Infected Necrosis in Severe Pancreatitis - Combined Nonsurgical Multi-Drainage with Directed Transabdominal High-Volume Lavage in Critically Ill Patients

Background: Infection of pancreatic necrosis is a life-threatening complication during the course of acute pancreatitis. In critically ill patients, surgical or extended endoscopic interventions are associated with high morbidity and mortality. Minimally invasive procedures on the other hand are often insufficient in patients suffering from large necrotic areas containing solid or purulent material. We present a strategy combining percutaneous and transgastric drainage with continuous high-volume lavage for treatment of extended necroses and liquid collections in a series of patients with severe acute pancreatitis. Patients and Methods: Seven consecutive patients with severe acute pancreatitis and large confluent infected pancreatic necrosis were enrolled. In all cases, the first therapeutic procedure was placement of a CT-guided drainage catheter into the fluid collection surrounding peripancreatic necrosis. Thereafter, a second endosonographically guided drainage was inserted via the gastric or the duodenal wall. After communication between the separate drains had been proven, an external to internal directed high-volume lavage with a daily volume of 500 ml up to 2,000 ml was started. Results: In all patients, pancreatic necrosis/liquid collections could be resolved completely by the presented regime. No patient died in the course of our study. After initiation of the directed high-volume lavage, there was a significant clinical improvement in all patients. Double drainage was performed for a median of 101 days, high-volume lavage for a median of 41 days. Several endoscopic interventions for stent replacement were required (median 8). Complications such as bleeding or perforation could be managed endoscopically, and no subsequent surgical therapy was necessary. All patients could be dismissed from the hospital after a median duration of 78 days. Conclusion: This approach of combined percutaneous/endoscopic drainage with high-volume lavage shows promising results in critically ill patients with extended infected pancreatic necrosis and high risk of surgical intervention. Neither surgical nor endoscopic necrosectomy was necessary in any of our patients. Copyright (C) 2009 S. Karger AG, Basel and IA

The analysis of facial beauty: an emerging area of research in pattern analysis

Much research presented recently supports the idea that the human perception of attractiveness is data-driven and largely irrespective of the perceiver. This suggests using pattern analysis techniques for beauty analysis. Several scientific papers on this subject are appearing in image processing, computer vision and pattern analysis contexts, or use techniques of these areas. In this paper, we will survey the recent studies on automatic analysis of facial beauty, and discuss research lines and practical application

Low temperature transport in AC-driven Quantum Dots in the Kondo regime

We present a fully nonequilibrium calculation of the low temperature transport properties of a quantum dot in the Kondo regime when an AC potential is applied to the gate voltage. We solve a time dependent Anderson model with finite on-site Coulomb interaction. The interaction self-energy is calculated up to second order in perturbation theory in the on-site interaction, in the context of the Keldysh non-equilibrium technique, and the effect of the AC voltage is taken into account exactly for all ranges of AC frequencies and AC intensities. The obtained linear conductance and time-averaged density of states of the quantum dot evolve in a non trivial way as a function of the AC frequency and AC intensity of the harmonic modulation.Comment: 30 pages,7 figure

Electron Dephasing in Mesoscopic Metal Wires

The low-temperature behavior of the electron phase coherence time, $\tau_{\phi}$, in mesoscopic metal wires has been a subject of controversy recently. Whereas theory predicts that $\tau_{\phi}(T)$ in narrow wires should increase as $T^{-2/3}$ as the temperature $T$ is lowered, many samples exhibit a saturation of $\tau_{\phi}$ below about 1 K. We review here the experiments we have performed recently to address this issue. In particular we emphasize that in sufficiently pure Ag and Au samples we observe no saturation of $\tau_{\phi}$ down to our base temperature of 40 mK. In addition, the measured magnitude of $\tau_{\phi}$ is in excellent quantitative agreement with the prediction of the perturbative theory of Altshuler, Aronov and Khmelnitskii. We discuss possible explanations why saturation of $\tau_{\phi}$ is observed in many other samples measured in our laboratory and elsewhere, and answer the criticisms raised recently by Mohanty and Webb regarding our work.Comment: 14 pages, 3 figures; to appear in proceedings of conference "Fundamental Problems of Mesoscopic Physics", Granada, Spain, 6-11 September, 200

Nonequilibrium Transport through a Kondo Dot in a Magnetic Field: Perturbation Theory

Using nonequilibrium perturbation theory, we investigate the nonlinear transport through a quantum dot in the Kondo regime in the presence of a magnetic field. We calculate the leading logarithmic corrections to the local magnetization and the differential conductance, which are characteristic of the Kondo effect out of equilibrium. By solving a quantum Boltzmann equation, we determine the nonequilibrium magnetization on the dot and show that the application of both a finite bias voltage and a magnetic field induces a novel structure of logarithmic corrections not present in equilibrium. These corrections lead to more pronounced features in the conductance, and their form calls for a modification of the perturbative renormalization group.Comment: 16 pages, 7 figure

Dynamical 1/N approach to time-dependent currents through quantum dots

A systematic truncation of the many-body Hilbert space is implemented to study how electrons in a quantum dot attached to conducting leads respond to time-dependent biases. The method, which we call the dynamical 1/N approach, is first tested in the most unfavorable case, the case of spinless fermions (N=1). We recover the expected behavior, including transient ringing of the current in response to an abrupt change of bias. We then apply the approach to the physical case of spinning electrons, N=2, in the Kondo regime for the case of infinite intradot Coulomb repulsion. In agreement with previous calculations based on the non-crossing approximation (NCA), we find current oscillations associated with transitions between Kondo resonances situated at the Fermi levels of each lead. We show that this behavior persists for a more realistic model of semiconducting quantum dots in which the Coulomb repulsion is finite.Comment: 18 pages, 7 eps figures, discussion extended for spinless electrons and typo

Quantum Monte Carlo with Directed Loops

We introduce the concept of directed loops in stochastic series expansion and path integral quantum Monte Carlo methods. Using the detailed balance rules for directed loops, we show that it is possible to smoothly connect generally applicable simulation schemes (in which it is necessary to include back-tracking processes in the loop construction) to more restricted loop algorithms that can be constructed only for a limited range of Hamiltonians (where back-tracking can be avoided). The "algorithmic discontinuities" between general and special points (or regions) in parameter space can hence be eliminated. As a specific example, we consider the anisotropic S=1/2 Heisenberg antiferromagnet in an external magnetic field. We show that directed loop simulations are very efficient for the full range of magnetic fields (zero to the saturation point) and anisotropies. In particular for weak fields and anisotropies, the autocorrelations are significantly reduced relative to those of previous approaches. The back-tracking probability vanishes continuously as the isotropic Heisenberg point is approached. For the XY-model, we show that back-tracking can be avoided for all fields extending up to the saturation field. The method is hence particularly efficient in this case. We use directed loop simulations to study the magnetization process in the 2D Heisenberg model at very low temperatures. For LxL lattices with L up to 64, we utilize the step-structure in the magnetization curve to extract gaps between different spin sectors. Finite-size scaling of the gaps gives an accurate estimate of the transverse susceptibility in the thermodynamic limit: chi_perp = 0.0659 +- 0.0002.Comment: v2: Revised and expanded discussion of detailed balance, error in algorithmic phase diagram corrected, to appear in Phys. Rev.