[Early kidney-pancreas transplantation in type 1 diabetics prevents hemodialysis]

BACKGROUND

The life-expectancy of type 1 diabetics (T1D) on dialysis is still shorter than that of non-diabetics. Pancreas transplantation (PT) in its different modalities should be considered as a life-saving procedure.

METHODS

We analyzed our referral activity of T1D to PT from 1992. Since 2002, we have created a kidney and diabetes out-patient clinic devoted to the prevention of diabetic nephropathy and to the early referral of suitable T1D to combined kidney- pancreas transplantation (KPT) and isolated pancreas (PTA).

RESULTS

In the last 14 yrs, 25 T1D underwent KP in our district (620000 inhabitants). At the beginning, KPT was performed abroad, but then the borders were closed. After stopping in the mid 1990s, KP activity restarted addressing preemptive KPT and PTA. Currently, only one patient is on dialysis while awaiting KPT. Four T1D were evaluated and excluded from the list on medical grounds; two patients are on the list and a further two patients are currently under evaluation.

CONCLUSIONS

The implementation of a cooperative network among dialysis and transplant centers, supported by devoted out-patient clinics allowed the effective prevention of the dialysis requirement in T1D. Out-patient clinics devoted to diabetic nephropathy should play a pro-active role in preemptive KP, including the 'new' option of islet transplantation according to the Edmonton protocol.

[Obesity: relationships with the endocrine system]

In this study we have examined the relationship between obesity and endocrine glands. We have underlined that obesity can be a symptom of some endocrine diseases and that, on the other side, only a few number of cases with excessive weight have a true endocrine pathogenesis. The endocrine implications of essential obesity, only detectable with appropriate dynamic tests, are sometimes expression of an altered peripheral metabolism. The more relevant hormonal data that we will examine in details are: increase of insulin plasma levels, altered hypothalamic neuroregulation with consequence on the gonadotropin secretion and values of prolactin, growth hormone and cortisol.

[Clonidine in the treatment of short stature: preliminary clinical experience]

Fourteen children between 5 and 12 years old at P1 B1 Tanner's pubertal stage were studied. Seven of them were affected by familiarly short height and seven had a constitutional growth delay. All those patients (responders) except two (hyporesponders) turned out positive to GH stimulation tests (GH to I.T.T., GH to clonidine test). We have treated with clonidine (0.100 mg/m2 for six months) all patients and there were significant results: higher values of basal GH and increase in the response to the clonidine test also in patients hyporesponders before treatment.