The effect of nephrectomy on the outcome of renal transplantation in patients with polycystic kidney disease.

Although various forms of polycystic kidney disease (PKD) account for up to 10% of patients requiring renal replacement therapy and severe complications may arise from these kidneys, no clear indications for pretransplant nephrectomy have been defined so far. A total of 104 renal transplants in three pediatric and 96 adult patients suffering from PKD were analysed retrospectively with regard to patient and graft survival in relation to pretransplant or posttransplant nephrectomy and no nephrectomy. Of these 99 patients, 25 had had either unilateral (19) or bilateral (6) nephrectomy sometime before transplantation and 10 patients between 3 and 81 months after transplantation. All patients received Cyclosporine-based immunosuppression. One-year patient and graft survivals for recipients of a first cadaveric renal graft (n = 91) were 94% and 92%, for recipients of second or third graft (n = 13) 89% and 78%. One- and five-year patient survival rates for patients with or without pretransplant nephrectomy were 100% and 100% vs 92% and 84%, respectively. One- and five-year graft survival rates were 100% and 93% for pretransplant nephrectomy patients vs 89% and 74% for the non-nephrectomy group (p < 0.05). Patients not undergoing nephrectomy sometime after transplantation had the same patient but better five-year graft survival when compared to the posttransplant nephrectomy group (89% vs 52%). In patients with early posttransplant urinary tract infection, which is considered in this analysis as a cyst-related complication, graft survival at one year was 77% but 97% in patients without this complication. From these data it is recommended that polycystic kidneys should be removed before transplantation if cyst-related complications occur repeatedly. Posttransplant nephrectomy can be performed with no mortality and should be carried out whenever clinically indicated.

[The place of pancreas transplantation in therapy]. / A hasnyálmirigy átültetés helye a terápiában.

Insulin dependent diabetes mellitus is one of the most ravaging diseases of the civilised world mainly because of its secondary complications. Even the most careful exogenous insulin administration can neither maintain an entirely physiological glucose metabolism nor prevent the development of the late complications. Today pancreatic transplantation is the only therapy leading to total normalisation of glucose and lipid metabolism in type I diabetic patients. Beside the improvement of the life quality resulted by the independence of the insulin administration and of the dietary restrictions, secondary complications as nephropathy, retinopathy and neuropathy are positively influenced. Best results can be obtained with the simultaneous procedure, grafting kidney and pancreas from the same donor. In this case the grafted pancreas can also increase the patient survival rate and the kidney graft function rate comparing with the results of the kidney transplantation alone. In conclusion simultaneous pancreatic-kidney transplantation is clearly indicated for the treatment of type I diabetic patients with end-stage kidney disease.

[Increased use of pancreas transplantation in the management of diabetics]. / A pancreas transzplantáció térhódítása a cukorbetegek gyógyításában.

The surgery looking for new ways takes part in the treatment of the type I diabetic patients. The development of pancreatic transplantation in the last decades is discussed. Nowadays the procedure has become accomplished and widely used in the transplantation practice. According to the results of the clinical trials the pancreatic transplantation can normalize the metabolism and improve the quality of life. By improving also the survival of the simultaneously transplanted kidney the procedure has become increasingly indispensable complement of the kidney transplantation in the treatment of type I diabetic patients with end stage kidney disease.

[Experience with chronic hemodialysis in diabetic patients with kidney failure]. / A veseelégtelenségben szenvedö cukorbetegek krónikus hemodialízisével szerzett tapasztalataink.

Between 1978 and 1992, 534 patients--including 35 (25 IDDM and 10 NIDDM) diabetics--were accepted to chronic hemodialysis (HD) at our Dialysis Center. The 1-year cumulative survival rate (CSR) was significantly lower in diabetic vs. non-diabetic group (66 +/- 8% vs. 78 +/- 2%), p < 0.05). At the onset of diabetes the mean age of IDDM patients vs. NIDDM patients was 18.2 +/- 2.7 years vs. 51.3 +/- 3.1 years, respectively. At the beginning of HD treatment the mean age of IDDM patients vs. NIDDM patients was 38 +/- 2.4 years vs. 58.3 +/- 2.6 years. In IDDM group until the start of HD treatment the mean duration of diabetes was 20 +/- 1.3 years and it did not depend on the quality of preuraemic metabolic control (p = 0.825); mean duration of diabetes until their death was 22.5 +/- 1.3 years. Mean age of IDDM and NIDDM patients at their death was 38.8 +/- 3 years and 60.5 +/- 3.7 years. Average duration of HD treatment was 16 +/- 2.5 months in IDDM group and 21.5 +/- 5.8 months in NIDDM group. Major causes of death were cardiovascular complications of diabetes (39%) and infections (33%). We found no difference in CSR related to gender, age, type of diabetes, quality of metabolic control during the HD treatment, but CSR was significantly higher in patients with good metabolic control from the onset of diabetes (1-year CSR of adequately vs. poorly controlled diabetics: 80% vs. 62%, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Late results after eversion endarterectomy of the internal carotid artery]. / Késói eredmények az arteria carotis interna everziós endarteriektómiája után.

OBJECTIVES: The eversion endarterectomy of the internal carotid artery was introduced in Hungary in 1991. The aim of this study was to define the long-term restenosis rate of this new method. MATERIALS AND METHODS: Between 1991 and 1993, 171 operations were performed by one surgeon on 151 patients: 109 patients had enough compliance to take part in long-term follow-up, which included annual physical and ultrasound (Ultramark 9) investigations. Restenosis rate and plaque morphology was defined. Survival and patency rates were calculated by life-table method. RESULTS: The perioperative combined stroke morbidity and mortality rate was 0.8%. The 5-year patient survival rate was 85%, the recurrent stenosis free rate was 88%/5 years, and 9% of the patients had restenosis greater than 70% in this period. The plaque morphology showed calcification in 1 case. Two patients needed 3 reoperations (2.4%). Plaque histology showed myointimal hyperplasia in every 3 cases. CONCLUSIONS: Comparing our results to the literature (2-34% restenosis rate) it seems to be acceptable and encouraging for the future. The ultrasound and histological findings suggest that arteriosclerosis does not play significant role in development of restenosis after the eversion method.

Transverse hepatectomy in surgical treatment of gallbladder carcinoma.

In the surgical treatment of gallbladder cancer not only the traditional resections (right trisegmentectomy, lobectomy), but newer, parenchyma sparing multisegmentectomies, resection of 4B, 5, 6, that is transverse resection is also justified, as it is shown by demonstrating the 2 first cases in Hungary with transverse hepatectomy. World-wide there is a tendency for more aggressive surgical treatment in case of gallbladder cancer. For this reason we introduced transverse hepatectomy in our surgical practice, and in this paper we demonstrate the technical details of the new procedure. The goal of the transverse resection is to remove the tumour with an adequate margin of resection. The remaining hepatic parenchyma allows good quality of life for the patients till recurrence develops.

Long-term restenosis rate of eversion endarterectomy on the internal carotid artery.

OBJECTIVES: The eversion endarterectomy of the internal carotid artery was introduced in Hungary in 1991. The aim of this study was to define the long-term restenosis rate of this procedure. PATIENTS AND METHODS: Between 1991 and 1993, 171 operations, on 151 patients, were performed by single surgeon: with long-term follow up of 109 patients, which included annual physical and ultrasound examinations. Restenosis rate and plaque morphology were defined. Survival and patency rate were analysed by life-tables. RESULTS: The combined perioperative stroke morbidity and mortality rate was 0.8%. The 5-year patient survival rate was 85%, the recurrent stenosis free rate was 88% at 5 years. Only 9% of the patients had carotid restenosis of more than 70% during this period. Ultrasound plaque morphology showed calcification in one case. Two patients had re-operations, with plaque histology showed myointimal hyperplasia in each case. CONCLUSIONS: Our results for restenosis are compare favourably with the 2-34% restenosis rate reported in the literature. Ultrasound and histological findings suggest that atherosclerosis does not play a significant role in the development of restenosis after the eversion carotid endarterectomy.

In vitro amylase release of preserved pancreas: a simple test to assess the viability of pancreatic allograft during preservation in the pigs.

To determine an in vitro marker of viability during pancreatic preservation, 12 pigs underwent total pancreas harvesting, and graft were stored in Euro-Collins or Belzer perfusion solution for up to 24 hours. Amylase concentration of the storage solution was analyzed in regular periods and tissue samples were taken for acridine-orange histochemical evaluation of viability in the same time. In vitro pancreatic amylase release (IU/g pancreas tissue) was calculated from the volume of solution and the weight of graft. A significant increase of amylase release was found in the course of preservation in both media. Comparing amylase release in different solutions we found significant difference between Euro-Collins and Belzer media (4 hours: 6.45 IU/g vs. 2.2 IU/g, 8 hours: 11.5 vs. 3.58, 24 hours: 8.7 vs. 42.8, respectively). Comparison of amylase release with histochemical evaluation of viability showed strict correlation. We concluded that amylase release is a good marker for exocrine tissue destruction as well as viability of preserved pancreas. Our data confirms that Belzer solution is superior in pancreatic preservation. It is suggested that after adaptation into human model in vitro pancreatic amylase release could be a time- and cost-saving, useful method in predicting pancreatic transplant function prior graft implantation.