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C G Groth

Publications and source records attributed to C G Groth.

At least 163 records · Page 9Linked to original sources
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 The cumbersome pancreatico-enteric anastomosis previously needed for enteric drainage has now been replaced by a simple bowel-to-bowel anastomosis.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↗
PubMed1991

Cytologic patterns in juice from human pancreatic transplants: correlation with histologic findings in the graft.

In 19 patients who had undergone pancreatic transplantation with temporary exteriorization of the pancreatic juice, graft tissue became available for histologic examination. In these patients the cytologic patterns in the pancreatic juice were compared with the histologic findings in the graft specimens. In five samples the diagnosis by cytologic studies was rejection. Acute rejection was confirmed in all the histologic specimens. In eight cytologic samples, graft pancreatitis was suspected because of the increased amounts of neutrophils, degenerating cells, epithelial cells, monocytes, and some macrophages, with or without necrotic tissue fragments. All eight histologic specimens showed findings characteristic of pancreatitis. In three cytologic samples, bacteria or fungi were observed. Histologic examination of these patients showed graft pancreatitis. In four patients the cytologic findings were normal. Graft histologic factors were normal in two instances. In one of these grafts there was graft pancreatitis, and in one graft chronic vascular rejection was seen. Our study shows that two different pathologic events occurring in the pancreatic graft (i.e., acute rejection and pancreatitis) are reflected by characteristic changes in pancreatic juice cytology.

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↗