Close relationship between strict blood glucose control, including suppression of blood glucose variability, and mortality reduction in acutely ill patients with glucose intolerance investigated by means of a bedside-type artificial pancreas.

The purpose of this study was to elucidate the relationship between strict control of blood glucose (BG) and mortality reduction with the use of an artificial pancreas (AP). Patients were evaluated in the (1) early phase (E phase: mean 3.3 ± 2.6 days after admission, n = 84) and in the (2) late phase (L phase: mean 9.9 ± 3.3 days, n = 88), and were classified into a (1) group with a higher daily mean BG level (BGm) (BGmXa: BGm above Xmg/dl) and a (2) group with a lower BGm (BGmXb: BGm below Xmg/dl). Each group was classified into a (1) subgroup with a higher daily standard deviation of the BG levels (BGsd) and a (2) subgroup with a lower BGsd. In the E phase, the (1) mortality of the BGm200a group was significantly higher than that of the BGm200b group (56 vs. 29%, p < 0.05), and (2) in the BGm200b group, the mortality of the subgroup with a BGsd above 14 mg/dl was significantly higher than that with a BGsd below 14 mg/dl (46 vs. 17%, p < 0.025). In the L phase, the mortality of the BGm175a group was significantly higher than that of the BGm175b group (50 vs. 28%, p < 0.05). In conclusion, (1) a higher BGm and (2) higher BGsd in the E phase were prognostic risk factors. Based on the findings, it was considered that the target for BG control should be set at (1) BGm below 200 mg/dl and BGsd below 14 mg/dl in the E phase, and (2) BGm below 175 mg/dl in the L phase.

Recent progress in mechanical artificial pancreas.

Strict blood glucose (BG) control is proved to improve the outcome in patients with glucose intolerance both in acute and chronic phases, irrespective of whether the patient has diabetes mellitus. However, strict BG control by conventional methods is so complicated that it cannot be performed easily in normal clinical situations. Furthermore, it is sometimes inadequate. Therefore, a clinically applicable, reliable artificial pancreas (AP) has long been sought after for more than 40 years. Considering the present important situations concerning AP, a survey of recent progress in AP is highly desirable. In this review, recent progress in mechanical AP (MAP) and in MAP-related items is presented. MAP is composed of three major components: a BG control algorithm, a drug administration system, and a glucose sensor. Recent progress in development of these components is presented, followed by descriptions of representative MAPs. Although significant progress in the development of MAP has been made, its use in clinical situations is limited or for research purposes at present. The main limiting factor is the slow progress in the development of glucose sensors. However, more widespread clinical application of the MAP will occur in the near future, considering the number of reliable long-life intravenous glucose sensors under development. Another factor is the worldwide recognition of the importance of BG control in acutely ill patients, in whom the period of strict BG control is usually for several days to a few weeks.

Arterial stimulation and venous sampling (ASVS) is useful for recurrent lesions of insulinoma: a case report.

We encountered a recurrent case of benign solitary insulinoma in the pancreatic tail, which may have been caused by an inadequate surgical margin in the use of an ultrasonic dissector. A 45-year-old man was referred with hypoglycemia and diagnosed solitary insulinoma in the pancreas. Laparoscopic pancreatic enucleation was performed using an ultrasonic dissector. The tumor was extracted and the surgical margins were microscopically negative. Six years later, he presented with hypoglycemia again. Multiple small well-enhanced lesions were detected by computed tomography distant from the resection stump of the first operation. He underwent resection of all visible lesions with omentum and wide excision of the soft tissue surrounding the pancreas after preoperative arterial stimulation and venous sampling test. The postoperative course of the second operation was uncomplicated and the patient presents no sign of hypoglycemia after 12 months.

Decontamination of mass casualties--re-evaluating existing dogma.

The events of 11 September 2001 became the catalyst for many to shift their disaster preparedness efforts towards mass-casualty incidents. Emergency responders, healthcare workers, emergency managers, and public health officials worldwide are being tasked to improve their readiness by acquiring equipment, providing training and implementing policy, especially in the area of mass-casualty decontamination. Accomplishing each of these tasks requires good information, which is lacking. Management of the incident scene and the approach to victim care varies throughout the world and is based more on dogma than scientific data. In order to plan effectively for and to manage a chemical, mass-casualty event, we must critically assess the criteria upon which we base our response. This paper reviews current standards surrounding the response to a release of hazardous materials that results in massive numbers of exposed human survivors. In addition, a significant effort is made to prepare an international perspective on this response. Preparations for the 24-hour threat of exposure of a community to hazardous material are a community responsibility for first-responders and the hospital. Preparations for a mass-casualty event related to a terrorist attack are a governmental responsibility. Reshaping response protocols and decontamination needs on the differences between vapor and liquid chemical threats can enable local responders to effectively manage a chemical attack resulting in mass casualties. Ensuring that hospitals have adequate resources and training to mount an effective decontamination response in a rapid manner is essential.