Financial opportunity costs and deaths among close kin are independently associated with reproductive timing in a contemporary high-income society.

Evolutionary demography predicts that variation in reproductive timing stems from socio-ecologically contingent trade-offs between current and future reproduction. In contemporary high-income societies, the costs and benefits of current reproduction are likely to vary by socioeconomic status (SES). Two influential hypotheses, focusing on the parenthood 'wage penalty', and responses to local mortality have separately been proposed to influence the timing of parenthood. Economic costs of reproduction (i.e. income loss) are hypothesized to delay fertility, especially among high childhood SES individuals who experience greater opportunities to build capital through advantageous education and career opportunities. On the other hand, relatively low childhood SES individuals experience higher mortality risk, which may favour earlier reproduction. Here, we examine both hypotheses with a representative register-based, multigenerational dataset from contemporary Finland (N = 47 678). Consistent with each hypothesis, the predicted financial cost of early parenthood was smaller, and mortality among close kin was higher for individuals with lower childhood SES. Within the same dataset, lower predicted adulthood income and more kin deaths were also independently associated with earlier parenthood. Our results provide a robust demonstration of how economic costs and mortality relate to reproductive timing. We discuss the implications of our findings for demographic theory and public policy.

CT follow-up of empyemas: pleural peels resolve after percutaneous catheter drainage.

In this prospective study, computed tomography (CT) was used to examine the resolution of pleural abnormalities following radiologic catheter drainage of empyemas. Ten patients with empyemas surrounded by pleural peels underwent thoracic CT scanning at 4, 8, and 12 weeks after removal of their catheter(s). The scans demonstrated extensive pleural thickening 4 weeks after catheter removal in all 10 patients. The pleural thickening had decreased 8 weeks after catheter removal. At 12 weeks, the pleura was essentially normal in four patients, demonstrated only a small area of plaque-like thickening in four patients, and was mildly thickened in two patients. This study demonstrates that the pleural surfaces have a remarkable capacity for healing after empyema drainage. The pleural peel resolves in most cases. These results suggest that decortication need not be performed routinely when such empyemas are encountered; rather, patients should be treated on an individualized basis and studied with serial CT to determine the necessity of decortication.

Limb salvage by extended profundaplasty of occluded deep femoral arteries.

This report presents our experience with extended profundaplasty as an outflow procedure for limb salvage in patients with occluded common and profunda femoris arteries. During a 5 year period at Salem Hospital, 15 limbs in 11 patients were revascularized by a variety of inflow procedures combined with extended endarterectomy and patch grafting of an occluded profunda femoris artery. All patients presented with rest pain, ischemic ulcers, or gangrenous toes. Patients with acute embolic disease or thrombosis of a limb of a graft which required immediate reconstruction were excluded from this study. Preoperative arteriograms revealed no patent femoral or graftable popliteal vessels but did demonstrate collateral circulation, specifically portions of the circumflex femoral arteries and muscular branches of the profunda. Operation was undertaken to disobliterate the profunda and reinstitute direct perfusion of the collateral bed. In all cases it was possible to endarterectomize the profunda to eliminate distal spared vessel and to open most of the profunda branches. There was no operative mortality. Follow-up revealed 87 percent limb salvage and 80 percent patency at 1 year. At 2.5 years limb salvage was 77 percent and reconstruction has remained patent in 60 percent of the limbs. These results compare favorably with series that have reported reconstructions for profunda stenosis alone. These preliminary data suggest that endarterectomy and long patch grafting of the proximally occluded profunda may have merit in providing worthwhile palliation in a small subset of patients with advanced occlusive disease.

Treatment os severe atrial injuries.

Four cases of severe atrial trauma are presented. These cases are unusual because of the magnitude of injury and because of their presentation in hospitals not usually involved in cardiac surgery. Three of the patients had blunt atrial injury. We found only 21 other successfully treated blunt atrial tears in our search of the world's literature. In patients with blunt atrial injuries, the setting of a high speed vehicle accident, significant chest trauma, hypotension, mental confusion and increased venous pressure should alert the emergency physician to the possibility of cardiac rupture. The use of simple operative techniques and the knowledge that most cardiac ruptures repaired successfully involve the atrium may help the surgeon produce a successful outcome.

Acute pancreatitis: analysis of factors influencing survival.

Of patients with acute pancreatitis (AP), there remains a group who suffer life-threatening complications despite current modes of therapy. To identify factors which distinguish this group from the entire patient population, a retrospectiva analysis of 519 cases of AP occurring over a 5-year period was undertaken. Thirty-one per cent of these patients had a history of alcoholism and 47% had a history of biliary disease. The overall mortality was 12.9%. Of symptoms and signs recorded at the time of admission, hypotension, tachycardia, fever, abdominal mass, and abnormal examination of the lung fields correlated positively with increased mortality. Seven features of the initial laboratory examination correlated with increased mortality. Shock, massive colloid requirement, hypocalcemia, renal failure, and respiratory failure requiring endotracheal intubation were complications associated with the poorest prognosis. Among patients in this series with three or more of these clinical characteristics, maximal nonoperative treatment yielded a survival rate of 29%, compared to the 64% survival rate for a group of patients treated operatively with cholecystostomy, gastrostomy, feeding jejunostomy, and sump drainage of the lesser sac and retroperitoneum.