Nursing care of the ambulatory patient with a mechanical assist device.

Since 1986, 10 men and one woman were ambulatory while supported with mechanical assist devices as a bridge to heart transplantation. Four patients received a subclavian intraaortic balloon pump, two were supported with a Novacor left ventricular assist system, three patients received Pierce-Donachy ventricular assist devices, and one patient received a Jarvik 7 total artificial heart. One patient with an intraaortic balloon pump later received a left ventricular assist system because of hemodynamic deterioration despite the intraaortic balloon pump. Before device insertion all 11 patients were in cardiogenic shock despite inotropic and vasodilator support. The time of support ranged from 8 to 440 days (median, 24 days). In-house coverage by the circulatory support team was necessary only during the first 24 to 72 hours of support. When the patient's condition was stabilized, nursing staff monitored the devices with "on-call" availability of the circulatory support team. After implant of the device, all patients were able to perform activities of daily living. Once patients were able to walk in their hospital rooms, ambulation began in the hallways; frequency and distance were gradually increased. Four of the patients walked outside the hospital while tethered to the drive console. Daily physical therapy contributed to increased exercise tolerance. Protective isolation was used before and after transplantation to minimize the risk of infection. Sterile dressing changes (gown, gloves, mask) were applied to drive lines, cannula sites, and incisions. All invasive lines and catheters were removed as soon as the patient's clinical condition warranted, and noninvasive monitoring was used to decrease the chance of infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Outpatient dobutamine for end-stage congestive heart failure.

Eleven patients with refractory class IV congestive heart failure who were not candidates for cardiac transplantation were given iv dobutamine therapy on an outpatient basis. All patients underwent hemodynamic evaluation to confirm a beneficial response to low dose (5 micrograms/kg.min) dobutamine and to establish arrhythmia control both on and off dobutamine before hospital discharge. Six of the 11 patients could not be weaned from dobutamine in hospital and were discharged on continuous infusion (maximum dose, 5 micrograms/kg.min), while four were discharged with an infusion regimen ranging from 3 to 5 consecutive days/wk. All patients had a chronic venous access placed and were instructed on the use of an external battery-powered infusion pump with a container holding a concentrated solution of dobutamine hydrochloride. All infusions were delivered at home on an ambulatory basis. Intravenous drug support was discontinued gradually over an average of 3.2 months; seven of 11 patients were able to be weaned entirely from iv inotropic therapy and were maintained on oral therapy alone. Seven of the 11 patients (six of whom were maintained on oral therapy alone) required no hospital readmission during the infusion or follow-up period.

Age and cohort effects in primary liver cancer.

Primary liver cancer incidence data from 30 populations reported in Cancer Incidence in Five Continents were analyzed. After adjustment for time trends, log incidence increases linearly with log age. Liver cancer risk increases more rapidly with age than that of colon cancer, stomach cancer, or lung cancer in non-smokers; it increases less rapidly than that of prostatic cancer or of lung cancer in smokers. Over the past 20 years, most populations have been found to have increasing age-adjusted liver cancer incidence. There is no correlation between change in rates and magnitude of rates. Male rates are higher than female rates and the ratio of the two tends to be higher in high-risk areas.

Comparison of an instrumental and modified Kjeldahl technique for determination of nitrogen in niobium and tantalum alloys.

Results obtained for the determination of nitrogen in two tantalum alloys and six niobium alloys by modified Kjeldahl and Leco TC-30 nitrogen-oxygen determinator are compared. In the 5-25 ppm range, for tantalum alloys, the relative standard deviation was 3-9% by the Kjeldahl procedure and 9-11% by the instrumental technique. In the range 30-80 ppm, for niobium alloys, the relative standard deviation was 2-8% by the Kjeldahl procedure and 5-7% by the instrumental technique.

Comparison of a modified Kjeldahl and a vacuum fusion technique for determination of nitrogen in tantalum alloys.

Results obtained for the determination of nitrogen in the tantalum alloys T-111 (Ta-8 W-2 Hf) and T-222 (Ta-10 W-2.5 Hf-0,1C) by Kjeldahl and vacuum fusion procedures are compared. Results obtained by each technique are shown for the determination of nitrogen m the MAB T-111 sample, two commercial T-111 samples and a commercial sample of T-222 alloy. In the 5-25 ppm range, the relative standard deviation was 3-9% by the Kjeldahl procedure and 4-8% by vacuum fusion. This is a measure of the homogeneity of the material as well as of the reproducibility of the results. The agreement of the results obtained by these two techniques increases confidence in the vacuum fusion results for nitrogen in tantalum.