Use of the personal computer in clinical research.

Personal computers are quickly becoming items of everyday use. More physicians' offices are using computers for billing and patients' records. Others have purchased computers for their word processing capabilities. These computers can be used for archives of medical case records or to collect and collate data for clinical research. This article focuses on how we use a personal computer for organization and management of clinical research projects. Included is a description of how we organize a research project, gather data, write computer programs, enter data into the computer, and generate and display reports. The use of a template program and a personal computer permits creation of individual programs without the aid of a professional programmer. When a single data-management program is used, five or six research projects can be carried out at a cost comparable to that of one project using a large computer and professional programmers.

[Non-invasive explorations of the carotid arteries (author's transl)]. / Explorations no invasives des artères carotides.

For the non-invasive evaluation of patients suspected of having extracranial carotid artery disease, the non-invasive vascular laboratory at the Lahey Clinic, Boston, Massachusetts uses three tests. Carotid phonoangiography (C.P.A.) by itself is 60% accurate, the Kartchner-McRae Oculoplethysmograph (O.P.G.) by itself 80% accurate, and the Echoflow doppler arterial imager, by itself 90% accurate. These examinations are used for surveillance of high-risk patients and to determine the need for carotid arteriography. In a series of 94 patients, the combination of these non-invasive methods yielded one false negative and 2 false positive studies, for an overall accuracy of 95%.

Fibrinolytic therapy.

Fibrinolytic therapy is a useful addition to the armamentarium of most clinicians. Patients with fibrin-based intraluminal clots are seen by almost all physicians. With proper patient selection and careful physician adherence to dosage schedule and monitoring, the incidence of significant complications with fibrinolytic agents is about the same as with heparin therapy. Heparin stops the thrombotic process, whereas fibrinolytic therapy not only stops the thrombotic process, but often reestablishes a normal, hemodynamic state. Patients who undergo fibrinolytic therapy are spared long-term problems like amputation and the postphlebitic syndrome.

Clinical use of noninvasive evaluation of the carotid artery.

The noninvasive evaluation of carotid artery disease should include a battery of tests that includes one direct and one indirect assessment of the extracranial carotid arteries. The resulting data should be correlated with the clinical findings and the patient's general status so the risks and benefits of carotid endarterectomy may be determined. These studies are usually outpatient procedures and allow one to determine in the office which patients would benefit from carotid surgery and who should be followed serially. Carotid arteriography is reserved for those patients who will be subjected to surgery. In our hands, the combination of CPA, Kartchner-McRae OPG, and Echoflow fulfill these requirements. In a small number of patients the history, physical examination, and noninvasive studies are inconclusive. For most patients, we are able to make decisions as to the best therapy in the office and can discuss risks and benefits with patients and their families with an accuracy of approximately 95 per cent before hospitalization and arteriography are considered.

Femoral-to-femoral bypass graft.

Femoral-to-femoral bypass reconstructions were first described by Vetto in 1962. It is a low-stress, low-risk procedure with excellent long-term results. Its use need not be confined to high-risk patients with tissue necrosis; it can be offered to moderate-risk patients with unilateral disease and incapacitating claudication. Studies in the noninvasive vascular laboratory assist in the preoperative selection of patients as they determine if the iliac artery on the asymptomatic side is capable of acting as an inflow vessel. Noninvasive evaluation and monitoring at regular intervals after operation allow for early detection and correction of new disease.