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Gondek S, Ogledzinski M, Lin W, Milejczyk K, Juengel B, Potter L, Bachul PJ, Basto L, Perea L, Wang LJ, Tibudan M, Witkowska Z, Barth R, Fung J, Witkowski P. Persistence of long-term insulin independence after islet transplantation and two subsequent pregnancies. Eur J Transl Clin Med 2023; 6:9-13. [PMID: 37693941 PMCID: PMC10485871 DOI: 10.31373/ejtcm/166178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Pregnancy increases metabolic demand for insulin and may lead to the exhaustion of intraportally transplanted islets and post-gestational hyperglycemia. To prevent these complications, we implemented preemptive insulin supplementation during two subsequent pregnancies in an insulin-independent islet transplant recipient. This strategy resulted in optimal blood glucose control during the pregnancies, the preservation of the optimal islet graft function and the postpartum maintenance of long-term insulin independence.
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Affiliation(s)
- Sarah Gondek
- The Transplantation Institute, University of Chicago, USA
| | | | - William Lin
- The Transplantation Institute, University of Chicago, USA
| | | | - Braden Juengel
- The Transplantation Institute, University of Chicago, USA
| | - Lisa Potter
- The Transplantation Institute, University of Chicago, USA
| | - Piotr J Bachul
- The Transplantation Institute, University of Chicago, USA
| | - Lindsay Basto
- The Transplantation Institute, University of Chicago, USA
| | | | - Ling-Jia Wang
- The Transplantation Institute, University of Chicago, USA
| | - Martin Tibudan
- The Transplantation Institute, University of Chicago, USA
| | | | - Rolf Barth
- The Transplantation Institute, University of Chicago, USA
| | - John Fung
- The Transplantation Institute, University of Chicago, USA
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Ogledzinski M, Bachul PJ, Rezania K, Hariprasad SM, Gondek S, Lin W, Juengel B, Milejczyk K, Basto L, Wang LJ, Perea L, Tibudan M, Barth RN, Fung JJ, Witkowski P. Peri-operative Reparixin therapy resulted in 50% 5-year insulin independence rate: The University of Chicago experience. Clin Transplant 2023; 37:e14981. [PMID: 37013956 DOI: 10.1111/ctr.14981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/18/2023] [Accepted: 03/15/2023] [Indexed: 04/05/2023]
Affiliation(s)
- Mateusz Ogledzinski
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Piotr J Bachul
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Kourosh Rezania
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Seenu M Hariprasad
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, USA
| | - Sarah Gondek
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - William Lin
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Braden Juengel
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Kamila Milejczyk
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Lindsay Basto
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Ling-Jia Wang
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Laurencia Perea
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Martin Tibudan
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Rolf N Barth
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - John J Fung
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Piotr Witkowski
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, Illinois, USA
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Anteby R, Lucander A, Bachul PJ, Pyda J, Grybowski D, Basto L, Generette GS, Perea L, Golab K, Wang LJ, Tibudan M, Thomas C, Fung J, Witkowski P. Evaluating the Prognostic Value of Islet Autoantibody Monitoring in Islet Transplant Recipients with Long-Standing Type 1 Diabetes Mellitus. J Clin Med 2021; 10:jcm10122708. [PMID: 34205321 PMCID: PMC8233942 DOI: 10.3390/jcm10122708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 12/03/2022] Open
Abstract
(1) Background: The correlation between titers of islet autoantibodies (IAbs) and the loss of transplanted islets remains controversial. We sought to evaluate the prognostic utility of monitoring IAbs in diabetic patients after islet transplantation (ITx); (2) Methods: Twelve patients with Type 1 diabetes mellitus and severe hypoglycemia underwent ITx. Serum concentration of glutamic acid decarboxylase (GAD), insulinoma antigen 2 (IA-2), and zinc transport 8 (ZnT8) autoantibodies was assessed before ITx and 0, 7, and 75 days and every 3 months post-operatively; (3) Results: IA-2A (IA-2 antibody) and ZnT8A (ZnT8 antibody) levels were not detectable before or after ITx in all patients (median follow-up of 53 months (range 24–61)). Prior to ITx, GAD antibody (GADA) was undetectable in 67% (8/12) of patients. Of those, 75% (6/8) converted to GADA+ after ITx. In 67% (4/6) of patients with GADA+ seroconversion, GADA level peaked within 3 months after ITx and subsequently declined. All patients with GADA+ seroconversion maintained long-term partial or complete islet function (insulin independence) after 1 or 2 ITx. There was no correlation between the presence of IAb-associated HLA haplotypes and the presence of IAbs before or after ITx; (4) Conclusions: There is no association between serum GADA trends and ITx outcomes. IA-2A and ZnT8A were not detectable in any of our patients before or after ITx.
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Affiliation(s)
- Roi Anteby
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Harvard School of Public Health, Boston, MA 02115, USA
| | - Aaron Lucander
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Piotr J. Bachul
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
| | - Jordan Pyda
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA;
| | - Damian Grybowski
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
| | - Lindsay Basto
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
| | - Gabriela S. Generette
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
| | - Laurencia Perea
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
| | - Karolina Golab
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
| | - Ling-jia Wang
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
| | - Martin Tibudan
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
| | - Celeste Thomas
- Department of Medicine, The University of Chicago, Chicago, IL 60637, USA;
| | - John Fung
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
| | - Piotr Witkowski
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
- Correspondence: ; Tel.: +1-773-702-2447
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Bachul PJ, Golab K, Basto L, Borek P, Perea L, Tibudan M, Pyda JS, Perez-Gutierrez A, Fung J, Matthews JB, Witkowski P. Long-term Stability of β-Cell Graft Function After Total Pancreatectomy and Islet Autotransplantation. Pancreas 2021; 50:e2-e4. [PMID: 33370034 PMCID: PMC7806119 DOI: 10.1097/mpa.0000000000001711] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Bachul PJ, Golab K, Basto L, Zangan S, Pyda JS, Perez-Gutierrez A, Borek P, Wang LJ, Tibudan M, Tran DK, Anteby R, Generette GS, Chrzanowski J, Fendler W, Perea L, Jayant K, Lucander A, Thomas C, Philipson L, Millis JM, Fung J, Witkowski P. Post-Hoc Analysis of a Randomized, Double Blind, Prospective Study at the University of Chicago: Additional Standardizations of Trial Protocol are Needed to Evaluate the Effect of a CXCR1/2 Inhibitor in Islet Allotransplantation. Cell Transplant 2021; 30:9636897211001774. [PMID: 33908301 PMCID: PMC8085379 DOI: 10.1177/09636897211001774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/14/2021] [Accepted: 02/22/2021] [Indexed: 12/11/2022] Open
Abstract
A recent randomized, multicenter trial did not show benefit of a CXCR1/2 receptor inhibitor (Reparixin) when analysis included marginal islet mass (>3,000 IEQ/kg) for allotransplantation and when immunosuppression regimens were not standardized among participating centers. We present a post-hoc analysis of trial patients from our center at the University of Chicago who received an islet mass of over 5,000 IEQ/kg and a standardized immunosuppression regimen of anti-thymocyte globulin (ATG) for induction. Twelve islet allotransplantation (ITx) recipients were randomized (2:1) to receive Reparixin (N = 8) or placebo (N = 4) in accordance with the multicenter trial protocol. Pancreas and donor characteristics did not differ between Reparixin and placebo groups. Five (62.5%) patients who received Reparixin, compared to none in the placebo group, achieved insulin independence after only one islet infusion and remained insulin-free for over 2 years (P = 0.08). Following the first ITx with ATG induction, distinct cytokine, chemokine, and miR-375 release profiles were observed for both the Reparixin and placebo groups. After excluding procedures with complications, islet engraftment on post-operative day 75 after a single transplant was higher in the Reparixin group (n = 7) than in the placebo (n = 3) group (P = 0.03) when islet graft function was measured by the ratio of the area under the curve (AUC) for c-peptide to glucose in mixed meal tolerance test (MMTT). Additionally, the rate of engraftment was higher when determined via BETA-2 score instead of MMTT (P = 0.01). Our analysis suggests that Reparixin may have improved outcomes compared to placebo when sufficient islet mass is transplanted and when standardized immunosuppression with ATG is used for induction. However, further studies are warranted. Investigation of Reparixin and other novel agents under more standardized and optimized conditions would help exclude confounding factors and allow for a more definitive evaluation of their role in improving outcomes in islet transplantation. Clinical trial reg. no. NCT01817959, clinicaltrials.gov.
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Affiliation(s)
- Piotr J. Bachul
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Karolina Golab
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Lindsay Basto
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Steven Zangan
- Department of Radiology, University of Chicago, Chicago, IL, USA
| | - Jordan S. Pyda
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Peter Borek
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Ling-Jia Wang
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Martin Tibudan
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Dong-Kha Tran
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Roi Anteby
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Gabriela S. Generette
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Jędrzej Chrzanowski
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Laurencia Perea
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Kumar Jayant
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Aaron Lucander
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Celeste Thomas
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Louis Philipson
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - J. Michael Millis
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - John Fung
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
| | - Piotr Witkowski
- Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, IL, USA
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Generette GS, Bachul PJ, Golab K, Basto L, Pyda JS, Borek P, Tibudan M, Anteby R, Perea L, Charlton M, Perez-Gutierrez A, Jayant K, Lucander A, Matthews JB, Millis JM, Fung J, Witkowski P. En bloc liver and pancreas transplantation after total pancreatectomy with autologous islet transplantation. ACTA ACUST UNITED AC 2020; 3:11-17. [PMID: 33409500 PMCID: PMC7785098 DOI: 10.31373/ejtcm/130187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present a patient with intractable and debilitating pain secondary to chronic pancreatitis who was effectively treated with total pancreatectomy with islet autotransplantation (TPIAT). Islets engrafted into his liver significantly contributed to improved blood glucose control and quality of life. Subsequently, the patient developed alcohol related acute liver failure and en bloc liver and pancreas transplantation was performed to replace the failing liver with engrafted islets. Pancreas transplantation was required to resolve his life-threatening severe hypoglycemic episodes. Herein, we detail an innovative and multidisciplinary management of this complex medical problem.
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Affiliation(s)
| | - Piotr J Bachul
- The Transplantation Institute, University of Chicago, USA
| | - Karolina Golab
- The Transplantation Institute, University of Chicago, USA
| | - Lindsay Basto
- The Transplantation Institute, University of Chicago, USA
| | - Jordan S Pyda
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, USA
| | - Peter Borek
- The Transplantation Institute, University of Chicago, USA
| | - Martin Tibudan
- The Transplantation Institute, University of Chicago, USA
| | - Roi Anteby
- The Transplantation Institute, University of Chicago, USA
| | | | | | | | - Kumar Jayant
- The Transplantation Institute, University of Chicago, USA
| | - Aaron Lucander
- The Transplantation Institute, University of Chicago, USA
| | | | | | - John Fung
- The Transplantation Institute, University of Chicago, USA
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Bachul PJ, Gołębiewska JE, Basto L, Gołąb K, Anteby R, Wang LJ, Tibudan M, Thomas C, Fendler W, Lucander A, Grybowski DJ, Dębska-Ślizień A, Fung J, Witkowski P. BETA-2 score is an early predictor of graft decline and loss of insulin independence after pancreatic islet allotransplantation. Am J Transplant 2020; 20:844-851. [PMID: 31597009 DOI: 10.1111/ajt.15645] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/10/2019] [Accepted: 09/29/2019] [Indexed: 01/25/2023]
Abstract
This study aimed to evaluate whether the BETA-2 score is a reliable early predictor of graft decline and loss of insulin independence after islet allotransplantation. Islet transplant procedures were stratified into 3 groups according to clinical outcome: long-term insulin independence without islet graft decline (group 1, N = 9), initial insulin independence with subsequent islet graft decline and loss of insulin independence (group 2, N = 13), and no insulin independence (group 3, N = 13). BETA-2 was calculated on day 75 and multiple times afterwards for up to 145 months posttransplantation. A BETA-2 score cut-off of 17.4 on day 75 posttransplantation was discerned between group 1 and groups 2 and 3 (area under the receiver operating characteristic 0.769, P = .005) with a sensitivity and negative predictive value of 100%. Additionally, BETA-2 ≥ 17.4 at any timepoint during follow-up reflected islet function required for long-term insulin independence. While BETA-2 did not decline below 17.4 for each of the 9 cases from group 1, the score decreased below 17.4 for all transplants from group 2 with subsequent loss of insulin independence. The reduction of BETA-2 below 17.4 predicted 9 (1.5-21) months in advance subsequent islet graft decline and loss of insulin independence (P = .03). This finding has important implications for posttransplant monitoring and patient care.
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Affiliation(s)
- Piotr J Bachul
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Justyna E Gołębiewska
- Department of Surgery, University of Chicago, Chicago, Illinois.,Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Lindsay Basto
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Karolina Gołąb
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Roi Anteby
- Department of Surgery, University of Chicago, Chicago, Illinois.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ling-Jia Wang
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Martin Tibudan
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Celeste Thomas
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Łódź, Łódź, Poland
| | - Aaron Lucander
- Department of Surgery, University of Chicago, Chicago, Illinois
| | | | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - John Fung
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Piotr Witkowski
- Department of Surgery, University of Chicago, Chicago, Illinois
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Gołębiewska JE, Bachul PJ, Fillman N, Kijek MR, Basto L, Para M, Perea L, Gołąb K, Wang LJ, Tibudan M, Dębska-Ślizień A, Matthews JB, Fung J, Witkowski P. Early Infectious Complications After Total Pancreatectomy with Islet Autotransplantation: a Single Center Experience. J Gastrointest Surg 2019; 23:2201-2210. [PMID: 30719679 DOI: 10.1007/s11605-019-04118-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/09/2019] [Indexed: 01/31/2023]
Abstract
INTRODUCTION We assessed whether positive microbiological cultures from the islet preparation had any effect on the risk of infectious complications (IC) after total pancreatectomy with islet autotransplantation (TPIAT) in our center. METHODS We analyzed preservation fluid and final islet product surveillance cultures with reference to clinical data of patients undergoing TPIAT. All patients received routine prophylactic broad-spectrum antibiotics. RESULTS The study involved 10 men and 18 women with a median age of 39 years. Over 30% of surveillance cultures during pancreas processing grew bacterial strains with predominantly polymicrobial contaminations (13 of 22 (59%)). At least one positive culture was identified in almost half of the patients (46%) undergoing TPIAT and a third had both surveillance cultures positive. Infectious complications affected 50% of patients. After excluding cases of PICC line-associated bacteremia/fungemia present on admission, incidence of IC was higher in cases of positive final islet product culture than in those with negative result (57% vs. 21%), which also corresponded with the duration of chronic pancreatitis (p = 0.04). Surgical site infections were the most common IC, followed by fever of unknown origin. There was no concordance between pathogens isolated from the pancreas and those identified during the infection. CONCLUSIONS While IC was common among TPIAT patients, we found no concordance between pathogens isolated from the pancreas and those identified during infection. Contamination of the final islet product was of clinical importance and could represent a surrogate marker for higher susceptibility to infection.
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Affiliation(s)
- Justyna E Gołębiewska
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr J Bachul
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Natalie Fillman
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
| | - Mark R Kijek
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
| | - Lindsay Basto
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
| | - Monica Para
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
| | - Laurencia Perea
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
| | - Karolina Gołąb
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
| | - Ling-Jia Wang
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
| | - Martin Tibudan
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Jeffrey B Matthews
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
| | - John Fung
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA
| | - Piotr Witkowski
- Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA.
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9
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Gołębiewska JE, Bachul PJ, Wang LJ, Matosz S, Basto L, Kijek MR, Fillman N, Gołąb K, Tibudan M, Dębska-Ślizień A, Millis JM, Fung J, Witkowski P. Validation of a New North American Islet Donor Score for Donor Pancreas Selection and Successful Islet Isolation in a Medium-Volume Islet Transplant Center. Cell Transplant 2018; 28:185-194. [PMID: 30520321 PMCID: PMC6362524 DOI: 10.1177/0963689718816989] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The selection of optimal pancreas donors is one of the key factors in determining the ultimate outcome of clinical islet isolation. North American Islet Donor Score (NAIDS) allows for estimating the chance of the success of islet isolation. It was developed based on the data from over 1000 donors from 11 islet isolation centers and validated in the University of Alberta, Edmonton, on the cohort from the most active islet transplant center. Now we aimed to also validate it in our much less active program. Areas under the receiver operating characteristic curves (AUROCs) and logistic regression analyses were obtained to test if NAIDS would better predict successful islet isolation (defined as post-purification islet yield >400,000 islet equivalents (IEQ)) than previously described Edmonton islet donor score (IDS) and our modified version of IDS. We analyzed the donor scores with reference to 82 of our islet isolation outcomes. The success rate increased proportionally as NAIDS increased, from 0% success in NAIDS < 50 points to 40% success in NAIDS ≥ 80 points. AUROCs were 0.67 (95% confidence interval (CI) 0.55–0.79) for NAIDS, 0.58 (95% CI 0.44–0.71) for modified IDS, and 0.51 (95% CI 0.37–0.65) for IDS and did not differ significantly. However, based on logistic regression analyses, NAIDS was the only statistically significant predictor of successful isolation (p = 0.01). The main advantage of NAIDS is an enhanced ability to discriminate poor-quality donors than previously used scoring systems at University of Chicago, with 0% chance for success when NAIDS was <50 as compared with 40% success rate for IDS <50. NAIDS was found to be the most useful available tool for donor pancreas selection in clinical and research practice in our center, allowing for identification and rejection of poor-quality donors, saving time and resources.
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Affiliation(s)
- Justyna E Gołębiewska
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA.,2 Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr J Bachul
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA.,3 Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Ling-Jia Wang
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Sabrina Matosz
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Lindsay Basto
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Mark R Kijek
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Natalie Fillman
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Karolina Gołąb
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Martin Tibudan
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Alicja Dębska-Ślizień
- 2 Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - J Michael Millis
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - John Fung
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Piotr Witkowski
- 1 Department of Surgery, University of Chicago, Chicago, IL, USA
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10
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Gołębiewska JE, Bachul PJ, Fillman N, Basto L, Kijek MR, Gołąb K, Wang LJ, Tibudan M, Thomas C, Dębska-Ślizień A, Gelrud A, Matthews JB, Millis JM, Fung J, Witkowski P. Assessment of simple indices based on a single fasting blood sample as a tool to estimate beta-cell function after total pancreatectomy with islet autotransplantation - a prospective study. Transpl Int 2018; 32:280-290. [PMID: 30353611 DOI: 10.1111/tri.13364] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/05/2018] [Accepted: 10/15/2018] [Indexed: 12/13/2022]
Abstract
We investigated six indices based on a single fasting blood sample for evaluation of the beta-cell function after total pancreatectomy with islet autotransplantation (TP-IAT). The Secretory Unit of Islet Transplant Objects (SUITO), transplant estimated function (TEF), homeostasis model assessment (HOMA-2B%), C-peptide/glucose ratio (CP/G), C-peptide/glucose creatinine ratio (CP/GCr) and BETA-2 score were compared against a 90-min serum glucose level, weighted mean C-peptide in mixed meal tolerance test (MMTT), beta score and the Igls score adjusted for islet function in the setting of IAT. We analyzed values from 32 MMTTs in 15 patients after TP-IAT with a follow-up of up to 3 years. Four (27%) individuals had discontinued insulin completely prior to day 75, while 6 out of 12 patients (50%) did not require insulin support at 1-year follow-up with HbA1c 6.0% (5.5-6.8). BETA-2 was the most consistent among indices strongly correlating with all reference measures of beta-cell function (r = 0.62-0.68). In addition, it identified insulin independence (cut-off = 16.2) and optimal/good versus marginal islet function in the Igls score well, with AUROC of 0.85 and 0.96, respectively. Based on a single fasting blood sample, BETA-2 score has the most reliable discriminant value for the assessment of graft function in patients undergoing TP-IAT.
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Affiliation(s)
- Justyna E Gołębiewska
- Department of Surgery, University of Chicago, Chicago, IL, USA.,Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr J Bachul
- Department of Surgery, University of Chicago, Chicago, IL, USA.,Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Natalie Fillman
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Lindsay Basto
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Mark R Kijek
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Karolina Gołąb
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Ling-Jia Wang
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Martin Tibudan
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Celeste Thomas
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Andres Gelrud
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | | | - John Fung
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Piotr Witkowski
- Department of Surgery, University of Chicago, Chicago, IL, USA
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11
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Mesquita M, Ratola A, Tiago J, Basto L. Neonatal hypotonia: is it a diagnostic challenge? Rev Neurol 2018; 67:287-292. [PMID: 30289151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Hypotonia is a frequent sign of disease in newborns. However, it's a nonspecific clinical finding: may be the presentation form of a systemic or neurological disease. AIMS To study the main causes of neonatal hypotonia as well as to evaluate the diagnostic accuracy of the anamnesis and physical examination of the hypotonic newborn. PATIENTS AND METHODS A 22-year retrospective study of hypotonic neonates admitted to the Neonatal Intensive Care Unit was conducted. It was performed an initial blind classification of hypotonia's type (central-CH, peripheral-PH or undetermined hypotonia) based on the clinical history and the recorded data of physical examination. RESULTS 91 infants were included. 42 (46.2%) had prenatal history abnormalities: polyhydramnios (28.6%), intrauterine growth restriction (21.4%) and pelvic presentation (19.0%). 53 (58.2%) required resuscitation at birth. The main associated symptoms were respiratory distress (65.9%), feeding difficulties (36.5%) and decreased spontaneous movements (22.4%). The final diagnosis was reached in 64 newborns (70.3%): 81.3% with CH, 18.7% with PH. The positive predictive value of the initial classification was 97.9% in CH and 66.7% in PH group. The mortality rate was 8.8% and it was higher in PH group (58.3% vs 1.3%). CONCLUSIONS Neonatal hypotonia can be associated to an extensive list of disorders. A detailed clinical history associated to a careful neurological evaluation present a high diagnostic predictive value that should guide the etiological investigation.
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Affiliation(s)
- M Mesquita
- Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - A Ratola
- Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - J Tiago
- Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - L Basto
- Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
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12
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Gołębiewska J, Solomina J, Kijek MR, Kotukhov A, Basto L, Gołąb K, Bachul PJ, Konsur E, Ciepły K, Fillman N, Wang LJ, Thomas CC, Philipson LH, Tibudan M, Krenc A, Dębska-Ślizień A, Fung J, Witkowski P. External Validation of the Newly Developed BETA-2 Scoring System for Pancreatic Islet Graft Function Assessment. Transplant Proc 2018; 49:2340-2346. [PMID: 29198674 DOI: 10.1016/j.transproceed.2017.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND BETA-2 score using a single fasting blood sample was developed to estimate beta-cell function after islet transplantation (ITx) and was validated internally by a high ITx volume center (Edmonton). The goal was to validate BETA-2 externally, in our center. METHODS Areas under receiver operating characteristic curves (AUROCs) were obtained to see if beta score or BETA-2 would better detect insulin independence and glucose intolerance. RESULTS We analyzed values from 48 mixed meal tolerance tests (MMTTs) in 4 ITx recipients with a long-term follow-up to 140 months (LT group) and from 54 MMTTs in 13 short-term group patients (ST group). AUROC for no need for insulin support was 0.776 (95% confidence interval [CI] 0.539-1, P = .02) and 0.922 (95% CI 0.848-0.996, P < .001) for beta score and 0.79 (95% CI 0.596-0.983, P = .003) and 0.941 (95% CI 0.86-1, P < .001) for BETA-2, in LT and ST groups, respectively, and did not differ significantly. In LT group BETA-2 score ≥ 13.03 predicted no need for insulin supplementation with sensitivity of 98%, specificity of 50%, positive predictive value (PPV) of 93%, and negative predictive value (NPV) of 75%. In ST group the optimal cutoff was ≥13.63 with sensitivity of 92% and specificity, PPV, and NPV 82% to 95%. For the detection of glucose intolerance BETA-2 cutoffs were <19.43 in LT group and <17.23 in ST group with sensitivity > 76% and specificity, PPV, and NPV > 80% in both groups. CONCLUSION BETA-2 score was successfully validated externally and is a practical tool allowing for frequent and reliable assessments of islet graft function based on a single fasting blood sample.
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Affiliation(s)
- J Gołębiewska
- Department of Surgery, University of Chicago, Chicago, Illinois, USA; Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - J Solomina
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - M R Kijek
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - A Kotukhov
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - L Basto
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - K Gołąb
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - P J Bachul
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - E Konsur
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - K Ciepły
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - N Fillman
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - L-J Wang
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - C C Thomas
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - L H Philipson
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - M Tibudan
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - A Krenc
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - A Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - J Fung
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - P Witkowski
- Department of Surgery, University of Chicago, Chicago, Illinois, USA.
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13
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Gołębiewska JE, Solomina J, Thomas C, Kijek MR, Bachul PJ, Basto L, Gołąb K, Wang LJ, Fillman N, Tibudan M, Ciepły K, Philipson L, Dębska-Ślizień A, Millis JM, Fung J, Witkowski P. Comparative evaluation of simple indices using a single fasting blood sample to estimate beta cell function after islet transplantation. Am J Transplant 2018; 18:990-997. [PMID: 29218834 DOI: 10.1111/ajt.14620] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/17/2017] [Accepted: 11/29/2017] [Indexed: 01/25/2023]
Abstract
Six single fasting blood sample-based indices-Secretory Unit of Islet Transplant Objects (SUITO), Transplant Estimated Function (TEF), Homeostasis Model Assessment (HOMA)2-B%, C-peptide/glucose ratio (CP/G), C-peptide/glucose creatinine ratio (CP/GCr), and BETA-2 score-were compared against commonly used 90-minute mixed meal tolerance test (MMTT) serum glucose and beta score to assess which of them best recognizes the state of acceptable blood glucose control without insulin supplementation after islet allotransplantation (ITx). We also tested whether the indices could identify the success of ITx based on the Igls classification of beta cell graft function. We analyzed values from 47 MMTT tests in 4 patients with up to 140 months follow-up and from 54 MMTT tests in 13 patients with up to 42 months follow-up. SUITO, CP/G, HOMA2-B%, and BETA-2 correlated well with the 90-minute glucose of the MMTT and beta-score (r 0.54-0.76), whereas CP/GCr showed a modest performance (r 0.41-0.52) while TEF showed little correlation. BETA-2 and SUITO were the best identifiers and predictors of the need for insulin support, glucose intolerance, and ITx success (P < .001), while HOMA2-B% and TEF were unreliable. Single fasting blood sample SUITO and BETA-2 scores are very practical alternative tools that allow for frequent assessments of graft function.
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Affiliation(s)
- Justyna E Gołębiewska
- Department of Surgery, University of Chicago, Chicago, IL.,Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Julia Solomina
- Department of Surgery, University of Chicago, Chicago, IL
| | - Celeste Thomas
- Department of Medicine, University of Chicago, Chicago, IL
| | - Mark R Kijek
- Department of Surgery, University of Chicago, Chicago, IL
| | - Piotr J Bachul
- Department of Surgery, University of Chicago, Chicago, IL.,Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Lindsay Basto
- Department of Surgery, University of Chicago, Chicago, IL
| | - Karolina Gołąb
- Department of Surgery, University of Chicago, Chicago, IL
| | - Ling-Jia Wang
- Department of Surgery, University of Chicago, Chicago, IL
| | | | - Martin Tibudan
- Department of Surgery, University of Chicago, Chicago, IL
| | - Kamil Ciepły
- Department of Surgery, University of Chicago, Chicago, IL
| | | | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | | | - John Fung
- Department of Surgery, University of Chicago, Chicago, IL
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14
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Costa J, Brandão A, Correia A, Pereira MA, Basto L, Rodrigues P. [Extra-adrenal pheochromocytoma simulating acute myocardial infarction]. Rev Port Cardiol 1999; 18:1025-9. [PMID: 10608162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
The authors present the case of a 65 year-old female who was admitted to the emergency room with epigastric pain, headache, palpitations, nausea, vomiting and sweating. The laboratory tests performed showed elevation of CK and CK-MB and the ECG presented sinus tachycardia. T-wave inversion and prolonged QT interval. The echocardiogram was normal. The patient was admitted to the ICU and during the standard myocardial infarction treatment (including beta-blocker) a wide range of the arterial pressure (230/140 to 70/40 mm Hg) was registered. In view of these new data, the hypothesis of pheochromocytoma and catecholamine induced myocarditis was suggested and later confirmed by high levels of plasmatic and urinary catecholamines. The abdominal echography. CT and MRI showed a large retroperitonal and para-aortic mass. The administration of phenoxybenzamine (30 mg/day) led to the normalization of the ECG and arterial pressure and the respective clinical improvement. The anatomopathological exam, after surgical removal, confirmed our hypothesis. Sixteen months after the surgical procedure the patient is assymptomatic, with normal arterial pressure and normal levels of plasmatic and urinary catecholamines.
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Affiliation(s)
- J Costa
- Serviço de Cardiologia, Hospital de S. Marcos, Braga
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15
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Ribeiro A, Correia A, Fernandes F, Barbosa AP, Basto L, Lima F, Rodrigues P. [Pulmonary thromboembolism in a female with resistance to activated protein C]. Rev Port Cardiol 1999; 18:601-7. [PMID: 10422456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
Primary or acquired hypercoagulable states favour thrombotic events. The identification of prothrombotic states is of immediate practical usefulness in the orientation, prophylaxis and treatment of pulmonary embolism. Detection of individuals resistant to activated protein C. the most frequent laboratory anomaly in the study of patients with venous thromboembolism, offers a better approach for these patients as well as a better prophylaxis and orientation of their direct relatives concerning thromboembolic events. The authors describe the clinical case of a young woman, previously healthy, who developed serious pulmonary thromboembolism, the resolution of which was difficult and the evolution unusual. Later, a state of resistance to activated protein C (aPCr) was identified. Concerning the case described, the authors reflect on hypercoagulable situations, especially "aPCr" states.
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Affiliation(s)
- A Ribeiro
- Serviços de Cardiologia e Imuno-hemoterapia, Hospita de S. Marcos, Braga
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16
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Ribeiro A, Fernandes F, Basto L, Rodrigues P. [Myocardial infarct without angiographic coronary atherosclerosis: study of a group of patients]. Rev Port Cardiol 1999; 18:371-8. [PMID: 10371845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
STUDY OBJECTIVES Clinical characterization and aspects of subsidiary clinical tests in a group of patients with myocardial infarction with no visible angiographic atherosclerotic stenosis. Etiologic identification, therapeutic approach and prognostic assessment of non atherosclerotic myocardial infarction. PATIENTS We studied patients admitted with myocardial infarction to coronary care unit over a 4 year period and in whom cardiac catheterism did not show atherosclerotic coronary stenosis (17 patients). METHODOLOGY Retrospective study; Assessment of clinical characteristics, exercise test parameters, echocardiogram, hemodynamics, heart rate variability (HRV) and signal-averaged electrocardiogram (ECG) of this group of patients; Maximal follow-up of 44 months and minimal of 3 months (average: 19.9 +/- 12.7 months) for the occurrence of ischemic cardiac events (recurrent angina, reinfarction or sudden death). RESULTS Non atherosclerotic coronary infarction was an unusual situation (2% of the totality of the infarction hospitalized during those 4 years--795 cases), occurring mainly among young men, with few vascular risk factors (except smoking), as small infarctions, without a preferential localization and with good evolution in the acute phase (Killip I). In the predischarge exercise test there was no residual ischemia and functional capacity was generally good. In the majority of cases left ventricular systolic function was preserved (82% of the cases). With cardiac catheterism, we observed two cases of "bridging" and four cases of slow contrast progression. In arrhythmic risk stratification with 24 hours ECG, HRV and high resolution ECG, we observed no adverse prognostic markers in the majority of the cases. The clinical observation of the patients and the tests permitted us to establish probable hypotheses for the etiological diagnoses in 10 of the cases (left main anterior descending artery "bridging"--2 cases; slow contrast progression in the coronary vessels--4 cases, severe aortic stenosis--1 case; left valvular mechanic prosthesis--1 case: probable coronary thrombosis with complete reperfusion after thrombolytic therapy--2 cases). The therapeutic approach in the acute phase was the same as that of atherosclerotic infarctions. Secondary prevention was individualized and according to each case etiology, maintaining the antiplatelet agents. In the follow-up there was unstable angina in 3 patients. There were no cases of reinfarction or sudden death. CONCLUSIONS This study allowed the characterization of the group of non atherosclerotic myocardial infarction as a group of young men with few vascular risk factors, with small infarctions and good prognosis, without adverse arrhythmic risk markers. It also allowed to identify the probable infarction etiology in 10 patients and the secondary individual prevention for each situation. We noted a good prognosis of this situation at two years.
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Affiliation(s)
- A Ribeiro
- Serviço de Cardiologia, Hospital de S. Marcos, Braga
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17
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Brandão A, Gomes A, Pereira M, Brandão I, Basto L, Delgado M, Gonçalves C, Lemos P, Falcão J, Rodrigues P. [Pheochromocytoma--apropos a clinical case]. Rev Port Cardiol 1993; 12:647-50, 601. [PMID: 8352984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A case of a 43-year-old woman with severe sustained hypertension resistant to many antihypertensive drugs, frequent hypertensive crisis and symptoms suggestive of pheochromocytoma (symptomatic triad) is presented. Three of the four determinations of the urinary catecholamines metabolites have been normal as it was the only determination of plasmatic catecholamines. Abdominal sonography and CT scan detected a left adrenal mass, that have been histologically confirmed, after surgery, to be a pheochromocytoma. After adrenalectomy, the patient symptoms disappeared but she maintained mild hypertension easily controlled with drugs. The finding of normal plasmatic and urinary catecholamines values in a patient with sustained hypertension may suggest that we are handling with a case of essential hypertension and a superimposed pheochromocytoma with paroxysmal secretion. Some considerations are made essentially about specificity and sensitivity of diagnostic tests.
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Affiliation(s)
- A Brandão
- Serviço de Cardiologia, Hospital de S. Marcos de Braga
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18
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Brandão A, Brandão I, Costeira A, Pereira M, Basto L, Correia A, Araújo O, Pacheco N, Sampaio N, Teles M. [Primary hyperaldosteronism. A report of 2 clinical cases]. Rev Port Cardiol 1993; 12:10, 69-72. [PMID: 8517971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
We describe two clinical cases of primary hyperaldosteronism caused by adrenal adenoma (Conn's syndrome) with very different forms of clinical presentation. Some theoretical considerations about diagnosis and treatment of the disease are made.
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Affiliation(s)
- A Brandão
- Serviço de Cardiologia, Hospital de S. Marcos, Braga
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19
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Roudaut R, Gosse P, Basto L, Reynaud P, Leherissier A, Dallocchio M. [Value and limitations of transthoracic Doppler echocardiography in the diagnosis of thromboses of mechanical valve prosthesis. Report of 19 cases]. Arch Mal Coeur Vaiss 1990; 83:1417-22. [PMID: 2122860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The diagnosis of thrombosis of a valvular prosthesis is difficult especially in cases of partial thrombosis. The authors report 19 cases of partial thrombosis of mainly (16 cases) mechanical valve prostheses confirmed by radioscopy and treated either by reoperation or fibrinolysis. Mitral Valve Prostheses: 14 cases (6 Björk, 7 SJM, 1 Carbomedics). All but one case showed significant prolongation of the pressure half time compared with the postoperative reference value. In one case, however, the functional parameters of the prosthesis were normal; the diagnosis was made from the finding of a mobile thrombus on the ventricular surface of the prosthesis. Aortic Valve Prostheses: 5 cases (3 Björk, 1 SJM, 1 Duromedics). Continuous wave Doppler showed significant increases in the velocity of transprosthetic blood flow with respect to the postoperative reference values. Accurate analysis of the mobile elements of the prostheses was usually impossible. These results show that transthoracic Doppler echocardiography remains an excellent method of study and surveillance of mechanical valve prostheses but the limitations of the technique should be familiar to all operators.
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Affiliation(s)
- R Roudaut
- Hôpital cardiologique du Haut-Lévêque, centre hospitalier et universitaire de Bordeaux, Pessac
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20
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Jesus IP, Gomes MV, Basto L, Reis O, Agoas R, Camacho A, Marques V, Cohen I, Castel-Branco JF, Leiria JM. [Cardiac pacing: experience at a district hospital]. Rev Port Cardiol 1988; 7:421-7. [PMID: 3273444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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