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Biomedical subjects

R Caldara

Publications and source records attributed to R Caldara.

At least 37 records · Page 2Linked to original sources
PubMed1992

Octreotide administration in the treatment of pancreatic fistulae after pancreas transplantation.

Among the surgical complications of pancreas transplantation are pancreatic fistulae, which arise rather frequently. Suppression of exocrine secretion with polymers has succeeded in reducing the rate of this complication. Nevertheless, in some instances, pancreatic fistulas may occur. Thirty pancreas transplantations were performed in 27 diabetic patients. In 5 cases a pancreatic fistula occurred and was drained after the insertion of a catheter for the collection of secretions. A serous liquid was collected with a high concentration of amylases (61604 +/- 19562 IU/24 h). Fistula output was 280 +/- 87 ml/24 h. Patients were treated with octreotide, administered subcutaneously in a dose of 300-750 micrograms/day. In all patients a progressive reduction in fistula output was observed after a mean of 16 + 2 days. Fistula flow rate dropped to 24 +/- 10 ml/24 h--a reduction of 95% +/- 5% and drainage was subsequently stopped. Sonographic follow-up did not show recurrence of peripancreatic collections in these patients. All patients were insulin-independent up to 12-44 months after surgery.

Adult↗
PubMed1991

Pancreas and kidney transplantation: the San Raffaele Hospital (Milan, Italy) experience.

Results of 33 simultaneous pancreas and kidney transplantations performed at the San Raffaele Hospital, Milan, Italy are presented. In 26 cases segmental neoprene duct-injected grafts were transplanted and in seven cases, duodenopancreatic bladder-drained grafts. Five-year patient, kidney and pancreas survival were respectively, 89%, 72% and 58%. Five-year survival in patients with technically successful pancreas transplants was 73%. Thrombosis occurred in 20% of cases. Mortality was 6% and overall morbidity 76%. Surgical complications were present in 51% of cases.

Adult↗
PubMed1991

Metabolic control after kidney and pancreas transplantation: whole series results and effects of segmental duct obstruction versus whole pancreas with bladder diversion technique.

From October 1976 to December 1990 181 pancreatic transplants were performed in our centre on 171 Type 1 (insulin-dependent) diabetic patients. Oral glucose tolerance test evaluated 1 year after surgery in 31 subjects showed an impaired glucose tolerance at 120 min (blood glucose 9.5 +/- 0.6 mmol/l). Similar results were obtained in seven patients 3 years after transplantation (blood glucose at 120 min 8.3 +/- 1.08 mmol/l). 24h metabolic profiles performed at the same intervals showed near normal blood glucose levels and good insulin release. Preliminary data concerning a randomized, comparative study between whole pancreas with bladder diversion and segmental pancreas transplantation, showed better metabolic control in the patients who received the whole pancreas, probably due to the greater islet mass grafted.

Adult↗
PubMed1991

First peak insulin release after intravenous glucose and arginine is maintained for up to 3 years after segmental pancreas transplantation.

In this study we have investigated blood glucose and serum free insulin response to glucose and to arginine orally or intravenously, 3 months and 3 years after a successful segmental, neoprene-injected, pancreas transplantation. Serum insulin responses to different secretagogues were normal 3 months after transplantation; they remained normal up to 3 years after transplantation.

Arginine↗
PubMed1991

Effect of pancreas transplantation on diabetic retinopathy: a 20-case report.

In order to study the effects of normoglycaemia on diabetic retinopathy, 20 diabetic uraemic patients who underwent a kidney-pancreas transplantation were evaluated before and after surgery (6.9 months and once a year). The control group consisted of 12 uraemic patients who underwent kidney transplantation alone. At each follow-up examination a complete clinical examination and a retinal fluorescein angiography were performed. The eyes with end-stage retinopathy at baseline were excluded from the study. The analysis of the results showed no significant differences in the two groups. The diabetic retinopathy at the moment of the transplantation was already too advanced to benefit from the better glycaemic control.

Adult↗
PubMed1991

Neurophysiological study of the effect of combined kidney and pancreas transplantation on diabetic neuropathy: a 2-year follow-up evaluation.

Previous study have reported a significant improvement of peripheral neuropathy following combined pancreas and kidney transplantation attributed to improvement of blood glucose control by some authors and to elimination of uraemia by others. To asses the specific role of uraemia and hyperglycaemia in neuropathy, 16 diabetic uraemic patients with combined pancreas and kidney transplantation were compared to 9 diabetic patients with a renal graft only. Neurophysiological studies of peripheral neuropathy included ulnar and deep peroneal nerve motor conduction velocity, median and sural nerve sensory conduction velocity were performed at baseline and 1 and 2 years after transplantation. One year after transplantation mean nerve conduction velocity significantly improved in both groups. However, changes were statistically significant in the kidney-pancreas group only. At the 2 year follow-up nerve conduction velocity had increased further in the pancreas-kidney group only. These data suggest that improvement of nerve conduction velocity following pancreas and kidney transplantation is predominantly due to the long-term euglycaemic state.

Adult↗
PubMed1991

Effect of pancreas transplantation on life expectancy, kidney function and quality of life in uraemic type 1 (insulin-dependent) diabetic patients.

The aim of our study was to evaluate the effects of haemodialysis, kidney transplantation and simultaneous kidney and pancreas transplantation on survival of diabetic subjects and on kidney function. 40 Type 1 (insulin-dependent) diabetic patients received a kidney transplantation: in 31 cases the kidney was transplanted simultaneously to a pancreas graft from the same donor (KP group), while in 9 cases the pancreas was not available (K group). 44 uraemic Type 1 (insulin-dependent) diabetic patients on dialysis and in waiting list for kidney transplantation, constituted the control group (HD group). Patient survival rate 1, 3 and 5 years following transplantation was better in KP group (93%, 89%, 89%, respectively) and in K group (88%, 88%, 73%, respectively) and in HD group (88%, 62%, 51%, respectively). Kidney graft survival at 1, 3 and 5 years post-transplant was better in KP group (93%, 72%, 72%, respectively) than in K group (76%, 61%, 31%, respectively). 1 year after transplantation, patients of the KP group who had lost the pancreas for technical reasons (thrombosis) were included in the K group so as to evaluate the effect of the transplanted pancreas on long-term patient and kidney survival. Patient survival rate in the KP group (17 patients) at 2 and 4 years was 100%, while at the same intervals it was 78% in the K group (13 patients). Kidney graft function rate at 2 and 4 years was 93% in the KP group (17 grafts) and 54% and 27% respectively in the K group (14 grafts).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Technique of pancreas revascularization after combined liver and pancreas harvesting in the same cadaveric donor.

Combined liver and pancreas harvesting in the same donor is nowadays a routine procedure in our institution. In terms of sharing of the vascular pedicule the priority is given in the majority of cases to the liver graft. Thus vascular reconstruction of the pancreatic graft is often required before transplantation. From February 1987 to June 1990 we transplanted 62 pancreases coming from a donor where also a liver graft had been harvested; 46 were segmental grafts prepared by duct injection with neoprene, 14 were pancreatico-duodenal grafts with bladder diversion of the exocrine secretion, and 2 were whole pancreas scheduled for bladder diversion and secondarily reconverted to duct injection (1 whole and 1 segmental graft) for poor duodenal blood supply. Among the 47 segmental grafts (46 + 1 reconverted from whole to segmental), in only 10 cases was the celiac axis with an aortic patch possible; conversely in 37 cases the splenic artery had been divided at its origin during the harvesting; bench surgery for vascular reconstruction was realized in 33 cases. Among the 14 pancreatico-duodenal grafts with bladder diversion and the whole pancreas with duct obstruction, in 5 cases the celiac axis and the superior mesenteric artery were harvested on the same aortic patch; in 10 cases the splenic artery was divided at its origin during the harvesting, requiring bench surgery for reconstruction.

Cadaver↗
PubMed1991

Pancreas transplantation: long-term results.

The rationale behind pancreatic transplantation is to provide a self-regulated, endogenous source of insulin and other islet hormones, thus restoring normal metabolism with the ultimate goals of prevention, stabilization or reversal of secondary degenerative complications. We report clinical and metabolic data of 8 patients submitted to simultaneous kidney and pancreas transplantation in our institute, who had a pancreatic graft function for 4 (1 case) and 5 (7 cases) years. To assess the impact of transplanted pancreatic mass on long-term function, we also included 10 patients from a comparative study between segmental pancreas transplantation (group A, 5 pts) and whole pancreas with enteric diversion transplantation (group B, 5 pts), who had pancreatic function for 2 and 3 yr. All patients are alive. Seven of these patients are off insulin, while one patient lost pancreatic function during an operation performed to correct an arterial stenosis of the graft. HbAlc levels were normal during the entire follow-up period (5.2+/-0.14% at 4 yr; 5.1+/-0.6% at 5 yr). In 24-hour metabolic profiles we observed near normal blood glucose levels, with good insulin release at 4 yr and a mild hyperglycemia at 5 yr (BG at 9 p.m.: 8.8+/-1.3 mmol/l). OGTT performed in 5 patients, 4 yr after pancreas transplantation, showed an impaired glucose tolerance, while the same test performed at 5 yr, showed higher values (BG 120 minutes: 14.7+/-0.2 mmol/l). Group A and group B patients are all alive, with good renal and pancreatic function.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Effects of FCE20700, a new PGE2 derivative, on gastric acid secretion and cytoprotective processes in man.

The pharmacodynamic effects of FCE20700, a new PGE2 derivative, have been investigated in 6 healthy volunteers given single intragastric (i.g.) and intraduodenal (i.d.) doses of 1 and 2 mg and placebo, according to a double-blind, within-subjects design. For 30-270 min following i.g. administration the effect of FCE20700 on peptone-stimulated gastric acid secretion (AS) was assessed by i.g. titration, and serum gastrin (G) levels were also determined. For the same period after i.d. dosing the effect of the compound on pentagastrin-stimulated AS and on mucoproteins and bicarbonate content in the gastric juice was measured. Blood pressure (BP), heart rate and possible side-effects were monitored. Following i.g. administration there was a moderate, dose-related, significant inhibition of AS; significant inhibition of G levels was observed only after the highest dose. After i.d. administration there was a very modest though dose-related and significant inhibition of AS; a brief maximal increase in mucoproteins and in bicarbonate levels was apparent after the 1 mg dose. After i.d. but not after i.g. administration of 2 mg there was a modest but significant decrease in BP. No side-effects of clinical relevance were reported. The results appear to suggest a major activity of FCE20700 on cytoprotection rather than in inhibiting gastric acid secretion. The observed change in BP may indicate that after i.d. administration there will be some systemic effects of FCE20700.

Adult↗