Slow metabolic deterioration towards diabetes in islet cell antibody positive patients with autoimmune polyendocrine disease

We studied metabolic progression to IDDM in a cohort of adults who are ICA-positive and have associated autoimmune endocrine disease or circulating organ-specific autoantibodies (the Polyendocrine Study). Of the 186 individuals recruited 27 developed overt diabetes after a median follow-up of 4.5 years (range 0.4-12). Of these, eight patients did not require insulin treatment until at least 6 months after clinical diagnosis, with an interval of 1.8 years (1.2-5.7). An IVGTT was performed in 38 subjects and 23 had sequential studies. Of the initial 38 subjects six developed diabetes and only three showed a loss of FPIR to glucose (below the first percentile of a normal control group) before clinical onset of the disease. An additional three subjects showed a loss of the FPIR, and all still have normal glucose tolerance after median follow-up of 28 months (22-95). A whole or mixed pattern of islet cell staining was found in five of the six patients who developed diabetes and antibodies against an islet 37 k-antigen were detectable in four patients, all of whom required insulin soon after diagnosis. A beta-cell selective ICA staining pattern was seen in 14 of 17 subjects who did not develop diabetes and the mixed pattern in only three. None of this group had detectable 37k-antibodies. We conclude that metabolic deterioration is slow in polyendocrine patients, and that the IVGTT has less prognostic significance in this group than in first degree relatives of patients with IDDM. In contrast, the presence of the whole or mixed ICA staining pattern or of 37k-antibodies can identify a high risk of progression to IDDM within this polyendocrine population and may indicate the rate of metabolic deterioration. © 1994 Springer-Verlag.</p

Slow metabolic deterioration towards diabetes in islet cell antibody positive patients with autoimmune polyendocrine disease

We studied metabolic progression to IDDM in a cohort of adults who are ICA-positive and have associated autoimmune endocrine disease or circulating organ-specific autoantibodies (the Polyendocrine Study). Of the 186 individuals recruited 27 developed overt diabetes after a median follow-up of 4.5 years (range 0.4-12). Of these, eight patients did not require insulin treatment until at least 6 months after clinical diagnosis, with an interval of 1.8 years (1.2-5.7). An IVGTT was performed in 38 subjects and 23 had sequential studies. Of the initial 38 subjects six developed diabetes and only three showed a loss of FPIR to glucose (below the first percentile of a normal control group) before clinical onset of the disease. An additional three subjects showed a loss of the FPIR, and all still have normal glucose tolerance after median follow-up of 28 months (22-95). A whole or mixed pattern of islet cell staining was found in five of the six patients who developed diabetes and antibodies against an islet 37 k-antigen were detectable in four patients, all of whom required insulin soon after diagnosis. A beta-cell selective ICA staining pattern was seen in 14 of 17 subjects who did not develop diabetes and the mixed pattern in only three. None of this group had detectable 37k-antibodies. We conclude that metabolic deterioration is slow in polyendocrine patients, and that the IVGTT has less prognostic significance in this group than in first degree relatives of patients with IDDM. In contrast, the presence of the whole or mixed ICA staining pattern or of 37k-antibodies can identify a high risk of progression to IDDM within this polyendocrine population and may indicate the rate of metabolic deterioration. © 1994 Springer-Verlag.</p

Patient demographics, and perioperative results stratified by surgery type for all diagnosed ccRCC.

Patient demographics, and perioperative results stratified by surgery type for all diagnosed ccRCC.</p

Overview of the current literature, comparing studies with patients presenting pT2 and cT2 RCC and treated by nephron sparing surgery (NSS) or radical nephrectomy (RN).

<p>Synopsis current literature.</p

Survival outcomes in patients with large (≥7cm) clear cell renal cell carcinomas treated with nephron-sparing surgery versus radical nephrectomy: Results of a multicenter cohort with long-term follow-up

<div><p>Background</p><p>Does the dogma of nephron sparing surgery (NSS) still stand for large renal masses? Available studies dealing with that issue are considerably biased often mixing imperative with elective indications for NSS and also including less malignant variants or even benign renal tumors. Here, we analyzed the oncological long-term outcomes of patients undergoing elective NSS or radical tumor nephrectomy (RN) for non-endophytic, large (≥7cm) clear cell renal carcinoma (ccRCC).</p><p>Methods</p><p>Prospectively acquired, clinical databases from two academic high-volume centers were screened for patients from 1980 to 2010. The query was strictly limited to patients with elective indications. Surgical complications were retrospectively assessed and classified using the Clavien-Dindo-classification system (CDS). Overall survival (OS) and cancer specific survival (CSS) were analyzed using the Kaplan-Meier-method and the log-rank test.</p><p>Results</p><p>Out of in total 8664 patients in the databases, 123 patients were identified (elective NSS (n = 18) or elective RN (n = 105)) for ≥7cm ccRCC. The median follow-up over all was 102 months (range 3–367 months). Compared to the RN group, the NSS group had a significantly longer median OS (p = 0.014) and median CSS (p = 0.04).</p><p>Conclusions</p><p>In large renal masses, NSS can be performed safely with acceptable complication rates. In terms of long-term OS and CSS, NSS was at least not inferior to RN. Our findings suggest that NSS should also be performed in patients presenting with renal tumors ≥7cm whenever technically feasible. Limitations include its retrospective nature and the limited availability of data concerning long-term development of renal function in the two groups.</p></div

Overview of the recurrence and survival of the current literature, comparing studies with patients presenting pT2 and cT2 RCC and treated by nephron sparing surgery (NSS) or radical nephrectomy (RN).

<p>Overview of the recurrence and survival of the current literature, comparing studies with patients presenting pT2 and cT2 RCC and treated by nephron sparing surgery (NSS) or radical nephrectomy (RN).</p

Patients who died or suffer from recurrence of disease during follow-up stratified by surgery type for all diagnosed ccRCC.

<p>Patients who died or suffer from recurrence of disease during follow-up stratified by surgery type for all diagnosed ccRCC.</p

Overall survival (OS).

<p>OS for 123 patients cT2 after radical nephrectomy (RN, n = 105) or elective NSS (n = 18) for ccRCC ≥7cm. Comparison of survival analysis performed using log-rank (Mantel-Cox) test; Chi square 5.94, <i>P =</i> 0.014. Median OS was 149 months (range 3–367), for NSS and was not reached for NSS.</p

Cancer-specific survival (CCS).

<p>CSS for 123 patients cT2 after radical nephrectomy or elective NSS for ccRCC ?7cm. Comparison of survival analysis performed using log-rank (Mantel-Cox) test; Chi square: 3.35, P = 0.04. Median survival for RN was 164 months (range 3–367 months), for NSS not reached.</p