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A 62-year-old male patient with diabetes underwent deceased-donor kidney transplant at our transplant unit. At reperfusion, a small and clinically not significant subcapsular hematoma was noted. The patient's postoperative course was characterized by delayed graft function since the beginning but was further complicated on postoperative day 6 by evidence (shown at daily Doppler ultrasonography) of a wide increase of the hematoma. The hematoma, which was just visible before, was now leading to graft compression because it covered up to two-thirds of the cortical surface. The patient showed no hemo-dynamic instability and showed no significant drop in hemoglobin values. Capsulotomy was not performed because it was deemed too risky. The patient was given strict follow-up with Doppler ultrasonography and high-resolution imaging techniques (magnetic resonance imaging and computed tomography scan). In the following days, spontaneous resolution of the hematoma and progressive improvement of Doppler findings were observed, which preceded full recovery of graft function. Conservative management, in hemodynamically stable patients, seems to be a valid approach of this condition. By avoiding surgery or other interventional procedures, a conservative approach allows reduced risk of further complications. Strict monitoring with Doppler ultrasonography is a valid tool for follow-up, along with high-resolution imaging techniques such as magnetic resonance imaging and computed tomography to confirm diagnosis.
Key words : Doppler ultrasonography, Kidney trans-plantation, Renal graft hematoma, Surgical complications
Renal transplant is recognized as the treatment of choice for end-stage renal disease. Several com-plications can arise at surgery or over the post-transplant period; among these, a subcapsular hematoma (SH) is believed to be rather uncommon.1 The treatment for this condition is still not clear as no systematic reviews have focused on this topic. Indeed, different options have been proposed, including conservative management,1 interventional procedures such as percutaneous drainage,2 or more often surgical capsulotomy.3 The choice of how to approach SH is crucial for both patient and graft outcomes because of the risk of further patient morbidity and even graft loss. Here, we describe our experience of an extensive SH aroused post-operatively and causing a prolonged delayed graft function (DGF), which was successfully treated with a conservative approach.
Case Report
A 62-year-old male patient with end-stage renal disease because of diabetic nephropathy was admitted to our center for deceased-donor renal transplant (patient features are described in Table 1). The graft, which was carefully evaluated at bench surgery and showed no pathologic findings, was subsequently implanted in the recipient's right iliac fossa. Transplant intervention was uneventful, and appropriate renal perfusion was observed after declamping. A small SH (more or less 1 cm in diameter) was then noted on the antihilar cortex of the graft, which did not enlarge during surgery. Despite optimal reperfusion, the patient did not have prompt urinary output. In view of the stability and the small size of the SH and the potential risks of complications, a capsulotomy was not elected as a treatment option. A surgical drain was left in place, and the transplant surgery was completed with a plan for close postoperative monitoring (transplant details are described in Table 2).
The early postoperative course was normal, immunosuppressive therapy was administered as per local practice (Table 2), and no signs of bleeding were recorded. Doppler ultrasonography on posto-perative day 1 showed normal vascular perfusion with no significant changes of the SH. The Doppler findings were similar over the next several days. Because there was no recovery of renal function, hemodialysis was prescribed starting on post-operative day 3. A routine ultrasonography on postoperative day 6 showed, in the absence of any symptoms, a wide enlargement of the SH extending up to two-thirds of the antihilar cortex and exerting a marked compression on the underlying parenchyma.
A concurrent Doppler study revealed elevated resistive indexes (0.82-0.91 ratio) with a preserved venous flow (Figure 1). A noncontrast enhanced com-puted tomography (CT) scan was also performed to confirm diagnosis (Figure 2). The patient was hemodynamically stable and asymptomatic, and blood pressure was normal with systolic pressure ranging between 120 and 140 mm Hg and diastolic pressure ranging between 60 and 80 mm Hg, with no recorded drop in hemoglobin values. In view of the lack of symptoms but the impairment of renal function, surgical exploration was deemed too risky. A decision was made to continue with a conservative approach. Because of graft dysfunction, hemodialysis was continued, and a percutaneous biopsy was excluded.
The patient remained hemodynamically stable, and no active bleeding was seen from the surgical drain over the next several days. Oligoanuria persisted until postoperative day 28 at which time a progressive increase in daily urine output and a decrease in serum creatinine levels were observed. Hemodialysis was discontinued on postoperative day 27 (a total of 11 dialytic treatments were performed). Ultrasonography, performed daily, showed progressive improvements from previous findings, with an almost complete resolution of the SH (Figure 3) and reduction of graft resistive indexes (ratio of 0.59-0.66), which preceded full recovery of graft function. Serum creatinine levels progressively normalized. To confirm an optimal perfusion within the graft, a contrast-enhanced magnetic resonance imaging was performed (Figure 4). The patient was discharged on postoperative day 40 in good condition; his serum creatinine level was 2.0 mg/dL.
Here, we describe our experience of a prolonged DGF in a diabetic kidney transplant recipient who also had an SH, which was noted at surgery but increased extensively during the postoperative course (postoperative day 6) and which was successfully treated with a conservative approach. Delayed graft function is a well-known complication of kidney transplant; its incidence does not differ significantly in kidney transplant recipients with versus without diabetes.4,5 In our patient, the prolonged DGF time was most likely related to the effects of the SH on graft parenchyma. Several causes can lead to the onset of SH. These can be classified as traumatic (eg, renal injuries at organ procurement,1,6 allograft trauma in transplant patients,3,7 and trauma during posttransplant biopsy8) or not traumatic, which are generally related to specific medical conditions causing spontaneous bleeding (eg, pancreatitis and warfarin therapy). In some cases, the cause is unknown, especially in those who have late onset of SH after transplant.9
With the exclusion of active bleeding requiring emergency surgery, the worst complication is "Page syndrome," a well-known condition caused by renal parenchyma compression, whose typical presen-tation is distinguished by acute impairment of renal function, anuria, and hypertension.10 The generally accepted pathophysiology of this phenomenon is based on the hypoperfusion, ischemia, and activation of the renin-angiotensin-aldosterone system second-ary to compression.11 More recently, rather than activation of the renin-angiotensin-aldosterone system, an interstitial nephritis due to inflammation has been proposed, with mycophenolate mofetil having some role in preventing the inflammation and thus the hypertension.12 Our patient had a pretransplant history of well-compensated blood hypertension, and no significant changes in blood pressure were recorded over the posttransplant period. In addition, per local practice, he underwent immunosuppression with mycophenolate. However, we are not able to state whether this had a protective role.
Finding the best treatment is crucial for the outcome. Salgado and associates1 successfully managed an extensive SH that had been aroused intraoperatively at transplant. The group reported no need for reintervention; however, the patient required a strict follow-up with Doppler ultrasono-graphy until the spontaneous resolution of the SH, which was followed by recovery of graft function.
In our case, the late increase in the size of the hematoma, along with the already recognized DGF, the lack of blood hypertension, drop in hemoglobin values or episodes of hemodynamic instability, the lack of finding a source of active bleeding,6,7 and the risk of further complications with surgery (especially of intraoperative and postoperative bleeding due to the friability of renal parenchyma when degloved) led us to exclude the need for surgical exploration.
For similar cases, we believe that close monitoring of both vital signs and the graft by daily ultraso-nography with Doppler flow is the most appropriate and cost-efficient approach, as spontaneous resolution of the SH can occur with a full recovery of renal function. Computed tomography scan and magnetic resonance imaging are more expensive diagnostic examinations, but they are extremely useful for addressing diagnosis and for detecting normal vascular perfusion within the graft. Surgery should be reserved to cases with confirmed Page syndrome, those with hemodynamic instability, and those with significant decreases in hemoglobin values or when a trend toward an increase in size of the SH is detected. The lack of large cohort studies with well-defined evidence prevents the definition of the best approach to follow; therefore, we may for now need to rely on the experiences of single-center studies. Further studies are needed to optimize and formulate a diagnostic and treatment algorithm for patients with this complication after kidney transplant.
Volume : 17
Issue : 5
Pages : 681 - 684
DOI : 10.6002/ect.2017.0156
From the General Surgery and Transplantation Unit of the "San Giovanni di Dio e
Ruggi D'Aragona" University Hospital, Scuola Medica Salernitana, Salerno, Italy
Acknowledgements: The authors declare that there are no conflicts of interest, grants, or other financial support regarding the publication of this article.
Corresponding author: Gerardo Sarno, General Surgery and Transplantation Unit, "San Giovanni di Dio e Ruggi D'Aragona" University Hospital, Scuola Medica Salernitana, 84131 Salerno, Italy
Phone: +39 089 67 3079
E-mail: email@example.com
Figure 1. Baseline and Concomitant Ultrasonographic Doppler Evaluations
Figure 2. Noncontrasted Enhanced Computed Tomography Scan
Figure 3. Ultrasonographic Image (Coronal View) on Posttransplant Day 29
Figure 4. Contrast-Enhanced Magnetic Resonance Imaging Confirming an Optimal Perfusion Within the Graft
Table 1. Patient Features
Table 2. Transplant Details and Immunosuppressive Regimen


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HUBER HEIGHTS — The Butler Girls and Boys Varsity teams swept Tippecanoe on Tuesday, the girls with a 1676 – 1536 victory while the Boys shot a big game 1 (1135) and cruised to a 2473 – 2266 win. The Girls improved their record to 6-5 (6-4 in the GWOC North, 2nd place), while the Boys improved to 10-1 (9-1 in the GWOC North, 1st place). The Girls were led by Alissa Spieles with a 323 (156-167) set, followed by Emily Gabert 315 (136-179), Breanne Kroeker 294 (144-150), Katrina Herzog 280 (165-125) and Emma Sutter with a 134 game. "We got an early lead and never looked back", said Coach Steve Sacks. "We bowled our 9th and 10th frames very strongly in both games 1 and 2 and those extra pins made the difference in the match." The Boys were led by Drew Sacks 464 (262-202), Will Yeary 458 (225-233), Ben French 447 (224-223), Aaron Seelbaugh 415 (211-204) and Jake Smith added a 213 game. Coach Sacks added, "Good overall performance coming off our 2nd place finish at the Baker Bash yesterday. We lost a little intensity in the two baker games this match and we'll work on that over the next couple days of practice."
Butler's JVA Boys team defeated an undermanned Tipp squad 2133-1144, while Butler JVB Boys also outscored Tipp's JV with a score of 1595. Dom Fiori (JVB) led all JV bowlers with a 405 (192-213) set while Jackson Losey added a 388 (204-188). Other high games were Hunter Spieles 203, Jared Murray 201, Tony Fiori 200 and Elijah Walters 191.
The Aviators return to league play next week with matches Tuesday in Greenville and next Thursday in Piqua.

subset: commoncrawl


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1883 — Born on July 31st in Döbeln, Saxony.
1904 — Studies architecture in Dresden. Becomes acquainted with Ernst Ludwig Kirchner and Fritz Bleyl.
1905 — Founding of the "Brücke".
1906 — Aquaintance with Max Pechstein and Emil Nolde. Friendship with Gustav Schiefler and Dr. Rosa Schapire.
1906—1910 — Recurring stays in Dangast and at the Moritzburg lakes.
1910 — Friendship with Otto Mueller.
1911 — Moves to Berlin. He meets Franz Marc and August Macke.
1912 — Participation at the "Sonderbundausstellung", Cologne. Friendship with Lyonel Feininger and Dr. Walter Kaesbach.
1914—1918 — Voluntarily serves in the German armed forces in Flanders. Marriage with Hilde Frieda Georgi (Sidi).
1919—1920 — Founding member of the "Arbeitsrat für Kunst". Member of the "Novembergruppe", Berlin.
1919 — Exhibition at the Kestner-Gesellschaft, Hannover. Friendship with Paul Klee.
1937 — Occupational ban. Paintings are confiscated and shown in the exhibition "Entartete Kunst" (degenerate art).
1949—1955 — Appointment to the Akademie der Bildenden Künste, Karlsruhe.
1956 — Awarded the Order of Merit of the Federal Republic of Germany.
1957 — Awarded with the Art prize of Berlin.
1961 — Awarded with the Art prize of Nordrhein-Westfalen.
1965 — Honorary citizen of Kiel.
1967 — Awarded the medal "Pour le mérite".
1970 — Dies in Radolfzell on January 27th


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Author: Dr. M / Source: Deep Sea News
noun: work or activity that is wasteful or pointless but gives the appearance of having value.
verb: waste money or time on unnecessary or questionable projects.
The end of 2018 was tough for the Ocean Cleanup and its founder, inventor, and CEO Boyan Slat. In September, the 2000 foot-boom and supposed plastic collection device, was first deployed about 240 nautical miles offshore of San Francisco where it was tested for two weeks. The boom was then towed an additional 1,400 miles off the West Coast, about halfway between California and Hawaii, to begin collecting plastic in the Great Pacific Garbage Patch. This was supposed to be the first real-world proof of concept and trials of the device in the Pacific Garbage Patch.
Note that the previous prototype in the North Sea also failed at a shallower depth in calm seas. Of course, the next step is to build a bigger one and place it in rougher and deeper seas.
But in November, Ocean Cleanup stated the system was not holding plastic it collected. This lack of plastic collection arose from the system moving too slowly at times to hold plastic within the U-shaped collection area. The system is supposed to work by currents pushing plastics into the booms and nets. Yet slow and complex currents in this region of the Pacific allowed plastics to float out of the device again.
In late December, 60-feet of boom had detached due to material fatigue. Slat then indicated that this likely occurred due to wave action placing stress on the boom. The fracture was caused by material fatigue, he wrote. That's likely because of the intense action of the waves that puts tremendous stress on objects in the water.
So to recap, the Ocean Cleanup system cannot either collect plastic or withstand the Pacific Ocean.
In a September interview with NPR, he said the device averages about four inches per second, which his team has now concluded is too slow. The break in the barrier was due to an issue with the material used to build it.
However, both of these issues could have easily been avoided by more appropriate simulations, analyses, and information prior to construction and deployment.
When the material failure occurred, it wasn't due to the result of a major Pacific storm. It was just normal wear and tear, Slat said
Understanding material stresses is a key component of an engineering project and one that is well understood before construction. Note as well that the system is not something actually new, but is a modification of RO-BOOMS used in oil spill clean up since 1988. I am confident the…
Editor for @MotherNatureCo @DogCoutureCNTRY | Love my outdoors, environment activist and climate change advocate, health & yoga | Family, friends and of course puppies and dogs. Go figure! Social media geek at heart #cmgr all night and day.


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text: BUSINESS ORGANIZATION BASICS CourseCode: 1169Degree: Bachelor's in Labor Relations and Human ResourcesFaculty of Social and Legal Sciences of ElcheYear: Year 1 of Bachelor's in Labor Relations and Human ResourcesSemester: FallType: CoreLanguage: SpanishECTS credits: 6Lecture: 3Laboratory: 3Hours: 150Directed: 60Shared: 10Autonomous: 80Subject matter: BusinessModule: Economic-Business PerspectiveDegree website Department: Economics and Financial StudiesArea: BUSINESS ORGANIZATIONCourse instructors are responsible for the course content descriptions in English.DescriptionThe company as a system. Types of companies. Relationship between the company and its economic environment. Functional areas: production, investment, financing, and marketing.FacultyNameCoordinatorLectureLaboratoryMARTÍNEZ MATEO, JESUS■GOMEZ JEREZ, CLARA■■Professional interest"Fundamentals of Business Organization" is a basic course of 6 credits, equivalents to 150 hours of work by the student, is given during the first part of the course of the Degree in Labor Relations and Human Resources of the UMH. Its main objective is familiarize the future graduates with some basic knowledge of the concept, structure and functioning of business organizations, within which - self-employed or employed - or for which, they will develop their professional future.The program deals with basic aspects about the company reality, as well as about its entrepreneurs, to concentrate afterwards in the management and business administration work, as well as the environment in which that work is developed.Besides, the different company subsystems are introduced, as well as the decisions made in them from a functional perspective, presenting the production functions, marketing and business financing.Competencies and learning outcomesGeneral competenciesCapacity to identify, interpret, formulate, and resolve problems and situations.Capacity for planning, organizing, directing, and controlling systems and processes within a framework that guarantees respect for values, rights and basic principles of the legal system, business competitiveness, protection and conservation of the environment, and sustainable development.Skills for the efficient application of tools that lead to the solution of problems.Capacity to consolidate, expand, and integrate knowledge.Disposition for methodologies and efficient self-learning skills to adapt to and update new knowledge and scientific advances, as well as to changing needs in order to adopt an aptitude for innovation and creativity in the profession.Specific competenciesAdvise, diagnose, lend support, and make decisions regarding organizational structure, work organization, methods, and work time studies.Interrelate the various disciplines shaping labor relations.Objectives (Learning outcomes)01Understand and distinguish the concepts of company, entrepreneur, businessman, and managerial work, its complexity, diversity and relevance.02Analyze decision-making situations in business and grasp the systematic to act in situations of decision.03Understand the business administration as an interactive process and distinguish between the different functions in it.04Identify the planning and control functions, their processes, components and instruments to reach the objectives in the company.05Identify and describe the most important organizational structures and the basic concepts related to Human Resources Administration, and to the Human Behavior Management in Organizations.06Identify and explain the influence of certain external and internal environmental elements on the activities and results of the business organizations and especially on the discretionary management area.07Identify the different strategic decisions leading to the production operation system design and the main tools of production management.08Know the terms that allow the company to know its markets and the consumers¿ behavior in them and also distinguish the operative tools of marketing.09Describe the company finance function and its financial environment. Express opinions about the economic-finance throwgh the knowledge and the analysis of the its main items.010Identify and value the various available sources of finance, and apply useful criteria for the investment valuation.ContentsLecture topicsTeaching unitsU1ENTERPRISES, ENTREPRENEURS AND MANAGERSU2THE BUSINESS MANAGEMENT PROCESSU3THE ENVIRONMENT AND ITS INFLUENCE ON BUSINESS MANAGEMENTU4PHYSICAL SUBSYSTEM: OPERATIONS AND MARKETINGU5INVESTMENT AND FINANCE SUBSYSTEMAssociation between objectives and unitsObjective/UnitU1U2U3U4U5010203040506070809010ScheduleWeekTeaching unitsDirected hoursShared hoursAutonomous hoursTotal hours1U140592U140593U1,U2415104U240595U2,U3426126U340597U3415108U3,U440599U44151010U4405911U4,U54261212U5405913U5415101440591542814Course contentsBasic bibliographyIborra Juan, María / Aldás Manzano, Joaquén / González Cruz, Tomás / Puig Payá, Vicente. "Fundamentos de dirección de empresas conceptos y habilidades directivas". Madrid Thomson [2007]. García Galán, María del Mar. "La economía de la empresa en espacio de educación superior". Madrid [etc.] McGraw Hill 2007. Camisón Zornoza, César coord. / Dalmau Porta, Juan Ignacio coord. / Alarcón García, María José. "Introducción a los negocios y su gestión". Madrid [etc.] Pearson-Prentice Hall D.L. 2009. Complementary bibliographyCuervo García, Alvaro, dir. / Vázquez Ordás, Camilo J., coord. "Introducción a la administración de empresas ". Madrid Thomson Civitas 2008. Abad Guerrero, Isabel María / Aguirre de Mena, Juan M. / Castillo Clavero, Ana María / García Mestanza, Josefa / Moreno Lorente, Francisco / Rastrollo Horrillo, María Ángeles. "Introducción a la economía y administración de empresas". Madrid Pirámide cop. 2009. Bateman, Thomas S. Snell, Scott A. "Administración una ventaja competitiva". México [etc.] McGraw-Hill Interamericana cop. 2001. Aguirre Sádaba, Alfredo. Castillo Clavero, Ana María / Tous Zamora, Dolores. "Administración de organizaciones en el entorno actual". Madrid Pirámide [2003]. Koontz, Harold. Weihrich, Heinz / Franklin Fincowsky, Enrique Benjamín. "Elementos de administración enfoque internacional". México Madrid McGraw-Hill cop. 2007. Brealey, Richard. Myers, Stewart C. "Fundamentos de financiación empresarial". Madrid [etc.] McGraw-Hill D.L. 1998, 2002. Miranda González, Francisco Javier. "Manual de dirección de operaciones". Madrid Thomson cop. 2005. Heizer, Jay. Render, Barry. "Dirección de la producción y de operaciones decisiones tácticas". Madrid [etc.] Prentice-Hall D. L. 2007. Heizer, Jay. Render, Barry / Moreno López, Yago. "Dirección de la producción y de operaciones decisiones estratégicas". Madrid [etc.] Pearson Educación D.L. 2008. Kotler, Philip. Armstrong, Gary / Moreno López, Yago trad. "Principios de marketing". Madrid Pearson Education D.L. 2008. LinksSoftwareMethodology and gradingMethodologyCase studies: Learning through the analysis of actual or simulated cases in order to interpret and resolve them by employing various alternative solution procedures.Cooperative learning: Develop active learning through cooperative working strategies among students and promote shared responsibility to reach group goals.Learning agreement: Develop active learning through an agreement between the teacher and the student containing commitments for what will be learned, how monitoring will take place for that learning, the set period of time, and the evaluation criteria.Lecture: Pass on knowledge and activate cognitive processes in students, encouraging their participation.Problem-based learning: Develop active learning strategies through problem solving that promote thinking, experimentation, and decision making in the student.Solving exercises and problems: Exercise, test, and apply previous knowledge through routine repetition.GradingThe evaluation of the course will include the following components: Final assessment : - Making a final exam of the course , consisting of a type test on theory and practice on the course content taught during issues. The test exam will mean 85% of the final grade , whether the practices raised during the course (15 % ) , or 100 % if the student does not receive any ongoing evaluation are made. Continuous assessment : practical evaluation that will take place throughout the course, with the level achieved in the different activities scheduled for the same will be measured. case studies and exercises developed during classes, with which students can obtain up to 1.5 points of the final grade (equivalent to the practical part). app_Android | app_iOS | Facebook | Twitter | YouTube | | LinkedIn | Instagram | Pinterest +34 96 665 8500 | Contact us:info(arroba)umh.es Miguel Hernández University 2020


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Designs by Ginny — dancer cutouts
Fun colorful 70's themed party table centerpieces
33 33 record 70's 70's centerpiece centerpiece Centerpieces custom dancer cutouts dancers disco disco ball festive party party centerpiece personalized platform shoe platform shoe-boot record player styrofoam centerpiece styrofoam cutouts styrofoam record player table centerpiece Uncategorized uniqueGinny Schumacher
At Designs by Ginny we can create something fun and unique for any theme party. Here we show 2 unique table centerpieces that can be used for a 70's themed party. We can personalize them by adding a name cutout or a birth year number cutout if you want to use these for a particular birthday party. In this very colorful unique table centerpiece we created a fun 70's number Styrofoam cutout along with a custom seventies style platform shoe-boot painted and glittered fun colors. For a realistic feel lime green satin ribbon was strung thru the shoe and tied into a bow....