-26,4) para la población con DM, con diferencias entre varones y mujeres (16,8 frente a 36,1, respectivamente). La edad media de AMI fue significativamente mayor (p < 0,05) para la población con DM (70,0 ñ 10,2 frente a 68,9 ñ 15,9 años, respectivamente). Las AMI mayores fueron más numerosas tanto en mujeres como en varones en los 2 grupos estudiados. La tasa de mortalidad y las complicaciones, así como la estancia media hospitalaria, fueron mayores en la población con DM.Conclusiones. Este estudio confirma el mayor riesgo de AMI en personas con DM. La incidencia de AMI en este estudio fue menor que la de países del norte de Europa, Estados Unidos y Australia, y mayor que la publicada anteriormente en España (AU)

[Incidence of amputaciones of the lower extremities in the population with diabetes mellitus in Málaga (1996-1997)]. / Incidencia de amputaciones de extremidades inferiores en la población con diabetes mellitus de Málaga (1996-1997).

OBJECTIVE: To find the frequency of amputations of lower limbs (ALL) with the aim of designing a programme to prevent ALL in people with diabetes mellitus (DM). DESIGN: Retrospective observation study. SETTING: Population study in Malaga and its province. PATIENTS: The clinical records of everyone with ALL in public or subsidized hospitals in the province of Malaga between January 1 1996 and December 31 1997 were reviewed. Traumatic or tumoural ALL were excluded. Cumulative incidence, relative risk (RR) of ALL and the mortality rate of people with DM were calculated. RESULTS: 449 ALL took place during the period studied, 316 (70.3%) in people with DM and 133 (29.6%) in people not suffering DM. The incidence of ALL per 100,000 people and per year was 6.3 (CI: 4.7-7.8) in the population without DM and 136.1 (CI: 114.9-157.3) in people with DM. The RR of ALL was 21.6 (CI: 17.6-26.4) for the population with DM, with differences between men and women (16.8 vs. 36.1, respectively). Mean age of ALL was significantly greater (p < 0.05) for the population with DM (70.0 +/- 10.2 vs. 68.9 +/- 15.9 years old). Older ALL were more numerous in both women and men in the two groups studied. The mortality rate, complications and mean stay in hospital were greater in the population with DM. CONCLUSIONS: This study confirmed the greater risk of ALL run by people with DM. The incidence of ALL in this study was less than in countries of Northern Europe, the USA and Australia, but more than in any study published before in Spain.

[Trends of antidiabetic drug prescriptions in Andalucia (1986-1994)]. / Tendencias de prescripción de medicamentos antidiabéticos en Andalucía (1986-1994).

OBJECTIVE: Tendencies in the consumption of antidiabetic agents in Andalusia between 1986-1994 were analysed, with special emphasis on the impact of the introduction of acarbose and mechanized systems for the injection of insulin. METHODS: The information concerning consumption was obtained from the data bases of the Andalusian Health Service and the Ministry of Health which contain details of the items sold in community chemists and charged to the National Health System. Data are expressed as defined daily doses per 1000 inhabitants per day (DID). RESULTS: Insulin consumption rose from 4.67 DID in 1986 to 9.33 DID en 1994, an increase (delta) of 99.8%. All types of insulins contributed to the increase, with the mixtures rising most (delta 275%). Intermediate insulins were the most used. Prefilled syringes accounted for 25% of all insulin dispensed in 1994. Consumption of oral antidiabetic agents (OAA) rose from 12.75 DID in 1986 to 20.92 DID in 1994 (delta 64%). The most prescribed OAAs during these years were second generation sulphonylureas, representing 83% of those dispensed in 1994, followed by acarbose (11%), biguanides (3.8%), and first generation sulphonylureas (2.1%). CONCLUSIONS: There was a notable increase in the consumption of insulins and OAAs. Although the tendency in the consumption differs from that expected according to consensus agreements, qualitative changes were seen, suggesting an improvement in prescription habits. The appearance of mechanized injection systems for insulin and of acarbose have clearly modified prescription habits.

[The response of the growth hormone to acute effort is a function of training]. / La respuesta de la hormona de crecimiento al esfuerzo agudo está en función del entrenamiento.

BACKGROUND: The increase of the growth hormone (GH) during exercise is known although the relationship of this response with other hormones, the type and intensity of the exercise, nutritional state and with the degree of training are reasons for discussion. The aim of this investigation was to study the response of the HG on a group of young adults with different degrees of training, according to the maximum consumption of oxygen (VO2 max) achieved over a short period of time. METHODS: Thirty-nine healthy subjects who underwent maximum effort on the treadmill were grouped according to VO2 max reached (less than 3,000 ml/min; 3,000-4,500 ml/min and greater than 4,500 ml/min). Systolic blood pressure (SBP) and diastolic blood pressure (DBP), respiratory quotient (RQ), O2 pulse, cardiac frequency (CF) respiratory equivalence (RE), glycemia, plasma insulin (PI), C peptide, lactic acid, venous pH, plasma renin activity (PRA), plasma aldosterone, thyrotropine (TSH), triodothyronine (T3), thyroxine (T4), adrenocorticotropine (ACTH), cortisol and GH were measured basally and following achievement of VO2 max. RESULTS: The GH was only increased in those subjects with a VO2 max higher than 3,000 ml/min with a significant positive correlation found between the GH and VO2 max and a significant negative correlation was found between the GH and lactic acid at the end of the test. The increase of glycemia at the end of the test correlated with the VO2 max. The PI and C peptide increased at the end of the test in the subjects with greater VO2 max capacity and correlated positively with the VO2 max and with the GH upon completion of the exercise. CONCLUSIONS: These results suggest that the response of the growth hormone to exercise is a function of maximum oxygen consumption although this only explains 24% of the variants of the growth hormone. Despite important hormonal and metabolic mobilization during exercise, no model of multiple regression has been found which substantially improves the association found between the growth hormone and maximum oxygen consumption.