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Biomedical subjects

R Gunnarsson

Publications and source records attributed to R Gunnarsson.

At least 55 records · Page 3Linked to original sources
PubMed1985

Pancreatic transplantation in diabetes mellitus: present status.

Between December 1966 and June 1982, 269 transplantations of vascularized pancreas (whole or segmental) were undertaken in 254 diabetic patients throughout the world. Most of the transplantations were performed in patients with end-stage renal disease who also received kidney grafts; a few patients received pancreatic grafts only. About 25% of the pancreatic grafts are still functioning after periods of various lengths, the longest being five years. To the problem of how to handle the exocrine secretion there are two main approaches: 1) occlusion of the duct with a synthetic polymer and 2) pancreatico-enterostomy. A disadvantage of the former procedure is late fibrosis and atrophy of the endocrine tissue. With the latter method duct leakage and fistula development cannot be completely prevented. In either case, vascular complications cause graft failure in about 20% of the operations. The risk of rejection of the graft seems not to differ significantly from that concerning other allogeneic organs, including the kidney and heart. Most of the patients with a functioning pancreatic graft are normoglycemic: they have a normal or near-normal oral or intravenous glucose tolerance and an early insulin response to intravenous glucose tolerance and an early insulin response to intravenous glucose challenge. Whether the improvement of the motor and sensory nerve conduction velocities observed in some patients whose graft has functioned for a long time is due to the reversal of renal insufficiency or to insulin deficiency cannot yet be determined. At present, pancreas transplantation at Huddinge Hospital is performed only in conjunction with renal transplantation in patients with end-stage diabetic renal disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Prevention of kidney graft diabetic nephropathy by pancreas transplantation in man.

Kidney graft biopsies were performed 2-3 yr after transplantation in eight type I (insulin-dependent) diabetic patients who had previously been subjected to kidney transplantation (six patients) or combined kidney and segmental pancreas transplantation (two patients). In five of the six patients that had undergone only kidney transplantation, light microscopic examination of the graft biopsy revealed changes compatible with diabetic nephropathy, and electron microscopic morphometry showed a thickening of the glomerular basement membrane (GBM). In the two patients who had been subjected to combined pancreas and kidney transplantation, the kidney graft biopsy showed no light microscopic changes suggestive of diabetic nephropathy, and electron microscopy showed no thickening of the GBM. Thus, it appears to be possible to prevent the recurrence of diabetic nephropathy in human kidney allografts by simultaneous pancreas transplantation.

Adolescent↗
PubMed1984

Acute myocardial infarction in renal transplant recipients: incidence and prognosis.

Acute myocardial infarction occurred in 11 of 212 consecutive renal transplant recipients. This incidence is more than 10 times greater than that for an age- and sex-matched unselected population. All 11 patients died from infarction. 5 of the first attack and the rest within the nest 12 months from recurrence. The risk of developing myocardial infarction was greatest for older recipients who had been suffering from angina pectoris prior to the transplantation.

Adolescent↗
PubMed1984

Influence of physical training on formation of muscle capillaries in type I diabetes.

The effects of physical training on skeletal muscle morphology and enzyme activities were compared in 10 male, type I diabetic subjects and 10 healthy, male, control subjects. The training program consisted of running for 45 min, three times per week for 8 wk. Muscle biopsies were obtained before and after the training period from the lateral portion of the gastrocnemius muscle. Pretraining maximal oxygen uptake was similar in the two groups (diabetic subjects 42 +/- 1 versus control subjects 43 +/- 2 ml X kg-1 X min-1), and the training resulted in an identical increase (+ 13%, P less than 0.01). Muscle capillarization (number of capillaries per muscle fiber) increased on the average in the control group (+ 14 +/- 4%, P less than 0.01), but was unchanged in the diabetic group (0 +/- 4%). Capillary density, expressed as number of capillaries per unit muscle cross sectional area, also increased on the average in controls (8 +/- 4%, P less than 0.05) but failed to do so in the diabetic patients (-8 +/- 6%, NS). The activities of the mitochondrial enzymes citrate synthase (+ 26-27%, P less than 0.01-0.05) and succinate dehydrogenase (+ 24-25%, P less than 0.05) increased significantly and similarly in the two groups, whereas training did not result in significant changes in the activities of the glycolytic enzymes 6-phosphofructokinase and glyceraldehyde-phosphate dehydrogenase. Glycemic control in the diabetic group did not improve with the training, as evaluated from hemoglobin A1 and home-monitored blood glucose.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Deterioration in glucose metabolism in pancreatic transplant recipients after conversion from azathioprine to cyclosporine.

Six recipients of combined pancreas and kidney transplants displayed a deterioration in glucose tolerance when the immunosuppressive therapy was changed from azathioprine-prednisolone to cyclosporine-prednisolone. Because at the same time the plasma C-peptide level increased it seems that insulin resistance, rather than reduced insulin secretion, caused the impairment in glucose tolerance. The condition was found to be reversible.

Adult↗
PubMed1984

Insulin secretion in human obesity: effects of prolonged fasting and refeeding.

The effects of prolonged fasting and refeeding on insulin secretion were examined in seven obese non-diabetic subjects. Plasma insulin and C-peptide concentrations were measured before and after fasting for 7 days, and after refeeding with a low caloric diet. Urine C-peptide excretion during 24 h was determined daily during the study period. Plasma insulin and C-peptide levels fell by about 50 percent during fasting and returned to the prefasting values after refeeding. During fasting the 24-h urine C-peptide excretion was markedly diminished; after 7 days it was less than 10 percent of the prefasting level; on refeeding a low caloric diet, it increased significantly although not to the initial basal values. It is concluded that in human obesity pancreatic insulin secretion is markedly diminished by prolonged fasting.

Adult↗
PubMed1983

Residual C-peptide production in type I diabetes mellitus. A comparison of different methods of assessment and influence on glucose control.

The aims of the present study were to compare various methods for assessment of residual insulin production and to evaluate its role in the metabolic regulation in insulin-dependent, type I diabetes mellitus. Glycosylated hemoglobin (HbA1) was used as a measure of the long-term glycemic control. Twenty-eight patients with type I diabetes mellitus with onset before the age of 30 and with a duration of less than 6 years were studied. C-peptide in plasma in the fasting state, after glucagon stimulation, and the 24-hour urinary excretion were measured. Fasting plasma C-peptide was detected in 61%, and 39% showed a significant rise after glucagon stimulation. The increment correlated negatively with HbA1 (rs = -0.57, p less than 0.001), as did the 24-hour urinary excretion (rs = -0.61, p less than 0.001). The 16 patients with urinary C-peptide values of at least 1 nmol had a mean HbA1 of 8.9 +/- 0.3%, as opposed to 11.6 +/- 0.5% for those excreting less (p less than 0.001). Measurement of the 24-hour urinary excretion of C-peptide provides a reliable method for evaluating residual insulin secretion.

Adult↗
PubMed1983

The pathogenesis of type II diabetes mellitus. A brief survey.

Type II, non-insulin-dependent, diabetes mellitus occurs worldwide, though with great variations in prevalence rates: the highest rates--about 30-35%--are reported for the Pima Indians and for the population of the island Nauru in the Pacific. The disease is to some extent inherited, but the mode of inheritance is unknown. Recent studies of the length polymorphism of the insulin gene, however, suggest that it may be possible to find a genetic marker for the disease. Obesity is common among type II diabetics, and the occurrence of the type II diabetes increases with age. One possible explanation is that both obesity and advanced age are associated with a decrease in insulin sensitivity. Insulin resistance is a common finding in type II diabetes; it has been demonstrated with several methods, including the euglycaemic insulin clamp technique. The role of insulin receptor and post-receptor defects in the pathogenesis of this insulin resistance is currently being studied with great interest. In addition to impairment of insulin sensitivity, there is a reduction in glucose-stimulated insulin secretion in individuals with type II diabetes. The primary defect of the disease, however, has yet to be established. Type II diabetes may well be a heterogeneous disorder with several different aetiologies; one argument for heterogeneity within the disease is the chlorpropamide alcohol flush reaction that can be demonstrated among about one third of type II diabetics. Further investigations of the pathogenesis of the disease are needed, and it is hoped that these will pave the way for the development of more specific therapy, and even prevention of the disease.

Age Factors↗
PubMed1982

Successful outcome of segmental human pancreatic transplantation with enteric exocrine diversion after modifications in technique.

Segmental pancreatic transplantation is now the most widely favoured form of pancreatic transplantation, but the major difficulty with this procedure is the handling of the exocrine secretion. The use of a pancreaticoenteric anastomosis for exocrine diversion has been re-evaluated and several ancillary measures to reduce the risk of fistula and bacterial contamination have been applied. In three consecutive patients there have been no complications related to the exocrine pancreas. The pancreatic and renal grafts of these patients are functioning well 7, 3, and 2 months, respectively, after transplantation.

Adult↗
PubMed1982

Increased peripheral insulin sensitivity and muscle mitochondrial enzymes but unchanged blood glucose control in type I diabetics after physical training.

Nine male, insulin-dependent diabetic patients participated in a 16-wk training program consisting of 1 h of jogging, running, ball games, and gymnastics, performed 2-3 times/wk. The training resulted in an 8% increase of maximal oxygen uptake (P less than 0.01). Insulin sensitivity as determined by the insulin clamp technique increased 20% (P less than 0.05). Glycosylated hemoglobin showed no change (10.4 +/- 0.7% versus 11.3 +/- 0.5%), 24-h urinary glucose excretion was not reduced, and home-monitored urine tests were unchanged. The frequency of hypoglycemic attacks did not change during the training period and body weight remained constant. There was a 14% fall in plasma cholesterol (P less than 0.01) and a rise in the proportion of HDL-cholesterol from 24 +/- 2% to 30 +/- 3% (P less than 0.01). Thigh muscle oxidative capacity increased, as indicated by a 24% increase in succinate dehydrogenase activity (P less than 0.05). The number of capillaries/muscle fiber increased 15% (P less than 0.01). However, as the mean muscle fiber cross-sectional area increased to a similar extent (11%, P less than 0.05), capillary density (cap x mm-2) was unchanged. In conclusion, this study demonstrates that physical training in insulin-dependent diabetics results in increased peripheral insulin sensitivity, a rise in muscle mitochondrial enzyme activities, decreased total plasma cholesterol levels, and unchanged blood glucose control. The findings suggest that in the absence of efforts to alter dietary regulation and insulin administration, physical training consisting of 2-3 weekly bouts of moderate exercise may not of itself improve blood glucose control in type I diabetes.

Adult↗