The role of graft material in aortic reconstructive surgery

Graft replacement of an aneurysmal abdominal aorta and bypass grafting for aorto-iliac occlusive disease has proven effective since synthetic materials were introduced three decades ago. During the period 1978-1981, 584 patients underwent aortic reconstruction for aneurysmal or aorto-iliac occlusive disease. Two hundred fifty-four patients (43%) were operated for aneurysms while 330 (57%) patients had symptomatic aorto-iliac occlusive diseases. There were 508 (87%) men and 76 (13%) women. Associated disease was common, with 245 patients (42%) having arteriosclerotic heart disease, 291 (50%) hypertensive, 128 (22%) having manifestations of extracranial occlusive disease, and 50 (8.6%) having diabetes mellitus. Sixty-four (10%) patients in this series had coronary revascularization prior to their aortic graft. One hundred five (17.9%) carotid endarterectomies had been performed previously or immediately prior to aortic grafting. Distal reconstructive operations had been performed in 106 patients (18%). Renal or mesenteric revascularizations were performed concomitantly in 87 and eight patients, respectively. One hundred two femoral reconstructions or distal bypasses were also performed to assure adequate outflow. Thirteen (2.27%) deaths occurred during the first 30 days. Cardiac problems accounted for eight of these deaths. Graft occlusion occurred in the immediate postoperative period in four (0.4%) limbs. During the follow-up, an additional seven limbs (1.04%) have occluded. There have been no other complications associated with the grafts during the follow-up period. Results in this series affirm the authors' strong commitment to direct aortic reconstruction.

Isocarboxazid. Efficacy and tolerance

In a double-blind study, isocarboxazid was found to have greater efficacy than placebo. Patients with weight gain, increased appetite, and increased sleep responded particularly well, with a rapid onset of improvement that was apparent by one week. Their response to placebo was poor. Using a flexible dose, the modal range was 30-60 mg per day. Higher doses were poorly tolerated. At the doses used, side effects were generally mild, the most common being dizziness and myoclonus.

A double-blind comparison of bupropion and amitriptyline in depressed inpatients

Bupropion and amitriptyline were compared in a double-blind study of depressed inpatients. Treatment ranged from 2 to 4 weeks: early responders (Hamilton Depression Scale scores less than 10) were often removed from treatment after 2 or 3 weeks. Twenty-two patients completed treatment with bupropion and 18 with amitriptyline. Doses ranged from 450 to 750 mg/day for bupropion and 75 to 225 mg/day for amitriptyline. Overall, bupropion and amitriptyline were equally effective, as measured by the Hamilton Depression and Anxiety scales, Clinical Global Impressions, Zung Depression scale, and the SCL-90. Differences in the side effect profile and in weight change are described.

Timolol maleate: side effects on healthy nonglaucomatous volunteers

As the number of military pilots over the age of 40 increases, open-angle glaucoma becomes an important aeromedical problem. Epinephrine ophthalmic solution is the only antiglaucomatotic agent in use among flying personnel. Timolol maleate, a new antiglaucomatotic agent, is a nonselective beta-blocker. This drug has a potent hypotensive effect on intraocular pressure with a minimal effect on visual functions. Our data show that it significantly decreases the pulse rate and may eventually be a basis for cardiac dysrythmias.

Studies on human milk macrophages: effect of activation on phagocytosis and secretion of prostaglandin E2 and lysozyme

Breast milk macrophages cultured in vitro synthesized and secreted increasing amounts of protein, lysozyme, and prostaglandin E2(PGE2) into the extracellular medium. These cells were also shown to actively phagocytose labeled zymosan particles in culture. Morphologic characteristics, phagocytosis, and secretory responses of the macrophages were altered depending on the presence of various stimuli in the culture. Concanavalin A, endotoxin and zymosan particles, but not latex particles, all resulted in an increased PGE2 secretion into the medium. Although total protein synthesis was not altered by any of these stimuli, Concanavalin A and endotoxin resulted in a decreased lysozyme concentration in the extracellular medium. Concanavalin A enhanced, whereas endotoxin and prior phagocytosis of latex particles inhibited phagocytosis of labeled zymosan particles. These findings indicate that phagocytosis and secretions of milk macrophages may be altered depending on the nature of the stimulating agent.

The survival of traditional medicine in a Peruvian barriada

Current trends in population dynamics reflect increasing movement from rural to urban environments. As a result the provision of health care for migrants has become a national priority in many countries 'in development'. Information describing the extent to which traditional medical beliefs and practices persist is crucial to the formation of systems of health care for migrant communities. This paper describes the dynamics of medical conservatism. Data analysis obtained from a comparative study of 52 Peruvian women living in a rural highland province and 50 Peruvian women from a migrant squatter settlement, a barriada, indicates that length of exposure to an urban environment is less of a determinant in medical conservatism than age of enculturation. Positive and negative implications of medical conservatism for the delivery of health services are discussed. Recommendations are suggested for greater emphasis on the coordination of programs of health care with community education.