Position of simultaneous kidney and pancreas transplantation in treatment of diabetes accompanied with end-stage renal failure: case discussion and new approaches

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Tip 1 diyabet, mikrovasküler ve makrovasküler komplikasyonlarla ilerleyen hastayı son dönem böbrek yetmezliğine götürebilen, pankreas adacık hücrelerinin kaybıyla karakterize otoimmün bir hastalıktır. Diyaliz ve insülin tedavisi, bu hastalara yaşama şansı tanırken, düşük yaşam kalitesi ve ilerleyici komplikasyonlar hastaları en çok zorlayan etkenlerdir. Eş zamanlı pankreas-böbrek nakli, bu grup hastada, hastanın yaşam kalitesini ve süresini artıran, normoglisemik kan düzeyiyle diyalizden bağımsız yaşamı sağlayan en önemli tedavi yöntemidir. Bu yazıda, eş zamanlı pankreas-böbrek nakli gerçekleştirilen bir olguyu, ameliyat tekniğini, tedavi sonuçlarını ve yeni yaklaşımları değerlendirdik.Type 1 diabetes, characterized with the loss of pancreatic islet cells and advanced with microvascular and macrovascular complications, is an autoimmune disease that can cause end stage renal failure. These patients have a chance to survive with hemodialysis and insulin therapy, but they may suffer from many co-morbidities and low quality of life. In this group of patients, simultaneous pancreas kidney transplantation is the only treatment modality that improves the quality and duration of life, providing normo-glycemic blood levels and dialysis-free life span. In this paper, we reviewed a simultaneous pancreas kidney transplanted case, the operation technique, treatment outcomes, and new trends

Gallstones and Concomitant Gastric Helicobacter pylori Infection

Background. The association of gallstones with Helicobacter pylori has been investigated but not clearly demonstrated. In this study, the presence of H. pylori in the gallbladder mucosa of patients with symptomatic gallstones was investigated. Method. Ninety-four consecutive patients with symptomatic gallstone disease were enrolled for the study. Gastroscopy and gastric H. pylori urease test were done before cholecystectomy to all patients who accepted. After cholecystectomy, the gallbladder tissue was investigated in terms of H. pylori by urease test, Giemsa, and immunohistochemical stain. Results. Overall 35 patients (37%) gallbladder mucosa tested positive for H. pylori with any of the three tests. Correlation of the three tests Giemsa, IHC, and rapid urease test was significant (rs: 0590, P>0.001). Rapid urease test was positive in the gastric mucosa in 47 (58.7%) patients, and it was positive in the gallbladder mucosa in 21 patients (22%). In 15 patients both gastric and gallbladder tested positive with the urease test. There was significant correlation of rapid urease test in both of gallbladder and gastric mucosa (P=0.0001). Conclusion. Study demonstrates the presence of H. pylori in the gallbladders of 37% of patients with symptomatic gallstones