Comparing clinical outcomes in high-volume and low-volume off-pump coronary bypass operation programs.

UNLABELLED: sites and then analyzed the patient and hospital characteristics that had an impact on clinical outcomes. RESULTS: The mortality rates for the high- and low-volume OPCAB facilities both averaged 2.9% (p = NS). Patients at the high-volume OPCAB facilities had significantly lower rates of major complications (shock/hemorrhage, neurologic, renal, and cardiac) than those at the low-volume OPCAB facilities. Of the seven minor complications, rates for six were lower in the high-volume OPCAB facilities, but none of the differences reached statistical significance. High-volume OPCAB sites were significantly more likely to discharge their patients directly home than were low-volume OPCAB sites (80% versus 66%; p = 0.001). CONCLUSIONS: The results suggested that surgical team experience and choice of approaches to performing CABG had an impact on patient outcomes.

Post-transplant peritonitis in patients undergoing continuous ambulatory peritoneal dialysis.

Two patients previously managed by continuous ambulatory peritoneal dialysis for end stage renal failure received cadaveric renal transplants. The peritoneal catheter was capped off and left in situ postoperatively. Both patients developed bacterial peritonitis shortly after transplantation. It was felt that the infections were associated with the presence of the indwelling peritoneal catheter as there was no clinical evidence of peritonitis at the time of transplantation.

An on-line computer system for hospital bacteriology: description of its development and comments after five years' use.

The development over several years of a computer system for hospital bacteriology reporting is described. The system was developed from a manual method to a punch-card batch processing system and finally to a real-time on-line system. The value of the system to the clinical departments and laboratory is discussed. Apart from minor defects the system has been of immense advantage to all who make use of its facilities.

Hemoptysis and pulmonary aspergilloma: operative versus nonoperative treatment.

The clinical experience with 42 patients with pulmonary aspergilloma evaluated at the Vanderbilt University Affliated Hospitals in a 22-year period was reviewed to determine the necessity and advisability of pulmonary resection. Twenty-nine patients (69%) had sustained one or more episodes of gross hemoptysis. Eleven of the 42 patients were treated operatively with lobectomy, wedge resection, or cavernostomy. Five of them had had hemoptysis preoperatively, but in only 1 patient was massive hemoptysis the primary indication for operation. The single death among these 11 patients occurred in the patient undergoing operation for control of massive hemoptysis. Nonoperative treatment was selected in 31 patients because of advanced chronic lung disease. Twenty-four of these 31 patients experienced 41 episodes of gross hemoptysis during observation periods up to 8 years (average, 32 months). Superimposed bacterial infection usually accompanied the episodes of hemoptysis, and medical therapy with bedrest, antibiotics, and postural drainage was successful in controlling the hemorrhage in 40 of the 41 episodes. One patient died from massive hemoptysis. On the basis of this experience, pulmonary resection for aspergilloma in patients with hemoptysis seems rarely indicated.

Hemodynamic and respiratory responses of conscious swine to E. coli endotoxin.

The injection of a sublethal bolus of E. coli into conscious swine produces an early increase in PAP and a decrease in LAP. This hemodynamic effect may be secondary to the pulmonary venous constriction seen in other species, or may relate to demonstrated multiple pulmonary microemboli. Hypoxemia developed in only four of 17 animals although all endotoxin-treated swine showed interstitial edema and elevated wet/dry weight ratios with normal pulmonary surfactant. In addition, endotoxin-treated swine developed signs of disseminated intravascular coagulation, with renal cortical infarcts in 44%, and coronary arterial thrombi in 28% including one transmural myocardial infarction. This effect was observed in the absence of prolonged hypotension in swine and should provide a useful model for further study of the relationship of endotoxin to disseminated intravascular coagulation.

Transvenous management of pulmonary embolic disease.

Clinical pulmonary embolic disease was categorized into four classes according to hemodynamic and respiratory effects of the occlusion at the time of diagnosis. A new approach to management of massive embolization (Class III and IV) by transvenous catheter embolectomy was attempted in ten patients with initial success in eight. Three additional deaths occurred postoperatively, two from recurrent embolization prior to vena caval plication. In view of this preventable complication, a wire filter device was developed for insertion at the time of embolectomy. The filter has also been utilized in 15 additional patients with lesser degrees of embolization (Class II). The conal shape of the device permits preservation of flow after embolic capture and followup venacavagrams in nine patients up to 20 months postoperative shows patency in all. Complications occurred in both groups related both to the underlying disorder and to the catheter technics.