Patterns of perception of health in cardiac patients

Thirty-seven patients hospitalized for cardiac disorders were classified by cluster analysis in four groups based on their patterns of perception of health during the first year of recovery. Striking differences were found in the four patterns obtained. The groups were compared for variables of demographic background, physical health, and psychological state. Significant differences were found between clusters in pre- and post-hospitalization employment, alcoholism, state anxiety in the CCU and ICU, and number of days in CCU. No differences were found for measures of physical health.     

Amputations in peripheral vascular occlusive disease

One hundred consecutive patients undergoing major lower extremity amputations were critically analyzed over a five year period. The results of surgical care and the degree of success of rehabilitation were determined. The number of patients with peripheral vascular occlusive disease who require major lower extremity amputations appears to be increasing and they continue to present a challenge to the surgeon.     

Temporal changes in the spatial pattern of disease rates incorporating known risk factors

Examining the geographical pattern of temporal changes in infant mortality rates illustrates the methodological problems of documenting and understanding temporal changes in any spatial pattern of disease. Early research on geographical differences in infant mortality rates showed strong ecological correlations with socio-economic factors such as poverty rates. More recent research established relationships between individual-level socio-economic values and probabilities of death. With geographic information available at the level of individuals, it is possible to estimate the probabilities of death on a person-by-person basis from knowledge of the relationships between individual factors and socio-economic measures. These estimated probabilities provide an expected geographic pattern of deaths. The difference between the observed spatial pattern and the expected pattern is the remaining spatial variation adjusted for this knowledge. For the study area, individual factors and some socio-economic measures were available for each year of the study period. Using data from the Iowa Birth Defects Registry and the Iowa Department of Public Health (USA), I tested the stability and continuity of these cross-sectional relationships and investigated whether any temporal lags in these variables relate to the unexplained spatial variations in infant mortality rates that remain. I accounted for the 'Change of Support Problem' [Gotway C. A. & Young L. J. (2002). Combining incompatible spatial data. Journal of the American Statistical Association, 97458, 632-648] inherent in frame-based geographical analysis. The analysis involved a generalized linear model (GLM) to estimate individual risks and a Monte Carlo simulation model to generate the non-linear probability density functions for disease rates whose densities are theoretically intractable. Results show the temporal changes in the observed spatial pattern and the expected spatial pattern differ by geographic location. In conclusion such differences are the result of a combination of unexplained place-based risk and unmeasured individual risks.     

Truncal vagotomy and pyloroplasty. Critical evaluation of one hundred cases

One hundred patients having truncal vagotomy and Heineke-Mikulicz pyloroplasty on the surgical service of a Veterans Administration hospital performing mainly vagotomy and distal antrectomy were carefully analyzed.In a follow-up study ranging from two to thirteen years, an operative mortality rate of 1 per cent and a proved recurrence rate of 2 per cent were found. The factors involved in the choice of operation for duodenal ulcer were reviewed, and in our hospital the following rates were developed: vagotomy and distal antrectomy, 73 per cent; vagotomy and pyloroplasty, 16.4 per cent; vagotomy and gastroenterostomy, 8.5 per cent; partial gastrectomy, 1.6 per cent; and miscellaneous operations, 0.5 per cent.     

Myocardial infarction in the newborn: A case report complicated by cardiogenic shock and associated with normal coronary arteries

Fatal myocardial infarction occurring in a neonate is reported. The patient presented with a clinical picture of cardiogenic shock simulating a hypoplastic left heart syndrome. Etiology of the myocardial infarction is uncertain for the coronary arteries were patent, anatomically and histologically normal, and there was no significant associated cardiac defect. The possible etiologies in relationship to myocardial infarction in the neonatal period are presented.