ATSDR's trichloroethylene subregistry methods and results: 1989-2000.

The National Exposure Registry of the Agency for Toxic Substances and Disease Registry (ATSDR) uses standard methods to study human exposure in four chemical subregistries: trichloroethylene (TCE), dioxin, benzene, and trichloroethane. The TCE Subregistry includes a baseline cohort of 4006 white registrants with drinking water exposure in Michigan, Indiana, Illinois, Pennsylvania, and Arizona. Between 3 and 6 follow-ups per site were conducted from 1989 to 2000, after baseline. Standardized morbidity ratios, controlling for age and sex, compared prevalences of 16 general health conditions in the subregistry with aggregated national estimates from the 1989-1994 National Health Interview surveys. Excess cases of dermatologic, hematologic, or hepatic disorders and strokes persisted over the lifetime of the registry. Persistent excess urinary tract disorders are likely caused by a systematic bias. This review of first-generation methods may be used to strengthen future exposure registries.

Remote superficial femoral artery endarterectomy and distal vein bypass for limb salvage: initial experience.

PURPOSE: To examine the results of remote superficial femoral artery endarterectomy (RSFAE) performed through a small groin incision in conjunction with distal saphenous vein (SV) bypass for limb salvage. METHODS: A retrospective study was conducted of 21 patients (14 men; mean age 68.5 years, range 47-78) who underwent RSFAE and distal SV bypass between May 1998 and September 2001 for limb salvage. Thirteen had gangrene and 8 had rest pain. RSFAE was performed with the MollRing Cutter device through a femoral arteriotomy; the distal atheromatous plaque was "tacked up" with a stent. Distal SV bypass from the proximal popliteal artery was performed in situ in 7, from a transposed harvested vein in 8, or from a reversed graft in 6. All patients underwent follow-up examination with serial color-flow ultrasound scans. RESULTS: The mean length of the endarterectomized SFA was 26.5 cm (range 12-40). There were no deaths, only 2 wound complications, and the mean hospital length of stay was 3.1+/-0.6 days. The primary cumulative patency rate by life-table analysis was 71.4% with follow-up extending to an average of 12.4 months (range 1-18). There were 2 amputations for gangrene and 6 percutaneous procedures in 4 (19.1%) patients to maintain bypass patency, producing an assisted primary patency rate of 81.5%. The locations of the restenoses were evenly distributed along the endarterectomized SFA and SV graft. CONCLUSIONS: When adequate SV is not available, RSFAE with residual SV bypass is a safe and moderately durable procedure that may prove to be a useful adjunct for limb salvage, especially in the presence of foot infection, where an autogenous tissue bypass is preferred.