Morbidity and mortality after operation in nonbleeding cirrhotic patients

The purpose of this study has been to provide information on the mortality and morbidity rates for operation on nonbleeding cirrhotic patients and to identify factors that portend a grave prognosis. A review of 102 cirrhotic patients who underwent a variety of major therapeutic operations revealed a mortality rate of 19.6 percent. Mortality rates were significantly increased (p less than 0.05) by emergency operation (45.8 percent), gastrointestinal related operation (27.6 percent), ascites (37.5 percent), a bilirubin concentration greater than 3.5 mg (44.4 percent), a prothrombin time increase greater than 2 seconds (36.1 percent), a partial thromboplastin time increase greater than 2 seconds (50 percent), an alkaline phosphatase concentration greater than 70 units (40.9 percent), an operative blood loss greater than 1,000 ml (33.3 percent), and the presence of one or more postoperative complications (39.6 percent). Mortality rates were not increased after extremity, genitourinary, or gynecologic operations, an albumin concentration less than 3 g, a serum glutamic oxalacetic transaminase concentration greater than 40 units, hepatomegaly, and a history of previous gastrointestinal bleeding. When significant risk factors were added, mortality rates were significantly associated (p less than 0.001): zero to one factors 5.1 percent, two to three factors 19.4 percent, four to five factors 33.3 percent, and more than six factors 66.7 percent. The complication rate was 47.1 percent and included liver failure (42.2 percent), sepsis (18.6 percent), and bleeding (8.8 percent). Thus, in cirrhotic patients a clear need for operation must exist, liver function must be optimized preoperatively, and the most simple and expeditious procedure must be performed to avoid excessive blood loss and postoperative complications.     

Relative effectiveness of bibliotherapy,individual and group self-control training in the treatment of problem drinkers

The effectiveness of 4 alternative forms of behavioral self-control training (BSCT) designed to reduce alcohol consumption was evaluated. Forty-one problem drinkers were assigned to 1 of 4 treatment conditions: (a) bibliotherapy, in which clients were evaluated and then provided with a self-help manual (Miller & Muñoz, 1976) and self-monitoring cards but were not given therapy sessions, (b) BSCT alone, consisting of 10 individual sessions following material presented in the manual, (c) BSCT plus relaxation training, being identical to (b) except that training in progressive deep muscle relaxation was added within the 10 sessions, and (d) group therapy identical in content to (c) but offered in a group rather than in individual format. Outcome data included information from client interviews, psychometric measures, self-monitoring cards, and interviews with significant others. All data sources indicated significant and substantial reduction in alcohol consumption, particularly in “alcoholismic” drinking patterns. No significant differences were found among the 4 treatment groups. The cost-effectiveness of a bibliotherapy approach was supported, consistent with prior research. Overall improvement rates were 84% and 69% at 3- and 12-month follow-up, respectively.     

Management of central venous catheters using a wire introducer

The wire introducer method is a satisfactory technique for management of central venous catheters if bacteriologic monitoring of the removed catheter is used to determine whether the introduced catheter should be allowed to remain. The data indicate that when central venous catheters become infected, they do so through the whole length of the catheter, from subcutaneous tunnel to intravascular tip. An intravenous catheter which produces negative cultures can be safely changed by the introducer method aseptically. An infected catheter must be removed as soon as the diagnosis is apparent, since the replacement catheter will be seeded by the colonized tract. Blood specimens drawn through central venous lines do not reflect the status of the line itself but rather the presence or absence of systemic bacteremia.     

Significant others as corroborative sources for problem drinkers.

Self-reported alcohol consumption data from clients in four treatment outcome studies were compared with corroborative data obtained from “significant other” collaterals. Overall product-moment correlations were strong and positive, supporting the validity of self-report. Approximately equal numbers of collaterals overestimated and underestimated clients' own reports. Intercorrelation increased with repeated interviews.     

Recovery of function of the reimplanted lung

In association with reimplantation of the lung of the dog by established techniques, serial determinations of oxygen uptake (bronchospirometry), cardiac output and blood flow to each lung (Fick method), and blood pressure were done preoperatively and postoperatively for 10 to 12 weeks. Ultimately pulmonary artery ligation was performed to demonstrate that animals could survive on the reimplanted lung. In animals free of postoperative complications, oxygen uptake and blood flow returned to normal in 5 to 6 weeks in 4 animals; delay of functional return until 10 to 12 weeks postoperatively occurred in 5. In one-third of the reimplanted lungs, stenosis or occlusion of the bronchial anastomosis prevented evaluation of function.