The New England journal of medicine
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Pancreatic tissue obtained by hemipancreatectomy from healthy living related donors has been transplanted into recipients with Type I diabetes mellitus. To determine the metabolic consequences of this procedure for the donors, we carried out oral glucose-tolerance testing and 24-hour monitoring of serum glucose levels and urinary C-peptide excretion as a measure of insulin secretion in 28 donors, both before and one year after hemipancreatectomy. The mean fasting serum glucose level was significantly higher one year after the procedure (mean +/- SD, 5.4 +/- 0.9 vs. 4.9 +/- 0.5 mmol per liter; P less than 0.003), as was the serum glucose value two hours after the administration of glucose (8.7 +/- 2.9 vs. 6.5 +/- 1.0 mmol per liter; P less than 0.001). ⋯ All 28 donors had fasting serum glucose concentrations lower than 7.8 mmol per liter, and their mean 24-hour plasma glucose levels remained within the normal range. We conclude that in healthy donors hemipancreatectomy results in a deterioration of insulin secretion and glucose tolerance, as measured one year later. Further study is required to ascertain whether the development of clinical diabetes mellitus is a risk inherent in hemipancreatectomy.
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Randomized Controlled Trial Clinical Trial
Preliminary report of the Stroke Prevention in Atrial Fibrillation Study.
Atrial fibrillation, even in the absence of rheumatic valvular disease, predisposes patients to embolic complications, but the role of antithrombotic therapy in the prevention of such complications has not been fully clarified. We therefore performed a randomized, placebo-controlled trial to evaluate warfarin and aspirin individually as prophylaxis against ischemic stroke and systemic embolism (the primary events) in such patients. Patients eligible to receive warfarin (group 1) were assigned to warfarin (open label), aspirin (325 mg per day), or placebo (aspirin and placebo were given in a doubleblind fashion). ⋯ However, we were unable to show a benefit of aspirin in patients over 75 years of age. These preliminary data indicate that antithrombotic therapy with warfarin or aspirin is effective in the short term in reducing the risk of stroke and systemic embolism in patients with atrial fibrillation due to causes other than rheumatic valvular disease. The relative benefits of aspirin and warfarin remain unclear, and the trial is continuing in order to address this issue.