Liver Graft Revascularization by Donor Portal Vein Arterialization Following “No Touch” Donor Hepatectomy

Unsatisfactory immediate function of the transplanted liver together with technical complications contribute to a persisting early mortality for hepatic transplantation in the 20% range. We report our initial clinical experience with methods, one not previously used clinically, that resulted in uniformly well-functioning liver grafts in 11 patients and contributed to a satisfactory success rate for the procedure. Donors were heart-beating. During the donor operation all manipulations of the liver were avoided until after cold preservation, achieved by external cooling at the same time as circulatory interruption, donor exsanguination and perfusion of the liver with cold oxygenated fluid of “extracellular̵ type. The organs were then gently dissected. At transplantation the livers were revascularized with arterial blood shunted from the recipient iliac artery to the graft portal vein after completion of the suprahepatic IVC anastomosis. The infrahepatic IVCs and hepatic arteries were then joined, the iliac artery shunts discontinued and the portal veins joined. Total ischaemic intervals for the allografts were 3½–8 (average 5). Anhepatic intervals were 1–2¼ (average 2). The arterio-portal shunts were operating for 18–85 (mean 46) min. Blood loss and haemodynamic, acid-base and electrolyte abnormalities at revascularization were minimal. All grafts secreted bile immediately and all parameters reflected continuing improvement of liver function thereafter. Nine patients (82%) are alive between 4 and 18 (mean 11) months after transplantation. We conclude that these methods offer effective avoidance of serious organ damage during donor hepatectomy and preservation, reduced allograft ischaemic interval and reduced recipient anhepatic time. They result in avoidance of blood loss at the time of revascularization, together with minimal haemodynamic, acid-base or biochemical changes. In addition, they allow the surgeon to perform and test all anastomoses without time constraints, provide the capability to deal with unexpected complications, and assure good early graft function

On the sign of the real part of the Riemann zeta-function

We consider the distribution of $\arg\zeta(\sigma+it)$ on fixed lines $\sigma > \frac12$, and in particular the density $$d(\sigma) = \lim_{T \rightarrow +\infty} \frac{1}{2T} |\{t \in [-T,+T]: |\arg\zeta(\sigma+it)| > \pi/2\}|\,,$$ and the closely related density $$d_{-}(\sigma) = \lim_{T \rightarrow +\infty} \frac{1}{2T} |\{t \in [-T,+T]: \Re\zeta(\sigma+it) < 0\}|\,.$$ Using classical results of Bohr and Jessen, we obtain an explicit expression for the characteristic function $\psi_\sigma(x)$ associated with $\arg\zeta(\sigma+it)$. We give explicit expressions for $d(\sigma)$ and $d_{-}(\sigma)$ in terms of $\psi_\sigma(x)$. Finally, we give a practical algorithm for evaluating these expressions to obtain accurate numerical values of $d(\sigma)$ and $d_{-}(\sigma)$.Comment: 22 pages, 3 tables. To appear in Proceedings of the International Number Theory Conference in Memory of Alf van der Poorten (Newcastle, Australia, 2011

Investigation of Laser Surface Treatment Effect on Coating Adhesion

Santr. angl., liet., rusBibliogr. : p. 69 (7 pavad.)Vytauto Didžiojo universitetasŽemės ūkio akademij

Mašinų gamybos technologijos uždavinynas : Metodiniai patarimai Ž. ū. inž. fak. ž. ū. technikos spec. studentams

Bibliogr.: p. 33 ( 14 pavad. )Vytauto Didžiojo universitetasŽemės ūkio akademij