Long-term results in pancreatic transplantation with special emphasis on the use of prolamine

Our pancreatic transplantation programme was initiated in 1979. Since then a total of 102 pancreas transplantations have been performed, blocking exocrine secretion using the duct occlusion technique with prolamine. Early non-immunological complications are frequent. The long-term results (9 years) in combined pancreas and kidney transplanted patients are satisfying: the survival rate for pancreas is 38% and 54% for kidney. Patient survival rate in this period is 85%. Beyond the first year post-transplant the exocrine activity disappears whereas the endocrine function remains well preserved

Aspects of the Mass Distribution of Interstellar Dust Grains in the Solar System from In-Situ Measurements

The in-situ detection of interstellar dust grains in the Solar System by the dust instruments on-board the Ulysses and Galileo spacecraft as well as the recent measurements of hyperbolic radar meteors give information on the properties of the interstellar solid particle population in the solar vicinity. Especially the distribution of grain masses is indicative of growth and destruction mechanisms that govern the grain evolution in the interstellar medium. The mass of an impacting dust grain is derived from its impact velocity and the amount of plasma generated by the impact. Because the initial velocity and the dynamics of interstellar particles in the Solar System are well known, we use an approximated theoretical instead of the measured impact velocity to derive the mass of interstellar grains from the Ulysses and Galileo in-situ data. The revised mass distributions are steeper and thus contain less large grains than the ones that use measured impact velocities, but large grains still contribute significantly to the overall mass of the detected grains. The flux of interstellar grains with masses $> 10^{-14} {\rm kg}$ is determined to be $1\cdot 10^{-6} {\rm m}^{-2} {\rm s}^{-1}$. The comparison of radar data with the extrapolation of the Ulysses and Galileo mass distribution indicates that the very large ($m > 10^{-10} {\rm kg}$) hyperbolic meteoroids detected by the radar are not kinematically related to the interstellar dust population detected by the spacecraft.Comment: 14 pages, 11 figures, to appear in JG

Outcome of renal grafts after simultaneous kidney/ pancreas transplantation

Nineteen patients with endstage renal failure due to Type 1 (insulin-dependent) diabetes mellitus received simultaneous pancreas/kidney transplants using bladder drainage technique. Another group of 25 Type 1 diabetic patients received pancreas/kidney transplants by the duct occlusion technique. We observed a higher incidence of rejection episodes in the patients of the bladder drainage group than those in the duct occlusion group, 14 of 19 patients (74%) vs 7 of 25 (28%) respectively. Anti CD3 antibodies (Orthoclone, OKT3) as a part of induction treatment was used more often in the bladder drainage group (58%) than in the control group (20%)

Follow-up study of sensory-motor polyneuropathy in Type 1 (insulin-dependent) diabetic subjects after simultaneous pancreas and kidney transplantation and after graft rejection

The influence of successful simultaneous pancreas and kidney transplantation on peripheral polyneuropathy was investigated in 53 patients for a mean observation period of 40.3 months. Seventeen patients were followed-up for more than 3 years. Symptoms and signs were assessed every 6 months using a standard questionnaire, neurological examination and measurement of sensory and motor nerve conduction velocities. While symptoms of polyneuropathy improved (pain, paraesthesia, cramps, restless-legs) and nerve conduction velocity increased, there was no change of clinical signs (sensation, muscle-force, tendon-reflexes). Following kidney-graft-rejection there was a slight decrease of nerve conduction verlocity during the first year, which was not statistically significant. Following pancreas-graft rejection there was no change of nerve conduction velocity during the first year. Comparing the maximum nerve conduction velocity of the patients with pancreas-graft-rejection to the nerve conduction velocities of these patients at the end of the study, there was a statistically significant decrease of 6.5 m/s. In conclusion, we believe that strict normalization of glucose metabolism alters the progressive course of diabetic polyneuropathy. It may be stabilized or partly reversed after successful grafting even in long-term diabetic patients

X-ray Halos and Large Grains in the Diffuse Interstellar Medium

Recent observations with dust detectors on board the interplanetary spacecraft Ulysses and Galileo have recorded a substantial flux of large interstellar grains with radii between 0.25 and 2.0 mu entering the solar system from the local interstellar cloud. The most commonly used interstellar grain size distribution is characterized by a a^-3.5 power law in grain radii a, and extends to a maximum grain radius of 0.25 mu. The extension of the interstellar grain size distribution to such large radii will have a major effect on the median grain size, and on the amount of mass needed to be tied up in dust for a given visual optical depth. It is therefore important to investigate whether this population of larger dust particles prevails in the general interstellar medium, or if it is merely a local phenomenon. The presence of large interstellar grains can be mainly inferred from their effect on the intensity and radial profiles of scattering halos around X-ray sources. In this paper we examine the grain size distribution that gives rise to the X-ray halo around Nova Cygni 1992. The results of our study confirm the need to extend the interstellar grain size distribution in the direction of this source to and possibly beyond 2.0 mu. The model that gives the best fit to the halo data is characterized by: (1) a grain size distribution that follows an a^-3.5 power law up to 0.50 mu, followed by an a^-4.0 extension from 0.50 mu to 2.0 mu; and (2) silicate and graphite (carbon) dust-to-gas mass ratios of 0.0044 and 0.0022, respectively, consistent with solar abundances constraints. Additional observations of X-ray halos probing other spatial directions are badly needed to test the general validity of this result.Comment: 17 pages, incl. 1 figure, accepted for publ. by ApJ Letter

Dust in the Local Interstellar Wind

The gas-to-dust mass ratios found for interstellar dust within the Solar System, versus values determined astronomically for the cloud around the Solar System, suggest that large and small interstellar grains have separate histories, and that large interstellar grains preferentially detected by spacecraft are not formed exclusively by mass exchange with nearby interstellar gas. Observations by the Ulysses and Galileo satellites of the mass spectrum and flux rate of interstellar dust within the heliosphere are combined with information about the density, composition, and relative flow speed and direction of interstellar gas in the cloud surrounding the solar system to derive an in situ value for the gas-to-dust mass ratio, $R_{g/d} = 94^{+46}_{-38}$. Hubble observations of the cloud surrounding the solar system yield a gas-to-dust mass ratio of Rg/d=551+61-251 when B-star reference abundances are assumed. The exclusion of small dust grains from the heliosheath and heliosphere regions are modeled, increasing the discrepancy between interstellar and in situ observations. The shock destruction of interstellar grains is considered, and comparisons are made with interplanetary and presolar dust grains.Comment: 87 pages, 9 figures, 6 tables, accepted for publication in Astrophysical Journal. Uses AASTe

Effect of pancreatic and/or renal transplantation on diabetic autonomic neuropathy

Thirty-nine Type 1 (insulin-dependent) diabetic patients were studied prospectively after simultaneous pancreas and kidney (n=26) and kidney grafting alone (n=13) by measuring heart rate variation during various manoeuvers and answering a standardized questionnaire every 6 to 12 months post-transplant. While age, duration of diabetes, and serum creatinine (168.1±35.4 vs 132.7±17.7 mgrmol/l) were comparable, haemoglobin A1 levels were significantly lower (6.6±0.2 vs 8.5±0.3%; p<0.01) and the mean observation time longer (35±2 vs 25±3 months; p<0.05) in the pancreas recipients when compared with kidney transplanted patients. Heart rate variation during deep breathing, lying/standing and Valsalva manoeuver were very similar in both groups initially and did not improve during follow-up. However, there was a significant reduction in heart rate in the pancreas recipient group. Autonomic symptoms of the gastrointestinal and thermoregulatory system improved more in the pancreas grafted subjects, while hypoglycaemia unawareness deteriorated in the kidney recipients. This study suggests that long-term normoglycaemia by successful pancreatic grafting is able to halt the progression of autonomic dysfunction