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M Büsing

Publications and source records attributed to M Büsing.

At least 19 recordsLinked to original sources
PubMed2002

Combined pancreas and kidney transplantation in a lean type 2 diabetic patient. Effects on insulin secretion and sensitivity.

BACKGROUND/AIMS: Pancreas transplantation is an established method of treating Type 1 diabetes. It was our aim to test the consequences of pancreas transplantation in a Type 2 diabetic patient by determining insulin secretion and sensitivity before and after surgery. PATIENTS AND METHODS: A female patient with Type 2 diabetes and end-stage nephropathy was treated with combined pancreas and kidney transplantation. Before surgery and at 4 weeks, 6 months and 2 years afterwards, insulin sensitivity was measured using hyperinsulinemic euglycemic clamps and insulin secretion was quantified after oral glucose or intravenous glucagon challenges. RESULTS: The patient was insulin resistant before surgery (glucose infusion 4.6 mg. kg (-1). min (-1), normal range 6.4 +/- 0.5 mg.kg( -1). min (-1). Insulin sensitivity declined further after transplantation (1.4 and 3.0 mg. kg -1. min -1 after 4 weeks and 6 months, respectively), but improved to 5.4 mg. kg (-1). min (-1) after 2 years. Insulin secretion was greatly impaired before surgery. Insulin and C-peptide responses after oral glucose and intravenous glucagon increased into the normal range from 6 months after surgery onwards and oral glucose tolerance remained non-diabetic (IGT). CONCLUSIONS: Insulin resistance is first aggravated after pancreas transplantation, probably due to immunosuppressive treatment including glucocorticoids, but improves on the long term. The initially impaired insulin secretion from the transplant may also be explained by the action of glucocorticoids or by transient and reversible organ damage.

Diabetes Mellitus, Type 2↗
PubMed1998

[Pancreas transplantation with bladder and intestinal drainage technique with systemic-venous and initial experiences with portal venous drainage. Which technique can be recommended today?].

The experience worldwide with pancreas transplantation includes more than 9000 cases. In the most popular patient group (simultaneous pancreas-kidney transplantation, SPK) the graft-function rate at 1 year now reaches more than 80%. More than 90% of all pancreas transplants were performed using the bladder-drainage technique (BD) with systemic venous anastomosis. Late problems with the BD require enteric conversion in 10-20% in the long term. In the present study we report the results of 40 SPK using the BD (n = 20) and enteric drainage (ED) techniques (n = 20). After 3 months, the patients pancreas and kidney survival rates in the BD group were 100, 95 and 100% and in the ED group 100, 100 and 100%, respectively. No anastomosis leakage occurred in either group. In two cases of the ED group the pancreas grafts were drained portal venously via the superior mesenteric vein without surgical complications. With growing experience, excellent SPK results can be reached with both the BD and ED techniques.

Adult↗
PubMed1998

Diagnosis and management of metastatic gastrinoma by multimodality treatment including liver transplantation: report of a case.

Neuroendocrine tumors of the pancreas are being recognized with increasing frequency, not because the incidence has increased, but as a result of improvements in diagnostic tools such as radioimmunoassays for a variety of circulating peptides, and imaging methods that include positron emission tomography (PET) and immunoscintigraphy. Nevertheless, establishing the diagnosis of a neuroendocrine tumor is always a challenge to the clinician from both diagnostic and therapeutic perspectives. Liver transplantation as the ultimate therapeutic, or at least palliative, option for hepatic metastases has produced contradictory results over the past decade. We report herein the case of a 23-year-old woman who, after being diagnosed with gastrinoma in 1989, underwent the complete therapeutic array including liver transplantation for hepatic metastases in 1991. Although an extrahepatic tumor recurred 2 years later, for which double chemotherapy with 5-FU and streptozotocin was given, she is currently leading a normal life with a full-time job. This case prompted a critical review of the current literature on diagnosis and medical and surgical treatment.

Adult↗
PubMed1997

Simultaneous pancreas-/kidney transplantation--the Bochum experience.

Since the introduction of the bladder drainage technique, the number of pancreas transplants performed has now reached 1,000 per year worldwide. Most of these transplants have been performed in the United States. In contrast, the number of pancreas transplants performed in the Eurotransplant community has remained at a low level for several years. The results of a consecutive series of 40 simultaneous pancreas/kidney transplantations (SPK) performed between June 1994 and July 1996 demonstrate that high 1-year graft function rates of 87.1% for pancreas and 94.8% for kidney grafts can be achieved. Therefore, SPK can be recommended as a standard procedure for patients with insulin-dependent diabetes mellitus and end-stage renal disease in Germany, too.

Adult↗
PubMed1997

The oncological approach to pylorus preserving pancreatoduodenectomy (PPPD) in pancreas malignancies.

There has been a considerable debate about whether pylorus preservation significantly detracts from the radicality in a palliative procedure where a conventional Whipple operation would have been curative. We know now, that the extending radicality of the Whipple operation does not improve the long-term survival rates. Our results of 127 PPPD and 54 Whipple procedures in pancreas malignancies from 1985 to 1996 showed the nutritional benefits of the PPPD group as compared to the standard Whipple group. 84% (99/121) vs. 24% (13/50) were able to gain postoperatively. The long-term survival rates of both groups and the results in the literature are similar.

Breath Tests↗
PubMed1996

Bone regeneration with resorbable polymeric membranes. III. Effect of poly(L-lactide) membrane pore size on the bone healing process in large defects.

Poly(L-lactide) membranes of various pore sizes: microporous, medium pore size (10-20 microns), and large pore size (20-200 microns) were implanted in 15 mature New Zealand female rabbits to cover a 10-mm diaphyseal defect created in the radius. Five rabbits were implanted with each membrane. No internal fixation was used, as it was assumed that the intact ulna splints the radius adequately. Postoperative radiographs revealed the formation of hematoma within the bone defect. At the 2nd week after surgery, the hematoma was resorbed and the formation of new bone was noted radiologically either at the ends of the bone fragments or as osteophytes on the proximal and distal edges of the membrane. At 4 weeks, the newly formed bone was growing centripetally from the fragment ends. The bone regeneration took place in the majority of the cases under investigation, regardless of the pore size of the polymeric membranes used. There were, however, some differences in the intensity of the bone regeneration process. Although at 2 weeks after surgery bone formation was seen radiographically in all animals, at 6 months five rabbits of five, four rabbits of five, and three rabbits of five implanted respectively with microporous membrane, medium pore-size membrane, and large pore-size membrane showed complete regeneration of bone within the defects. It is suggested that the primary function of the membrane used to cover bone defects is to preserve the osteogenic components present in the space under the membrane from escaping and support the growth of cells within the "medullary cavity" formed by the tubular implant.

Animals↗
PubMed1996

Liposoluble antioxidants are not consumed in the pancreas after reperfusion in human simultaneous pancreas-kidney transplantation.

There is considerable evidence that under experimental conditions, oxygen free radicals (OFRs) are decisive in the pathogenesis of ischemia-reperfusion injury. Normally OFRs are scavenged by antioxidants such as alpha-tocopherol. Thus, in the following study we investigated whether antioxidants are consumed locally in human pancreatic grafts after reperfusion. A series of ten patients receiving bladder-drained pancreaticoduodenal and renal allografts were studied. Sequential blood samples were drawn locally from the venous outflow of the graft and simultaneously from the radial artery after reperfusion. alpha-Tocopherol, retinol, lycopene, and alpha- and beta-carotene levels were determined. After reperfusion these levels remained largely unchanged. Hence, in our study a consumption of antioxidants locally in the pancreatic graft after transplantation was not demonstrated. Therefore, the antioxidant capacity seems not to be exhausted at that time. This suggests that in clinical pancreatic transplantation oxidant stress in the initial reperfusion period might not have the relevance suggested by animal models.

Antioxidants↗
PubMed1996

Determinants of a normal (versus impaired) oral glucose tolerance after combined pancreas-kidney transplantation in IDDM patients.

After successful pancreas transplantation, insulin-dependent diabetic patients are characterized by a normal or at worst impaired oral glucose tolerance (World Health Organisation criteria). It is not known which pathophysiological mechanisms cause the difference between normal and impaired oral glucose tolerance. Therefore, we studied 41 patients after successful combined pancreas-kidney transplantation using stimulation in the fasting state with oral glucose (75 g), intravenous glucose (0.33 g/kg) and glucagon bolus injection (1 mg i.v.). Glucose (glucose oxidase), insulin and C-peptide (immunoassay) were measured. Repeated-measures analysis of variance and multiple regression analysis were used to analyse the results which showed: 28 patients had a normal, and 13 patients had an impaired oral glucose tolerance. Impaired oral glucose tolerance was associated with a greatly reduced early phase insulin secretory response (insulin p < 0.0001; C-peptide p = 0.037). Age (p = 0.65), body mass index (p = 0.94), immunosuppressive therapy (cyclosporin A p = 0.84; predniso(lo)ne p = 0.91; azathioprine p = 0.60) and additional clinical parameters were not different. Reduced insulin secretory responses in patients with impaired oral glucose tolerance were also found with intravenous glucose or glucagon stimulations. Exocrine secretion (alpha-amylase in 24-h urine collections) also demonstrated reduced pancreatic function in these patients (-46%; p = 0.04). Multiple regression analysis showed a significant correlation of 120-min glucose with ischaemia time (p = 0.003) and the number of HLA-DR mismatches (p = 0.026), but not with HLA-AB-mismatches (p = 0.084). In conclusion, the pathophysiological basis of impaired oral glucose tolerance after pancreas transplantation is a reduced insulin secretory capacity. Transplant damage is most likely caused by perioperative influences (ischaemia) and by the extent of rejection damage related, for example, to DR-mis-matches.

Adult↗
PubMed1996

[Combined pancreas/kidney transplantation as standard procedure in therapy of type I diabetic patients in renal failure].

Sinde the introduction of the bladder drainage technique, the number of pancreas transplants performed has now reached 1000/year worldwide. Most of these transplants have been performed in the United States. In contrast, the number of pancreas transplants performed in the Eurotransplant community has remained at a low level for several years. The results of a consecutive series of 20 simultaneous pancreas/kidney grafts (SPK) performed between June 1994 and October 1995 demonstrate that high graft function rates of 83.5% for pancreas and kidney grafts can be achieved. Therefore SPK can be recommended as a standard procedure for patients with insulin-dependent diabetes mellitus and end-stage renal disease in Germany, too.

Adult↗
PubMed1996

[Kidney donation by the elderly--an emergency solution?].

In 1994 the number of kidney donors once again decreased in Germany. On the other hand, more and more old people are being considered for renal transplantation; thus the shortage of transplants is becoming more severe. The kidneys of elderly donors might improve this situation. The results available are inconsistent. There is no doubt that kidney function declines with age, but the individual aging process depends mainly on concomitant disease, especially arterial hypertension. Transplantation of kidney from an elderly person requires appropriate selection of donors as well as good perioperative management. Doctors in medical intensive care units should contact transplant centres more often to evaluate potential elderly kidney donors. More open-minded assessment of certain situations is necessary in conservative medical disciplines.

Adult↗