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Biomedical subjects

A Tibell

Publications and source records attributed to A Tibell.

At least 109 records · Page 6Linked to original sources
PubMed1991

The Stockholm experience with pancreatic transplantation using enteric exocrine diversion.

Between April 1974 and June 1990, 128 pancreatic transplantations were performed. Of these 117 were with pancreatico-enterostomy. In four consecutive series of combined transplantations in uraemic diabetic patients the 1-year graft survival rate have successively improved (27%, 65%, 68% and 73%). In three similar series of single pancreatic transplantations the results also improved but still remained inferior (0%, 33% and 33%). In a series of combined transplantations performed in preuraemic diabetic patients the 1-year actuarial graft survival rate was only 25%. The results with pancreatic transplantation with pancreatico-enterostomy are now satisfactory. However, immunological loss graft function still constitute a major problem in the non- or pre-uraemic recipients. The metabolic control in patients with functioning grafts is normal or near-normal in the majority of patients followed for at least 1 year.

Diabetes Mellitus, Type 1↗
PubMed1991

Long-term metabolic control after pancreas transplantation with enteric exocrine diversion.

Long-term metabolic control after pancreatic transplantation with enteric exocrine diversion was evaluated in 42 Type I (insulin-dependent) diabetic pancreas recipients with functioning grafts for 1 to 7 years. Glycaemic control (fasting blood glucose, glycosylated haemoglobin A1c, oral and intravenous glucose tolerance tests) was normal or near-normal in most patients, and showed no deterioration with time. In ten patients with functioning grafts for 5 years there was a small, but significant, improvement in the glucose control at 3 to 5 years as compared with that at 6 months post-operatively. In the latter recipients the number of acute rejection episodes correlated negatively with the intravenous glucose tolerance at 6 months (r = -0.64, p less than 0.01) and at 5 years (r = -0.60, p less than 0.01) after transplantation, respectively. The glycaemic control at 6 and 12 months after transplantation was similar whether segmental (n = 35) or whole-organ (n = 7) pancreatic grafts had been used. In six non-uraemic recipients who had received a pancreas transplant alone the serum cholesterol increased in all but one patient (0.05 less than p less than 0.1), and the LDL/HDL-cholesterol ratio was significantly higher (p less than 0.005) one year after transplantation than before. Conversely, in six diabetic patients who had lost the function of their single pancreatic grafts the lipid and lipoprotein profiles remained unaltered. It is concluded that the long-term glycaemic control after segmental or whole-organ pancreatic transplantation with enteric exocrine diversion remains essentially normal in most recipients, and it may even improve with time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Pancreatico-duodenal transplantation with enteric exocrine drainage: technical aspects.

When a pancreatic transplant program was initiated in Stockholm in 1974 we elected to use enteric drainage of the pancreatic juice; 103 segmental pancreatic transplantations were performed with this technique. However, in 1988 we began to use pancreatico-duodenal grafts with enteric exocrine drainage and we have now performed 25 such procedures. Here we report the technical aspects of this procedure. The cumbersome pancreatico-enteric anastomosis previously needed for enteric drainage has now been replaced by a simple bowel-to-bowel anastomosis. In the present series, only one graft was lost due to the enteric drainage technique, i.e. because of exocrine leakage. No grafts were lost in thrombosis. In the uremic recipients of combined renal and pancreatic grafts the 1-year actuarial graft survival rate was 86%. Pancreatico-duodenal transplantation with enteric exocrine drainage would, therefore, seem to be a sound surgical procedure which is also physiological and not associated with any long-term sequelae.

Adult↗
PubMed1990

Late graft pancreatitis.

Among 40 type I diabetic patients who received a segmental pancreatic allograft with enteric exocrine diversion and had normal endocrine graft function for more than one year, 12 patients have had occasional episodes of "graft pain" associated with short-term hyperamylasemia. The symptoms usually resolved after 1-4 days. To determine possible precipitating factors, 80 such episodes were analyzed by interviewing all the patients and reviewing their files. To study the impact on endocrine graft function, the results of the serial intravenous glucose tolerance tests were plotted versus time. Episodes of late graft pancreatitis occurred at any given time between 6 and 51 months after transplantation. The frequency of bouts ranged between 1 and 31 per patient. The symptoms and clinical course were clearly different from late rejection episodes. Except for one severe case which resulted in graft loss, endocrine graft function did not deteriorate. Four conditions were found to correlate with the attacks: mental stress, alcohol and food intake, infections, and direct mechanical pressure to the pancreatic graft. We conclude that late graft pancreatitis can be distinguished from late rejection episodes and that the pancreatic graft may be more prone to acute pancreatitis than the native pancreas. The endocrine capacity of the pancreatic graft is usually not affected even by repeated attacks.

Alcohol Drinking↗
PubMed1990

Diagnosis of pancreatic graft rejection by duplex-Doppler ultrasonography.

The utility of duplex-Doppler ultrasonography (US) in the diagnosis of pancreatic graft rejection was evaluated in 9 patients. The examinations assessed the resistive index (RI) of arteries within the graft parenchyma, the homogeneity and echogenicity of the parenchyma, and the presence of fluid collections around the grafts. For the first 3 days after transplantation, the RI was found to be high. Subsequently, it decreased, and when the graft was in a stable condition, the mean RI was 0.63. With acute rejection episodes, the RI increased to a mean of 0.68 (p=0.002). Thus the increase in mean RI was small but significant. If serial US examinations were performed then an increase in RI, above an individual stable base-line level, was more apparent. After successful anti-rejection treatment, the RI decreased again. In 1 case with chronic rejection, the RI was found to be high, and the parenchyma was non-homogenous with high echogenicity. With pancreatitis, the RI did not change significantly. In 2 patients, fluid collections--which later resolved spontaneously--were seen around the grafts. In 1 patient, an arterial pulsation, which had been detectable previously, was found to be absent, and arterial thrombosis was confirmed at operation. In conclusion, serial duplex-Doppler US may be useful for monitoring pancreatic grafts and the RI may assist in the diagnosis of pancreatic graft rejection.

Adolescent↗
PubMed1990

Central nervous system complications in children treated with ciclosporin after renal transplantation.

Severe complications involving the central nervous system occurred in 7 of 36 children (19%) after renal transplantation. The children, aged 1.6-13.1 years at transplantation were treated with ciclosporin and prednisolone. Six of them had azathioprine as well. The neurological symptoms consisted of seizures, drowsiness, confusion, hallucinations, visual disturbances, and mental changes. In all cases electroencephalograms were severely pathological, showing diffuse abnormalities with or without focal abnormalities and epileptic activity. In all but one case the ciclosporin trough blood levels were within the therapeutic range. Blood glucose and electrolytes were normal. Several factors might contribute to the central nervous system complications: ciclosporin, corticosteroids, hypertension, rejection, and as yet unknown ones.

Adolescent↗
PubMed1990

Pancreatic transplantation using enteric exocrine diversion: the Stockholm experience with 117 cases.

One-hundred twenty-eight pancreatic transplantations were performed between 1974 and 1990; 117 of which were with pancreatico-enterostomy. Combined renal and pancreatic transplantations were performed in 68 uremic patients and in 8 preuremic recipients. Single pancreatic transplantations were performed in 31 recipients and in 6 instances, the pancreatic transplantation was performed in a patient who already had a renal graft. In 4 consecutive series (n = 15, 20, 21, 11) of combined transplantations in uremic diabetic patients, the 1-year graft survival rate has excessively improved markedly (27%, 65%, 68%, and 73%). In 3 similar series of single pancreatic transplantations (n = 7, 13, 6) the results also improved, but still remained inferior (0%, 33%, and 33%). In 42 patients followed for more than 1 year after transplantation, the mean blood glucose tolerance test 4.2 +/- 0.5, HbA1c 5.1 +/- 0.8, 2-hour blood glucose level of the oral glucose tolerance test 6.9 +/- 2.1 and the K-value of the intravenous glucose tolerance test 1.2 +/- 0.6%. The results with pancreatic transplantation with pancreatico-enterostomy are now satisfactory. However, immunological graft losses still constitute a major problem in the non- or preuremic recipients.

Diabetes Mellitus, Type 1↗