239 results on '"Terpstra OT"'
Search Results
2. Contribution of donor and recipient characteristics to short- and long-term pancreas graft survival
- Author
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Terpstra Ot, Andrzej Baranski, Haasnoot A, Marang-van de Mheen Pj, van der Boog Pj, and Denise E. Hilling
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pancreas graft ,Kaplan-Meier Estimate ,Perioperative Care ,Body Mass Index ,Donor Selection ,Sex Factors ,Medicine ,Humans ,Netherlands ,Proportional Hazards Models ,Retrospective Studies ,Transplantation ,business.industry ,Hazard ratio ,Graft Survival ,General Medicine ,Middle Aged ,Kidney Transplantation ,Tissue Donors ,Surgery ,medicine.anatomical_structure ,Diabetes Mellitus, Type 1 ,Treatment Outcome ,Graft survival ,Female ,Pancreas Transplantation ,business ,Pancreas ,Follow-Up Studies - Abstract
BACKGROUND Many donor and recipient factors are known to affect pancreas graft survival. However, their relative importance in explaining differences in graft survival is unknown. Purpose of this study was to retrospectively evaluate the impact of donor and recipient factors on pancreas graft survival, and compare their contribution in explaining graft survival differences. MATERIAL/METHODS Patient records of all 170 pancreas transplantations (158 Simultaneous Pancreas-Kidney; 12 Pancreas-after-kidney) in the period 1997-2008 were reviewed retrospectively to assess recipient factors before/during transplantation, and to assess graft survival. Eurotransplant reports were reviewed to assess donor factors. RESULTS Death-censored 1-year graft survival was 88.4% and 82.3% at 3 years. Several factors significantly influenced graft survival: female recipient gender (Hazard Ratio (HR) 2.81[1.10-7.14]), enteric graft drainage (HR 2.85[1.15-7.05]), and donor-recipient match on BMI (HR 2.46[1.01-6.02]). None of the donor factors significantly affected survival. Similar results were found for 1-year survival, except for enteric graft drainage and donor-recipient BMI matching. In total, donor factors explained 3.6% and recipient factors 10.0% of the variance in graft survival. Donor factors were more important for 1-year survival (3.1%), but still less important than recipient factors which explained 6.4%. CONCLUSIONS Recipient factors are more important in explaining differences in pancreas graft survival than donor factors.
- Published
- 2013
3. Pylorus preserving paincreaticoduodenectomy versus standard Whipple procedure: a prospective, randomized, multi-center analysis of 170 patients with pancreatic and periampullary tumors
- Author
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Smeenk, HG, Tran, Khe, van Eijck, Casper, Kazemier, G, Greve, JW, Terpstra, OT (Onno), Klinkert, P, Jeekel, J (Hans), and Surgery
- Published
- 2003
4. Aprotinin and reduced epinephrine requirements in orthotopic liver transplantation - Reply
- Author
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Molenaar, IQ, Begliomini, B, Martinelli, G, Putter, H, Terpstra, OT, Porte, RJ, Faculteit Medische Wetenschappen/UMCG, and Groningen Institute for Organ Transplantation (GIOT)
- Published
- 2002
5. De opleiding tot chirurg in Australië en Nieuw Zeeland
- Author
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Terpstra, OT (Onno), Wilt, JHW, Verhagen, HJM, Heineman, E, Surgery, and Pediatric Surgery
- Published
- 2002
6. The effect of aprotinin on renal function in ortho topic liver trans plantation
- Author
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Molenaar, IQ, Begliomini, B, Grazi, GL, Ringers, J, Terpstra, OT, Porte, R.J., and Groningen Institute for Organ Transplantation (GIOT)
- Subjects
TRASYLOL ,REDUCTION ,BLOOD-LOSS ,CARDIOPULMONARY BYPASS ,SEPSIS ,TRANSPLANTATION ,FIBRINOLYSIS ,FAILURE ,HIGH-DOSE APROTININ ,hormones, hormone substitutes, and hormone antagonists - Abstract
Background. In the European Multicenter Study on the Use of Aprotinin in Liver Transplantation (EIMSALT), a randomized, double-blind, placebo-controlled, prospective study, we demonstrated that aprotinin significantly reduces intraoperative blood loss during orthotopic Liver transplantation (OLT). Aprotinin is metabolized in the kidney and potentially nephrotoxic at high concentrations. Renal insufficiency is a common and serious complication after OLT. It is unknown whether aprotinin increases the risk of renal failure after OLT. Methods. We analyzed intraoperative urine output, need for postoperative dialysis, perioperative serum creatinine levels, and creatinine clearance in 93 patients enrolled in EMSALT, receiving a high dose of aprotinin, a regular dose, or placebo. Results. Peak increase in serum creatinine exceeding 0.5 mg/dl during one of the postoperative days occurred in 11 (35%) patients in the placebo group, in 11 (34%) patients in the high-dose group, but only in 1 (3%) patient in the regular-dose group (P=0.007). Furthermore, a perioperative decrease in creatinine clearance was seen in the placebo group (-23.9+/-10.1 ml/min) but not in both high-dose (-1.6+/-13.3 ml/min) and regular-dose (9.7+/-10.3 ml/min) groups (P Conclusions. Despite its potential nephrotoxicity, the use of aprotinin for reducing blood loss during OLT does not lead to a higher incidence of postoperative renal insufficiency. In combination with the observed reduction in blood loss, these findings support the prophylactic use of regular-dose aprotinin during OLT.
- Published
- 2001
7. Routine testing of liver function after biliary-enteric anastomosis has no clinical relevance
- Author
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Plaisier, PW, Hul, RL, Lameris, JS, Oei, HY, Terpstra, OT (Onno), Other departments, Surgery, and Radiology & Nuclear Medicine
- Abstract
Patients who had a biliary-enteric anastomosis often have elevated liver function tests. The aim of this study was to investigate whether elevated liver function tests are associated with recurrent episodes of cholangitis. Thirty-two patients, who received a biliary-enteric anatomosis for benign biliary disease were evaluated. Follow-up consisted of the patient's history, physical examination, determination of liver function tests, ultrasonography and hepatobiliary scintigraphy using 99mTc-HIDA. Median duration of follow-up was 45 months (range: 1-192) and liver function tests were elevated in 22 patients (69%) at some time during follow-up. Dilated intrahepatic ducts were found in 3 of 30 patients (10%), all of whom had elevated liver function tests at follow-up. Delayed passage from the liver was observed using scintigraphy in 10 (31%) of the patients. Seven patients (22%) experienced one episode of cholangitis and none experienced more than one episode. Multivariate analysis showed that male sex was an independent risk factor for elevated liver function tests (odds ratio: 10.9; P < 0.05). For cholangitis, no risk factors could be identified. It is concluded that elevated liver function tests are relatively common after a biliary-enteric anastomosis for benign biliary tract disease and are not predictive of the occurrence of cholangitis. We, therefore, recommend omitting routine laboratory screening for elevated liver function tests in the follow-up of a biliary-enteric anastomosis
- Published
- 2001
8. Biodistribution and bioactivity of tetra-pegylated metatetra(hydroxyphenyl)chlorin compared to native metatetra(hydroxyphenyl)chlorin in a rat liver tumor model
- Author
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Rovers, JP, Saarnak, AE, de Jode, M, Sterenborg, Dick, Terpstra, OT (Onno), Grahn, MF, Radiation Oncology, and Surgery
- Published
- 2000
9. Levertransplantatie
- Author
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Metselaar, Herold, Jansen, PLM, Slooff, MJH, Terpstra, OT (Onno), van Lanschot, J.J.B., Gouma, D.J., Schouten, W.R., Tytgat, G.N.J., Jansen, P.L.M., Internal Medicine, and Surgery
- Published
- 1999
10. Blocking of alpha1ß1 Integrin Strongly Improves Survival of Hepatocytes in Allogeneic Transplantation
- Author
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Kocken, JM (Clemens), de Heer, E, Borel Rinkes, IHM, Sinaasappel, M (Maarten), Terpstra, OT (Onno), Bruijn, Jan, Pediatrics, Surgery, and Psychiatry
- Published
- 1997
11. Observations on Initial Cell Loss after Intraportal Hepatocyte Transplantation of 5'-Bromo-Deoxy-Uridine-Labeled Hepatocytes
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Kocken, JM (Clemens), Bouwman, E, Borel Rinkes, IHM, Sinaasappel, M (Maarten), Terpstra, OT (Onno), Pediatrics, and Surgery
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- 1997
12. Acute Death After Intraportal Hepatocyte Transplantation in an Allogeneic Rat Strain Combination: A Possible Role for Complement Activation
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Kocken, JM (Clemens), Bouwman, E, Scheringa, M (Marcel), Borel Rinkes, IHM, Bruijn, Jan, Sinaasappel, M (Maarten), Terpstra, OT (Onno), Pediatrics, Surgery, and Psychiatry
- Published
- 1997
13. Pylorus preserving pancreaticoduodenectomy versus standard whipple procedure: a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors
- Author
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Tran, Khe, Smeenk, HG, van Eijck, Casper, Kazemier, G, Hop, Wim C.J., Greve, JW, Terpstra, OT (Onno), Zijlstra, JA, Klinkert, P, Jeekel, J (Hans), Tran, Khe, Smeenk, HG, van Eijck, Casper, Kazemier, G, Hop, Wim C.J., Greve, JW, Terpstra, OT (Onno), Zijlstra, JA, Klinkert, P, and Jeekel, J (Hans)
- Published
- 2004
14. UNEXPECTED DIFFICULTIES IN RANDOMIZING PATIENTS IN A SURGICAL TRIAL - A PROSPECTIVE-STUDY COMPARING EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY WITH OPEN CHOLECYSTECTOMY
- Author
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PLAISIER, PW, BERGER, MY, VANDERHUL, RL, NIJS, HGT, DENTOOM, R, TERPSTRA, OT, BRUINING, HA, Damage and Repair in Cancer Development and Cancer Treatment (DARE), and Life Course Epidemiology (LCE)
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STANDARD ,DESIGN ,GALLSTONES ,LAPAROSCOPIC CHOLECYSTECTOMY ,GALLBLADDER STONES ,PREFERENCES ,CLINICAL-TRIALS - Abstract
Shortly after extracorporeal shock wave lithotripsy (ESWL) was introduced as a promising new treatment modality for gallstone disease, a randomized controlled study was performed to assess the cost-effectiveness of ESWL compared to open cholecystectomy, the gold standard. During the performance of this study it was found that during a 3-year intake period only 8.3% (37 of 448) of the patients could be entered into the trial. Three factors were identified that hampered patient accrual: (1) restricted eligibility for ESWL, (and thus for the study), which could not have been predicted on the data provided in the literature; (2) the introduction of laparoscopic cholecystectomy; and (3) strong patient preference, inhibiting randomization. All three mechanisms could not have been predicted during the design phase of the study. It is concluded that it is not always feasible to conduct a randomized study in surgery due to unforeseen circumstances. Entering patients into surgical trials is difficult in quickly evolving fields of surgery, such as the management of gallstone disease. Acquiring informed consent is also difficult when treatment characteristics are divergent. A randomized controlled study on the effects of laparoscopic cholecystectomy will therefore probably never be performed.
- Published
- 1994
15. Variant mannose-binding lectin gene alleles in donor livers constitute a major risk for severe infections after orthotopic transplantation
- Author
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Bouwman, LH, primary, Verspaget, HW, additional, van Hoek, B, additional, Roos, A, additional, Terpstra, OT, additional, de Knijff, P, additional, Berger, SP, additional, Daha, MR, additional, Fr??lich, M, additional, van der Slik, AR, additional, Doxiadis, II, additional, Roep, BO, additional, and Schaapherder, AFM, additional
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- 2006
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16. Interstitial photodynamic therapy with the second-generation photosensitizer bacteriochlorin a in a rat model for liver metastases
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Rovers, JP, primary, Schuitmaker, JJ, additional, Vahrmeijer, AL, additional, van Dierendonck, JH, additional, and Terpstra, OT, additional
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- 1998
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17. Interstitial photodynamic therapy in a rat liver metastasis model
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van Hillegersberg, R, primary, Marijnissen, JPA, additional, Kort, WJ, additional, Zondervan, PE, additional, Terpstra, OT, additional, and Star, WM, additional
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- 1992
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18. Integrin signaling via RGD peptides and anti-beta1 antibodies confers resistance to apoptosis in islets of Langerhans.
- Author
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Pinkse GGM, Bouwman WP, Jiawan-Lalai R, Terpstra OT, Bruijn JA, de Heer E, Pinkse, Gabrielle G M, Bouwman, Wendy P, Jiawan-Lalai, Reshma, Terpstra, O T, Bruijn, Jan A, and de Heer, Emile
- Abstract
Islet transplantation is associated with a high rate of early graft failure caused by early immune attack and poor functionality of islets. Apoptosis of islet cells appears soon after islet isolation and primarily involves the beta-cell. The purpose of this study was to determine the effect of ligation to extracellular matrix (ECM) proteins on survival of the islets of Langerhans following islet isolation. Islets that had been cultured for 24 h on collagen type I showed an islet survival of 59.7 +/- 8.7%, while islets that had been cultured on collagen type IV and laminin showed an islet survival of 88.6 +/- 10.3 and 94.3 +/- 5.6%, respectively. Islets that had been pretreated with anti-beta1 antibodies and argenin-glycin-aspartic acid (RGD) peptides showed a decrease in the level of apoptosis by a factor of 2.5 and 3.1, respectively, and an increase of phospho-Akt Ser 473 activity by a factor of 3.1 and 2.9, respectively, compared with untreated islets. When detached from their natural ECM surrounding in the pancreas, islet cells undergo apoptosis, unless islets are cultured on collagen IV or laminin or treated with anti-beta1 integrin antibodies or RGD peptides to mimic ECM ligation. These results indicate that inhibition of anoikis may offer opportunities to improve function and viability of islet cells. [ABSTRACT FROM AUTHOR]
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- 2006
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19. Role of fibrinolysis during auxiliary partial liver transplantation
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Bakker, CM, primary, Porte, RJ, additional, Knot, ZAR, additional, de Maat, MPM, additional, Stibbe, J., additional, and Terpstra, OT, additional
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- 1989
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20. Auxiliary partial liver transplantation: imaging evaluation in 10 patients
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Zonderland, HM, primary, Lameris, JS, additional, Terpstra, OT, additional, Ausema, L, additional, Krenning, EP, additional, Schalm, SW, additional, and Schutte, HE, additional
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- 1989
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21. European Working Time Directive: experience of directive in the Netherlands.
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Terpstra OT
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- 2008
22. Acute death after intraportal hepatocyte transplantation in an allogeneic rat strain combination: A possible role for complement activation.
- Author
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Kocken, JM, Bouwman, E, Sinaasappel, M, Bruijn, JA, and Terpstra, OT
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- 1996
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23. Plasma MMP-2 and MMP-9 and their inhibitors TIMP-1 and TIMP-2 during human orthotopic liver transplantation - The effect of aprotinin and the relation to ischemia/reperfusion injury
- Author
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Bart van Hoek, Hein W. Verspaget, Marietta G Veldman, Onno T. Terpstra, Robert J. Porte, Sanne E Moolenburgh, Johan Ph. Kuyvenhoven, Cristina Legnani, Gualtiero Palareti, Cornelis B.H.W. Lamers, I. Quintus Molenaar, Rijksuniversiteit Groningen, Groningen Institute for Organ Transplantation, Kuyvenhoven JP, Molenaar IQ, Verspaget HW, Veldman MG, Palareti G, Legnani C, Moolenburgh SE, Terpstra OT, Lamers CB, van Hoek B, and Porte RJ.
- Subjects
Male ,Pathology ,Time Factors ,Plasmin ,medicine.medical_treatment ,MATRIX METALLOPROTEINASES MMP-2 ,Liver transplantation ,ischemia/reperfusion injury ,Placebos ,IMMUNOCAPTURE ASSAY ,Blood plasma ,Aprotinin ,REPERFUSION INJURY ,liver transplantation ,matrix metalloproteinases ,Hematology ,Middle Aged ,ISCHEMIA ,Matrix Metalloproteinase 9 ,Matrix Metalloproteinase 2 ,Female ,medicine.drug ,Adult ,aprotinin ,medicine.medical_specialty ,Antifibrinolytic ,Adolescent ,CARCINOMA ,medicine.drug_class ,GELATINASE ,Double-Blind Method ,Internal medicine ,medicine ,Humans ,Aspartate Aminotransferases ,PRESERVATION ,PLASMINOGEN-ACTIVATOR ,Aged ,plasmin ,Tissue Inhibitor of Metalloproteinase-2 ,Tissue Inhibitor of Metalloproteinase-1 ,business.industry ,Tumor Necrosis Factor-alpha ,medicine.disease ,Transplantation ,Endocrinology ,ACTIVATOR-ASSOCIATED FIBRINOLYSIS ,business ,Plasminogen activator ,Reperfusion injury ,SYSTEM - Abstract
SummaryUncontrolled activation of matrix metalloproteinases (MMPs) can result in tissue injury and inflammation, yet little is known about the activation of MMPs during orthotopic liver transplantation (OLT). OLT is associated with increased fibrinolytic activity due to elevated plasmin generation. The serine-protease plasmin not only causes degradation of fibrin clots but is also thought, amongst others, to play a role in the activation of some matrix metalloproteinases. We therefore studied the evolution of MMP-2 and -9 plasma concentrations during OLT and the effect of serine-protease inhibition by aprotinin on the level and activation of these MMPs. In a group of 24 patients who participated in a randomized, double-blind, placebo-controlled study we determined serial MMP-2 and MMP-9 plasma levels during transplantation using ELISA (total MMP), activity assays (activatable MMP) and zymography. In addition, the MMP-inhibitors TIMP-1 and TIMP-2 were assessed by ELISA. The putative regulating factors tumor necrosis factor alpha (TNF-α) and tissue-type plasminogen activator (t-PA) were assessed as well. Patients were administered high-dose aprotinin, regular-dose aprotinin or placebo during surgery. Plasma TIMP-1, TIMP-2 and MMP-2 level gradually decreased during transplantation. Approximately twothirds of total MMP-2 appeared to be in its activatable proMMP form. No release of MMP-2 from the graft could be detected. In contrast, plasma levels of MMP-9 increased sharply during the anhepatic and postreperfusion periods. Peak MMP-9 levels of about eight times above baseline were found at 30 minutes after reperfusion. Most MMP-9 appeared to be in its active/inhibitorcomplexed form. No significant differences were observed between the three treatment groups. However, in patients with more severe ischemia/reperfusion (I/R) injury the MMP-9 concentration, particularly of the active/inhibitor-complexed form, remained high at 120 minutes postreperfusion compared to patients with no or mild I/R injury. The decrease in plasma levels of MMP-2,TIMP-1 and TIMP-2 during OLT occurred irrespective of the severity of the I/R injury. There was a significant correlation between MMP-9 and t-PA levels, but not with TNF-α. In conclusion, OLT is associated with a sharp increase of MMP-9 during the anhepatic and postreperfusion periods, which coincided with the changes in t-PA. MMP-2, TIMP-1 and TIMP-2 gradually decreased during OLT. The composition of these MMPs was not altered by the use of aprotinin, suggesting that serine–protease/plasmin-independent pathways are responsible for MMP regulation during OLT. In addition, only MMP-9 seems to be involved in I/R injury during human liver transplantation.
- Published
- 2004
24. A physicochemical perspective of aging from single-cell analysis of pH, macromolecular and organellar crowding in yeast.
- Author
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Mouton SN, Thaller DJ, Crane MM, Rempel IL, Terpstra OT, Steen A, Kaeberlein M, Lusk CP, Boersma AJ, and Veenhoff LM
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- Cellular Senescence, Hydrogen-Ion Concentration, Organelles, Population Density, Single-Cell Analysis, Saccharomyces cerevisiae physiology
- Abstract
Cellular aging is a multifactorial process that is characterized by a decline in homeostatic capacity, best described at the molecular level. Physicochemical properties such as pH and macromolecular crowding are essential to all molecular processes in cells and require maintenance. Whether a drift in physicochemical properties contributes to the overall decline of homeostasis in aging is not known. Here, we show that the cytosol of yeast cells acidifies modestly in early aging and sharply after senescence. Using a macromolecular crowding sensor optimized for long-term FRET measurements, we show that crowding is rather stable and that the stability of crowding is a stronger predictor for lifespan than the absolute crowding levels. Additionally, in aged cells, we observe drastic changes in organellar volume, leading to crowding on the micrometer scale, which we term organellar crowding. Our measurements provide an initial framework of physicochemical parameters of replicatively aged yeast cells., Competing Interests: SM, DT, MC, IR, OT, AS, CL, AB, LV No competing interests declared, MK Reviewing editor, eLife, (© 2020, Mouton et al.)
- Published
- 2020
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25. Effects of donor-, pancreas-, and isolation-related variables on human islet isolation outcome: a systematic review.
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Hilling DE, Bouwman E, Terpstra OT, and Marang-van de Mheen PJ
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- Aged, Humans, Islets of Langerhans Transplantation methods, Middle Aged, Islets of Langerhans cytology, Pancreas cytology, Tissue Donors
- Abstract
Different factors have been reported to influence islet isolation outcome, but their importance varies between studies and are hampered by the small sample sizes in most studies. The purpose of this study was to perform a systematic review to assess the impact of donor-, pancreas-, and isolation-related variables on successful human islet isolation outcome. PubMed, Embase, and Web of Science were searched electronically in April 2009. All studies reporting on donor-, pancreas-, and isolation-related factors relating to prepurification and postpurification islet isolation yield and proportion of successful islet isolations were selected. Seventy-four retrospective studies had sufficient data and were included in the analyses. Higher pre- and postpurification islet yields and a higher proportion of successful islet isolations were obtained when pancreata were preserved with the two-layer method rather than University of Wisconsin solution in donors with shorter cold ischemia times (CITs) [1 h longer CIT resulted in an average decline of prepurification and postpurification yields and proportion of successful isolations of 59 islet equivalents (IEQs)/g, 54 IEQs/g, and 21%, respectively]. Higher prepurification yields and higher percentage of successful islet isolations were found in younger donors with higher body mass index. Lower yields were found in donation after brain death donors compared to donation after cardiac death donors. Higher postpurification yields were found for isolation with Serva collagenase. This review identified donor-, pancreas-, and isolation-related factors that influence islet isolation yield. Standardized reports of these factors in all future studies may improve the power and identify additional factors and thereby contribute to improving islet isolation yield.
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- 2014
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26. Knowing and acting in the clinical workplace: trainees' perspectives on modelling and feedback.
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Stegeman JH, Schoten EJ, and Terpstra OT
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- Female, Humans, Longitudinal Studies, Male, Netherlands, Philosophy, Qualitative Research, Clinical Clerkship, Feedback, Health Knowledge, Attitudes, Practice, Students, Medical psychology, Workplace
- Abstract
In this article we discuss clinical workplace learning using a dual approach: a theoretical one and an empirical one. Drawing on the philosophical work of Aristotle, Polanyi and Schön we posit that the 'knowing and acting' underpinning day-to-day medical practice is personal and embraces by nature a tacit dimension. Consequently, imparting and acquiring this knowledge type necessitates personal interaction between trainer and trainee. The tacit dimension particularly influences modelling and feedback. In our empirical exploration we explore these educational routes in two disparate disciplines: surgery and paediatrics. We use a longitudinal design with in-depth interviewing. Our conclusion on modelling is: modelling is a dynamic and fragmented process reflecting discipline bound characteristics and working styles. On feedback it is: 'feedback' serves as vehicle for three distinctive forms of commenting on performance, each holding a specific power of expression for learning. We propose to view clinical workplace learning as: an interactive master-apprenticeship model encompassing modelling and feedback as natural educational routes. We conceptualise modelling and feedback as 'function' of interaction (developing grounded theory). Modelling function and feedback function may serve to study these routes as didactical components of ongoing interaction between trainer and trainee rather than an educator-driven series of unrelated events.
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- 2013
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27. Contribution of donor and recipient characteristics to short- and long-term pancreas graft survival.
- Author
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Hilling DE, Baranski AG, Haasnoot A, van der Boog PJ, Terpstra OT, and Marang-van de Mheen PJ
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- Adult, Body Mass Index, Donor Selection, Female, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Kidney Transplantation, Male, Middle Aged, Netherlands, Perioperative Care, Proportional Hazards Models, Retrospective Studies, Sex Factors, Treatment Outcome, Diabetes Mellitus, Type 1 surgery, Graft Survival, Pancreas Transplantation, Tissue Donors statistics & numerical data
- Abstract
Background: Many donor and recipient factors are known to affect pancreas graft survival. However, their relative importance in explaining differences in graft survival is unknown. Purpose of this study was to retrospectively evaluate the impact of donor and recipient factors on pancreas graft survival, and compare their contribution in explaining graft survival differences., Material/methods: Patient records of all 170 pancreas transplantations (158 Simultaneous Pancreas-Kidney; 12 Pancreas-after-kidney) in the period 1997-2008 were reviewed retrospectively to assess recipient factors before/during transplantation, and to assess graft survival. Eurotransplant reports were reviewed to assess donor factors., Results: Death-censored 1-year graft survival was 88.4% and 82.3% at 3 years. Several factors significantly influenced graft survival: female recipient gender (Hazard Ratio (HR) 2.81[1.10-7.14]), enteric graft drainage (HR 2.85[1.15-7.05]), and donor-recipient match on BMI (HR 2.46[1.01-6.02]). None of the donor factors significantly affected survival. Similar results were found for 1-year survival, except for enteric graft drainage and donor-recipient BMI matching. In total, donor factors explained 3.6% and recipient factors 10.0% of the variance in graft survival. Donor factors were more important for 1-year survival (3.1%), but still less important than recipient factors which explained 6.4%., Conclusions: Recipient factors are more important in explaining differences in pancreas graft survival than donor factors.
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- 2012
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28. On doctor-patient relationship and feedback interventions.
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Terpstra OT
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- 2012
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29. Effects of the restriction of working time for residents: a dutch perspective.
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Terpstra OT and Stegeman JH
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- 2011
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30. Reduced porcine islet isolation yield in the presence of hyperemic islets.
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Hilling DE, Rijkelijkhuizen JK, Töns HA, Marang-van de Mheen PJ, Merks JW, Terpstra OT, and Bouwman E
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- Animals, Cell Size, Hyperemia pathology, Islets of Langerhans pathology, Organ Culture Techniques methods, Sus scrofa physiology
- Abstract
When studying histological characteristics of porcine pancreata in relation to islet isolation, a remarkably high number of hyperemic islets (HIs) was encountered. The abnormalities observed in these HIs ranged from a single dilated vessel to hemorrhages extending into the surrounding exocrine tissue. The aim of the present study was to compare pancreata with and without HI on islet isolation outcomes. This study involved a histological examination of 143 purebred (74 juvenile and 69 adult) and 47 crossbred (only juvenile) porcine pancreata. Islet isolation was performed in 48 purebred adult pigs and in 25 crossbred pigs. Tissue samples were stained with Aldehyde Fuchsine. The presence of HIs was scored semi-quantitatively (HI-, HI+). We observed HIs in 48% of the purebred and in 68% of the crossbred pigs. However, only 3.3±3.1% and 3.1±4.7% of all assessed islets was hyperemic in HI+ pancreata in purebred and crossbred pigs, respectively. In both groups, significantly higher endocrine cell mass was found in the HI+ pancreata (p<0.01). When the higher endocrine cell mass was taken into account, we found significantly lower yields in the HI+ pancreata in both purebred and crossbred pigs (p=0.03 in both groups). The presence of HIs occurs frequently in porcine donor-pancreata and is associated with reduced isolation outcomes., (Georg Thieme Verlag KG Stuttgart · New York.)
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- 2011
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31. Presence of hyperemic islets in human donor-pancreata results in reduced islet isolation yield.
- Author
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Hilling DE, Töns HA, Marang-van de Mheen PJ, Baranski AG, van den Akker EK, Terpstra OT, and Bouwman E
- Subjects
- Adult, Female, Humans, Islets of Langerhans anatomy & histology, Male, Middle Aged, Pancreas anatomy & histology, Regional Blood Flow, Retrospective Studies, Tissue Donors, Tissue and Organ Procurement, Cell Separation, Islets of Langerhans blood supply, Pancreas blood supply
- Abstract
When studying histological characteristics of human donor-pancreata, a remarkably high number of hyperemic islets (HIs) were encountered. The abnormalities in these HIs ranged from single/multiple dilated vessels to hemorrhages extending into the exocrine tissue. We aimed to determine the relevance of the presence of HIs in human donor-pancreata for isolation outcome and to identify donor and procurement factors associated with the occurrence of HIs. The presence of HIs was scored semi-quantitatively (HI-, HI+) in 102 human donor-pancreata. Islet isolation was performed in 40 cases. Donor and procurement factors were retrospectively analyzed in 94 donors. HIs were found in 54.6% of all donor-pancreata. However, only 4.5% of all islets in the affected pancreata was hyperemic. The affected pancreata contained slightly more endocrine tissue, but produced significantly lower yields. When corrected for other factors known to influence isolation outcome, the presence of HIs and endocrine content were the only factors significantly influencing isolation outcome. Prolonged ICU stay and pre-procurement hypertension were associated with the presence of HIs. This study is a first indication that the presence of HIs in human donor-pancreata are associated with reduced isolation outcomes and suggest an impact of the procurement procedure and pre-procurement hemodynamic status of the donor on the islet quality. It is tempting to speculate that this contributes to the generally experienced difficulties in obtaining sufficient amounts of human islets., (© Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2011
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32. Morphological changes of porcine islets of Langerhans after collagenase and HBSS infusion of the pancreas.
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Hilling DE, Rijkelijkhuizen JK, Marang-van de Mheen PJ, Töns A, Terpstra OT, and Bouwman E
- Subjects
- Animals, Humans, Swine, Collagenases metabolism, Islets of Langerhans cytology, Islets of Langerhans drug effects, Islets of Langerhans metabolism, Isotonic Solutions pharmacology, Pancreas anatomy & histology, Pancreas drug effects, Pancreas metabolism
- Abstract
Background: A remarkable change in porcine islet morphology was observed after infusion of the pancreas with collagenase. The aim of the present study was to quantify these morphological changes and to assess whether these changes were due to the volume expansion caused by the collagenase entering the islet or the result of its digestive effects., Methods: This study was performed in pancreata of 28 crossbred pigs. First, eight pancreata were intraductally injected with collagenase by a continuous controlled pressure of 180 mmHg. Pancreas samples before collagenase infusion were used as controls. All tissue samples, both before and after infusion, were stained with anti-insulin. To quantify the morphological change of the islets, the mean beta cell/endocrine content ratio of the infused and not-infused tissue samples was compared. In a second experiment, 20 pancreata were similarly assessed after intraductal injection with Hank's balanced salt solution (HBSS)., Results: In both the collagenase- and HBSS-infused groups, mean beta cell/endocrine content ratio was lower than in the control samples. The observed decline in the beta cell/endocrine content ratio was not significantly different between collagenase- and HBSS-infused pancreata. This suggests that the lower beta cell/endocrine content ratio and thus the morphological change in the infused tissue samples is caused by volume expansion of the fluid entering the islet and that the digestive effect of collagenase plays no or only a minor role., Conclusion: Morphological changes of islets are observed after infusion of pancreata with collagenase and HBSS, most likely caused by volume expansion due to fluid entering the islets., (© 2010 John Wiley & Sons A/S.)
- Published
- 2010
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33. Porcine islet isolation outcome is not affected by the amount and distribution of collagen in the pancreas.
- Author
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Hilling DE, Rijkelijkhuizen JK, Töns HA, Terpstra OT, and Bouwman E
- Subjects
- Animals, Drug Compounding, Humans, Islets of Langerhans Transplantation, Swine, Cell Separation methods, Collagen analysis, Islets of Langerhans cytology, Pancreas chemistry, Pancreas cytology
- Abstract
Variable islet yields in porcine islet isolation may be caused by the collagen substrate within the pancreas. The aim of the present study was to determine the total amount and distribution of collagen within porcine pancreata and their relationship to islet isolation outcome. A total of 64 juvenile and 76 adult porcine pancreata of eight purebred breeds were histologically examined. The amount of collagen was quantitatively assessed in tissue samples stained with Sirius Red. Collagen distribution was semi-quantitatively determined by assessing the presence of collagen in the endocrine-exocrine interface and within the islet, in tissue samples stained with Sirius Red and anti-insulin. Islet isolation was performed in 58 pancreata of the adult group. Total collagen content and islet encapsulation ranged widely in both adult and juvenile pigs. However, the majority of islets in adult and juvenile pigs had no or only a limited collagen capsule. The difference in collagen content between adult and juvenile pigs could not be explained by age. Furthermore, no differences between adult and juvenile pigs were found in islet encapsulation or the amount of intra-islet collagen. In adult pigs, no significant relationships were found between obtained islet yield and total collagen content, islet encapsulation or amount of collagen within the islet. Considering the limitations in experimental design (staining method) and study material, isolation outcome does not seem to be affected by the total collagen content or collagen distribution. The influence of other matrix elements and collagen subtypes should be investigated.
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- 2010
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34. More than 25 years of surgical treatment of hydatid cysts in a nonendemic area using the "frozen seal" method.
- Author
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Stoot JH, Jongsma CK, Limantoro I, Terpstra OT, and Breslau PJ
- Subjects
- Adolescent, Adult, Aged, Child, Echinococcosis, Hepatic diagnosis, Echinococcosis, Hepatic epidemiology, Female, Humans, Length of Stay statistics & numerical data, Male, Middle Aged, Netherlands epidemiology, Postoperative Complications epidemiology, Recurrence, Reoperation, Retrospective Studies, Statistics, Nonparametric, Treatment Outcome, Cryosurgery methods, Echinococcosis, Hepatic surgery
- Abstract
Background: Hydatid disease of the liver remains endemic in the world and is an imported disease in The Netherlands. The aim of this study was to evaluate the treatment and outcome of surgically treated patients for hydatid disease in a single center in The Netherlands., Methods: This retrospective study included 112 consecutive patients surgically treated for hydatid disease between 1981 and 2007. The primary outcome was relapse of the disease. Secondary outcomes were infections, complications, reoperations, length of hospital stay, and mortality., Results: In all cases, echinococcosis was diagnosed by computed tomography or ultrasonography (US). Serology (enzyme-linked immunosorbent assay, immunofluorescence) confirmed the diagnosis in 92.9%. Most of the cysts were seen only in the liver (73.5%). All cysts were operated on with the frozen seal technique. Relapse of disease was seen in 9 (8.0%) cases. Five (4.5%) required surgical treatment at a later stage. Twenty (17.9%) complications were recorded. Four (3.6%) needed radiological drainage and three (2.7%) a reoperation. Follow-up was performed with US and/or serology at a mean of 24 months (range 0.5-300 months). All but one complication were seen in the liver-operated group, this proved not to be of statistical significance (P = 0.477). Patients with complications stayed significantly longer in hospital than did the patients without complications (P < 0.001). No mortality was observed in this study., Conclusions: The present study suggests that the frozen seal method of surgery for hydatid disease is safe and effective. Future studies are needed to prove its position in the treatment of hydatid disease as new developments show promising results.
- Published
- 2010
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35. Transplantation of long-term cultured porcine islets in the rat: prolonged graft survival and recipient growth on reduced immunosuppression.
- Author
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Rijkelijkhuizen JK, Töns A, Terpstra OT, and Bouwman E
- Subjects
- Animals, Anti-Inflammatory Agents therapeutic use, Cyclophosphamide pharmacology, Cyclophosphamide therapeutic use, Cyclosporine therapeutic use, Diabetes Mellitus, Experimental therapy, Drug Therapy, Combination, Gadolinium therapeutic use, Graft Rejection prevention & control, Immunosuppressive Agents therapeutic use, Male, Models, Animal, Rats, Rats, Inbred Lew, Swine, Transplantation, Heterologous, Graft Survival drug effects, Immunosuppression Therapy, Islets of Langerhans Transplantation
- Abstract
To evaluate whether further improvement in porcine islet xenotransplantation is feasible, a number of questions were addressed. Earlier we showed significant improvement in the nude mouse of the porcine islets by selection through long-term culture. Now these islets were tested in the stringent pig-to-rat model. Islets were isolated from adult pigs, cultured for 1.5-3 weeks and transplanted to rats. Possible rejection mechanisms were assessed by interference of the cellular response with cyclosporine A (CsA), blocking macrophages with gadolinium chloride (GdCl), and suppressing the humoral response with cyclophosphamide. Modifications in graft size and condition were analyzed. Untreated control recipients showed primary nonfunction (PNF). CsA treatment could fully overcome PNF and resulted in graft survival from 10 to over 134 days. Rejection was the main cause of function loss. Although rejection could not be prevented by intensifying the induction therapy, increased maintenance immunosuppression effectively blocked rejection, albeit at the expense of toxicity. Blocking the humoral response was ineffective; all grafts showed PNF. In contrast, depletion of macrophages fully prevented PNF. Combination of GdCl and CsA gave no additional effect, and grafts were rejected between 57 and 162 days. Generally, graft survivals were similar to those reported in the literature; however, long-term cultured islets required much less maintenance immunosuppression. Cessation of graft function was not always due to rejection; in some cases "islet exhaustion" was found, possibly caused by discrepancy between the graft size and the rapidly growing recipient. Neither the presence of damaged islet tissue in the graft nor the size of the graft exerted any influence on graft survival. On rejection, no real infiltration of the graft was seen; destruction gradually processed from the outside. The good functional capability of the cultured islets was illustrated by disappearance of the clinical symptoms and increase in body weight, which almost doubled in the long-term survivors.
- Published
- 2010
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36. Amount and distribution of collagen in the pancreas have no effect on porcine islet isolation outcome.
- Author
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Hilling D, Rijkelijkhuizen JK, Töns HA, Terpstra OT, and Bouwman E
- Subjects
- Aging, Animals, Cell Separation methods, Humans, Insulin analysis, Islets of Langerhans cytology, Islets of Langerhans Transplantation, Pancreas growth & development, Swine, Transplantation, Heterologous, Collagen analysis, Islets of Langerhans physiology, Pancreas physiology
- Abstract
Xenotransplantation of porcine islets of Langerhans is considered to be a possible alternative for clinical islet transplantation. However, porcine islet isolation procedures have been shown to produce highly variable yields between pigs with similar backgrounds. One of the variables that could account for this is the collagen substrate within the pancreas. We determined the amount and distribution of collagen within porcine pancreata as they determined islet isolation outcomes. This study involved the histological examination of 140 porcine pancreata (64 juvenile and 76 adult) and islet isolation from 58 adult organs. To quantify the amount of collagen, tissue samples were stained with Sirius Red. Collagen distribution was determined by assessing the presence of collagen in the endocrine-exocrine interface (the "islet capsule"), in tissue samples double-stained with Sirius Red and anti-insulin. Strong variation in total collagen was observed in both adult and juvenile pigs. The mean collagen content in the juvenile group was significantly lower than that in the adult group. Apparently, the pancreas undergoes a process of fibrosis as pigs age. The vast majority of islets from both adult and juvenile pancreata had no or only a limited collagen capsule. However, islet encapsulation was highly variable between pancreata. We observed no significant correlation between total collagen content or the percentage islet encapsulation and islet yield. Although total collagen content and islet encapsulation show great variability between pancreata, neither the amount nor the distribution of collagen affected porcine islet isolation outcome.
- Published
- 2009
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37. Hyperemic islets: a possible explanation for poor yields in human and porcine islet isolation.
- Author
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Hilling DE, Rijkelijkhuizen JK, Töns HA, Terpstra OT, and Bouwman E
- Subjects
- Animals, Humans, Hyperemia, Hypertension physiopathology, Islets of Langerhans pathology, Pancreatic Diseases pathology, Swine, Tissue Donors, Hemorrhage physiopathology, Islets of Langerhans blood supply, Islets of Langerhans cytology
- Abstract
When studying histological characteristics of human and porcine pancreata in relation to islet isolation, we encountered a remarkably high number of hyperemic islets. The abnormalities observed in these islets ranged from a single dilated vessel through multiple widely dilated vessels to hemorrhages extending into the surrounding exocrine tissue. We determined their possible relevance for outcomes of islet isolation. This study involved a histological examination of 143 porcine pancreata (72 juvenile and 71 adult) and islet isolation from 48 adult pancreata. Human pancreata obtained from 71 multiple organ donors yielded islet isolation in 24 cases. To determine their endocrine content, tissue samples were stained with Aldehyde Fuchsin. The presence of hyperemic islets was scored semiquantitatively with pancreata allotted to categories based on the severity. In humans and pigs we observed hyperemic islets in 48% of pancreata, but only 4.0 +/- 2.4% of the islets were hyperemic. In both humans and pigs, significantly higher endocrine content was found in the most severely affected pancreata. When the higher endocrine content was taken into account and isolation results were expressed as ratios of yield and content, we observed significantly lower yields in the most affected pancreata in pigs with a trend toward lower yields in humans. A substantial proportion of human and porcine pancreata contain hyperemic islets. Although the results in humans are preliminary, our data suggest that this phenomenon may contribute to the unpredictable, highly variable islet yields in pigs and humans.
- Published
- 2009
- Full Text
- View/download PDF
38. Experience of directive in the Netherlands.
- Author
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Terpstra OT
- Subjects
- European Union, Humans, Netherlands, Time Factors, Medical Staff, Hospital organization & administration, Personnel Staffing and Scheduling
- Published
- 2008
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- View/download PDF
39. Isolation of the islets of Langerhans from the human pancreas with magnetic retraction.
- Author
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Töns HA, Baranski AG, Terpstra OT, and Bouwman E
- Subjects
- Humans, Islets of Langerhans Transplantation, Pancreas cytology, Cell Separation methods, Islets of Langerhans cytology, Magnetics
- Abstract
Low yield and insufficient purity limit the transplantation of human islets of Langerhans. In the rat, a new technique to isolate the islets of Langerhans was developed by intraarterial infusion of iron particles into the islet capillaries. After digestion the iron-loaded islets were purified with magnetic retraction (MR). In the present study, 10 human pancreata not suitable for clinical use were arterially injected with an iron-oxide suspension. After injection a small piece was used for histological analysis, and the tail was intraductally perfused with collagenase and manually digested. The yield was compared with 11 pancreata processed in the standard way. Nine of 10 pancreata were successfully injected with iron-oxide and digested. After MR, enrichment was achieved but the purity was not more than 50%. Similar results between the 2 groups were obtained regarding digestion times (23 +/- 1.1 vs 22.7 +/- 1.5 minutes) and purification yields (1749 +/- 502.1 vs 2111 +/- 501.8 IE/g, P = .6) for the MR vs control groups, respectively. Histological analysis revealed that 60% to 88% of the islets contained iron aggregations with substantially higher concentrations compared with the exocrine tissue. In conclusion, iron-oxide did not influence the isolation outcome before purification. Islet purification with MR gave enrichment but no pure fractions.
- Published
- 2008
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40. Heterogeneity of human pancreata in perspective of the isolation of the islets of langerhans.
- Author
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Töns HA, Terpstra OT, and Bouwman E
- Subjects
- Age Factors, Humans, Pancreas cytology, Patient Selection, Tissue Donors, Tissue and Organ Harvesting methods, Treatment Outcome, Islets of Langerhans cytology, Islets of Langerhans Transplantation, Pancreas anatomy & histology
- Abstract
The success of human islet isolation is hampered by the varied and unpredictable outcomes of the islet isolation procedure. Pancreata which meet well-defined criteria are no guarantee for success. Interindividual variations may contribute to the differences in isolation outcomes. The present study examined several structural elements in the anatomy of the human pancreas for possible relevance for islet isolation. Sixty pancreata were used for histochemical and immunochemical analyses. We assessed the total percentage of endocrine tissue and the size distribution of the islets. Sirius Red staining quantified total collagen content; the degree of islet encapsulation with collagen was correlated with total collagen. We analyzed the percentage of pancreatic edema and amount of intraparenchymal fat. The percentage of endocrine tissue varied 5-fold with wide variations in islet size distribution. A strong variation was observed for total collagen; its content increased slightly with age. The number of islets totally encapsulated with collagen varied strongly with no relation to age or to total collagen. Pancreatic edema and intraparenchymal fat also showed great differences. These differences justifies continued study to evaluate the correlation of these variables with isolation outcomes.
- Published
- 2008
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41. Differential inhibition of autoreactive memory- and alloreactive naive T cell responses by soluble cytotoxic T lymphocyte antigen 4 (sCTLA4), CTLA4Ig and LEA29Y.
- Author
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Huurman VA, Unger WW, Koeleman BP, Oaks MK, Chandraker AK, Terpstra OT, and Roep BO
- Subjects
- Abatacept, Antigen-Presenting Cells metabolism, Autoimmunity, CTLA-4 Antigen, Cell Proliferation, Dose-Response Relationship, Immunologic, Humans, Immune Tolerance, Immunologic Memory, Lymphocyte Activation immunology, Lymphocyte Culture Test, Mixed, Antigens, CD immunology, Antigens, Differentiation immunology, Diabetes Mellitus, Type 1 immunology, Immunoconjugates immunology, T-Lymphocytes immunology
- Abstract
Cytotoxic T lymphocyte antigen 4 (CTLA4) is a potent inhibitory co-stimulatory molecule believed to be involved in type 1 diabetes and other autoimmune diseases. An association has been reported of both mRNA expression and serum levels of the soluble splice variant of CTLA4 (sCTLA4) with type 1 diabetes. Furthermore, recombinant fusion proteins CTLA4Ig and LEA29Y have been proposed as therapies for type 1 diabetes. We studied the role of (s)CTLA4 in islet autoimmunity. Binding capacity of the proteins to antigen-presenting cells was determined by flow cytometry in competition and binding assays. Functionality of sCTLA4 as well as the therapeutic inhibitory fusion proteins CTLA4Ig and LEA29Y was measured in a dose-response lymphocyte stimulation test, using a panel of diabetes-associated T cell clones reactive to islet autoantigens. As controls, mixed lymphocyte reactions (MLR) were performed to assess functionality of these proteins in a primary alloreactive setting. All three CTLA4 molecules were able to bind to antigen-presenting cells and inhibit the expression of CD80/CD86. sCTLA4 was able to suppress proliferation of different committed autoreactive T cell clones in a dose-dependent manner, whereas CTLA4Ig and LEA29Y were not. Conversely, CTLA4Ig and LEA29Y, rather than sCTLA4, were able to suppress naive alloreactive proliferation in a MLR. Our results indicate a differential role for sCTLA4, CTLA4Ig and LEA29Y proteins in memory versus primary immune responses with implications for efficacy in intervention therapy.
- Published
- 2007
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42. Life-saving therapy for haemorrhaging liver adenomas using selective arterial embolization.
- Author
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Stoot JH, van der Linden E, Terpstra OT, and Schaapherder AF
- Subjects
- Adolescent, Adult, Emergency Treatment, Female, Humans, Liver Neoplasms blood supply, Magnetic Resonance Imaging, Male, Middle Aged, Rupture, Spontaneous, Tomography, X-Ray Computed, Adenoma, Liver Cell therapy, Embolization, Therapeutic methods, Hemorrhage prevention & control, Liver Neoplasms therapy
- Abstract
Background: Emergency treatment for patients with a ruptured hepatocellular adenoma is controversial. The aim of this study was to evaluate management with selective arterial embolization., Methods: The study included 11 consecutive patients treated for ruptured hepatocellular adenomas between 2001 and 2006. After initial haemodynamic support, all patients received selective embolization of branches of the hepatic artery. The primary outcome was effectiveness in stopping the bleeding. Secondary outcomes were complications and changes in tumour size after embolization., Results: A single embolization brought haemorrhaging under control in ten patients; one patient needed three embolizations. None of the patients required emergency surgery. In the follow-up of 19 (range 7-49) months, no general or hepatobiliary complications were observed. All 25 adenomas, including those without signs of haemorrhaging in the same liver lobe, were either smaller or not detectable on computed tomography or magnetic resonance imaging after embolization, with the median diameter decreasing from 7.0 to 2.5 cm (P < 0.001)., Conclusion: Selective embolization of the hepatic artery is a safe and adequate first approach in the management of patients with haemorrhaging hepatocellular adenomas. Furthermore, arterial embolization reduces the size of adenomas in the liver., (Copyright (c) 2007 British Journal of Surgery Society Ltd.)
- Published
- 2007
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43. A novel technique for auxiliary partial liver transplantation with reno-portal anastomosis and avoidance of the hepatoduodenal ligament.
- Author
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Ringers J, Baranski AG, Dubbeld J, Sarton E, Veenendaal RA, Schaapherder AF, van der Linden E, Terpstra OT, and van Hoek B
- Subjects
- Acute Disease, Adult, Anastomosis, Surgical, Duodenum anatomy & histology, Fatty Liver surgery, Female, Hepatic Artery surgery, Humans, Ligaments, Liver anatomy & histology, Portal Vein surgery, Renal Circulation, Tissue and Organ Harvesting methods, Treatment Outcome, Hepatectomy methods, Liver Transplantation methods, Living Donors
- Abstract
Auxiliary liver transplantation (ALT) is a treatment for acute liver failure when regeneration of the native liver is possible or for metabolic disorders. In selected cases ALT and orthotopic liver transplantation (OLT) have similar survival when ALT is performed in the orthotopic position (auxiliary partial orthotopic liver transplantation, APOLT). Drawback of ALT with portal vein to portal vein anastomosis is the frequent occurrence of thrombosis, compromising both graft and native liver, and the necessity of a significant resection. To avoid division of portal flow we performed ALT with an end-to-end anastomosis between the graft portal vein and the left renal vein of the recipient (reno-portal ALT, REPALT). The hepatic artery was anastomosed to the aorta using an iliac arterial graft conduit. The bile duct was anastomosed to the stomach. In the two cases presented here excellent immediate graft function occurred with rapid regeneration of the graft and without early vascular complications.
- Published
- 2006
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44. Necrosis of a large hepatic tumor after hemorrhage and subsequent selective arterial embolization.
- Author
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Huurman VA, Stoot JH, van der Linden E, Terpstra OT, and Schaapherder AF
- Subjects
- Adenoma, Liver Cell blood supply, Adult, Female, Hemorrhage etiology, Hepatic Artery pathology, Humans, Liver Neoplasms blood supply, Necrosis pathology, Adenoma, Liver Cell complications, Embolization, Therapeutic methods, Hemorrhage therapy, Liver Neoplasms complications
- Abstract
This case report describes a young female patient presenting with acute intra-abdominal hemorrhage originating from a large tumor in the liver, most likely a hepatocellular adenoma. The bleeding was stopped by selective embolization of right hepatic artery branches. Subsequently, partial hepatectomy was performed after 6 mo. Macro- and microscopic examination showed complete necrosis and absence of tumorous tissue. The patient was discharged without complications, and subsequent follow-up until 22 mo after resection did not reveal any new lesions in the liver. This case emphasizes the significance of selective arterial embolization in the management of bleeding liver tumors and questions the need for (partial) hepatectomy after this procedure in selective cases.
- Published
- 2006
- Full Text
- View/download PDF
45. Persistent portal venous gas.
- Author
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Huurman VA, Visser LG, Steens SC, Terpstra OT, and Schaapherder AF
- Subjects
- Campylobacter Infections microbiology, Enterocolitis microbiology, Humans, Male, Middle Aged, Portal Vein, Thrombophlebitis complications, Thrombophlebitis microbiology, Campylobacter isolation & purification, Campylobacter Infections complications, Embolism, Air microbiology, Enterocolitis complications
- Abstract
This case report describes a patient diagnosed with ongoing portal venous gas, initiated by a rather common Campylobacter enterocolitis and maintained by septic thrombophlebitis and possibly by chronic cholecystitis. Cholecystectomy attenuated the patient's septic condition. The etiology of portal venous gas determines both the patient's prognosis and the choice for either conservative or surgical treatment. This report describes persistence of portal venous gas for a long period and a possible role for chronic cholecystitis as a cause.
- Published
- 2006
- Full Text
- View/download PDF
46. Pretransplant culture selects for high-quality porcine islets.
- Author
-
Rijkelijkhuizen JK, van der Burg MP, Töns A, Terpstra OT, and Bouwman E
- Subjects
- Animals, Blood Glucose analysis, Cells, Cultured, Diabetes Mellitus, Experimental surgery, Male, Mice, Mice, Nude, Swine, Transplantation, Heterologous, Islets of Langerhans cytology, Islets of Langerhans Transplantation
- Abstract
Objectives: The pig is generally considered a suitable alternative donor for clinical islet transplantation. However, adult pig islets are difficult to isolate and culture, often behave variably in in vitro assays, and do not consistently cure diabetic nude mice. In this study, we compared the in vivo function of freshly isolated and cultured adult porcine islets by transplantation in diabetic nude mice., Methods: Freshly isolated and cultured islets were transplanted in different doses to diabetic nude mice (N = 48)., Results: Average islet yield was 1924 islet-equivalents per gram of pancreas, purity 96%, and the viability that was measured by acridine orange and propidium iodide was greater than 80% in all freshly isolated islet preparations. Grafts of freshly isolated islets failed to reduce hyperglycemia in 17 of 18 recipients. Although after 1 day of culture islet recovery was only 21%, grafts of these islets cured 12 of 17 mice. After 7 to 14 days of culture, the recovery had decreased to 11%; however, these islets reversed hyperglycemia in all mice (13/13) and showed shorter time-to-normoglycemia and more tightly regulated blood glucose., Conclusions: Although freshly isolated adult porcine islets survive culture and transplantation poorly, islets selected by prolonged culture are of high potential.
- Published
- 2006
- Full Text
- View/download PDF
47. Life-threatening hemorrhage from adenomas in the liver during pregnancy.
- Author
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Stoot JH, van Roosmalen J, Terpstra OT, and Schaapherder AF
- Subjects
- Adenoma, Liver Cell diagnostic imaging, Diagnosis, Differential, Embolization, Therapeutic, Female, Hemorrhage diagnostic imaging, Hemorrhage therapy, Humans, Liver Neoplasms diagnostic imaging, Pregnancy, Rupture, Spontaneous complications, Rupture, Spontaneous diagnostic imaging, Tomography, X-Ray Computed, Adenoma, Liver Cell complications, Hemorrhage etiology, Liver Neoplasms complications, Pregnancy Complications, Neoplastic
- Published
- 2006
- Full Text
- View/download PDF
48. Photodynamic therapy with 5,10,15,20-tetrakis(m-hydroxyphenyl) bacteriochlorin for colorectal liver metastases is safe and feasible: results from a phase I study.
- Author
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van Duijnhoven FH, Rovers JP, Engelmann K, Krajina Z, Purkiss SF, Zoetmulder FA, Vogl TJ, and Terpstra OT
- Subjects
- Adult, Aged, Female, Humans, Infusions, Intravenous, Laser Therapy, Male, Middle Aged, Photochemotherapy adverse effects, Skin pathology, Colorectal Neoplasms secondary, Liver Neoplasms drug therapy, Liver Neoplasms secondary, Photochemotherapy methods, Porphyrins therapeutic use
- Abstract
Background: The prognosis for patients with liver metastases from colorectal carcinoma is limited because of the low number of patients who are eligible for curative hepatic resection. In this phase I study, 31 liver metastases in 24 patients with nonresectable metastases from colorectal carcinoma were treated with photodynamic therapy (PDT)., Methods: The photosensitizer 5,10,15,20-tetrakis(m-hydroxyphenyl)bacteriochlorin (mTHPBC) was intravenously administered in a dose of .6 mg/kg (n = 12) or .3 mg/kg (n = 12). After 120 hours (n = 18) or 48 hours (n = 6), tumors were illuminated for 300 to 600 seconds through percutaneously inserted optical fibers with a light dose of 60 J/cm of diffuser (740 nm)., Results: Tumor necrosis at 1 month after PDT was achieved in all treated lesions. Laser treatment was associated with mild pain (n = 8) and transient subclinical hepatotoxicity (n = 21). In one patient, PDT damage to the pancreas was inflicted, and in another patient, PDT damage of the skin occurred, but no serious clinical complications from PDT were reported. Administration of .6 mg/kg of mTHPBC led to transient phlebitis in 10 patients, and 3 patients experienced mild skin phototoxicity after excess light exposure., Conclusions: Colorectal liver metastases that are ineligible for resection can be safely and effectively treated with interstitial mTHPBC-based PDT.
- Published
- 2005
- Full Text
- View/download PDF
49. Elevated levels of mannose-binding lectin at clinical manifestation of type 1 diabetes in juveniles.
- Author
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Bouwman LH, Eerligh P, Terpstra OT, Daha MR, de Knijff P, Ballieux BE, Bruining GJ, van der Slik AR, Roos A, and Roep BO
- Subjects
- Adolescent, Autoantibodies blood, C-Reactive Protein analysis, Child, Child, Preschool, Diabetes Mellitus, Type 1 genetics, Female, Fructosamine blood, Genetic Predisposition to Disease, Genotype, HLA Antigens analysis, Humans, Male, Mannose-Binding Lectin genetics, Polymorphism, Genetic, Promoter Regions, Genetic genetics, Diabetes Mellitus, Type 1 blood, Mannose-Binding Lectin blood
- Abstract
Mannose-binding lectin (MBL) is a recognition molecule of the lectin pathway of complement and a key component of innate immunity. MBL polymorphisms have been described that are associated with MBL serum concentration, impaired function, and diabetic complications. We investigated 86 new-onset juvenile type 1 diabetic patients and compared these with their nondiabetic siblings and healthy unrelated control subjects. Polymorphisms of MBL exon 1 and promoter were determined, and serum concentration and MBL-complex activity were measured. Although the genetic polymorphisms of MBL were not different between patients and control subjects, MBL serum concentration as well as MBL complex activity was significantly higher in new-onset diabetic patients compared with their siblings matched for high-producing MBL genotypes (P = 0.0018 and P = 0.0005, respectively). The increase in MBL complex activity in high-MBL-producing patients could only partially be explained by high MBL production, as demonstrated by an increased MBL complex activity-to-MBL concentration ratio (P = 0.004). We conclude that MBL serum concentration and complex activity are increased in early-onset diabetic patients upon manifestation independently of genetic predisposition to high MBL production, indicating a possible role in the immunopathogenesis of type 1 diabetes, in addition to the adaptive islet autoimmunity.
- Published
- 2005
- Full Text
- View/download PDF
50. Mannose binding lectin gene polymorphisms confer a major risk for severe infections after liver transplantation.
- Author
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Bouwman LH, Roos A, Terpstra OT, de Knijff P, van Hoek B, Verspaget HW, Berger SP, Daha MR, Frölich M, van der Slik AR, Doxiadis II, Roep BO, and Schaapherder AF
- Subjects
- Adult, Bacterial Infections epidemiology, Base Sequence, Blotting, Western, Cohort Studies, Female, Gene Expression Regulation, Genetic Markers, Graft Survival, Humans, Incidence, Liver Failure diagnosis, Liver Failure mortality, Liver Failure surgery, Liver Transplantation methods, Male, Mannose-Binding Lectin genetics, Middle Aged, Molecular Sequence Data, Polymerase Chain Reaction, Postoperative Complications mortality, Probability, Prognosis, Risk Assessment, Sensitivity and Specificity, Severity of Illness Index, Statistics, Nonparametric, Survival Rate, Bacterial Infections genetics, Liver Transplantation adverse effects, Mannose-Binding Lectin metabolism, Polymorphism, Genetic, Postoperative Complications diagnosis
- Abstract
Background & Aims: Infection is the primary cause of death after liver transplantation. Mannose binding lectin (MBL) is a recognition molecule of the lectin pathway of complement and a key component of innate immunity. MBL variant alleles have been described in the coding region of the MBL gene, which are associated with low MBL serum concentration and impaired MBL structure and function. The aims of our study were to establish the role of the liver in production of serum MBL and to evaluate the effect of MBL variant alleles on the susceptibility to infection after liver transplantation., Methods: We investigated 49 patients undergoing orthotopic liver transplantation. MBL exon 1 and promoter polymorphisms were determined in patients and in liver donors. MBL serum concentration was determined before and during 1 year after transplantation. The incidence of clinically significant infections during this period was assessed., Results: Transplantation of MBL wildtype recipients with donor livers carrying MBL variant alleles resulted in a rapid and pronounced decrease of serum MBL levels. This serum conversion was associated with the disappearance of high molecular weight MBL. No indication for extrahepatic production of serum MBL could be obtained. The presence of MBL variant alleles in the MBL gene of the donor liver, but not in the recipient, was associated with a strongly increased incidence of clinically significant infections after transplantation., Conclusions: Serum MBL is produced by the liver under strong genetic control. After liver transplantation, the MBL genotype of the donor liver is a major risk determinant for life-threatening infections.
- Published
- 2005
- Full Text
- View/download PDF
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