A novel method of shortening an aortic graft.

We describe a simple method of shortening the abdominal aortic graft during an emergency procedure which is easy to perform and does not unduly delay the completion of the operation.

Amputations at the London Hospital 1852-1857.

Between 1852 and 1857 at the London Hospital, 142 amputations were performed in 136 patients. The most common indication was an injury sustained at work. Overall mortality was 46% and the death rate was especially high for lower-limb amputations. Most deaths were due to postoperative sepsis. Those who received chloroform anaesthesia did worse than those who received ether.

Evolving standards in patient and caregiver support.

It has become increasingly clear that family members and others have enormous potential to contribute positively to the care of the patient suffering from Alzheimer disease (AD). Various methods such as respite services and day care as well as counseling and support groups have been shown to reduce caregiver stress and burnout. Moreover, there are many areas in which the informed, trained caregiver can contribute positively to, and even lead, the interdisciplinary ongoing care of AD patients. For example, the caregiver can help with memory aids, behavioral interventions, the maintenance of exercise and nutrition, healthcare proxies and housing arrangements, decisions about intensity of treatment, and the timely implementation of palliative care approaches. Caregivers skilled in such matters will increase the quality of life of the AD patient and reduce their dependency. Many support services and educational activities are known to help caregivers and their patients, yet their availability is variable, and it is unclear whose responsibility it is to organize and finance them.

After the diagnosis.

When the words "Alzheimer's disease" are first used regarding a patient with increasing memory and judgment problems, the person involved and his or her family members usually leave the office with sinking hearts. However, Dr. Ham believes that using the term is important, because it gives structure to management and can be the impetus to seek information about the disease and learn about local support organizations. Clarifying the diagnosis is but the first of many ways that primary care physicians can assist families in deciding about home care, intensity of treatment, and long-term placement.

Photodynamic therapy in a cell culture model of human intimal hyperplasia.

OBJECTIVE: To investigate the effectiveness of photodynamic therapy (PDT) in eliminating proliferating vascular smooth muscle cells (VSMCs). This may have a potential role in reducing restenosis rates clinically. MATERIALS AND METHODS: Human VSMCs were successfully cultured from 15 long saphenous veins (SV) and seven restenotic lesions (RL) removed during revision coronary and peripheral vein graft surgery. Cultured VSMCs were incubated with photofrin at doses of 0-5 micrograms/ml for 48 h, and then exposed to 4 J/cm2 of polychromatic light. Cell destruction was quantified by a colorimetric assay using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide. RESULTS: Results are expressed as a mean percentage survival +/- standard error. Cells were minimally affected by either photofrin alone (SV: 95.5% +/- 5.3; RL: 119.8 +/- 4.8) or light alone (SV: 75.38% +/- 3.99; RL: 100.1 +/- 11.0). The combination of 2 micrograms/ml of photofrin and 4 J/cm2 of polychromatic light energy, i.e. PDT, was severely toxic to cells derived from saphenous veins (5.52% +/- 0.85) as well as cells derived from restenotic lesions (9.6 +/- 2.3). These doses are comparable to doses that can be achieved in vivo. CONCLUSION: PDT in the appropriate drug and light doses can eliminate human VSMCs, including those responsible for vascular restenosis.