Australian experience with total pancreatectomy with islet autotransplantation to treat chronic pancreatitis

BACKGROUND

This study aimed to describe the clinical outcomes of total pancreatectomy with islet autotransplantation (TP-IAT) in Australia.

METHODS

Individuals selected for TP-IAT surgery according to the Minnesota Criteria (Appendix) without evidence of diabetes were evaluated including time to transplantation from pancreatectomy, islet numbers infused and post-transplantation HbA1c, C-peptide, total daily insulin and analgesic requirement.

RESULTS

Sixteen individuals underwent TP-IAT from Australia and New Zealand between 2010 and 2020. Two recipients are deceased. The median islet equivalents/kg infused was 4244 (interquartile range (IQR) 2290-7300). The median C-peptide 1 month post-TP-IAT was 384 (IQR 210-579) pmol/L and at median 29.5 (IQR 14.5-46.5) months from transplant was 395 (IQR 139-862) pmol/L. Insulin independence was achieved in eight of 15 (53.3%) surviving recipients. A higher islet equivalents transplanted was most strongly associated with the likelihood of insulin independence (P < 0.05). Of the 15 surviving recipients, 14 demonstrated substantial reduction in analgesic requirement.

CONCLUSION

The TP-IAT programme in Australia has been a successful new therapy for the management of individuals with chronic pancreatitis including hereditary forms refractory to medical treatment to improve pain management with 50% insulin independence rates.

Uncommon complications of renal transplantation

As a result of advances in surgical technique and immunosuppressive therapy, the incidence and the consequences of post-transplant surgical complications has decreased. However, surgical complications still cause considerable morbidity and test the skills of the surgical team. Several reviews have been published analyzing the incidence of these complications and the management strategies employed to correct them. We report some uncommon or rare complications encountered in our unit after the introduction of low-dose steroids or steroid-free immunosuppressive protocols.

Phase I trial of the murine monoclonal anti-GD2 antibody 14G2a in metastatic melanoma

In a phase I trial, 12 patients with GD2 antigen-positive metastatic melanoma received the murine anti-GD2 monoclonal antibody 14G2a. The monoclonal antibody was administered in four doses over an 8-day period with total dose ranging from 10 to 120 mg. All patients receiving greater than 10 mg of 14G2a experienced transient abdominal/pelvic pain during the antibody infusion. Five patients had a delayed extremity pain syndrome following the third and fourth antibody infusion. Four of the five patients developed neurological toxicity, including two patients with significant although reversible motor neuropathy. Two of the patients developed hyponatremia secondary to a syndrome of inappropriate antidiuretic hormone. All 12 patients developed high levels of human anti-14G2a antibody. The plasma half-life of 14G2a was 42 +/- 6 (SD) h. One patient each had a partial response, mixed response, and stable disease, respectively. The very modest antitumor activity accompanied by dose-limiting neurological toxicity at total doses greater than 80 mg may restrict the clinical utility of murine 14G2a.

In-111 labeled monoclonal anti-carcinoembryonic antigen antibody (ZCE025) in the immunoscintigraphic imaging of metastatic antigen-producing adenocarcinomas

The carcinoembryonic antigen (CEA) is a clinically useful marker since it is expressed by adenocarcinomas of diverse origin. Detection and quantitation of circulating CEA levels is used to follow the clinical course of metastatic adenocarcinoma. In this phase I study, the toxicity, pharmacokinetics, and optimal imaging dose of an In-111 labeled monoclonal anti-CEA antibody (ZCE025) was studied in patients with colorectal carcinoma or any CEA-producing tumor. Twenty-four of 26 evaluable patients (92%) demonstrated at least one site of tumor-specific antibody uptake. Sixty-seven sites of metastatic cancer were identified by conventional diagnostic studies. Twenty-nine (43%) of these sites were demonstrable by radioimmune imaging using ZCE025. Twenty-five additional sites of antibody uptake were observed but could not be associated with metastatic deposits. Lymph node and visceral metastases were visualized more frequently than bone, subcutaneous, lung, or liver metastases. Neither tumor size nor antibody dose (2.5-40 mg) appeared to influence the frequency of tumor imaging. The pharmacokinetics of the In-111 labeled antibody fitted a two-compartment model, and patients receiving less than 10 mg of antibody showed a faster clearance of the antibody than those who received greater than 10 mg.

Sampling Bulk Fertilizers in Railroad Cars and Piles

The AOAC official samplers (stream sampler, compartmental triers, and Missouri “D” tube) secured samples of ammoniated granular fertilizers at all locations in railroad cars and warehouse piles that were well within the AAFCO tolerances. Dry blended fertilizers in lots of this size could not be sampled as outlined in this study. Recommendations are made for the sampling of fluid fertilizers (in absence of free ammonia).

Sampling Bulk Fertilizers

An experimental "D" sampler, which encompasses a core of fertilizer in place, and a powered auger sampler are compared with official compartmented probe and stream samplers on dry mixed fertilizer from three types of blending plants in six states. Standard deviations reflecting variability and precision of the "D" tube indicate performance comparable or superior to the official samplers in both chemical and mechanical analysis. The powered auger compared favorably to the official samplers in chemical analysis, but comparison as to mechanical analysis could not be made because particle size reduction occurred. The official stream sampler failed to secure representative samples from baffle-type mixers when the discharge time was unusually short. Improved indexes of sampling accviracy and precision were secured for all samplers used. It is recommended that sec. 2.001(b), as expanded, be raised to official, final action status.

Sampling Bulk Fertilizers

A sampling study was designed to investigate the sampling of bulk loads of semigranular, granular, pulverized, and blended fertilizers. The study was designed to obtain information on appropriate instruments and methods for sampling bulk fertilizers. An accurate fertilizer sample can be secured by passing a stream sampling cup through the entire flow of material at equally timespaced intervals during the loading of a truck; this "stream" sample is used as a reference point. The AOAC triers did not secure accurate samples of bulk loads. Two compartmented triers and t h e stream sampler were recommended as official sampling instruments. A concentric sampling pattern for taking bulk samples was recommended. Studies on bulk sampling will continue.