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D E Sutherland

Publications and source records attributed to D E Sutherland.

At least 649 records · Page 36Linked to original sources
PubMed1983

Clinical pancreas and islet transplantation. Part 1: registry statistics and an overview.

Pancreas transplantation has evolved into a safe and moderately successful procedure for the treatment of selected patients whose diabetic complications are more serious than the potential side effects of chronic immunosuppression. Islet transplantation, however, remains largely unsuccessful. An overview of pancreas and islet transplantation experience worldwide is presented. Results of transplants according to association with kidney transplants, technique, immunosuppression, and organ preservation are evaluated.

Adult↗
PubMed1983

Primary gallbladder carcinoma: significance of subserosal lesions and results of aggressive surgical treatment and adjuvant chemotherapy.

Advances in methods to diagnose biliary disease have not improved the dismal survival rates reported for primary gallbladder cancer. We analyzed the results of operation in 112 patients with gallbladder cancer. Tumors limited to the gallbladder wall and those that required aggressive surgical therapy and adjuvant chemotherapy for advanced disease were analyzed separately according to the following staging system: tumors that were localized to the mucosa (stage, I, n = 4); tumors that penetrated the muscularis (stage II, n = 4); subserosal tumors (stage III, n = 3); tumors with cystic node involvement (stage IV, n = 13); and tumors that had spread to adjacent organs (stage V, n = 88). Of the 11 patients (10%) with tumor limited to the gallbladder wall (stages I to III), one of five patients (20%) treated with cholecystectomy alone and four of six patients (60%) treated with cholecystectomy and lymphadenectomy (with hepatic wedge resection in three and pancreaticoduodenectomy in one) were alive and tumor free 3 to 6 years after operation. Three patients treated with cholecystectomy alone died of recurrent cancer at 18, 48, and 60 months after operation. Of the 13 patients with cystic node involvement (stage IV), nine were treated by cholecystectomy alone, three with lymphadenectomy, and one with pancreaticoduodenectomy; the cumulative survival rate was only 37% at 6 months, and all patients were dead within 18 months. Of 14 patients with advanced disease (stage V) treated with aggressive surgical therapy, including lymphadenectomy in six patients, hepatic wedge resection in six patients, and right hepatic lobectomy in two patients, the mean survival rate was only 3 months.

Adult↗
PubMed1983

Quantitative glomerular morphology of the normal human kidney.

We determined glomerular basement membrane (GBM) width (as the harmonic mean) and relative volumes of the glomerular mesangium and of its cellular and matrix components in 59 male (73% living-related) and 59 female (93% living-related) donors of kidneys for transplantation. The GBM, consistently wider in male (mean, 373 nm.) versus female (mean, 326 nm.) donors, increased in width in all donors until the fourth decade of life when it appeared to decrease in width. The relative volume of the mesangium did not differ as to sex or age (mean, 14.2% of the glomerular volume), nor did either of its components (mean cellular mesangium, 7.1%; mean matrix mesangium, 7.1%). We found no correlations among renal index, GBM width, or the mesangium. No parameter differed in diabetic-related compared with nondiabetic-related donors. Results in cadavers for GBM width and the mesangium were no different from those of living-related donors. These observations yield insights into the development of the human kidney and its glomerular components, and in addition the GBM and mesangial measures will serve as normative values to which surgical or biopsy specimens can be related.

Adolescent↗
PubMed1982

Pancreas transplantation.

Between December, 1966 and October, 1981, 183 pancreas transplants were performed in attempts to correct the metabolic defect in 171 insulin-dependent diabetic patients. Nearly half of the transplants have been performed in the last two years. Currently, 20 patients have functioning grafts and are insulin independent. Twelve grafts (including six current ones) functioned for more than a year (the longest for four years). A variety of techniques have been used to drain or suppress the secretions of the exocrine pancreas; the most frequent method is injection of the pancreatic duct with a synthetic polymer. In most patients carbohydrate metabolism has been normal or nearly normal while the graft was functioning. Although the technical problems are not entirely solved, the major cause of graft failure has been rejection. The need for antirejection therapy has limited the application of pancreas transplantation to diabetic renal allograft recipients or to non-uraemic patients whose complications of diabetes are, or predictably will be, worse than the side- effects of chronic immunosuppression. If consistently effective methods to suppress the immune response of the recipient to donor histocompatibility antigens are developed, pancreas transplantation could be applied to a wider variety of diabetic patients.

Diabetes Mellitus↗
PubMed1982

Fractionated total lymphoid irradiation as preparative immunosuppression in high risk renal transplantation: clinical and immunological studies.

Twenty-two patients at high risk to reject renal allografts have been treated with fractionated total lymphoid irradiation (FTLI) prior to transplantation of primary (2), secondary (16) or teritary (4) renal allografts. All patients undergoing retransplantation had rapidly rejected previous grafts. At 24 months following transplantation, 72% of grafts were functioning in the TLI group compared with a 38% graft function in an historical control group of recipients receiving secondary or tertiary grafts and treated with conventional immunosuppression. Important variables in determining success of transplantation following fractionated TLI include the dose of TLI, the interval from radiation to transplantation, and maintenance, post-transplant immunosuppressive therapy. Optimal results were achieved with 2500 rads delivered in 100 rad fractions followed by transplantation within two weeks, and a tapering prednisone schedule and maintenance azathioprine post-transplantation. Seventeen patients had significant complications of the radiation treatment and there was one death, prior to transplantation, associated with pneumonitis. In vitro assessment of immune function demonstrated marked peripheral T cell depletion and loss of in vitro responsiveness to mitogen and allogeneic stimulation following FTLI. The administration of donor bone marrow at the time of transplantation did not produce chimerism. The results suggest that when properly utilized FTLI can produce effective adjunctive immunosuppression for clinical transplantation.

Adolescent↗