The significance of vein wall thickness and diameter in relation to the patency of femoropopliteal saphenous vein bypass grafts.

Two hundred and twenty-five reversed saphenous vein femoropopliteal bypass graft procedures were performed on 186 patients with occlusive vascular disease. These grafts were followed for a mean of 19 months, with the longest period being 64 months. Numerous factors ascertained before, during, and after operation were analyzed using a life-table technique to see how these factors correlated with graft patency. The internal diameter and wall thickness of the vein grafts appeared to significantly influence graft patency. The best results were obtained using veins with a large internal diameter and a thin wall. In contrast, none of the other factors studied (which included age, sex, blood pressure, height, weight, indication for surgery, diabetic state, serum lipids, angiographic data, the site of the upper and lower anastomoses, the use of spliced vein segments, the type of vein preparation and the consumption of cigarettes before operation) were useful predictors of graft patency. It is suggested that vein diameter and vein wall thickness should be taken into consideration when analyzing the results of saphenous vein femoropopliteal bypass graft procedures, and also that the assessment of these factors may influence the choice of graft material for a femoropopliteal bypass graft.

Social factors and clinical disease: a checklist data base for correlative analysis.

The adequate care of a patient entails consideration of his social and psychological problems in addition to the relevant medical data. To facilitate this integrated approach, a Social Work Indices Checklist (SWIC) is described, and its use in practice is illustrated. A narrative report is generated from a possible 3095 items of information recorded in SWIC.

Cancer and teratogenesis: infrequent occurrence after medical use of immunosuppressive drugs.

This study examines long term "medical" immunosuppression with azathioprine or cyclophosphamide for immunopathic disease in relation to cancer and foetal malformation. The experience represent an aggregate of 241 years of treatment and 508 patient-years of follow-up in 133 non-transplant patients. For azathioprine the mean duration of treatment was 1-9 years and the mean duration of observation was 3-8 years, and for cyclophosphamide, the mean durations of treatment and observation were 0-7 and 4-6 years. A sample of 70 patients was shown by in vivo tests to have significantly suppressed cell-mediated immunity. In the period of review there were observed two cancers, both squamous cell carcinomas of skin, two benign neoplasms and six keratoses; after the period of review, three further cancers were recorded, one being in a subject with a known previous cancer. Nine pregnancies with azathioprine yielded no foetal malformations.

A problem-orientated outpatient record.

A problem-orientated record for use in outpatient clinics has been in operation over a period of 2 1/2 years. Its special features include: (i) preprinted stationery bound in appropriate sequence in the conventional hospital record; (ii) clear presentation of an up-to-date list of each patient's past and present diagnoses; (iii) problem-orientated progress notes. This study considers the definition of an illness problem, recording of progress information, adjustments to a problem list in the outpatient setting and recording of minor "noise" problems. Experience with the system consisted of 5,000 patient attendances. A sampling of these indicated that there were 3-1 +/- SD 1-5 concurrently treated problems per patient, and there were 9-3 +/- SD 6-6 clinic visits per patient. The system was subjectively assessed by 18 doctors, using a semantic differential technique, with a high frequency of "yes" responses to "saves time", "benefits the patient" and "benefits the doctor". This and similar systems may help to resolve the present paradox of the clinical chart becoming decreasingly useful with increasing complexity of illness.