To overcome critical islet processing and to ensure patient safety and quality care, we have established an international collaboration between two geographically distant transplant centers for islet ...transplantation. Four pancreata were harvested and immediately preserved by the two-layer method (oxygenated perfluorocarbon+University of Wisconsin) and subsequently transported for the automated method isolation to Geneva. After purification, the islets were cultured overnight and transported the next day back to Budapest. Three consecutive kidney transplant patients with type 1 diabetes mellitus underwent islet transplantation via percutaneous transhepatic portal embolization using the bag-method. The immunosuppression consisted of daclizumab, sirolimus, and low-dose tacrolimus. Mean donor age was 43.7 years, mean body mass index: 26.5. The islet isolation process began within 8 hours from the donor aorta cross-clamp in all cases. The isolation success rate was 80% (4 of 5). In Budapest, the islets were assessed for viability. No complications occurred during the transplantation, and the portal pressure remained within the normal range. The first patient received 12,000 IU/BW from two donors and the insulin requirement decreased from 40 U/d to 10 U/d. The second patient received 7200 IU/BW from a single donor and became immediately insulin free. The third patient was given 7100 IU/BW; the insulin requirement decreased from 39 U/d to 14 U/d. Posttransplant follow-up for the three patients are 7 months, 4 months, and 2 weeks, respectively. All patients achieved metabolic stability. These preliminary results demonstrate the feasibility of an international collaborative islet transplantation program at a distance over 1000 km.
Abstract Background Liver transplantation (OLT) in the setting of portal vein thrombosis (PVT) has been a matter of controversy in the past. We herein report our experience with OLT for PVT in the ...absence of hepatocellular carcinoma. Patients and Methods Data from patients undergoing OLT for end-stage liver disease, having a documented PVT before OLT, were reviewed. Results Twenty-five patients were included for the period July, 2003 to December, 2009. There were 20 men and 5 women of median age 57 years. Median values for waiting time and Model for End-Stage Liver Disease score were 150 days and 18, respectively. PVT was classified as grade II ( n = 6), IIIa ( n = 7), IIIb ( n = 9), or IVa ( n = 3). Partial portal vein resection/reconstruction, operative thrombectomy, and eversion thromboendovenectomy were performed in 2, 16, and 7 instances, respectively. After a median follow-up of 18 months, 14 patients are alive. Survival rates at 3, 6, 9, and 12, months and 3 years post-OLT were 68%, 64%, 61%, 61%, and 61%, respectively. PVT grade was a negative predictor of survival by Cox proportional hazard analysis ( P = .0253). Conclusion Despite the technical innovations in recent years, PVT grade correlated with poor patient survival irrespective of the surgical technique.
The Boda Claystone Formation (BCF), explored as a possible geological disposal of HLW in Hungary, has peculiar physical and chemical characteristics. Due to the petrophysical behaviour many new ...methods and experimental development were applied, while the traditional methods, e.g. steady state flow test on the basis of Darcy’s law, are too time-consuming. The pressure pulse decay (PPD) technique destinated to estimating gas and water permeability is one of these new methods developed for the BCF study. The main advantage of the PPD permeability compared with traditional permeability measurements is that very fast (in case of
k
g
∼
10
−19
m
2 15–25
min,
k
w
∼
10
−21
m
2 6–7
h), only 0.1–0.5
MPa pressure difference applied in the two sides of the examined core, quasi in situ circumstances can be provided and their uncertainty estimated.
For the correct interpretation of results of the three cores originated from different underground boreholes of the formerly URL’s Alpha-1 drift, geochemical, minerological and petrophysical analysis were carried out.
The time-consumption of drying, the fact that the dry core absorbed humidity of the atmosphere very fast, as well as the unsuccess of saturation under vacuum drew attention to the importance of the necessity of careful preparation and handling as well as the necessity of geochemical and mineralogical analysis.
Paragangliomas are rare tumours originating from neuroectodermic remnants and are usually considered as benign. We present two cases of paraganglioma of the ampulla of Vater that were treated ...surgically by pancreaticoduodenectomy. In one case, histopathology revealed malignant characteristics of the tumour with invasion of the pancreas and simultaneous duodenal lymph-node metastases. Both patients had a favourable outcome without disease recurrence at 40 and 44 months postoperatively. Only 21 cases of ampullary paraganglioma have been reported in the literature, 7 of them with malignant characteristics. In conclusion, paragangliomas of the ampulla of Vater have malignant potential. Surgical therapy of these tumours should not be limited to local resection, as disease recurrence and lymph node involvement have been reported. We propose that paragangliomas of the ampulla of Vater should be operated by cephalic pancreaticoduodenectomy, which allows long-term and disease-free survival.
Fe2+ Fe3+ species in layered clay minerals are analysed in samples obtained from two boreholes in Boda Siltstone Formation. In the first series occurrence of Fe2+ components and Fe2+ > Fe3+ oxidation ...is demonstrated in upper layers of a strata near to the surface. In the second series minerals are identified with iron present exclusively in ferrous form in a thin strata found in a borehole at 1050 m depth.
Froth models proposed in the literature are reviewed with the aim of identifying their significance and usefulness in the modelling and scale-up of the froth phase in steady state flotation systems. ...Literature indicates that froth phase performance is better understood in terms of froth recovery, the fraction of material presented at the pulp-froth interface that reports to the concentrate. This review suggests that froth recovery is a strong function of drainage rate of particles from the froth phase to the slurry phase. Drainage rate, in turn, is determined by physical factors, such as froth removal technique, geometry of the flotation cell, flux and distribution of air at the pulp-froth interface, the water content, particle size and solids content, and chemical factors, such as froth stability and froth loading. These factors influence the froth residence time, which has been identified as a key froth parameter.
Finally, it is proposed that future work should focus largely on the development of a methodology to investigate froth performance based on the froth recovery in different flotation systems. This will enable generic relationships between the froth recovery and froth sub-processes and key froth parameters to be established, and make it possible to relate froth performance in different flotation systems.
Abstract Spontaneous pneumomediastinum is a rare condition with nonspecific signs and symptoms. A 39-year-old underwent cadaver kidney transplantation. After an uncomplicated operation, progressive ...dyspnea of unknown origin developed. Findings at chest radiography suggested pneumomediastinum, which was confirmed at computed tomography. Esophageal or tracheal injury was ruled out. The rapidly developing atelectasis of the left lung necessitated urgent bronchoscopy, which revealed occlusion of the left main bronchus. After removal of the occluding mucus plug, the clinical symptoms immediately improved, and the spontaneous pneumomediastinum resolved within 3 days. Asymptomatic increase in airway secretions in patients receiving peritoneal dialysis may result in mucus plug formation during general anesthesia, which can cause spontaneous pneumomediastinum.
A 51-year-old man (126 kg, 192 cm) with massive hepatomegaly causing cardiopulmonary symptoms was referred to our transplant center 14 years after initial diagnosis of polycystic liver disease.
...Uneventful hepatectomy was followed by orthotopic liver transplantation using caval replacement. Donor liver came from a 73-year-old woman (extended criteria donor organ offer). A portocaval shunting was not established during transplantation although the explanted liver weighed 22 kg. 18 months after transplantation liver function is stable and the patient enjoys normal quality of life.
This case report demonstrates the value and success of transplantation for patients suffering from enormous hepatomegaly due to polycystic liver disease.
Background
Orthotopic liver transplantation (OLT) has emerged as the mainstay of treatment for end-stage liver disease. However, technical aspects of OLT are still subject of ongoing debate and are ...widely based on personal experience and local institutional protocols.
Methods
An international online survey was sent out to all liver transplant centers (
n
= 52) within the Eurotransplant, Swisstransplant, Scandiatransplant, and British Transplant Society networks. The survey sought information on center-specific OLT caseload, vascular and biliary reconstruction, graft reperfusion, intraoperative control of hemodynamics, and drain policies.
Results
Forty-two centers gave a valid response (81%). Out of these, 50% reported piggy-back and 40.5% total caval replacement as their standard technique. While 48% of all centers generally do not apply veno-venous bypass (vvBP) or temporary portocaval shunt (PCS) during OLT, vvBP/PCS are routinely used in six centers (14%). Portal vein first reperfusion is used in 64%, followed by simultaneous (17%), and retrograde reperfusion (12%). End-to-end duct-to-duct anastomosis without biliary drain (67%) is the most frequently performed method of biliary reconstruction. No significant associations were found between the center caseload and the surgical approach used. The predominant part of the centers (88%) stated that techniques of OLT are not evidence-based and 98% would participate in multicenter clinical trials on these topics.
Conclusion
Technical aspects of OLT vary widely among European centers. The extent to which center-specific variation of techniques affect transplant outcomes in Europe should be elucidated further in prospective multicenter trials.
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