Zsolt Kanyári

New Insights into the Neuromuscular Anatomy of the Ileocecal Valve

The neuroanatomy of the ileocecal valve (ICV) is poorly understood. A better understanding of this important functional component of the gastrointestinal tract would enable surgeons to reconstruct an effective valve following surgical resection of the ICV. ICVs were examined in young pigs (N = 5) using frontal and transverse paraffin embedded and frozen sections. Hematoxylin+Eosin (H+E) staining, acetylcholinesterase (AchE), and NADPH‐diaphorase (NADPH‐d) histochemistry and protein gene product 9.5 (PGP 9.5) and C‐kit immunohistochemistry were performed. The H+E staining revealed that the ICV consists of three muscle layers: an external circular muscle layer continuous with that of the ileal circular muscle layer, an inner circular muscle layer continuous with that of the cecal circular muscle layer, and a single longitudinal muscle layer, which appears to be secondary to a fusion of the ileal and cecal longitudinal muscle layers. The AchE, NADPH‐d, and PGP 9.5 staining revealed two distinct coaxial myenteric plexuses, together with superficial and deep submucosal plexuses. The C‐kit immunostaining showed a continuous myenteric ICC network within the ICV. The structure of the neuromuscular components within the ICV suggests that the valve is a result of a simple intussusception of the terminal ileum into the cecum. This knowledge may help surgeons in their future attempts at reconstructing more anatomically and functionally suitable ICVs following surgical resection of native ICVs. Anat Rec 2009.

Primary angiosarcoma of the pancreas mimicking severe acute pancreatitis – Case report

Primary angiosarcoma of the pancreas is an extremely rare neoplasm that often mimicks severe acute pancreatitis. A 58-year-old man was admitted with clinical and laboratory signs of severe acute pancreatitis. Contrast enhanced CT scan demonstrated haemorrhagic necrotizing inflammation of the pancreas involving the pancreatic tail, splenic hilum and small bowels with multiple peripancreatic and free abdominal fluid collection. Percutaneous drainage was performed. After 13 days, laparotomy was indicated because of persistent intra-abdominal bleeding, fever and a palpable, rapidly growing mass in the left upper quadrant of the abdomen. During the operation a necrotic, haemorrhagic mass was found in the pancreatic tail; a frozen section showed malignancy, although the tumour was unresectable. Despite all conservative and surgical therapeutic attempts, the patient died within four weeks after diagnosis. Final histology justified primary angiosarcoma of the pancreas. If a patient with signs of severe acute pancreatitis has fever without elevated PCT, the presence of a malignant tumour of the pancreas should be considered.

Horseshoe kidney transplantation

Horseshoe kidney is a fusion anomaly found in approximately one in 400-600 people. Due to vascular and ureteral variations, transplantation with a horseshoe kidney presents a technical challenge. In our case, the isthmus connected the upper poles and contained parenchyma. It consisted of three renal arteries, five veins collected to the inferior vena cava, and two ureters and pyelons. It was implanted en bloc to the left side retroperitoneally. During the early period, cellular and humoral rejection was confirmed and treated. For a urine leak, double J catheters were implanted into both ureters. Later, the first catheter was removed. Subsequently, urinary sepsis developed, necessitating graftectomy. The uncommon anatomy of ureters and antibody-mediated rejection (AMR) may both be factors for a ureter tip necrosis led to an infected urinoma. After other Hungarian authors, we also report a horseshoe kidney transplantation that was technically successful. However, after an adequately treated but severe acute humoral rejection, the patient developed sepsis, and the kidney had to be removed. We conclude that transplantation with horseshoe kidney is technically feasible but may increase the risk for urinary complications and resultant infections. Careful consideration of risk and benefit is advised when a transplant professional is faced with this option.

A Single-center Experience of Allograft Nephrectomies Following Kidney Transplantation

INTRODUCTION Approximately 10% of renal allografts fail during the first year after kidney transplantation (KT) and 3%-5% thereafter yearly. The indication and timing of allograft nephrectomy (AN) is still uncertain in some cases. The aim of this study was to reveal the ratio, etiology, and complications of AN at our center. MATERIAL AND METHODS This is a retrospective study of all patients who underwent KT at our center between January 1, 2004 and December 31, 2014. We analysed the frequency, indications, timing, and complications of ANs. Also early and late ANs were compared. RESULTS From 417 renal transplantations 49 ANs were performed (11.7%). The most frequent indications were chronic allograft nephropathy (25; 51%), arterial blood supply complications, like arterial thrombosis and stenosis (7; 15%), treatment-resistant acute rejection (3; 6%), and nonreparable ureter complications (3; 6%). The average time of AN since KT was 28 months. ANs were performed as an urgent setting in 16 (33%) cases, whereas it was elective in 33 cases (67%). The AN was executed within 30 days (early) in 11 (22%) cases, and thereafter (late) in 38 (78%) cases. The main indication for early AN was renal artery thrombosis (4; 37%) and chronic allograft nephropathy (25; 66%) for late AN. Surgical complications occurred in 10 cases (20; 4%). The most common was hematoma. CONCLUSION The majority of the ANs were elective and late (more than 30 days; average time, 47 months). Leading indication was chronic allograft nephrectomy. Early ANs were urgent and life-saving in all cases.

Eredményeink a teljes jogú Eurotransplant-tagság óta. A Debreceni Vesetranszplantációs Központ tapasztalatai

Absztrakt Bevezetes: A Debreceni Egyetemen 1991-ben vegeztek el az első veseatultetest. Hazank 2013-ban csatlakozott az Eurotransplanthoz. Celkitűzes: A szerzők elemeztek a tapasztalatokat. Modszer: 2008. januar 1. es 2013. augusztus 31. kozott (A csoport = 163) es 2013. szeptember 1. es 2015. oktober 22. kozott vegzett cadavervese-atultetesek (B csoport = 90) adatait elemeztek. Eredmenyek: Az elődonorok aranya 3,5%-rol 9,1%-ra nőtt. 2013 ota a recipiensek 25%-a 60 evesnel idősebb, a >30 kg/m2 testtomegindex aranya 31%-ra, a diabetesesek aranya ketszeresere emelkedett. Az ureteroneocystostomia mellett bevezetesre kerult a veg az oldalhoz ureteroureteralis anastomosis. Indukcios kezeles mellett az akut rejectios epizod jelentősen csokkent (34%-rol 8%-ra). A technikai szovődmenyek aranya nem valtozott. A bakterialis fertőzesek aranya csokkent (41%-rol 33%-ra). Az 1, 3 es 5 eves veseallograft-tulelesek 86,6%, 85% es 82,7%, valamint 88%, 84% es 84% voltak a ket csoportban. Kovetkeztetesek: Az extended criteri...

Graftectomiák a debreceni vesetranszplantációs programban

Absztrakt Bevezetes: A graftectomia indikacioja es pontos időzitese bizonyos esetekben vita targya, elsősorban a tuneteket nem okozo, mar nem műkodő graftok eseten. Celkitűzes: A szerzők atfogo kepet kivantak adni a debreceni veseatultetesi programban elvegzett graftectomiakrol. Modszer: Retrospektiv vizsgalattal elemeztek a 2004. januar 1. es 2015. december 31. kozott veseatultetett betegek adatait. Attekintettek a graftectomiak indikacioit, időziteset, szovődmenyeit, tovabba osszehasonlitottak a korai es kesői graftectomiakat. Eredmenyek: A vizsgalt időszakban 480 veseatultetes tortent. Kozuluk 55 betegnel (11%) tortent graftectomia. A gyakoribb indikaciok a kovetkezők voltak: kronikus allograft-nephropathia (47%), arterias keringesi zavar (13%), ureterszovődmenyek (9%). A grafteltavolitas 22 betegnel (40%) akut, 33-nal (60%) tervezett volt. A graftectomiak 24%-a a transzplantacio utan 30 napon beluli, 76%-a kesői volt. Korai graftectomiat tulnyomoreszt arterias keringeszavar (31%), a kesőiek tobbseget ...

Donorszelekciós kritériumok vizsgálata a debreceni veseátültetési programban

Absztrakt Bevezetes: A donorszervhiany, a donorok eletkoranak novekedese es a tarsbetegsegek gyakoribba valasa arra osztonzi a transzplantalokozpontokat, hogy olyan donorvesek elfogadasat is merlegeljek, amelyeket korabban elutasitottak volna. A donorszelekcios kriteriumok segithetnek ennek eldonteseben. Celkitűzes: A kulonboző kriteriumok hasznossagat illetően nincs egyseges allaspont, ezert a szerzők megvizsgaltak az expanded criteria donor, a deceased donor score es a kidney donor risk index donorszelekcios kriteriumok hatasat a posztoperativ vesefunkciora es grafttulelesre. Modszer: Oteves intervallumban 205 donor parametereinek es 138 veseatultetes kimenetelenek retrospektiv elemzeset vegeztek el. Eredmenyek: Az expanded criteria donor rendszer szerint optimalisnak velemenyezett donorok negyede a magas kockazatu csoportba kerult a deceased donor score alapjan. A magas kockazatu csoportokban rosszabb volt a műtet utani graftfunkcio. A deceased donor score segitsegevel tovabb lehetett bontani a magas k...