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Biomedical subjects

X Martin

Publications and source records attributed to X Martin.

At least 163 records · Page 9Linked to original sources
PubMed1991

Pancreas transplantation in Lyon: overall results.

A total of 182 pancreatic transplantations were performed between 1976 and 1990. Survival of the grafts was 45% at 5 years. Major causes of graft loss have been rejection and venous thrombosis. Death occurred in 24 patients and was usually related to vascular complications. The techniques of duodenopancreatic transplantation with enteric drainage, bladder drainage and the technique of segmental duct obstructed grafts were compared. A higher rate of surgical complications was observed with enteric drainage, whereas it is unclear from the data whether segmental grafts or duodenopancreatic grafts drained into the bladder lead to different results.

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

Ophthalmological follow-up of type 1 (insulin-dependent) diabetic patients after kidney and pancreas transplantation.

We studied the effect of successful kidney and pancreas transplantation on visual function and diabetic retinopathy in 18 patients with long-term Type 1 (insulin-dependent) diabetes mellitus (17 to 38 years) and with advanced proliferative retinopathy. The average age of the patients was 42 years. Prior to transplantation, 5 eyes were in end-stage ophthalmic complication due to neovascular glaucoma. An ophthalmological follow-up was performed between 1-6 years post-surgery. Analysis of the results showed that the diabetic retinopathy had stabilized after transplantation in 12 cases (66%) with a supplementary photocoagulation in the majority of cases. The proliferation continued in 4 patients (22%) leading to blindness in 2 patients and recurrence of vitreous haemorrhages despite the photocoagulation in the other 2 cases. An improvement was observed on fluorescein angiography in a patient with pre-papillar glial proliferation without photocoagulation. Ten patients were reported to have a cataract and were operated on in two cases before transplantation; in one patient, the cataract increased following transplantation. In conclusion, the kidney and pancreas transplantation was not effective in our patients in reversing the clinical and angiographic signs of diabetic retinopathy. Moreover, a worsening of the lesions was observed in some cases; this was probably due to the irreversible microangiopathic lesions due to advanced evolution of diabetes.

Adult↗
PubMed1991

Sequential electrodiagnostic evaluation of diabetic neuropathy after combined pancreatic and renal transplantation.

To assess the long-term evolution of diabetic polyneuropathy after a combined kidney-pancreas transplant, an electrophysiological study was performed in 20 diabetic patients before transplant, and 1 (n = 18), 2 (n = 16), 3 (n = 10) and 4 years (n = 5) at a later date. Motor and sensory scores were calculated for conduction velocity and amplitude to determine the physiopathological process. During evolution the scores were not found to be decreasing. Motor and sensory velocity scores were significantly improved (p less than 0.05) 1 and 2 years after the graft, when score values tended to stabilize. Motor and sensory amplitude scores, which are more sensitive for axonal loss assessment were slightly but not significantly improved.

Adult↗
PubMed1991

Endocrinometabolic effects of whole versus segmental pancreas allotransplantation in diabetic patients--a two-year follow-up.

We have investigated the metabolic effects of segmental (neoprene-injected) pancreas transplantation versus whole (enteric-diverted) pancreas transplantation. Seventeen uremic insulin-dependent diabetes mellitus (IDDM) patients received a simultaneous pancreaticorenal transplant: in a prospective, randomized study, 9 patients received a segmental neoprene-injected graft (group A) while 8 patients received a total pancreaticoduodenal graft, with enteric diversion (group B). The immunosuppressive therapy was based on ALG, CsA, azathioprine, and steroids. Three months after surgery, patients were submitted to the following metabolic investigation: i.v. and oral glucose tolerance tests, Hba1, i.v. arginine test, and a 24-hr metabolic profile. The OGTT, HbA1, and metabolic profile were repeated 12 and 24 months after transplantation. At 3 months after transplantation, the OGTT showed delayed insulin secretion and higher blood glucose levels in group A. Serum insulin levels after IVGTT or arginine were higher in group B than in group A. OGTT at 12 and 24 months were unchanged in group B, while in group A a higher incidence of impaired glucose tolerance (IGT) and diabetes mellitus response were observed. HbA1 and blood glucose levels during the 24-hr profile showed good metabolic control in both groups at 3, 12, and 24 months. We can conclude that both the segmental and total pancreas transplantation restore a good metabolic control in IDDM patients, though a higher incidence of IGT and DM responses were observed after OGTT in the patients receiving a segmental graft. These abnormalities do not seem to interfere with metabolic control in everyday life. These results seem to be the consequence of the different B cell masses transplanted with these two techniques.

Adult↗
PubMed1991

Cystine stones: the impact of new treatment.

The hardness and frequent recurrence of cystine stones present a special challenge to the urologist. In this study, 15 cystinuric patients (11 males, 4 females; mean age 36 years, range 17-54) were treated and followed up over a period of 30 months (range 2-40). Most patients had previous history of open surgery. The diagnosis of cystinuria was confirmed by metabolic studies and infrared spectrometry of stones. Over the follow-up period recurrence was observed in 23 instances in 11 patients, leading to 38 "stone treatments" on 74 cystine stones. The percutaneous approach was used alone in 9 cases and in association with extracorporeal shock wave lithotripsy (ESWL) in 9 cases. ESWL was used alone in 18 cases. Medical treatment included high fluid intake, alkalinisation and Thiola (tiopronin, N-(2-mercaptopropionyl)glycine) in 6 patients. The overall stone-free rate assessed 3 months after treatment was 44.7%, which compares poorly with the rate for non-cystine stones. The recurrence rate is very high and instrumental treatment should not therefore be used excessively; it is indicated only for stones that are symptomatic or refractory to intensive medical therapy.

Adolescent↗
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↗
PubMed1991

[Results of endoscopic treatment of primary vesico-ureteral reflux with a follow-up of 2-5 years].

34 patients treated by endoscopic injection of Teflon for vesico-ureteric reflux were reviewed with a follow-up of 2 to 5 years. 45 of the 48 treated ureters showed no signs of reflux, i.e. 93.7% medium-term success rate. 3 cases of reflux recurred after two years and 2 of them were successfully reinjected. There were no upper urinary tract complications. Endoscopic injection of Teflon appears to be a reliable alternative to open surgery.

Adolescent↗
PubMed1991

[Kidney transplantation with cutaneous continent urinary diversion (apropos of 6 cases)].

In a series of 525 renal transplantations performed between January 1987 and September 1990, 5 patients (i.e. 1%) presented with vesical, sphincteric and urethral lesions which prevented classical uretero-vesical or uretero-ureteric reimplantation and functionally satisfactory vesico-sphincteric reconstruction. Under these conditions, in which drainage of the urine into the bladder was impossible, a diversion was created using a continent intestinal reservoir constructed prior to the graft. Four Kock pouches and one Mainz pouch were created during the months preceding renal transplantation with a cadavre kidney. A sixth patient, transplanted in 1981, had to undergo continent urinary diversion in February 1988 after a non-functional bladder augmentation for problems of bladder drainage. We did not observe any mortality or major medical or surgical complications. The follow-up after transplantation in the first 5 patients is now 3, 6, 10, 37 and 40 months. Renal function is normal in all 5 cases with serum creatinine below 130 mmol/l. For the sixth patient, the follow-up is 9 years after the transplantation and 32 months after the continent urinary diversion; serum creatinine is 200 mmol/l and stable since the urinary diversion. Continence is excellent and the comfort of all of the patients is undeniable. However, all patients present with bacteriuria with no symptomatic urinary tract infection.

Adult↗
PubMed1991

[Resuscitation during renal transplantation in children].

Over a 4 yr-period, 60 children (aged 10 months to 17 yr) received 66 kidney transplants with the same surgical intensive care program, the fist 48 hr-period of which has been analysed in this study. Thirty percent of recipients were transplanted without previous dialysis and in 8%, body weight was below 10 kg at the time of surgery. The duration of anesthesia was 4.4 +/- 1.0 h and 32% received locoregional anesthesia. The mean duration for cold ischemia was 14.7 +/- 11.7 h and 26 +/- 7 min for warm ischemia; diuresis began during the operation in 79% of the patients. Routine vascular filling consisted of standard isotonic solute (11 +/- 4 ml/kg/h) associated with mannitol infusion; 59% of recipients required 20% human serum albumin and 42% blood transfusion. Post-operative diuresis was 7.4 +/- 6.0 ml/kg/h during the first 24 h, and sometimes resulted in hypovolemic episodes; 9% of the patients had primary non-functioning kidneys (4 transient acute tubular necrosis; 2 vascular thrombosis) and 4% required dialysis; the 1-yr survival rate was 82% for the grafts and 98% of the patients.

Adolescent↗