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Biomedical subjects

D E Sutherland

Publications and source records attributed to D E Sutherland.

At least 613 records · Page 34Linked to original sources
PubMed1984

Effect of venous drainage to the vena cava and denervation on endocrine function of pancreatic segments in dogs.

IVGTTs and OGTTs (0.5 g/kg glucose) were performed in 36 normal dogs (group N) and one to two weeks postoperatively in 22 dogs after partial pancreatectomy [( ppx ] group I); nine dogs after ppx and pancreatic venous drainage to the inferior vena cava (group II); nine dogs after ppx and pancreatic denervation (group III); and in seven dogs after ppx , venous drainage to the vena cava, and denervation (group IV). Fasting glucose and insulin were in the same range in all dogs. In IVGTT peak insulin levels were diminished by ppx , but total insulin secretion was similar in all dogs. Systemic venous drainage and denervation had no effect on glucose tolerance, peak insulin, and total amount of insulin appearing in the peripheral circulation. In groups II and IV, there was a linear correlation between individual K values and the area under the insulin curve, whereas there was no such correlation in groups I and III. In OGTTs , glucose tolerance and the total amount of insulin were equal in groups I through IV but diminished compared to group N. Venous transposition resulted in an early increase of insulin secretion and a late insulin peak. Thus, glucose load and islet cell mass are the determinants of glucose tolerance and insulin secretion in this model. Neither drainage of the pancreatic blood to the vena cava nor denervation have measurable influence on magnitude and effectivity of fasting and stimulated insulin secretion.

Animals↗
PubMed1984

Chronic pancreatitis: long-term surgical results of pancreatic duct drainage, pancreatic resection, and near-total pancreatectomy and islet autotransplantation.

Severe abdominal pain was the major indication for operation in 85 patients with chronic pancreatitis. Preoperative endoscopic retrograde cholangiopancreatography (50 patients) or intraoperative pancreatic ductograms (44 patients) demonstrated dilated or obstructed major pancreatic ducts in 50 patients (59%), nonvisualization of the distal duct in 10 patients (12%), and normal or small sized ducts in 34 patients (40%). Operative procedures, tailored according to duct morphology, included pancreatic duct drainage (46 patients), subtotal (40% to 80%) pancreatectomy (21 patients), near-total (85% to 95%) pancreatectomy alone (eight patients), and near-total or total pancreatectomy and intrahepatic islet autotransplantation (10 patients). Pancreatic duct drainage resulted in pain relief in 37/46 patients (80%) followed for 6 years. However, 20/46 patients (43%) had continued loss of pancreatic function after duct drainage as measured by the development of insulin-dependent diabetes (16 patients) or steatorrhea (seven patients). Seven years after subtotal pancreatectomy, pain relief was partial in 9/21 patients (43%) and complete in five patients (24%). A higher incidence of hypoglycemic or ketoacidotic complications was noted in patients treated by subtotal pancreatectomy (three patients, 14%) than by duct drainage (one patient, 2%). Near-total pancreatectomy was the most effective surgical procedure in relieving pain, but late sequelae in three patients (38%) included one hypoglycemic death and two ketoacidotic episodes. Five years after near-total pancreatectomy and islet autotransplantation, one patient remained permanently insulin independent; three patients were insulin independent for 4, 5, and 15 months, respectively, but subsequently developed nonketosis-prone diabetes (tested by insulin withdrawal) and require 15 to 30 U of insulin daily; three patients had immediate insulin requirements and currently need 20 to 30 U of insulin per day but are nonketosis prone; and two patients are ketosis prone and require 30 to 60 U of insulin daily. Our analysis suggests that 5-year survival of patients undergoing operation for chronic pancreatitis is similar after treatment by duct drainage, subtotal pancreatectomy, or near-total pancreatectomy, regardless of duct morphology. Five years after duct drainage or subtotal pancreatic resection, a high incidence of diabetes (59% and 48%) and/or continued pain (20%) and (35%) can be expected.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1984

Osteonecrosis in the transplant recipient.

From 1969 to 31 March 1982, 1,769 organ transplants were performed by the University of Minnesota Transplant Service. Fifty-one patients had severe osteonecrosis develop requiring 83 total joint arthroplasties. Patients with diabetes were underrepresented in the arthroplasty population; this may be due to neuropathy masking some disease. All of the patients received dramatic relief from pain and experienced improved function. Only one surgical mortality occurred--a patient with sepsis. To minimize complications, prophylactic antibiotics were used, and most patients did not undergo prophylactic anticoagulation. The most common complication was dislocation of the hip, at five to eight times the rate of those in the nontransplant arthroplasty population. These can be minimized by avoiding the posterior lateral surgical approach and by meticulous capsular repair. Despite the youth and activity of these patients, component wear was not a problem. However, because of the multicentric nature of this disease, components and surgical approach should be chosen carefully. Incidence of severe osteonecrosis was highest among cadaver kidney recipients. No HLA identical kidney recipient had severe osteonecrosis develop. Consequently, we concur with previous authors that osteonecrosis may be caused by the higher dosages of immunosuppressive agents required to prevent rejection of HLA nonidentical organs.

Adolescent↗
PubMed1984

Percutaneous subclavian vein catheterization for hemodialysis in small children.

Angioaccess for hemodialysis in infants can be accomplished by percutaneous insertion of an Uldall catheter if certain modifications are made. We have used this technique in six children for 2 to 9 weeks until either fistulas matured for chronic dialysis, transplantation could be accomplished, or uremia resolved.

Body Weight↗
PubMed1983

H-2 antigen class: effect on mouse islet allograft rejection.

Rejection of mouse pancreatic islet allografts occurred in a high percentage of donor recipient combinations identical for H-21-region antigens and differing at H-2K and H-2K + H-2D without I-region disparities. The results suggest that disparities in major histocompatibility complex antigens of class I (H-2K and H-2D) alone are capable of eliciting islet allograft rejection, and that lack of a stimulus from class II (I-region) alloantigens does not ensure permanent islet allograft survival.

Animals↗
PubMed1983

Technical aspects of segmental pancreatic grafting in rats.

Four techniques for segmental pancreatic transplantation were used sequentially in rats. The success rate and the incidence and type of technical complications that developed in each group of recipients were determined and attempts were made to improve the microsurgical technique. A strict comparison of the relative merits of the four different techniques was not made, but rather the development of an approach to an original technique that resulted in a high success is rate presented. The various modifications and details of this experience are documented. The various complications, each of which results in a typical postoperative pattern of weight and plasma glucose changes and each of which is preventable by the use of proper microsurgical techniques, are also analyzed.

Aneurysm↗
PubMed1983

Technical aspects of segmental pancreatic autotransplantation in dogs.

Heterotopic segmental pancreatic autotransplantation in dogs is more appropriate than allograft models for the investigation of several problems associated with transplantation. We have defined the anatomic variations of blood supply in the pancreatic tail and designed various modifications of vascular anastomosis to the iliac vessels in order to eliminate technical failures, such as thrombosis, as much as possible. In 187 of 240 dogs (77.9 percent), the pancreatic artery originated from the splenic artery and the pancreatic vein entered the splenic vein (normal anatomy). The main venous variation was direct confluence of the pancreatic and portal veins (12.1 percent), and the main arterial variation was origin of the pancreatic artery from the superior mesenteric artery (10 percent). Ninety-seven animals with normal anatomy qualified for a comparative study of seven methods of segmental pancreatic autotransplantation. Venous anastomoses were always performed in an end-to-side fashion between the splenic and external iliac veins. Arterial anastomosis techniques follow. Group I: interposition of the splenic artery into the external iliac artery; (14 days, failure rate 50 percent), Group II: end-to-end arterial anastomosis of the splenic artery to a long external iliac artery segment with the graft directed caudad, resulting in an acute curve to the vessel loop (8 dogs, failure rate 38 percent); Group III: end-to-end arterial anastomosis to a long external iliac artery with the graft directed cephalad, resulting in a gentle curve to the vessel loop (11 dogs, failure rate 36 percent); Group IV: end-to-end arterial anastomosis to a short external iliac artery stump (20 dogs, failure rate 20 percent); Group V: same as in Group IV with the addition of a distal splenic arteriovenous fistula (12 dogs, failure rate 17 percent); Group VI: end-to-side anastomosis of the splenic artery to the external iliac artery (31 dogs, failure rate 6 percent); Group VII: same as in Group VI but with the addition of an arteriovenous fistula of the distal splenic vessels (1 dog, failure rate 0). The end-to-side technique proved to be straight-forward and reliable. The low failure rate with this method allows metabolic preservation and other aspects of pancreatic transplantation to be studied and the results to be interpreted without the influence of a high complication rate from the operation itself.

Animals↗
PubMed1983

Predictive value of thallium stress testing for coronary and cardiovascular events in uremic diabetic patients before renal transplantation.

Coronary artery disease and the ability of noninvasive exercise perfusion imaging with thallium-201 to predict future coronary and cardiovascular events was prospectively evaluated in a group of 85 insulin-dependent diabetic renal transplantation candidates. Sixty patients received renal allografts (36 living related donors, 24 cadaver donors) after a thallium stress test; the actuarial 2 year patient survival rate after transplantation was 84 percent. Twenty-five patients remained on dialysis, and the 2 year actuarial survival rate from onset of dialysis was 41 percent, significantly lower than the actuarial survival rate of transplanted patients (p less than 0.01). Thirteen transplanted patients had positive thallium stress test results, and 6 (46 percent) had cardiovascular events (two fatal). In contrast, of 47 transplant patients with negative thallium stress test results, only 13 (28 percent) had cardiovascular events (four fatal). Five patients treated by hemodialysis only had positive test results and three (60 percent) had cardiovascular events (two fatal), whereas of 20 hemodialysis patients with negative test results, 9 (45 percent) suffered cardiovascular events (four fatal). In this study, cardiovascular events included arrhythmia, stroke, and pulmonary embolism. Within the total group, 4 of 18 patients (22 percent) with a positive test result (22 percent) had a fatal myocardial infarction, whereas only 3 of 67 patients (4 percent) with a negative result had a fatal myocardial infarction (p less than 0.05). In comparison, 24 of 85 patients had a history or electrocardiographic evidence of preexisting cardiovascular disease, and 13 (54 percent) had subsequent cardiovascular events (5 of 11 patients with positive test results and 8 of 13 patients with negative results). In summary, renal transplant candidates with positive thallium stress test results appear to be at increased risk compared with those with negative results for the development of fatal myocardial infarction, but thallium stress testing is no more predictive for future coronary and cardiovascular events than is a history or an abnormal electrocardiogram.

Adult↗
PubMed1983

Successful long-term cryopreservation of neonatal rat islet tissue.

Neonatal rat pancreatic tissue was frozen to -196 degrees C using Me2SO as a cryoprotectant and a slow freezing rate to -70 degrees C followed by immersion in liquid nitrogen. Rapid thawing was used. Viability was demonstrated by successful transplantation to streptozotocin-induced diabetic recipients. Long-term preservation, up to 4 weeks, did not demonstrably affect viability. Cryopreservation techniques may afford a method for providing a diabetic recipient the opportunity to receive a large quantity of pooled islet tissue from well-matched donors.

Animals↗