Congestive cardiomyopathy in association with AIDS

During a 10-month period in 1985 and 1986, three cases of acquired immunodeficiency syndrome (AIDS) and a rapidly progressive fatal cardiomyopathy were encountered. All three patients originally presented with common opportunistic infections and later experienced marked congestive heart failure associated with echocardiographic and radiologic findings consistent with four-chamber cardiomyopathy. Diffuse cardiomyopathy was confirmed postmortem, but in each case a specific cause was not found.     

Multivariate discriminant analysis of risk factors for operative mortality following isolated coronary artery bypass graft. Loyola University Medical Center experience, 1970 to 1984

The Loyola Open-Heart Registry is a fully operational database that contains detailed data on approximately 9,000 patients who have undergone coronary bypass or cardiac valve replacement from January 1970 to December 1984. We analyzed the registry data using multivariate discriminant analysis to identify and quantitate those factors that might predict operative mortality (OM) for patients undergoing coronary artery bypass grafts at Loyola University Medical Center: Operative mortality was defined as death within 30 days following surgery. A total of 50 clinical and angiographic variables were analyzed for possible univariate association with operative mortality. Twenty-two variables were found to have significant univariate association with OM, and these 22 variables were subjected to multivariate discriminant analysis. For patients undergoing isolated, elective coronary artery bypass, the factors found to be predictive of OM are age (greater than 70) (F = 11.57), severe (more than six stenoses) coronary artery disease (F = 5.81), diffuse disease (F = 5.54), positive family history (F = 5.17), and number of coronary arteries bypassed (F = 4.78).     

Carpo-metacarpal growth disturbance and the assessment of carpal narrowing in children with juvenile rheumatoid arthritis

Second metacarpal length (M2), radio-metacarpal length (RM), and intermetacarpal width (W) were measured on 96 radiographs in 52 children with polyarticular juvenile rheumatoid arthritis (JRA), and compared with body height and skeletal maturation in order to: (1) differentiate between processes resulting in retardation of bone growth and those producing delay in skeletal maturation; (2) assess the severity and progression over time of such retardation; and (3) assess the impact of retardation of the second metacarpal on the assessment of carpal narrowing in children with JRA. All measurements were converted into z scores (the units of standard deviation above or below the normal mean for each measurement) based on published norms. Retardation of M2 (mean z scores -0.91) began earlier and was more severe compared with retardation of height (mean z score -0.25). This disproportion widened with increasing duration of disease. That this primarily represents a disturbance in M2 growth rather than a secondary effect due to altered maturation is suggested by the bone ages being normal (mean z score 0.14) and the absence of premature closure of the metacarpal physes. Z scores for RM/W (mean -3.53) were at least 1 Z more negative than for corresponding measurements of RM/M2 (mean -2.41) in 47 (90.4%) children and the mean difference between the z scores for RM/W was -1.12. This discrepancy between RM/W and RM/M2 was eliminated by correcting for the reduction in M2.     

Erythropoietin concentrations in obstructive sleep apnoea.

Eight patients with obstructive sleep apnoea and a normal haemoglobin concentration underwent nocturnal studies during which oxyhaemoglobin saturation was recorded continuously with an ear oximeter and serum erythropoietin concentration was measured hourly by means of a radioimmunoassay. Serum erythropoietin concentrations remained within the normal range throughout the study despite falls in oxyhaemaglobin saturation in individuals to 33-78%. There was no relation between the degree of nocturnal hypoxaemia and serum erythropoietin concentrations. The brief cyclical episodes of hypoxaemia typical of obstructive sleep apnoea may not be a sufficient stimulus for erythropoietin secretion.     

Approaches to the ankle region

This article has attempted to address the surgical realm of the ankle region. With the advent of more interest in treating patients who require atraumatic and corrective surgical procedures of the ankle region, it is mandatory for us to become better trained and to improve our skills and expertise. The points worth summarizing in the surgical approach to the ankle region are a complete anatomic knowledge, basic principles of lines of tension, thorough understanding of biomechanics, and good preoperative judgment. The atraumatic approach was presented by describing how to accomplish this objective--by protecting neurovascular bundles, by following normal skin lines or creases, by avoiding scars over a bony prominence, and by avoiding incisions on a weight-bearing surface. Certain basic anatomic and physiologic principles were stated, such as making incisions large enough, using tourniquets when possible, avoiding excessive and unnecessary dissection, and avoiding stretching, crushing, or allowing tissue to dry. Various approaches for surgical procedures to the ankle region were given. The approaches described the location of the incision, the anatomy to be seen while deepening the wound, and the reason for the surgical procedure.