Management of coexistent carotid and coronary artery disease.

Simultaneous coronary artery bypass grafting (CABG) and carotid endarterectomy (CE) were done on 133 patients over an 8-year period. Twenty-seven patients (20%) had previous transient ischemic attacks (TIAs), 12 (9%) had previous strokes, and the remainder (71%) were asymptomatic. All asymptomatic patients had greater than 85% stenosis of the internal carotid artery demonstrated by noninvasive ultrasonography and four-vessel angiography. CE was performed prior to the sternotomy for coronary artery bypass, under the same anesthesia. Nineteen patients had bilateral carotid artery disease. Postoperatively, three patients (2.3%) suffered strokes, an additional three patients (2.3%) suffered transient upper extremity weakness, and one patient from each of these groups died. There were no postoperative strokes or TIAs in patients with bilateral carotid artery disease. Average length of hospital stay was 10 days. Our experience leads us to conclude that the morbidity and mortality of the simultaneous procedure are not affected by bilateral carotid artery disease. In patients with symptomatic coronary artery disease and symptomatic carotid artery disease or asymptomatic carotid artery disease with a high-grade stenosis, we think that simultaneous repair of both lesions should be done.

Laparoscopy and the general surgeon.

Laparoscopic cholecystectomy has belatedly awakened the general surgical community to the concept of closed abdominal surgery. Current techniques have largely been developed by our colleagues in gynecology. The unanticipated demand by the public has placed unprecedented pressure on our systems for training, credentialing, developing, supplying, and evaluating changes in surgical technique. The diagnostic value of laparoscopy has been documented by a handful of general surgeons over the past several decades and is likely to become a more widely accepted technique. The potential of future developments in video-controlled operations is immense.

Arthritis in hereditary hemochromatosis.

Seven pedigrees with 45 members were evaluated for arthropathy associated with hereditary hemochromatosis (HC). Patients with symptomatic extraarticular disease were compared with asymptomatic patients who had evidence of HC on laboratory findings, and with normal subjects. Patients who were homozygous for HC were compared with heterozygous patients and normal subjects. HC arthritis does not appear to be an early predictor of disease, and chondrocalcinosis is a late manifestation of HC arthropathy.

Susceptibility and resistance to 6-sulfanilamidoindazole-induced arthritis among inbred strains of rats.

Inflammation induced by 6- sulfanilamidoindazole (6-SAI) in aged, outbred rats is predictably produced, but the pathogenesis is not understood. We demonstrate the variable resistance of 15 inbred rat strains to 6-SAI arthritis. Susceptibility to 6-SAI arthritis is not directly linked to the major histocompatibility complex, although resistance is related to the major histocompatibility complex in other experimental forms of rat arthritis. The genetic background of these inbred rat strains appears to have a major role in 6-SAI arthritis susceptibility.

Familial brachydactyly and chondrocalcinosis. Report of a patient, pedigree and review of the literature.

Familial brachydactyly has been recognized for many years but no published accounts report associated chondrocalcinosis. We recently evaluated such a patient and report the occurrence of brachydactyly in 4 generations of his kindred. The pattern of brachydactyly in this pedigree suggest autosomal dominant inheritance that is the mode of inheritance in most kindreds. The prepositus with chondrocalcinosis has longstanding arthralgias of both knees as does at least one other close relative who also has brachydactyly. The possibility that chondrocalcinosis may be part of the syndrome is suggested but awaits further clarification.

Paradoxical embolization with Ebstein's anomaly.

A 48-year-old woman with known Ebstein's anomaly had bilateral, lower-extremity arterial emboli after a total abdominal hysterectomy. She underwent embolectomy, placement of a Greenfield caval filter, subsequent tricuspid valve replacement, and closure of an atrial septal defect. Antemortem diagnosis of a paradoxical embolus is rare. To our knowledge, this is the first case associated with this congenital cardiac anomaly in a survivor.

Spontaneous nasal septal perforation in patients with rheumatoid arthritis.

Nasal septal perforation is known to be associated with various traumatic and disease states, yet spontaneous nasal septal perforation (SNSP) is relatively rare. SNSP has been reported in three patients with seropositive rheumatoid arthritis (RA) and we report an additional seven patients with SNSP and RA, four of whom were seronegative and none of whom had Raynaud's, in contrast to those reported previously. Manifestations of overt infectious, neoplastic or granulomatous disease have not been found in our seven patients over several years of close follow-up. We have identified no obvious pathogenesis or specific etiology for SNSP. We suggest that SNSP may represent an unusual manifestation of RA previously not well recognized.

Chromosomal location of pleiotropic negative sporulation mutations in Bacillus subtilis.

Genetic analysis by PBS-1 transduction and transformation of a large group of pleiotropic negative sporulation mutants has shown that mutations of this phenotype may be located in five genetically distinct regions. The first group of mutant sites, spoA mutations, is located in the terminal region of the chromosome and linked to the lys-1 marker by PBS-1 transduction. The second group, spoB mutations, is located between phe-1 and the attachment site for the lysogenic bacteriophage varphi 105. Fine structure analysis of the mutant sites within the spoB locus has been accomplished. A third location for mutants of this phenotype, spoE mutants, was found between the metC3 and ura-1 markers. Two mutants were found at this site and both were capable of sporulation, in contrast to the rest of the pleiotropic sporulation mutants. A fourth chromosomal site, spoH mutations, was found near the ribosomal and RNA polymerase loci. A large group of mutant sites, spoF mutations, was found to be linked to each other by recombination index analysis in transformation but unlinked to any of the known auxotrophic mutations comprising the chromosomal map. All mutants analyzed showing a pleiotropic negative phenotype were found to map within one of these five regions. Interspecific transformation with Bacillus amyloliquefaciens as donor has shown that all of the pleiotropic negative sporulation mutations are conserved relative to a selected group of auxotrophic markers. The degree of conservation in decreasing order is: spoH > spoF = spoB > spoA.