Showing papers by "Marco Castagneto published in 1998"

A Surgical Option for Familial Chylomicronemia Associated with Insulin-Resistant Diabetes Mellitus

Abstract: Background: The goal of the present work is to present an effective surgical approach for the treatment of a medically-resisitant form of hyperlipidemia. Methods: Two siblings with familial lipoprotein-lipase deficiency and subsequent hyperchylomicronemia, widespread skin xanthomas and severe insulin-resistant diabetes mellitus came to our observation after several unsuccessful attempts at medical treatment. In order to lower plasma lipids through lipid malabsorption, a modified bilio-pancreatic diversion operation was employed. The rationale in deciding to use this surgical approach was based also on the likely hypothesis that diabetes, in these subjects, was secondary to high circulating and tissue levels of lipids. Insulin sensitivity in the two treated subjects, as well as in 24 healthy volunteers constituting the control group, was assessed by euglycemic hyperinsulinemic clamp and indirect calorimetry, obtaining total end-clamp glucose uptake (M) and end-clamp glucose oxidation (ECGO) rates. Results: Within 3 weeks of surgery, plasma triglycerides and cholesterol levels had decreased from 4500 and 500 mg/dl (with dietary restrictions) to lower than 450 and 150 mg/dl (on a free, lipid-rich diet) respectively. Fasting plasma glucose levels had decreased from above 300 (under daily repeated subcutaneous injections of insulin) to 80-100 mg/dl (without administration of insulin or oral hypoglycemic agents). Body weight and fat free mass were maintained in both subjects after surgery. In both patients, before surgery M and ECGO were significantly lower than in normal subjects, while after surgery they were not significantly different from normal subjects, confirming the positive metabolic effect of the operation. Conclusion: The surgical option used in these patients may represent an interesting and effective new possibility for treatment of those severe cases of hyperlipemia leading otherwise to metabolic complications and a low quality of life.

A randomized study comparing three cyclosporine-based regimens in cadaveric renal transplantation: results at 7 years.

Abstract: AFTER the worldwide adoption of cyclosporine (CsA) for maintenance immunosuppression, a striking improvement in renal transplant survival has been obtained. Recipients of first cadaver allografts commonly achieve 1-year graft survival approaching 90% with low patient mortality. Yet, in spite of the large experience accumulated with CsA, we still do not know which CsA-based protocol is better in the long-term. Although CsA was administered alone in clinical transplantation at the beginning of its use, steroid-free immunosuppression has not been accepted in most transplant centers because of the risk of nephrotoxicity associated with the large dose of CsA required for successful immunosuppresion and the increased risk of acute rejection, which could expose patients to chronic graft dysfunction in the long term. The results obtained using an association between CsA and steroids (double therapy) or CsA, steroids, and azathioprine (triple therapy) did not show any significant differences in either the patient or graft survival rates or in the incidence of drug-related complications. We recently reported the results of a randomized trial simultaneously comparing the three treatment schemes. We have now reanalyzed the data by extending the follow-up at 7 years after transplantation.

Preoperative recipient data and immunosuppression levels are predictive of early patient survival after liver transplantation

Abstract: The role of donor, preoperative, intraoperative, and postoperative factors in predicting patient survival after liver transplantation was evaluated by the Bio Medicus data package on a database containing 162 variables filled with records from 100 consecutive first-liver transplant cases. Donor data did not predict outcome. Recipient preoperative data (Child status, HCV status) were predictive using life table and Cox regression methods. Recipient intraoperative data (by-pass time, warm ischemia time, delay in arterial revascularization, and packed red blood cell requirements) were predictive of outcome using life table analysis. Recipient postoperative data (rejection, sepsis, primary dysfunction, and hepatic artery thrombosis) were predictive of outcome.

Outcome of liver transplantation after acute rejection and sepsis

Abstract: ORGAN transplantation is the best treatment modality for end-stage failure of the kidney, heart, liver, and lung. To avoid or reduce the rejection, therapy is based mainly on immunosuppressive strategies. The main complications of the immunosuppressive therapy are septic events which can lead to organ loss and/or patient death. The goal of specific, selective, safe immunosuppression is to avoid rejection without complications. Immunosuppressive therapy doses are often too low with risks of rejection or to too high with risks of sepsis. The aim of this study was to evaluate, by life-table analysis, the outcome of liver transplantation after acute rejection and sepsis episodes.