Present status of pancreas transplantation in Japan--donation predominantly from marginal donors and modified surgical technique: report of Japan pancreas transplantation registry.

In Japan, organ donation has been still limited because of the strict donor criteria. The aim of this study was to show the effectiveness of pancreas transplantation (PTx) by analyzing the outcomes even under poor donor conditions. Thirty-six cases of PTx (32 simultaneous pancreas and kidney transplantations [SPK], 4 pancreas after kidney transplantations) performed during the last 8 years were examined especially for donor characteristics. Mean donor age of 41.4 +/- 11.9 years was considerably older compared with that in the United States and Europe; donors aged over 40 years comprised 67% of the total. According to the criteria described by Kapur, 29 cases (81%) in our series would be considered marginal. Thus, to increase blood supply into the pancreatic head, the gastroduodenal artery (GDA) was anastomosed using donor artery to common hepatic artery or iliac Y graft. These procedures were performed in 16 of the 24 cases in which there was liver procurement. Eventually, 34 cases (94%) preserved GDA continuity. Mean total cold ischemic time of pancreatic grafts was 12 hours 15 minutes. Of 214 registrants, 17 patients on the waiting list for SPK died of diabetic complications. To date, patient survival remains 100% with a mean follow-up period of 33 months. Pancreas graft survivals at 1, 3, and 5 years posttransplantation were 92%, 80%, and 80%, respectively. In contrast, kidney survivals were 91%, 91%, and 91%, respectively. The integrity of the pancreas head and duodenum by preservation of the GDA continuity might have decreased the risk associated with the marginal donors.

Terson syndrome caused by ventricular hemorrhage associated with moyamoya disease--case report.

A 24-year-old female presented with Terson syndrome secondary to bilateral ventricular hemorrhage as a complication of moyamoya disease. Ophthalmoscopy and magnetic resonance imaging clearly demonstrated vitreous hemorrhage in the left eye globe. Various visual symptoms are associated with moyamoya disease, almost all of which result from ischemic lesions in the visual cortex and optic pathways. In this case, the visual disturbance was caused by Terson syndrome secondary to ventricular hemorrhage. Close ophthalmological and radiological evaluation is mandatory even in patients with moyamoya disease and hemorrhagic manifestation located in the intracerebral, subarachnoid, or intraventricular space.

Role of leukocytes in diabetic microcirculatory disturbances.

Various rheological abnormalities of the blood have been widely reported in diabetes. However, it remains unclear which one affects blood flow at the level of microcirculation, an important site in the pathogenesis of diabetic microangiopathy. To differentiate which blood component leads to microcirculatory disturbances in diabetes, we studied the hemorheological properties of diabetic patients using an array flow analyzer that has microchannels simulating capillaries. Venous blood was collected from 19 diabetic patients and 24 control subjects. Three blood samples were prepared: plasma alone, erythrocyte suspension (ES) at 10% hematocrit (Ht), and erythrocyte and leukocyte suspension (ELS) having leukocyte counts of 1000/microl at 10% Ht. These samples were forced to flow through microchannels (equivalent diameter 6 micron, equivalent length 30 micron, 2600 in parallel) by applying a pressure difference of 20 cm H2O. Transit times for 100 microl of samples were measured, and the flow behavior of cells through the microchannels was recorded with a video-microscope. The transit time of ELS was 52.5 +/- 6.2 sec (mean +/- SD) in the diabetic group and 47.7 +/- 3.3 sec in the control group; there was significant prolongation in the transit time of diabetic ELS (P = 0.005), whereas the transit times of plasma alone and ES showed no significant differences between control and diabetic groups. Leukocytes were occasionally observed to plug the microchannels during the measurements of ELS from some diabetic patients. Our results imply that reduced deformability of leukocytes in diabetes may contribute to flow disturbances in the microcirculation. Leukocytes could play a potential role in the pathogenesis of diabetic microangiopathy.