Renal Transplantation in Diabetic Patients with or Without Simultaneous Pancreatic Transplantation 1986: Data from the EDTA Registry

This report summarises the outcome of 90 combined kidney/pancreatic grafts performed in Europe in 1986. Data for the combined kidney/pancreas grafts were obtained by a special questionnaire. The one-year patient and kidney graft survival is compared to the results of a group of 389 patients with diabetic nephropathy on the EDTA Registry data file who received kidney grafts alone. The recipients of combined kidney-pancreas grafts were younger, whereas a greater proportion of males received kidney graft alone. Patient survival at one year after transplantation was similar: 89% in recipients of combined transplants compared to 90% in recipients of kidney grafts alone. Kidney graft survival was 78% at one year for recipients of combined grafts versus 76%. It is concluded that pancreas transplantation has little effect on the fate of concomitant kidney grafts. The procedure should - in experienced hands and in selected patients - be almost as safe as kidney grafting alon

Hydrogen and Helium Atoms and Molecules in an Intense Magnetic Field

We calculate the atomic structure of hydrogen and helium, atoms and molecules in an intense magnetic field, analytically and numerically with a judiciously chosen basis.Comment: 16 pages, 5 figures, to appear in Phys. Rev.

The Hydrogen Atom in Combined Electric and Magnetic Fields with Arbitrary Mutual Orientations

For the hydrogen atom in combined magnetic and electric fields we investigate the dependence of the quantum spectra, classical dynamics, and statistical distributions of energy levels on the mutual orientation of the two external fields. Resonance energies and oscillator strengths are obtained by exact diagonalization of the Hamiltonian in a complete basis set, even far above the ionization threshold. At high excitation energies around the Stark saddle point the eigenenergies exhibit strong level repulsions when the angle between the fields is varied. The large avoided crossings occur between states with the same approximately conserved principal quantum number, n, and this intramanifold mixing of states cannot be explained, not even qualitatively, by conventional perturbation theory. However, it is well reproduced by an extended perturbation theory which takes into account all couplings between the angular momentum and Runge-Lenz vector. The large avoided crossings are interpreted as a quantum manifestation of classical intramanifold chaos. This interpretation is supported by both classical Poincar\'e surfaces of section, which reveal a mixed regular-chaotic intramanifold dynamics, and the statistical analysis of nearest-neighbor-spacingComment: two-column version, 10 pages, REVTeX, 10 figures, uuencoded, submitted to Rhys. Rev.

Hydrogen atom moving across a strong magnetic field: analytical approximations

Analytical approximations are constructed for binding energies, quantum-mechanical sizes and oscillator strengths of main radiative transitions of hydrogen atoms arbitrarily moving in magnetic fields 10^{12}-10^{13} G. Examples of using the obtained approximations for determination of maximum transverse velocity of an atom and for evaluation of absorption spectra in magnetic neutron star atmospheres are presented.Comment: 17 pages, 3 figures, 5 tables, LaTeX with IOP style files (included). In v.2, Fig.1 and Table 5 have been corrected. In v.3, a misprint in the fit for oscillator strengths, Eq.(21), has been correcte

Matter in Strong Magnetic Fields

The properties of matter are significantly modified by strong magnetic fields, $B>>2.35\times 10^9$ Gauss ($1 G =10^{-4} Tesla$), as are typically found on the surfaces of neutron stars. In such strong magnetic fields, the Coulomb force on an electron acts as a small perturbation compared to the magnetic force. The strong field condition can also be mimicked in laboratory semiconductors. Because of the strong magnetic confinement of electrons perpendicular to the field, atoms attain a much greater binding energy compared to the zero-field case, and various other bound states become possible, including molecular chains and three-dimensional condensed matter. This article reviews the electronic structure of atoms, molecules and bulk matter, as well as the thermodynamic properties of dense plasma, in strong magnetic fields, $10^9G << B < 10^{16}G$. The focus is on the basic physical pictures and approximate scaling relations, although various theoretical approaches and numerical results are also discussed. For the neutron star surface composed of light elements such as hydrogen or helium, the outermost layer constitutes a nondegenerate, partially ionized Coulomb plasma if $B<<10^{14}G$, and may be in the form of a condensed liquid if the magnetic field is stronger (and temperature $<10^6$ K). For the iron surface, the outermost layer of the neutron star can be in a gaseous or a condensed phase depending on the cohesive property of the iron condensate.Comment: 45 pages with 9 figures. Many small additions/changes. Accepted for publication in Rev. Mod. Phy

Comparison of total parathyroidectomy without autotransplantation and without thymectomy versus total parathyroidectomy with autotransplantation and with thymectomy for secondary hyperparathyroidism: TOPAR PILOT-Trial

<p>Abstract</p> <p>Background</p> <p>Secondary hyperparathyroidism (sHPT) is common in patients with chronic renal failure. Despite the initiation of new therapeutic agents, several patients will require parathyroidectomy (PTX). Total PTX with autotransplantation of parathyroid tissue (TPTX+AT) and subtotal parathyroidectomy (SPTX) are currently considered as standard surgical procedures in the treatment of sHPT. Recurrencerates after TPTX+AT or SPTX are between 10% and 12% (median follow up: 36 months).</p> <p>Recent retrospective studies demonstrated a lower rate of recurrent sHPT of 0–4% after PTX without autotransplantation and thymectomy (TPTX) with no higher morbidity when compared to the standard procedures. The observed superiority of TPTX is flawed due to different definitions of outcomes, varying follow up periods and different surgical treatment strategies (with and without thymectomy).</p> <p>Methods/Design</p> <p>Patients with sHPT (intact parathyroid hormone > 10 times above the upper limit of normal) on long term dialysis (>12 months) will be randomized either to TPTX or TPTX+AT and followed for 36 months. Outcome parameters are recurrence rates of sHPT, frequencies of reoperations due to refractory hypoparathyroidism or recurrent/persistent hyperparathyroidism, postoperative morbidity and mortality and quality of life. 50 patients per group will be randomized in order to obtain relevant frequencies of outcome parameters that will form the basis for a large scale confirmatory multicentred randomized controlled trial.</p> <p>Discussion</p> <p>sHPT is a disease with a high incidence in patients with chronic renal failure. Even a small difference in outcomes will be of clinical relevance. To assess sufficient data about the rate of recurrent sHPT after both methods, a multicentred, randomized controlled trial (MRCT) under standardized conditions is mandatory.</p> <p>Due to the existing uncertainties the calculated number of patients necessary in each treatment arm (n > 4000) makes it impossible to perform this study as a confirmatory trial. Therefore estimates of different outcomes are performed using a pilot MRCT comparing 50 versus 50 randomized patients in order to establish a hypothesis that can be tested thereafter.</p> <p>If TPTX proves to have a lower rate of recurrent sHPT, no relevant disadvantages and no higher morbidity than TPTX+AT, current surgical practice may be changed.</p> <p>Trial registration</p> <p>International Standard Randomized Controlled Trial Number Registration (ISRCTN86202793)</p

Therapeutic strategies to slow chronic kidney disease progression

Childhood chronic kidney disease commonly progresses toward end-stage renal failure, largely independent of the underlying disorder, once a critical impairment of renal function has occurred. Hypertension and proteinuria are the most important independent risk factors for renal disease progression. Therefore, current therapeutic strategies to prevent progression aim at controlling blood pressure and reducing urinary protein excretion. Renin-angiotensin-system (RAS) antagonists preserve kidney function not only by lowering blood pressure but also by their antiproteinuric, antifibrotic, and anti-inflammatory properties. Intensified blood pressure control, probably aiming for a target blood pressure below the 75th percentile, may exert additional renoprotective effects. Other factors contributing in a multifactorial manner to renal disease progression include dyslipidemia, anemia, and disorders of mineral metabolism. Measures to preserve renal function should therefore also comprise the maintenance of hemoglobin, serum lipid, and calcium-phosphorus ion product levels in the normal range