bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical management of malignant islet cell tumors
Authors: Grant Clive S. 
Published: May 2005

AbstractThe surgical management of pancreatic islet cell carcinomas poses a complicated set of questions resulting from their rare occurrence and the difficulty in establishing a diagnosis in early cases or, conversely, the problems inherent in dealing with metastatic disease. However, because their biologic behavior is rather indolent, a real opportunity exists not only for cure but also for meaningful palliation. These goals apply both to the tumor itself and the effects of the hormones they may secrete. The challenge facing the multidisciplinary management team in general, and the surgeon specifically, is to achieve the optimal combination of surgical resection and other treatment options. While the precept of aggressive excision applies to most islet cell carcinomas, it is not universally applicable. In contrast to other islet cell tumors, insulinomas are overwhelmingly benign, and are well treated by enucleation or limited pancreatic resection. Although based on relatively few cases, cytoreductive surgery seems beneficial for malignant insulinomas. Advances that have occurred over the past decade in Zollinger‐Ellison syndrome have markedly altered surgical management. Medication which reliably prevents ulcer formation has permitted the surgical perspective to be redirected from end organ ablation to curative tumor excision. Multicentricity and metastases, however, limit the extent to which cure can actually be achieved. Patients with vasoactive intestinal peptide‐producing tumors and glucagonomas are very rare, and when possible, should undergo tumor resection to correct the severe hormonally caused metabolic derangements. Increasingly recognized are islet cell carcinomas that do not produce clinical syndromes. They may be confused with ductal carcinomas, but when resected, lead to distinctly superior survival rates among patients.
Pulmonary function after cholecystectomy performed through Kocher's incision, a mini‐incision, and laparoscopy
Authors: Coelho Julio C. U. , de Araujo Roberto P. M. , Marchesini Jõao B. , Coelho Izabel C. M. M. , de Araujo Luiz R. R. 
Published: May 2005

AbstractComparative pulmonary function after cholecystectomy performed through Kocher's incision, a mini‐incision, and laparoscopy was evaluated. Forty‐five patients were randomly and prospectively divided into three groups of 15 each, depending on the surgical access employed. Forced vital capacity (FVC), forced expiratory volume at 1 second (FEV1), and forced expiratory flow at 25% to 75% (FEF25–75%) were determined 1 to 3 days before and 16 to 24 hours after cholecystectomy. The percent reduction of FVC (p=0.0170), FEV1(p=0.0191), and FEF25–75%(p=0.0045) was smaller after laparoscopic cholecystectomy than after Kocher's incision cholecystectomy. The percent reduction of FVC (p=0.0170) was smaller after mini‐incision cholecystectomy than after Kocher's incision cholecystectomy. There was no difference in the FEV1(p=0.0971) or FEF25–75%(p=0.2058) between these two groups. FEF25–75%was significantly less impaired in the laparoscopic group than in the mini‐incision group (p=0.0327). No difference between these two groups was found in FVC (p=0.5755) or FEV1(p=0.3952). It is concluded that postoperative pulmonary function is less impaired after laparoscopic cholecystectomy than after either mini‐incision or Kocher's incision cholecystectomy.
Bile duct injury during laparoscopic cholecystectomy: Mechanism of injury, prevention, and management
Authors: Asbun Horacio J. , Rossi Ricardo L. , Lowell Jeffrey A. , Munson J. Lawrence 
Published: May 2005

AbstractAlthough several studies have shown a low incidence of bile duct injuries during laparoscopic cholecystectomy, concerns remain because of the sustained increase in the number of referrals for biliary reconstruction after the procedure. Twenty‐one patients have been referred to our institution because of major bile duct injuries after laparoscopic cholecystectomy. The injury was recognized during the laparoscopic procedure in only 6 of the 21 (29%). Nineteen patients underwent hepaticojejunostomy at least once, one patient required hepaticojejunostomy and repair of a choledochoduodenal fistula, and one patient needed repair of a biliary colonic fistula. Hepaticojejunostomy above the bifurcation was required in 10 patients (50%), at the bifurcation in 3, and below the bifurcation in 7. Nine of the eleven patients in whom the initial repair was performed at the local hospital presented with early stricture (median 7 months). The common denominator of the development of bile duct injuries during laparoscopic cholecystectomy is the failure to identify the structures of the triangle of Calot. Specific steps during laparoscopic cholecystectomy to avoid bile duct injuries are described. Expertise in hepatobiliary surgery appears to optimize results of biliary reconstruction.
Isolation and transplantation of islet tissue
Authors: Scharp David W. 
Published: May 2005

AbstractRecently, there have been remarkable advances in the area of islet tissue isolation and immuno‐alteration that place islet tissue transplantation on the verge of clinical trials. This paper reviews the islet isolation advances by focusing on 5 approaches: altering the pancreas in vivo, distending and/or perfusing the pancreas in vitro, chopping the pan‐creas, isolating either intact islets or islet cells, and purifying the islet tissue. This review also focuses on 3 areas of islet tissue transplantation: islet tissue preparation, transplantation sites, and the prevention of rejection. Advances in these areas should solve the remaining technical problems currently preventing clinical trials.
The effect of islet transplantation on complications in experimental diabetes of the rat
Authors: Federlin Konrad F. , Bretzel Reinhard G. 
Published: May 2005

AbstractExperimental diabetes in the rat induces secondary complications of kidney, eye, and nervous system similar to the changes observed in humans. Transplantation of a sufficient number of isolated islets from isogeneic donors inhibits or reverses those lesions. Detailed studies have been made in order to examine renal glomerular and tubular lesions in diabetic rats prior to and following transplantation. Streptozotocin‐treated rats after 2 to 3 months begin to develop renal lesions with severe morphological changes, such as enlargement of the mesangial space, thickening of the capillary wall, deposition of IgG and C3, vacuolization of the tubular epithelial cells, and protein casts. Functional disturbances including increased glomular filtration rate, proteinuria, accumulation of basement membrane products (glucosyltransferase in the kidney, laminin P2, 7‐S collagen in serum), and increased excretion of brush border enzymes in the urine also developed. Intraportal islet transplantation leading to normalization of fasting blood glucose and insulin and of body weight either prevented these lesions or reversed early changes. Advanced renal changes are not reversible; however, further progression is halted. The experimental data support the view that rigid control in human diabetics may help to prolong the phase without secondary complications and that islet transplantation in the future may be a useful therapy.
Cryopreservation of insulin‐producing tissue in rats and dogs
Authors: Rajotte Ray V. , Warnock Garth L. , Kneteman Norman N. 
Published: May 2005

AbstractTransplantation of frozen‐thawed islets of Langerhans normalized urine volume, urine glucose, plasma glucose, and weight gain in diabetic rats. However, these animals had abnormal intravenous glucose tolerance tests (ivGTT) at 3 mo post‐transplant. Modified cryopreservation protocols were extended to canine islet‐containing tissue: a higher temperature was used during equilibration in the 2 M dimethyl sulfoxide. Recipients of frozen‐thawed isografts had prolonged normoglycemia with plasma glucose <105 mg/100 ml for up to 18 mo. During ivGTT at 6 mo post‐transplant, K values (decline in glucose concentration, %/min) were similar in dogs autotransplanted with fresh (K=1.22±0.37) or cryopreserved tissue (K=1.8±0.4). Because of the similar compactness of the pancreas in humans and dogs, this canine model should be useful for formulating an optimal cryopreservation technique for human islets.
Experimental immuno‐alteration
Authors: Lacy Paul E. 
Published: May 2005

AbstractIn the past few years, remarkable advances have been made in preventing rejection of islet allografts and xenografts (rat to mouse) by 6 procedures which do not involve continuous immunosuppressive therapy of recipient rodents. Four methods alter or destroy passenger lymphoid cells in the islets prior to transplantation. These include in vitro culture of donor rat islets at low temperature and a single injection of anti‐lymphocyte serum in the recipients, culture of rat or mouse islet aggregates in 95% O2, and pretreatment of mouse islets with Ia antibody and complement or with a monoclonal antidendritic cell antibody and complement. Two methods induce partial tolerance in recipients by preimmunization with donor blood treated either with Ia antibody and complement or ultraviolet irradiation. These preimmunization procedures permit the use of untreated donor islets.Two methods have been developed for the mass isolation of canine islets. Initial studies indicate that low‐temperature culture of donor canine islets and a single injection of anti‐lymphocyte serum will prevent rejection of canine islet allografts. The technical problems remaining for human islet allografts are selection of the optimum method of preventing islet allograft rejection based on studies in the dog, adaptation of the mass islet isolation techniques to the human pancreas, and selection of a safe and optimum site for transplantation.
Pancreatic islet transplantation: Immuno‐alteration with ultraviolet irradiation
Authors: Hardy Mark A. , Lau Henry T. , Weber Collin , Reemtsma Keith 
Published: May 2005

AbstractTo circumvent rejection of allogeneic pancreatic islet grafts, we have examined the use of ultraviolet (UV) irradiation to inactivate allostimulatory cells in blood prior to their use for the induction of donor‐specific tolerance and to decrease the immunogenicity of pancreatic islets by direct UV irradiation. UVB (280–320 nm) irradiation of blood can effectively abrogate lymphocyte stimulatory capacity in an MLC, while subsequent transfusions of appropriately UV irradiated blood have indefinitely prolonged islet allograft survival in the Lewis to ACI rat strain combination (greater than 250 days), without the use of immunosuppressive agents. This treatment is donor specific in that third‐party W/F islet allograft survival is not prolonged in ACI rats transfused with UV‐treated Lewis blood (MST, 7.5 days). When W/F rats are used as donors of blood, moderate prolongation of W/F islet allograft survival is obtained (MST of 21±12 days). When non‐UV‐treated W/F blood is transfused, rejection of W/F islets is accelerated (MST of 2 days versus no treatment control of 6.5 days) in the ACI recipient.UV irradiation of rat dendritic cells can completely abrogate their powerful stimulatory activity in an MLC at a dose of 900 J/m2. Rat islets subjected to this same dose of UV irradiation do not exhibit any alteration in their endocrine function when transplanted into syngeneic diabetic animals. UV irradiated (900 J/m2) Lewis islets transplanted into non‐immunosuppressed ACI rats showed marked prolongation of survival (greater than 80 days).We conclude that UV irradiation is effective in immuno‐alteration of the stimulatory cells in blood and can selectively decrease immunogenicity of pancreatic islets without being deleterious to their endocrine function. Both these methods are readily applicable to islet transplantation in other animals and eventually in humans.
Islet immuno‐isolation: The use of hybrid artificial organs to prevent islet tissue rejection
Authors: Scharp David W. , Mason Norbert S. , Sparks Robert E. 
Published: May 2005

AbstractImmuno‐isolation protects islet tissue from rejection by enclosing it within semi‐permeable membranes. Four major techniques have been developed to achieve this goal: (1) Extravascular diffusion chambers. These can be implanted in many locations but are limited by host fibroblastic responses which further reduce diffusion capability. (2) Intravascular diffusion chambers. These have improved diffusion characteristics dependent on design but have serious vascular access problems. (3) Intravascular ultrafiltration chambers. These have a more rapid response since they do not rely on diffusion but have an additional problem of protein deposition on their membranes. (4) Microencapsulation. This technique incorporates the islet tissue inside a biochemical membrane making it more efficient. Yet the technique is limited by membrane instability. Immuno‐isolation offers an alternative to immunosuppression, but the biotechnology must be improved to develop suitable materials for effective clinical trials.
Minnesota experience with 85 pancreas transplants between 1978 and 1983
Authors: Sutherland David E. R. , Chinn Patricia L. , Goetz Frederick C. , Elick Barbara A. , Najarian John S. 
Published: May 2005

AbstractWe have performed 85 pancreas transplants in 79 diabetic patients since 1978 in a new clinical trial. Fifty grafts were from cadaver donors (32 segmental, 18 whole organ) and 35 (segmental) were from related donors (4 parent, 17 HLA identical and 7 non‐identical siblings, 6 identical twins, 1 cousin). All the grafts from the living related donors were immediately transplanted, but 48% of the cadaver donor grafts were stored at 4°C in silica gel‐filtered plasma for an average of 11.4 hours. Of the 67 recipients with HLA‐DR typing, 27% were DR3, 30% were DR4, and 39% were DR3,4 (96% for one or both). Fifty‐five percent of the recipients had had functioning renal allografts from 6 to 9 months earlier, while 45% were not renal recipients who had serum creatinine levels < 2.5 mg/100 ml and had not been previously immunosuppressed. Of the 75 patients transplanted, 62 (83%) are alive and 23 (32%) are insulin independent ranging from 1 to 65 months after transplant. The 1‐year actuarial graft survival rate is 25% overall, 36% from related and 16% from cadaver donors. Thirteen (17%) of the 75 have been insulin independent for more than 1 year. Graft failure resulted from technical error in 22 (26%) [10 from vascular problems, 4 (open duct) from severe ascites, 3 from peritonitis, 2 (pancreatico‐jejunostomy) from pancreatic leaks, and 3 from inadequate preservation]. Thirteen patients died (5 with functioning grafts): 6 from infections, 4 from cardiovascular disease, 1 from hyperkalemia, 1 from anaphylaxis to ALG, and 1 from unknown causes as a sudden death at home. One of the unresolved problems is that of the optimal technique to handle exocrine drainage. Of the 3 duct‐ligated grafts, all failed technically, and the 4 prolamine‐injected grafts had no long‐term function. Of the 15 open‐duct grafts, 53% were technical failures with 3 currently functioning. Of the 28 pancreatic‐jejunal grafts, 29% failed technically with 13 functioning from 1 to 28 months. Of the 35 silicone‐injected grafts, 9% technically failed with 7 currently functioning from 3 to 36 months. The 35 living related pancreatic donors have shown 2 (6%) to develop abnormal glucose tolerance tests, 2 (6%) to acquire complications requiring additional surgical correction, and 1 (3%) to show a nonoperative pancreatic complication. We favor cyclosporine A over azathioprine but the results must be individualized. Questions regarding autoimmune recurrence of disease are also raised by our studies in identical twins.
Segmental pancreatic transplantation with enteric exocrine diversion
Authors: Groth Carl‐Gustav , Tydén Gunnar , Lundgren Göran , Wilczek Henryk , Klintmalm Göran , Öst Lennart , Gunnarsson Rolf , Östman Jan 
Published: May 2005

AbstractFourteen combined cadaveric renal and segmentai pancreatic transplantations with both of the organs provided by the same donor were performed, and exocrine diversion was to the recipient's bowel. Nine of the grafts have failed because of technical surgical complications, and 2 grafts failed because of rejection. Three patients are carrying well‐functioning grafts 6, 19, and 24 months, respectively, after transplantation. Ten of the kidneys are functioning; thus, the use of combined transplantation has not jeopardized the results of renal grafting. Patients who had functioning pancreatic grafts had normal or near‐normal fasting blood glucose levels; studies of intravenous glucose tolerance test revealed k‐values around or just over 1.0 and glycosylated hemoglobin levels were normal. When azathioprine was replaced with cyclosporine, 4 of 6 patients showed a significant decline in k‐value. This deterioration in blood glucose control was reversible by dosage adjustment.
Transplantation for the treatment of insulin‐dependent diabetes: Clinical experience with polymer‐obstructed pancreatic grafts using neoprene
Authors: Dubernard Jean‐Michel , Traeger Jules , Bosi Emanuele , Gelet Albert , El Yafi Seoud , Devonec Marion , Piatti Pier Marco , Chiesa Roberto , Martin Xavier , Mongin‐Long Denise , Touraine Jean‐Louis , Pozza Guido 
Published: May 2005

AbstractWe performed 45 pancreatic transplants in 43 insulin‐dependent diabetics through October, 1983. In 11 cases the pancreas was transplanted alone; in 2 cases it preceded and in 1 case it followed a kidney transplant; and in 31 cases pancreas and kidney were transplanted simultaneously. Forty‐ four transplants were segmental, while in 1 case the pancreas was transplanted whole. The handling of the exocrine secretion was obtained through the duct occlusion technique by neoprene injection. The overall patient survival rate was 84.8%, 73.9%, 64.5%, 50.3%, and 35.0% at 3, 6, 12, 24, and 36 months, respectively. The overall pancreatic graft survival rate was 49.0%, 38.9%, 22.1%, 14.7%, and 7.4% at 3, 6, 12, 24, and 36 months, respectively. The survival rate for the pancreas transplanted simultaneously with kidney was 63.7%, 52.0%, 35.7%, and 23.8% at 3, 6, 12, and 24 months, respectively. Thirty‐four pancreatic grafts (76%) failed due to: rejection (31%), death of the patient (27%), vascular thrombosis (16%), and local infection (2%), while 11 pancreatic grafts (24%) are currently functioning up to 31 months.
Simultaneous renal and intraperitoneal segmental pancreatic transplantation: The Zürich experience
Authors: Baumgartner Dieter , Largiadèr Felix 
Published: May 2005

AbstractSimultaneous renal and interperitoneal segmental pancreas transplantation with a prolamine‐occluded duct was performed in 15 type I diabetics with end‐stage renal failure. Four pancreas grafts are currently functioning at 2 days, 2 weeks, 30, and 39 months. In 3 patients, both organs were rejected within 6 months; 2 patients died with functioning grafts at 36 hr and 2 months. In 6 patients pancreatic failure for nonimmunological reasons did not jeopardize the simultaneous kidney graft. No adverse effects of duct occlusion with prolamine could be demonstrated. It is concluded that simultaneous renal and pancreatic transplantation is the method of choice in most patients with complicated type I diabetes and end‐stage renal failure.
Pancreas and islet transplant registry data
Authors: Sutherland David E. R. 
Published: May 2005

AbstractFrom December 16, 1966, to June 30, 1983, some 337 pancreas transplants in 316 diabetic patients from 305 cadaveric and 32 living related donors were performed at 46 institutions throughout the world. A total of 60 pancreas transplants in 56 patients were performed prior to July 1, 1977, with only 2 functioning for more than 1 year. Therefore, the present era includes 277 pancreas trans‐plants performed in 262 patients at 39 institutions. Seventy‐four of these were done in 1982, while 72 were performed in the first 6 months of 1983 with 11 new institutions reporting. Of the 262 patients in the present era, 74 (28%) have died with 48 (18%) of these dying within the first 3 months of transplantation. Of the 190 pancreas transplants performed up to December, 1982, and available for evaluation of 1‐year graft function, 31 (16%) are currently functioning; another 8 (4%) functioned for 1 year but then failed (7) or the recipient died (1). Of the 72 transplants done in the first 6 months of 1983, there are 26 (37%) still functioning. Results are expressed according to technique of handling the ductal drainage, association with kidney transplantation, and association with the type of immunosuppression. Seventeen non‐diabetic patients (13 with chronic pancreatitis, 4 with adenocarcinoma) had autotransplantation of a segment of the pancreas after pancreatectomy. Thirteen were said to function but follow‐up data are incomplete. There were 73 islet tissue allografts reported as of June 30, 1980, but none of the patients achieved insulin independence. Since then an additional 86 islet tissue allografts have been reported without any insulin independence achieved to make a total of 159 performed without normoglycemia. A total of 79 pancreatectomized patients have received islet tissue autografts with 50% being reported as insulin independent, but the results are difficult to interpret.
The role of radiotherapy following total mastectomy for patients with early breast cancer
Authors: Berstock D. A. , Houghton J. , Haybittle J. , Baum M. 
Published: May 2005

AbstractAnalysis from a multicenter trial of the management of operable breast cancer now in its fifteenth year has confirmed earlier published results that there are no significant differences in survival and distant recurrence between the two treatment groups (“watch policy” and radiotherapy). However, patients receiving prophylactic radiotherapy at the time of mastectomy continue to have a reduced risk of developing local recurrence as the first sign of treatment failure (p<0.001). This increased risk is related to various known prognostic indicators such as tumor size and histological grade. Detailed analysis of local recurrence data has shown protection for the radiotherapy patients against recurrence in the chest wall and axilla but not in the supraclavicular area. The question of uncontrolled local disease persisting to death has also been addressed.
Mastectomy versus radiotherapy as treatment for stage I‐II breast cancer: A prospective randomized trial at the National Cancer Institute
Authors: Findlay P. A. , Lippman M. E. , Danforth D. , McDonald H. , d'Angelo T. , Gorrell C. R. , Gerber N. L. , Schain W. , Lichter A. S. 
Published: May 2005

AbstractIn 1979, the National Cancer Institute in Bethesda, Maryland initiated a randomized, prospective trial to compare surgery versus radiation therapy in the treatment of stages I and II breast cancer. Surgical treatment consists of total mastectomy with axillary lymph node dissection (modified radical mastectomy) and breast reconstruction; radiation treatment consists of gross tumor excision, axillary lymph node dissection, and comprehensive irradiation including a boost dose to the tumor bed. All patients with pathologically positive axillary nodes receive 11 cycles of adjuvant Adriamycin®/Cytoxan® chemotherapy. As of December 1984, there have been 175 patients entered in the study. Twenty‐three patients have developed disease recurrence (12 mastectomy, 11 radiation), but it is too early to obtain definitive treatment‐related results.