• Interventional radiological procedures are often used to treat post-transplant hepatic artery stenosis. • Meta-analysis shows that percutaneous balloon angioplasty and stent placement are both efficacious. • Percutaneous balloon angioplasty and stent placement appear to have similar complication rates. • Re-transplantation rates have declined, partly due to interventional management for arterial stenosis.

No abstract

No abstract

At ≥5 years of follow-up, use of PADM as a bioprosthesis in ventral hernia in high-risk patients is unreliable as a definitive repair in the majority of patients, but may provide satisfactory outcomes in some patients.

Objective Determine biological mechanisms involved in post transplantation diabetes mellitus caused by the immunosuppressant FK506. Methods INS-1 cells and isolated rat islets were incubated with vehicle or FK506 and harvested at 24 hr intervals. Cells were assessed for viability, apoptosis, proliferation, cell insulin secretion and content. Gene expression studies by microarray analysis, qPCR and motifADE analysis of the microarray data identified potential FK506-mediated pathways and regulatory motifs. Mitochondrial functions, including cell respiration, mitochondrial content and bioenergetics were assessed. Results Cell replication, viability, insulin secretion, oxygen consumption, and mitochondrial content were decreased (p < 0.05) 1.2-, 1.27-, 1.77-, 1.32-, and 1.43-fold, respectively after 48 hr FK506 treatment. Differences increased with time. FK506 (50 ng/ml) and Cyclosporine A (800 ng/ml) had comparable effects. FK 506 significantly decreased mitochondrial content and mitochondrial bioenergetics and showed a trend towards decreased oxygen consumption in isolated islets. Cell apoptosis and proliferation, mitochondrial DNA copy number and ATP/ADP ratios were not significantly affected. Pathway analysis of microarray data showed FK506 modification of pathways involving ATP metabolism, membrane trafficking and cytoskeleton remodeling. PGC1-α mRNA was down-regulated by FK506. MotifADE identified nuclear factor of activated T-cells (NFAT), an important mediator of β cell survival and function, as a potential factor mediating both up- and down-regulation of gene expression. Conclusions At pharmacologically relevant concentrations FK506 decreases insulin secretion and reduces mitochondrial density and function without changing apoptosis rates, suggesting that post transplantation diabetes induced by FK506 may be mediated by its effects on mitochondrial function.

SummaryInsulinoma is the most common (functioning) islet cell tumour of the pancreas and is highly curable with accurate localization and precise extirpation of the often benign, solitary lesion. Although previous reports describe high success rates without pre-operative localization, more recent recognition of the overlap among causes of endogenous hyperinsulinism, coupled with the deleterious long-term effects of blind distal pancreatectomy and re-operation, mandate the need for precise pre-operative localization or regionalization of the tumour(s). If these criteria have not been met and the surgeon finds him/herself in the operating room without a localized or regionalized tumour, the operation should be concluded without resection, the diagnosis reconfirmed, and a calcium stimulation test performed. At experienced centres, this can be often carried out within 24 -48 h and the patient returned to the operating room for a gradient-guided resection. Intraoperative venous sampling for insulin might be an option in the future but its accuracy has not been validated in sufficient numbers of patients to date. Insulinoma is the most common functioning endocrine tumour of the pancreas, seen in approximately four persons per 1 000 000 persons/year. More than 90% of insulinomas are benign, solitary, and < 2 cm in diameter. Importantly, insulinomas are equally distributed throughout the gland. The female : male ratio is approximately 3 : 2. Less than 10% are seen in association with the multiple endocrine neoplasia type 1 (MEN1) syndrome, and 5-10% of tumours are malignant.1,2 Mean age at presentation is approximately 45 years.Multiple insulinomas can be seen in 2-3% of sporadic cases but are more often seen in the MEN1 syndrome; although the insulinsecreting tumour itself is very often solitary.3,4The diagnosis of insulinoma can be challenging. 5,6 Although originally considered to present only in the fasting state or with exercise, it is now known that patients with an insulinoma can present with postprandial symptoms as well. Patients may have nonspecific adrenergic symptoms, which include anxiety, sweating and palpitations, but true organic endogenous hyperinsulinism is characterized by neuroglycopaenic symptoms that include confusion, amnesia, visual disturbances, seizures and coma. The diagnosis of endogenous hyperinsulinism is dependent on the satisfaction of Whipple's triad and remains the cornerstone of the screening process: hypoglycaemia (plasma glucose < 50 mg/dl), neuroglycopaenic symptoms, and prompt relief of symptoms with the administration of glucose define Whipple's triad. 2 Once Whipple's triad has been satisfied, the patient should be fasted either formally (72-h fast) or informally (outpatient) to a plasma glucose < 50 mg/dl with concomitant documentation of inappropriate β -cell polypeptides (insulin, C-peptide, and proinsulin). With a glucose level ≤ 45 mg/dl, an insulin level ≥ 3 μ IU/ml and a C-peptide level of ≥ 200 pmol/l, the endogenous nature of the hyperinsulinism is confirmed. It is impor...

No abstract

BACKGROUND.: Pancreas transplantation (PT) provides the best glycemic control option for diabetes mellitus but is associated with significant morbidities related to infectious disease. METHODS.: We performed a retrospective study of a cohort of consecutive PT recipients in whom PT was performed from 1998 to 2006 (n=216) and followed up them until July 2008. Data regarding infections, rejection, infection chemoprophylaxis, graft failure, absolute lymphocyte counts (ALCs), and mortalities were collected. RESULTS.: Simultaneous pancreas and kidney, pancreas transplantation alone, and pancreas after kidney (PAK) transplantations were performed in 42, 67, and 107 patients, with a mean (standard deviation) age at transplantation of 46.8 (8.03), 40.6 (10.1), and 43.7 (8.19) years. Of the simultaneous pancreas and kidney, pancreas transplantation alone, and PAK transplant recipients, 54.7%, 37.3%, and 58.8% were men. Overall, 63% developed a serious infection during the median follow-up of 6.4 years. Mean (range) number of infectious episodes was 2.3 (1-12), with mostly bacterial infections both within (68%) and after 1 year (78%). Incidence of bacterial and viral infections was greatest in the first 3 months after transplantation. Fungal infections were more constant. Bladder exocrine drainage was associated with higher risk of infection (hazard ratio=2.5, P<0.001). Infection within the first 3 months after transplantation was related to higher mortality after the first 3 months (hazard ratio=3.19). ALC was associated with the risk of first infections (P=0.005) and bacterial infections (P<0.001). CONCLUSIONS.: Incidence of infections after PT was 63% and mostly bacterial. Bladder drainage increases infection risk and low ALC partially predicts episodes. Limitations include retrospective design, unequal composition of PT groups, and lack of data between kidney and PT for PAK.