To evaluate the beneficial effect of pancreatic grafting on peripheral microcirculation and long-term clinical outcome, we compared data of 28 Type 1 (insulindependent) diabetic patients either given a pancreatic and kidney graft simultaneously or given a solitary kidney graft (n-17). Peripheral microcirculation was estimated by transcutaneous oxygen pressure measurement (including reoxygenation potential after blood flow occlusion) and erythrocyte flow / velocity by a non-contact laser speckle method. All the measured parameters showed significant differences between diabetic and control subjects in the mean follow-up time of 49 (simultaneous pancreas and kidney transplantation) and 43 (solitary kidney transplantation) months. The data from patients after simultaneous pancreas and kidney transplantation revealed an improvement of transcutaneous oxygen pressure measurement (rise from 46 + 2 mm Hg to 63 + 3 mmHg), reoxygenation time (fall from 224 + 12s to 114 + 6s) and laser speckle measurement (rise from 4.2 + 1.7 to 5.6 + 1.8 relative units). The control group with solitary kidney transplantation did not show a positive evaluation. Data from patients after simultaneous pancreas and kidney transplantation revealed an improvement in transcutaneous oxygen pressure measurement, reoxygenation time and laser speckle measurement whereas the control group with solitary kidney transplantation did not show a positive evaluation. Improved microcirculation was more pronounced in patients with better microvascular preconditions. The results confirm that diabetic microangiopathy is positively influenced by pancreatic transplantation.

Cushing's syndrome is frequently associated with osteoporosis. Therefore, the incidence of osteoporotic spine fractures is significant. They are a rare cause of paraplegic syndromes. Additionally, epidural lipomatosis may occur in those patients. The combination of both fracture and lipomatosis may cause neurological deficit. A case of a young patient suffering from drug-induced Cushing's syndrome is reported. She developed progressive paraplegia. Radiographs demonstrated kyphosis of the thoracic spine from T7 to T9 and pathologic fractures. Urgent operation was planned to stabilize and decompress the spinal cord in the area of the kyphosis. Fortunately, magnetic resonance imaging (MRI) was conducted first. It confirmed pathologic fractures of T7-9 but also showed massive epidural fat extending from the level of T1 to T9. As suspected, laminectomy alone in the area of the fracture proved to be insufficient, as shown by myelography during operation. For treatment of paraplegia in this case of symptomatic epidural lipomatosis, an expanded laminectomy was necessary to remove all the epidural fat. Having undergone this procedure, the patient is now recovering from paraplegia. Our experience suggests that care should be taken before operative treatment of patients with pathological fractures in combination with Cushing's syndrome. In addition to vertebral fractures, epidural lipomatosis has to be taken into consideration. Those patients with neurological deficits have to be treated by an extensive laminectomy.

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The laser speckle method allows the noncontact determination of skin blood flow and its dynamics from a distance of 5 cm. The method is based on the time dependency of the speckle pattern formed by the scattered light of a 5 mW He-Ne laser (632.8 nm). Utilizing the speckle intensity measured through a pinhole, an electronic circuit generates an output signal denoted as blood flow parameter B. All measurements were carried out on the foot dorsum during steady-state, ischemia, and reactive hyperemia induced by a 3-min arterial occlusion. The investigations were carried out in four groups: healthy subjects, asymptomatic smokers, PAOD-patients, and type-I diabetics (D) with severe late complications. As shown by parallel measurements with the tcpO2-method, the initial value Binit of the blood flow parameter B indicates the steady-state blood flow. Binit decreases significantly from 5.95 +/- 2.55 (S.D.) for the control to 4.07 +/- 1.69 (PAOD) and 3.81 +/- 1.51 (D). The half-time BTrh for the increase of B at the beginning of the reactive hyperemia is significantly increased from 4.10 +/- 2.06 s (control) to 14.5 +/- 15.4 s (smokers), 17.6 +/- 32.7 s (PAOD), and 5.31 +/- 3.55 s (D). Other characteristic values such as peak value and time of peak during the reactive hyperemia as well as the final steady-state value and the time of its achievement exhibit similar effects. The correlation coefficients between the different characteristic values obtained from the laser speckle method indicate that the characteristic times of the dynamics and the absolute values of B vary separately and provide supplemental information. A two-dimensional representation of the characteristic values facilitates the differentiation between the four measured groups.

The pancreatic release of arachidonic acid metabolites was studied in a porcine model of acute pancreatitis. In situ isolation of the pancreatic gland enabled selective collection of pancreatic venous blood, pancreatic lymph, and ascites fluid. Three experimental groups were studied: 1) control (n = 9); 2) hemorrhagic pancreatitis induced by injection of 5% bile salt (sodium taurocholate) into the pancreatic duct (n = 10); and 3) edematous pancreatitis induced by injection of free fatty acid (FFA) into the pancreatic artery (n = 10). Determinations of cyclooxygenase metabolites were performed by radioimmunoassay; lipoxygenase metabolites (LTC4, LTD4) were measured by radioimmunoassay after purification by high-performance liquid chromatography. Prostaglandin (PG)F1 alpha, thromboxane B2, and PGF2 alpha concentrations were almost doubled in the lymph of the FFA group during pancreatitis, as were PGF1 alpha levels in pancreatic venous blood. However, concentrations of cyclooxygenase metabolites remained unchanged in the control group and in the bile salt group. Concentrations of LTC4 and LTD4 in lymph and ascites fluid of both pancreatitis groups increased from about 50 pg/ml to a mean level of 600 pg/ml at 6 h. Leukotriene concentrations in the control group were consistently below 50 pg/ml. The results of this study indicate that above all LTC4 and LTD4 are released from the organ and that these arachidonic acid metabolites may be also involved in the events following acute pancreatitis contributing to the systemic effects of the disease.

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Since the use of lactated Ringer's solution and hydroxyethyl starch after hemorrhage did not adversely affect cell-mediated immune functions, but produced salutary effects on macrophage functions, hydroxyethyl starch is a safe and beneficial resuscitation adjunct.