Pancreas transplantation for treatment of generalized allergy to human insulin in type 1 diabetes.

We report the case of a 29-year-old man with a 14-year history of type 1 diabetes, normal renal function, and mild diabetic retinopathy. The patient progressively developed a generalized allergic reaction to two insulin excipients--protamine and metacresol--with systemic manifestations of tremor, tachycardia, vertigo, shortness of breath, and short episodes of unconsciousness causing him to be out of work. In June 2003, he received a vascularized cadaveric pancreas transplant using induction with polyclonal antibodies along with tacrolimus and sirolimus but without steroids. A hyperglycemic episode following corticosteroid therapy for rejection treatment required reintroduction of insulin therapy with prompt reappearance of allergic manifestations. Now, the patient is euglycemic without insulin or allergic manifestations and a glycated hemoglobin of 6.4%.

Six human pancreas transplants: results and perioperative management.

Satisfactory results were obtained in 5 type I diabetic recipients of 6 human pancreas transplantations. We chose the three following options: diversion of the pancreatic juice by a pancreaticojejunostomy, simultaneous kidney transplantation from the same donor and cyclosporin A as the basic drug in the immunosuppressive regimen. Further conclusions were also drawn from our experience. Firstly, biological data alone might not be relevant for donor selection: histologic examination of the non transplanted cephalic portion of the donor pancreas is needed to rule out pancreatitis. Secondly, donor management usually needs large amounts of fluids and blood. Finally, besides the general rules of recipient management common to kidney transplantation, pancreas transplantation further requires heparinization, insulin therapy and parental nutrition during the immediate postoperative period.

Evolution of native kidney function after pancreas transplantation alone.

INTRODUCTION: This study investigated changes in kidney function over time among a cohort of patients undergoing pancreas transplantation alone (PTA) from January 2002 to December 2011. PATIENTS AND METHODS: Ten of eighteen PTA patients bearing functioning grafts for at least 1 year were recruited for the analysis. Primary endpoints were changes in mean serum creatinine (SCr, mg/L) and mean estimated glomerular filtration rate (eGFR) using the 4-variable Levey-MDRD equation (mL/min/1.73 m(2)) comparing baseline (pretransplantation) to 6-month, 1-year, 3-year, and 5-year posttransplantation values. Mean follow-up time was 75.7 ± 20.5 months (range, 46-106.5). RESULTS: Baseline eGFR was 89.3 ± 27.9 (range, 58-145). eGFR decreased to 75.7 ± 26.2, 71 ± 20.6, 66.5 ± 14.8, and 62.1 ± 11.2 at 6 months, 1, 3, and 5 years representing -15.2%, -20.5%, -15.8%, and -22.6% percentage decreases respectively (P < .05 for all pairwise comparisons). The Baseline SCr was 8.6 ± 2.3 mg/L (range, 5-13). SCr progressively increased to 10.1 ± 3, 10.5 ± 3.1, 10.9 ± 3.1, and 11.3 ± 1.7 at 6 months, 1, 3, and 5 years a 17.1%, 22%, 16.6%, and 19.9% increase respectively (P < .05 for all pairwise comparisons). One of ten, 2/8, and 3/7 patients displayed an eGFR <60 at transplantation versus 3 and 5 years thereafter, respectively. No patient developed a SCr > 25 mg/L or eGFR <30 or needed dialysis or kidney transplantation. Five of ten patients had micro-albuminuria or proteinuria before transplantation. Tacrolimus levels were within recommended therapeutic ranges over time. CONCLUSION: Kidney function deteriorated significantly after PTA. Understanding of risk factors for the development of renal impairment is important to preserve kidney function and to select appropriate candidates for PTA.

Effect of an in-patient education programme upon the knowledge, behaviour and glycaemic control of insulin dependent diabetic patients.

The aim of this study was to evaluate the efficiency of a diabetes education programme (5 days in hospital) in type I diabetic patients by comparing their diabetes-related knowledge, behaviour and the level of HbA1 before with that 6 months and 1 year after the teaching session. The patients were divided into 2 groups according to whether they answered a questionnaire after 6 months (group I; 41 "responder" patients) or not (group II; 38 "non-responder" patients). Their usual regime of insulin therapy (2 daily injections of a mixture of regular and intermediate-acting insulins) was not modified during their hospitalization for teaching; the total daily doses of insulin and the percentages of regular insulin were comparable before and after the teaching session. In group I, we observed an improvement in knowledge and behaviour indices (evaluated by a written questionnaire) from 69 +/- 3 and 67 +/- 4% (mean +/- SEM) before the teaching session to 86 +/- 2 and 85 +/- 2% 6 months after, respectively (p less than 0.001). HbA1 decreased from 12.1 +/- 0.3% to 11.2 +/- 0.3% (p less than 0.05) and to 10.7 +/- 0.4% (p less than 0.025) after 6 and 12 months respectively. This improvement was observed in patients with or without residual insulin secretion. In group II patients, the index of knowledge increased similarly from 67 +/- 4 to 85 +/- 2% (p less than 0.001). No significant decrease of HbA1 was observed in this group after 6 and 12 months, however whether the patients possessed residual insulin secretion or not.(ABSTRACT TRUNCATED AT 250 WORDS)

Familial phaeochromocytoma: successful treatment with 131I-MIBG.

We report the case of a family in which the mother died of hypertensive encephalopathy following the relapse of a phaeochromocytoma. Two of her children are still alive. Both children had malignant phaeochromocytomas that have been treated by surgery and 131I-MIBG. The first child presented with phaeochromocytoma of the right suprarenal gland at the age of 7 years. Surgery was performed. At the age of 14 years, he developed a tumour of the left suprarenal gland and two pulmonary metastases demonstrated by 131I-MIBG. The three tumours were removed, but new lesions occurred. The boy then was treated with 200 mCi (7,400 MBq) of 131I-MIBG given twice, and is now free of disease more than 2 years after treatment. His sister presented at the age of 12 years with phaeochromocytoma of the left suprarenal gland, the only lesion recognized by 131I-MIBG. The tumour was removed, but 5 months later, she developed phaeochromocytoma in the right suprarenal gland. She was treated with 200 mCi (7,400 MBq) of 131I-MIBG and surgery was performed 6 months later. Histology of the suprarenal gland could not demonstrate the persistence of phaeochromocytoma cells. The child is now free of disease more than 2 years after treatment.