Nineteen patients with Hancock Modified Orifice prosthesis (HMO-250), size 19 to 23 mm, were recatheterized 6 to 16 months following aortic valve replacement (AVR). Although hemodynamic ...characteristics varied widely, HMO-250 compared favorably to the standard model 243 (less than 0.05). Mean peak resting gradient across HMO-250 was 14.8 torr at rest and rose to 26.8 torr with exercise. Systolic gradients for HMO-250, both resting and exercise, were improved for 21 mm (p less than 0.01), but not for 23 mm. Increasing the patient's body surface area (BSA) correlated with increasing gradients for 23 mm (p less than 0.05), but was unrelated to 21 mm. Effective orifice areas were similarly found to be improved with 21 mm HMO-250 but unchanged for 23 mm. Use of the 21 or 23 mm size HMO for AVR is supported only when the patient's body surface area is less than 1.8 m2. If the body surface area is greater than 1.8 m2, annulus enlargement and a larger size bioprosthesis should be employed. Use of 19 mm porcine xenograft for AVR is not supported.
Efficacy and safety of alternate-day prednisolone compared to single daily cloprednol were evaluated over a six-week period in 11 children with severe asthma requiring in-residence medical ...supervision and long-term corticosteroid therapy. Clinical indices of efficacy, including daily pulmonary symptom scores, number of asthma attacks, asthma severity scores, and bronchodilator usage, all favored cloprednol. Afternoon pulmonary function tests (FEV1, FVC, and PEFR) were all significantly improved during the cloprednol period. Although plasma cortisol values remained within the broad range of normal during the cloprednol period, mean values were consistent with partial pituitary-adrenal suppression similar in degree to that observed 24 hours after administration of an alternate-day program of prednisolone therapy. The results of this trial showed cloprednol in single daily doses to be more effective than prednisolone in alternate doses for the treatment of children with severe asthma.
In a geographically defined survey of 3,097 rural lowans who were at least 65 yr of age, we examined the association between prior farm experience (≥25 yr) and various measures of current health ...status; we controlled for age, current working status, and, where appropriate, smoking and alcohol consumption. Health status was indexed by self reported morbid conditions, symptoms, and physical function. After controlling for smoking behavior, it was found that both men and women with previous farm exposure currently experience a greater prevalence of all nine respiratory symptoms employed in the study relative to non-farmers. Farm men report a lower prevalence of Parkinson's disease and prostate conditions, but report a greater prevalence of stroke and a lower level of self perceived health status. Women with a farm work history experience a greater level of physical function and fewer symptoms associated with mental illness. Overall significant benefits as well as risks associated with a history of farm work were identified. However, of those who survived to age 65, extended exposure to farm work did not have a major impact on the overall current health status of men and women.
The composition of pigment gallstones from patients with and without cirrhosis was compared. Carbonate-containing pigment stones were distinguished from noncarbonate stones by infrared spectroscopy. ...Calcium was the major cation of each stone group. The major anion in noncarbonate pigment stones was bilirubinate or phosphate, but was carbonate in carbonate stones. The composition of pigment stones from cirrhotic and noncirrhotic patients was similar except that significantly less carbonate was present in carbonate stones, and less pigment (bilirubinate) was present in noncarbonate stones from noncirrhotics. These data suggest that irrespective of the presence of cirrhosis, the formation of noncarbonate pigment stones involves the selective precipitation of calcium bilirubinate and phosphate, whereas carbonate stone formation involves the selective precipitation of calcium carbonate.
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