Pancreas Transplantation at a Single Latin-American Center; Overall Results with Type 1 and Type 2 Diabetes Mellitus.

BACKGROUND: Simultaneous pancreas-kidney transplantation (SPK) has become the treatment of choice for type 1 diabetes mellitus (T1DM) patients with chronic renal failure. Type 2 diabetes mellitus (T2DM), was once considered to be a contraindication for pancreas transplantation; however, it has been accepted as a new indication, under strict criteria. Although favorable results have increase the indication for T2DM in developed countries, there have been no reports of long-term results for this indication from Latin American centers. METHODS: From April 2008 to March 2016, patients receiving SPK or pancreas transplant alone (PTA) for T2DM were included and compared with T1DM recipients. Variables were compared between groups with the use of χ2 and t tests; Kaplan-Meier with log rank was used for patient and graft survivals; P < .05 was considered to be significant. RESULTS: A total of 45 SPK and 1 PTA were performed, 35 (76.1%) for T1DM and 11 (24.5%) for T2DM. Mean pre-transplantation C-peptide was significantly higher in the T2DM group (P = .01); HbA1c was higher in the T1DM group (P = .03). No differences were found in weight, body mass index, and pre-transplantation glycemia. Patient survivals for T1DM recipients were 88.2% and 84.8% at 1 and 5 years, respetively, versus 100% and 74.1% for T2DM recipients (P = .87). CONCLUSIONS: Our initial prospective experience in a single Latin American center showed that medium- and long-term outcomes for T1DM and T2DM individuals receiving pancreas transplants are similar, under strict selection criteria.

A new beta adrenergic blocking agent, sotalol, in the treatment of angina pectoris. A double blind-crossed treatment study.

The present therapy for coronary insufficiency includes the use of drugs which decrease the cardiac work, thus reducing the needs for oxygen (beta adrenergic blocking agents). The 4- (2-isopropylamino-1-hydroxyethil) methane sulfonamylide (Sotalol (R)) is considered the most active of the alkylsulfonamide phethenolamines group. 69 patients with angina pectoris were selected for treatment with Sotalol. The administration was preceded by a five weeks period during which the patients received placebo. Afterwards they received for three weeks a dose of Sotalol (titration period), set the optimal effective dose. At the end of this period all patients began a double blind-crossed treatment which continued for 12 weeks. Two schedules were followed: group 1, Sotalol-placebo; group 2, placebo-Sotalol. No statistically significant variations were shown in the number of anginose attacks during the initial placebo period. The decline in the number of anginose attacks during the titration period (Group 1: weeks 5 to 8, p less than 0.0001; Group 2: weeks 5 to 8, p less than 0.0002) is statistically significant. In the first group the continued administration of Sotalol decreased the number of painful attacks even further, which describe a slope which is abruptly interrupted at the end of the six weeks, coinciding with the initiation of the placebo treatment (Group 1: weeks 8 to 14, p less than 0.001, significant). In group 2 (drug-placebo-drug) the administration of the placebo in the six weeks following the titration period was followed by a recrudescence of the symptomatology, whose intensity, however remained far below that recorded during the initial period (Group 2: weeks 8 to 14, p less than 0,0783, not significant). Then, in the final six weeks, the administration of Sotalol produced a sustained and considerable improvement in the weekly number of anginose attacks (Group 2: weeks 14 to 20, p less than 0.0011, significant). All the differences produced by the ingestion of Sotalol are statistically significant. These facts, together with the absence of clinical or humoral side effects incontestably bear out the efficacy of the drug in controlling the number and the intensity of painful attacks of coronary origin.