Duct-drained versus duct-occluded pancreatic grafts: a personal view

Conclusion My personal experience with DO and BD pancreas transplantation confirms that the DO technique is a safe procedure associated with more frequent, but less serious, complications. However, because of the likelihood of vascular thrombosis, graft survival probability does not reach the same level as that achieved by the BD technique.With triple drug induction therapy, recipients of BD pancreatic grafts often experience severe rejection episodes requiring intense antirejection therapy. Subsequently, the compromised immune system increases the susceptibility of the recipients to life-threatening infections. However, improved prophylactic and therapeutic measures, such as quadruple immunosuppressive induction therapy, CMV prophylaxis, and effective antifungal drugs, are now available. Therefore, these complications may now be prevented or effectively treated in most cases.The BD technique provides methods for diagnosing early graft rejection, which is obviously of major importance in isolated pancreas transplantation. Nevertheless, the further development of markers for early graft rejection, as well as of immunosuppressive approaches, seems necessary in order to improve the results of isolated pancreas transplantation. When the pancreas is transplanted simultaneously with a kidney using the BD technique, the probability of survival for both grafts is excellent. The problems directly associated with BD may be solved by draining the pancreatic duct to the intestine, which may ultimately prove to be the method that should be given preference.     

Radiographic identification of simulated carious lesions in relation to fillings with Adaptic Radiopaque®

The purpose of the present study was to elucidate the possible significance of the radiopacity of a composite restorative material for the radiographic identification of filling deficiencies. Class III cavities of varied size and shape were prepared at 28 proximal surfaces of 14 extracted human canines. All cavities were filled with Adaptic Radiopaque®. Simulated secondary or recurrent carious lesions were produced in 16 of the cavities by insertion of small amounts of radiolucent wax prior to filling. Each tooth was radiographed under standardized conditions using 15 different angulations. The 210 radiographs were interpreted by three observers without knowledge of the distribution of the deficiencies. They made 78.7% correct diagnoses, 18.7% false positive and 2.6% false negative diagnoses. The sensitivity of the method was 95.4, but the specificity was only 56.5. The results indicate that radiopacity of a composite resin is of a certain, although limited, value in detecting secondary and recurrent carious lesions. Regarding the high number of false positive diagnoses the radiographic findings should as far as possible be verified by a clinical examination. A majority of the false positive diagnoses could be explained by an inhomogeneous structure of the fillings.     

Renal allograft rupture.

In the present material of 448 consecutive renal transplants the incidence of allograft rupture was 3.6%. Among 389 first transplants there were two ruptures in the living donor group (126 patients, 1.5%) and 12 ruptures in the cadaveric donor group (263 patients, 4.6%). Only one ruptured kidney (living donor) achieved long term function. Four patients with first graft rupture were retransplanted with early loss of the kidney in all, in two because of rupture. Two of these patients received a 3rd cadaveric graft, of which one is functioning well after two years. All ruptures occurred within three weeks after transplantation, 14 kidneys ruptured during the first week. The clinical course and the operative findings suggested that rejection was the cause of rupture in all cases. This was confirmed by light and immunofluorescent microscopy of specimens from 15 kidneys, while one kidney only demonstrated extensive intrarenal vessel thrombosis. It is concluded that renal allograft rupture signals a strong immunological response in the recipient with poor graft prognosis. The chance of a successful retransplantation is small.     

Circadian rhythms in accessory sex gland function in the male rat

Alterations in various parameters of accessory sex gland function were monitored during two separate 24 h periods in adult male rats, and compared to fluctuations in the circulating levels of testosterone, prolactin, corticosterone and LH. Bimodal circadian rhythms in ventral prostate prolactin binding, cytosolic oestrogen binding and seminal vesicle weight could be discerned which appeared to be related to a similar rhythmicity in circulating testosterone levels, but with a phase shift of 3 h. Prostatic membrane bound adenylyl cyclase activities (basal and hormone stimulated) and prostatein concentrations followed different patterns possibly correlated to other endocrine changes.     

Mechanical Wear of Pacemaker Lead Insulation. A Cause of Loss of Pacing

A pacemaker-treated patient is described in whom lead insulation defect caused sudden loss of capture. The defect was caused by mechanical wear of the posterior leaflet of the tricuspid valve and resulted in shunting of the pulse generator with a current drain exceeding the capacity of the pacemaker. In three further cases a similar explanation to sudden loss of pacing was highly suspected.     

An improved microsurgical course for a mixed group of surgeons

Although the participants in the various microsurgical courses were of varied backgrounds and experience, and published materials that can serve as an adequate text are limited, the principles of microsurgery can be learned by skilled surgeons determined to become microsurgeons. Fundamental training depends upon the proper text and suitable models for practice under the guidance of a properly trained microsurgeon instructor. In particular, audiovisual aids are of substantial value. Techniques from the fundamental, simple vascular anastomosis to highly sophisticated organ transplantation in rodents may be mastered in a course of several days' duration. A 7- to 10-day course should be repeated annually to enable participants to polish their skills. Further, during an annual course, a half to whole day can be set aside for a microsurgical scientific program to allow exchange of scientific and clinical information, and to stimulate junior participants.

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Résumé Tout bon chirurgien, s'il est décidé à apprendre la microchirurgie, peut en acquérir les principes, même si les cours organisés dans ce but reçoivent des participants de formation et d'expérience très variable et même si les ouvrages de référence sont peu nombreux. Pour la formation de base, il faut un texte valable, un programme d'application pratique de qualité et un instructeur entraîné. Les moyens audiovisuels sont fort utiles. Il est possible d'apprendre en quelques jours toutes les techniques, depuis la plus simple, l'anastomose vasculaire, jusqu'aux plus complexes, comme la transplantation d'organe chez les rongeurs. Les cours de 7 à 10 jours devraient être répétés chaque année pour permettre aux participants de perfectionner leur maîtrise technique. De plus, pendant ce cours annuel, une journée, ou une demi-journée, peut être consacrée à un programme scientifique de microchirurgie qui stimule les jeunes et permet les échanges d'information scientifique et clinique.

     

The Importance of Consumer Perceived Criticism on Clinical Outcomes for Outpatient African Americans with Schizophrenia

This is the second of two studies that tests the impact of family factors on consumer functioning. This study tests the impact of the consumer’s perception of being criticized by the family (consumer perceived criticism) on the consumer’s clinical functioning. It likewise, concurrently tests the impact that other family factors have on perceived criticism. The sample was ninety-three consumer-family dyads. Results showed that none of the family factors directly contributed to level of perceived criticism, but more consumer perceived criticism was significantly related to higher levels of psychiatric symptoms. The findings suggest that an important component of treatment for symptom stabilization for African American consumers involves perceptions of the family being critical toward the consumer. The finding confirms for a sample of poor outpatient African American consumers what was found in previous research with African Americans. Results are in marked contrast to what impacted consumer psychosocial functioning in the companion study, suggesting that clinical and psychosocial functioning domains are distinct, particularly for African American consumers. This should be reflected in the interventions that are developed for African American consumers and their families.     

Does β2-adrenergic stimulation attenuate fluid extravasation during hypothermic cardiopulmonary bypass? An experimental study in pigs

Objectives: Hypothermic cardiopulmonary bypass (CPB) is associated with increased fluid filtration, edema formation and, occasionally, organ dysfunction. Cold-induced reduction in endothelial barrier function may play a role. β(2)-adrenergic activation elevates cellular cyclic adenosine monophosphate (cAMP) which maintains endothelial barrier properties. In this study, we tested whether β-adrenergic stimulation could influence the increase in fluid extravasation observed during hypothermic CPB. Materials and methods: Fourteen pigs randomly received terbutaline infusion (T-group) (n=7) or a control infusion (C-group) (n=7). All animals were given 60 min of normothermic CPB, followed by 90 min of hypothermic CPB. Fluid input and losses, plasma volume, colloid osmotic pressures (plasma, interstitial fluid), hematocrit, serum proteins and total tissue water content were measured and the fluid extravasation rates (FER) calculated. Statistics: by SPSS. Values presented as mean ± SD. Repeated measure analysis of variance was performed and a t-test used when appropriate. RESULTS: The commencement of normothermic CPB resulted in a 20% hemodilution, with an abrupt increase in fluid requirements during the first 10 min. FER increased from 0.18 (0.06) pre-bypass to 0.78 (0.27) ml/kg/min (T-group) (p=0.002) and from 0.16 (0.05) to 0.93 (0.26) ml/kg/min (C-group) (p<0.001) with no between-group differences. Thereafter, FER stabilized at a level of 0.32 (0.13) and 0.27 (0.14) ml/kg/min in the T-group and C-group, respectively. After the start of cooling, FER increased in the T-group to 0.55 (0.12) ml/kg/min (P=0.046) and in the C-group to 0.54 (0.13) ml/kg/min (P=0.006), with no between-group differences (P=0.738). CONCLUSION: In the present experimental study, we were unable to demonstrate any clinically relevant modulating effect of terbutaline on fluid extravasation during hypothermic cardiopulmonary bypass.