Combined paediatric liver-kidney transplantation: analysis of our experience

Thesis (M.Med.(General Surgery)--University of the Witwatersrand, Faculty of Health Sciences, 2014.Background. Renal insufficiency is increasingly common in end-stage liver disease and allocation of livers to this category of patient has escalated. The frequency of combined liver-kidney transplantation (CLKT) has consequently increased. Indications for CLKT in children differ from those for adults and typically include rare congenital conditions; subsequently limited numbers of this procedure have been performed in paediatric patients worldwide. Scant literature exists on the subject. Methods. Subsequent to institutional approval, a retrospective chart analysis of all paediatric CLKTs performed at the Transplant Unit, Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa between January 2005 and July 2013 was conducted. Results. Defining children as younger than 18 years of age, 43 patients had received a liver transplant since 2005, of whom 8 received a CLKT. Indications included autosomal recessive polycystic kidney disease (n=3), primary hyperoxaluria type 1 (n=4) and heterozygous factor H deficiency with atypical haemolytic uraemic syndrome (n=1). Graft combinations included whole liver and one kidney (n=5), whole liver and two kidneys (n=1) and left lateral liver segment and one kidney (n=2), all from deceased donors. Patient age ranged from 4 to 17 years (median 9) and included 4 females and 4 males. Weight ranged from 13 to 42 kg (median 22.5). We describe one in-hospital mortality. The remaining 7 patients were long-term survivors with a survival range from 6 to 65 months. Conclusions. Although rarely indicated in children, CLKT is an effective treatment option, appropriately utilising a scarce resource and significantly improving quality of life in the recipient

Makeover

Die Modestrecke „Makeover Madness“ von Steven Meisel wird in der vorliegenden Arbeit zur Beschreibung folgender Fragestellung herangezogen: Wie wirken sich die abgebildeten Idealkörper auf die Wahrnehmung unserer Körper aus? Meine Themenstellung bezieht sich auf die Verschränkung von medialen Bilddiskursen und den Wahrnehmungsbedingungen von Körpern. In der Serie wird die körperformende Kraft von Idealbildern durch die Inszenierung von Mode in einer Privatklinik für Schönheitschirurgie thematisiert. Der Bilddiskurs der Mode und die Materialisation der Körper konvergieren in den Praxen der Schönheitschirurgie auf offensichtlichste Weise. Um den Körper in seiner ideologischen Bestimmtheit näher zu beschreiben, habe ich Butlers Werke „Das Unbehagen der Geschlechter“ und „Körper von Gewicht“ herangezogen. Die ausführlichen Erläuterungen zu Butlers Theoriegebäude in den ersten beiden Abschnitten der Arbeit dienen hierbei zur Entwicklung meiner Thesen einer „schematisierten Wahrnehmung von Körpern im Diskurs“ (Abschnitt III). Der Körper wird bei Butler als jener produzierte Effekt des Diskurses entlarvt, der stets als vordiskursives „Außen“ seine heteronormative Wirkungsmacht entfaltet. Hierzu beschreibe ich Butlers sprachphilosophischen Ansatz des Körpers und seine Materialisation im Diskurs. Der Körper wird in der Performativität, im Vollzug des Handelns, gleichzeitig mit dem Subjekt gebildet. Die diskursiven Körper erweisen sich hierbei als Schemata der Intelligibilität bzw. der Identität des Subjekts. Die sprachlichen und bildlichen Repräsentationen von Körpern fungieren als Körperzeichen idealer Körperformen, welche unsere Wahrnehmung strukturieren. Von medial vermittelten Körperbildern im Diskurs angerufen, erkennen wir uns darin wieder und identifizieren uns mit ihnen. Gleichzeitig wirken Körperbilder als intelligible Schemata in unserer Wahrnehmung weiter und sind an der Formgebung bzw. Differenzierung unserer Körper aktiv beteiligt. Die Bildproduktion und die Körperproduktion gehen demnach Hand in Hand. Steven Meisel trägt diesen Ansatz in seiner Bildserie exemplarisch zur Schau. Innen und Außen, Vorher und Nachher entpuppen sich dabei als bloße Konstruktionen von Körpern. Körperproduktion und Körperformierung sind in einem zirkulären Schema gefangen. Doch gibt Auswegsmöglichkeiten aus der reglementierenden Produktion diskursiver Körper?! Derrida spricht von den Bedeutungsverschiebungen der Signifikanten, Butler von den Neuinterpretationen des Geschlechts mittels subversiver Praxen. Die Möglichkeiten von Bedeutungsverschiebungen des Körpers in seiner Zeichenfunktion sind somit konstitutiv für jede Neuinterpretation des Körpers. Meisels Modefotografien können demnach ebenso als offen stehende Darstellungen von Körper, wie auch als Kritik an den Produktionsverhältnissen der Idealbilder von Körpern gelesen werden

Baryon Stopping in Heavy-Ion Collisions at E_{lab}= 2--160 GeV/nucleon

It is argued that the experimentally observed baryon stopping may indicate (within the present experimental uncertainties) a non-monotonous behaviour as a function of the incident energy of colliding nuclei. This can be quantified by a midrapidity reduced curvature of the net-proton rapidity spectrum. The above non-monotonous behaviour reveals itself as a "zig-zag" irregularity in the excitation function of this curvature. The three-fluid dynamic calculations with a hadronic equation of state (EoS) fail to reproduce this irregularity. At the same time, the same calculations with an EoS involving a first-order phase transition into the quark-gluon phase do reproduce this "zig-zag" behaviour, however only qualitatively.Comment: 6 pages, 5 figures, the paper is essentially extended. This version will be published in Phys. Lett.

Combined paediatric liver-kidney transplantation: Analysis of our experience and literature review

Background. Renal insufficiency is increasingly common in end-stage liver disease and allocation of livers to this category of patient has escalated. The frequency of combined liver-kidney transplantation (CLKT) has consequently increased. Indications for CLKT in children differ from those for adults and typically include rare congenital conditions; subsequently limited numbers of this procedure have been performed in paediatric patients worldwide. Scant literature exists on the subject. Methods. Subsequent to institutional approval, a retrospective chart analysis of all paediatric CLKTs performed at the Transplant Unit, Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa between January 2005 and July 2013 was conducted. Results. Defining children as younger than 18 years of age, 43 patients had received a liver transplant since 2005, of whom 8 received a CLKT. Indications included autosomal recessive polycystic kidney disease (n=3), primary hyperoxaluria type 1 (n=4) and heterozygous factor H deficiency with atypical haemolytic uraemic syndrome (n=1). Graft combinations included whole liver and one kidney (n=5), whole liver and two kidneys (n=1) and left lateral liver segment and one kidney (n=2), all from deceased donors. Patient age ranged from 4 to 17 years (median 9) and included 4 females and 4 males. Weight ranged from 13 to 42 kg (median 22.5). We describe one in-hospital mortality. The remaining 7 patients were long-term survivors with a survival range from 6 to 65 months. Conclusions. Although rarely indicated in children, CLKT is an effective treatment option, appropriately utilising a scarce resource and significantly improving quality of life in the recipient.

SINFONI in the Galactic Center: young stars and IR flares in the central light month

We report 75 milli-arcsec resolution, near-IR imaging spectroscopy within the central 30 light days of the Galactic Center [...]. To a limiting magnitude of K~16, 9 of 10 stars in the central 0.4 arcsec, and 13 of 17 stars out to 0.7 arcsec from the central black hole have spectral properties of B0-B9, main sequence stars. [...] all brighter early type stars have normal rotation velocities, similar to solar neighborhood stars. We [...] derive improved 3d stellar orbits for six of these S-stars in the central 0.5 arcsec. Their orientations in space appear random. Their orbital planes are not co-aligned with those of the two disks of massive young stars 1-10 arcsec from SgrA*. We can thus exclude [...] that the S-stars as a group inhabit the inner regions of these disks. They also cannot have been located/formed in these disks [...]. [...] we conclude that the S-stars were most likely brought into the central light month by strong individual scattering events. The updated estimate of distance to the Galactic center from the S2 orbit fit is Ro = 7.62 +/- 0.32 kpc, resulting in a central mass value of 3.61 +/- 0.32 x 10^6 Msun. We happened to catch two smaller flaring events from SgrA* [...]. The 1.7-2.45 mum spectral energy distributions of these flares are fit by a featureless, red power law [...]. The observed spectral slope is in good agreement with synchrotron models in which the infrared emission comes from [...] radiative inefficient accretion flow in the central R~10 Rs region.Comment: 50 pages, 10 figures, 2 tables, submitted to ApJ, February 6th, 2005, abstract abridge

The RHIC zero-degree calorimeters

Abstract The RHIC zero-degree calorimeters provide common event characterization in the four heavy ion experiments which recently completed their first data taking run. Here, we describe simulations which lead to the design of these devices, teastbeam performance and initial experience at RHIC.

Measurement of event-by-event transverse momentum and multiplicity fluctuations using strongly intensive measures Δ[PT,N]\Delta[P_T, N] and Σ[PT,N]\Sigma[P_T, N] in nucleus-nucleus collisions at the CERN Super Proton Synchrotron

Results from the NA49 experiment at the CERN SPS are presented on event-by-event transverse momentum and multiplicity fluctuations of charged particles, produced at forward rapidities in central Pb+Pb interactions at beam momenta 20$A$, 30$A$, 40$A$, 80$A$, and 158$A$ GeV/c, as well as in systems of different size ($p+p$, C+C, Si+Si, and Pb+Pb) at 158$A$ GeV/c. This publication extends the previous NA49 measurements of the strongly intensive measure $\Phi_{p_T}$ by a study of the recently proposed strongly intensive measures of fluctuations $\Delta[P_T, N]$ and $\Sigma[P_T, N]$. In the explored kinematic region transverse momentum and multiplicity fluctuations show no significant energy dependence in the SPS energy range. However, a remarkable system size dependence is observed for both $\Delta[P_T, N]$ and $\Sigma[P_T, N]$, with the largest values measured in peripheral Pb+Pb interactions. The results are compared with NA61/SHINE measurements in $p+p$ collisions, as well as with predictions of the UrQMD and EPOS models.Comment: 12 pages, 14 figures, to be submitted to PR

Antideuteron and deuteron production in mid-central Pb+Pb collisions at 158AA GeV

Production of deuterons and antideuterons was studied by the NA49 experiment in the 23.5% most central Pb+Pb collisions at the top SPS energy of $\sqrt{s_{NN}}$=17.3 GeV. Invariant yields for $\bar{d}$ and $d$ were measured as a function of centrality in the center-of-mass rapidity range $-1.2<y<-0.6$. Results for $\bar{d}(d)$ together with previously published $\bar{p}(p)$ measurements are discussed in the context of the coalescence model. The coalescence parameters $B_2$ were deduced as a function of transverse momentum $p_t$ and collision centrality.Comment: 9 figure

Charged Particle Production in Proton-, Deuteron-, Oxygen- and Sulphur-Nucleus Collisions at 200 GeV per Nucleon

The transverse momentum and rapidity distributions of net protons and negatively charged hadrons have been measured for minimum bias proton-nucleus and deuteron-gold interactions, as well as central oxygen-gold and sulphur-nucleus collisions at 200 GeV per nucleon. The rapidity density of net protons at midrapidity in central nucleus-nucleus collisions increases both with target mass for sulphur projectiles and with the projectile mass for a gold target. The shape of the rapidity distributions of net protons forward of midrapidity for d+Au and central S+Au collisions is similar. The average rapidity loss is larger than 2 units of rapidity for reactions with the gold target. The transverse momentum spectra of net protons for all reactions can be described by a thermal distribution with `temperatures' between 145 +- 11 MeV (p+S interactions) and 244 +- 43 MeV (central S+Au collisions). The multiplicity of negatively charged hadrons increases with the mass of the colliding system. The shape of the transverse momentum spectra of negatively charged hadrons changes from minimum bias p+p and p+S interactions to p+Au and central nucleus-nucleus collisions. The mean transverse momentum is almost constant in the vicinity of midrapidity and shows little variation with the target and projectile masses. The average number of produced negatively charged hadrons per participant baryon increases slightly from p+p, p+A to central S+S,Ag collisions.Comment: 47 pages, submitted to Z. Phys.

Strangeness Enhancement in p+Ap+A and S+AS+A Interactions at SPS Energies

The systematics of strangeness enhancement is calculated using the HIJING and VENUS models and compared to recent data on $\,pp\,$, $\,pA\,$ and $\,AA\,$ collisions at CERN/SPS energies ($200A\,\, GeV\,$). The HIJING model is used to perform a {\em linear} extrapolation from $pp$ to $AA$. VENUS is used to estimate the effects of final state cascading and possible non-conventional production mechanisms. This comparison shows that the large enhancement of strangeness observed in $S+Au$ collisions, interpreted previously as possible evidence for quark-gluon plasma formation, has its origins in non-equilibrium dynamics of few nucleon systems. % Strangeness enhancement %is therefore traced back to the change in the production dynamics %from $pp$ to minimum bias $pS$ and central $SS$ collisions. A factor of two enhancement of $\Lambda^{0}$ at mid-rapidity is indicated by recent $pS$ data, where on the average {\em one} projectile nucleon interacts with only {\em two} target nucleons. There appears to be another factor of two enhancement in the light ion reaction $SS$ relative to $pS$, when on the average only two projectile nucleons interact with two target ones.Comment: 29 pages, 8 figures in uuencoded postscript fil