In patients with hypotension and pelvic fracture, therapy selection based on initial response to resuscitation in BPF yields a 73% positive ANGIO rate in NR patients. Delay in ANGIO for EX FIX in patients with amenable fractures would have delayed embolization in the face of ongoing arterial bleeding in 44% of patients. In stable patients with pelvic fracture, contrast blush also indicates a high likelihood of arterial injury and ANGIO is indicated. Optimal therapy in the face of BPF requires early determination of the presence of arterial bleeding so that ANGIO can be rapidly obtained, and response to initial resuscitation as well as the presence of contrast blush aid in this decision.

BACKGROUND.: Alemtuzumab and rabbit antithymocyte globulin (rATG) are commonly used for induction of immunsuppression for kidney and pancreas transplantation, but the two agents have not been compared directly. METHODS.: We conducted a prospective randomized single-center trial comparing alemtuzumab and rATG induction in adult kidney and pancreas transplantation in patients treated with similar maintenance immunosuppression. RESULTS.: Between February 1, 2005, and September 1, 2007, 222 patients randomly received either alemtuzumab (n=113) or rATG (n=109) induction; 180 (81%) underwent kidney alone, 38 (17%) simultaneous pancreas-kidney, and 4 (2%) pancreas after kidney transplants. Of 180 kidney-alone transplants, 152 (84%) were from deceased donors, including 61 (34%) from expanded criteria donors. Retransplantation, human leukocyte antigen match, antibody titer, expanded criteria donors, race, cytomegalovirus status, delayed graft function, and immunologic risks were similar between the two induction groups. With a median follow-up of 2 years (minimum 1 year), overall patient, kidney, and pancreas graft survival rates were 96%, 89%, and 90%, respectively. Survival, initial length of stay, and maintenance immunosuppression (including early steroid elimination) were similar between alemtuzumab and rATG groups, but biopsy-proven acute rejection (BPAR) episodes occurred in 16 (14%) alemtuzumab patients compared with 28 (26%) rATG patients (P=0.02). Late BPAR (>12 months after transplant) occurred in 1 (8%) alemtuzumab patient and 3 (11%) rATG patients (P=NS). Infections and malignancy were similar between the two induction arms. CONCLUSION.: Alemtuzumab and rATG induction therapies were equally safe, but alemtuzumab was associated with less BPAR.

By appropriate donor and recipient profiling and the use of management algorithms to project and protect renal function, excellent intermediate-term outcomes can be achieved with ECD kidney transplants that are comparable to SCD kidney transplants.

The Coromandel Peninsula comprises the central subaerial part of the late Cenozoic Coromandel Volcanic Zone (CVZ) of New Zealand and hosts the Hauraki Goldfield. Some 73 K-Ar and 9 zircon fission-track dates representative of 28 lithostratigraphic volcanic units mapped on the peninsula are reported, and more than 250 major element analyses of volcanic rocks, including all the dated rocks, have been collated and their broad geochemical affinities used to underpin the stratigraphy and volcanic history of the region.The age data confirm that the central part of the CVZ evolved more or less continuously throughout the late Cenozoic from c. 18 to 4 Ma ago (late-early Miocene to early Pliocene), with regional time breaks of no more than i -2 Ma. From c. 18 to 9 Ma, an andesite-dominated volcanic arc was active, and at c. 10 Ma initiation of the Kapowai Caldera began with the first eruption of ignimbrite. A bimodal basalt to basaltic andesite/rhyolite association developed from c. 9 to 7 Ma and accompanied major caldera collapse, ignimbrite eruption, and postcaldera andesite eruption. Bimodal eruptions of basalt to basaltic andesite (with minor andesite) plus rhyolite and rhyolitic ignimbrite began once more from c. 6 to 5.5 Ma, and these became entirely basaltic from 4.7 to 4.2 Ma. At about the same time (c. 5.5 Ma), basalt was also erupted on the southern Colville Ridge. During late Miocene to early Pliocene time, andesitic to dacitic eruptions continued in the south and southwest of the CVZ. With time, the locus of volcanism moved irregularly eastwards at c. 3 mm/yr and southwards at c. 8 mm/yr, such that minimum ages are younger progressively southwards.Volcanism in the Coromandel Peninsula is mainly calcalkaline and medium-K, with some early and late lavas showing tholeiitic affinities. The rocks range from highalumina basalts (including picritic basalt) through basaltic andesites and (dominant) andesites to dacites. There is an apparent gap between dacites at 63-68% SiO 2 and rhyolites/ ignimbrites at 73-78% SiO 2 , several of which have high-K affinities. Many of the volcanic formations have distinct chemical signatures, confirming earlier suggestions that each has an independent magmatic history.

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