No abstract

The optimal management of severe ascites in patients with alcoholic cirrhosis has not been defined. in a 5 1/2-year study, we randomly assigned 299 men with alcoholic cirrhosis, who had persistent or recurrent severe ascites despite a standard medical regimen, to receive either intensive medical treatment or peritoneovenous (LeVeen) shunting. We identified three risk groups: Group 1 had normal or mildly abnormal results on liver-function tests, Group 2 had more severe liver dysfunction or previous complications, and Group 3 had severe prerenal azotemia without kidney disease. For the patients who received the medical treatment and those who received the surgical treatment combined, the median survival times were 1093 days in Group 1, 222 days in Group 2, and 37 days in Group 3 (P less than or equal to 0.01) for all comparisons). For all the groups combined, the median time to the resolution of ascites was 5.4 weeks for medical patients and 3.0 weeks for surgical patients (P less than 0.01). Within each risk group, mortality during the initial hospitalization and median long-term survival were similar among patients receiving either treatment. However, the median time to the recurrence of ascites in Group 1 was 4 months in medical patients, as compared with 18 months in surgical patients (P = 0.01); in Group 2 it was 3 months in medical patients as compared with 12 months in surgical patients (P = 0.04). The median duration of hospitalization was longer in medical patients than in surgical patients (6.1 vs. 2.4 weeks in Group 1 [P less than 0.001] and 5.0 vs. 3.1 weeks in Group 2 [P less than 0.01]). Group 3 was too small to permit a meaningful comparison. During the initial hospitalization, the incidence of infections, gastrointestinal bleeding, and encephalopathy was similar among the medical and surgical patients. We conclude that peritoneovenous shunting alleviated disabling ascites more rapidly than medical management. However, survival was closely related to the severity of the illness at the time of randomization and was not altered by shunting.

The dispersion interaction in the helium dimer is considered from the viewpoint of the force on a nucleus. At large internuclear separations, Brueckner coupled cluster BD(T) forces agree well with near-exact dispersion forces. The atomic density distortion associated with the dispersion force is quantified by comparing the BD(T) dimer density with a superposition of atomic densities. For density functional theory calculations in the Hartree–Fock–Kohn–Sham (HFKS) formalism, the accuracy of the dispersion force is governed by the correlation potential. Calculations using the conventional Lee–Yang–Parr [Phys. Rev. B 37, 785 (1988)] potential only generate a small density distortion, giving forces significantly smaller than BD(T). The BD(T) electron densities are therefore used to determine improved correlation potentials using a modified Zhao–Morrison–Parr (ZMP) approach [Phys. Rev. A 50, 2138 (1994)]. HFKS calculations using these ZMP potentials quantitatively reproduce the distortion, giving dispersion forces in good agreement with BD(T). The dimer ZMP correlation potential is partitioned into two parts, one equal to the sum of two unperturbed spherical atomic correlation potentials and the other representing an interaction potential. HFKS calculations using the former do not generate the distortion; forces are close to Hartree–Fock. Calculations using the latter do generate the distortion, giving forces essentially identical to those from the full dimer potential. The origin of the distortion is traced to the asymmetric structure of the interaction correlation potential in the vicinity of each nucleus.

The energies of the gauche and anti conformers of 2-fluoroethylamine, 2-fluoroethanol and their protonated analogues are calculated using density functional theory. Unlike the non protonated systems, the protonated systems show a strong gauche effect where the C-F and the C-(+)NH(3) or C-F and C-(+)OH(2) bonds are gauche rather than anti to each other. Single crystal X-ray diffraction studies of 2-fluoroethylammonium compounds identify the same conformational preference.