Effects of positive impression management on the NEO Personality Inventory--Revised in a clinical population.

Sixty adults in outpatient psychotherapy completed the NEO Personality Inventory--Revised (NEO PI-R, P. T. Costa & R. R. McCrae, 1992a). Half were instructed to fake good and half were given standard instructions. All completed the Interpersonal Adjective Scale--Revised, Big Five (J. S. Wiggins & P. D. Trapnell, 1997) under standard instructions, and their therapists completed the observer rating form of the NEO Five-Factor Inventory. A comparison group of 30 students completed the NEO PI-R under standard instructions. Standard and fake-good participants obtained significantly different NEO PI-R domain scores. Correlations between the NEO PI-R and criterion measures were significantly lower for faking than for standard patients. Validity scales for the NEO PI-R (J. A. Schinka, B. N. Kinder, & T. Kremer, 1997) were moderately accurate in discriminating faking from standard patients, but were only marginally accurate in discriminating faking patients from students.

Coronary artery bypass surgery in the elderly.

In order to place the issue of CABG surgery in the elderly in a personal perspective, we have reviewed our series of 250 consecutive patients 70 years or greater in age at the time of surgery and have noted a very acceptable (3.6%) operative mortality. Good short and long term survival has been documented. A modest but important elevation of postoperative CNS morbidity has been documented and remains of concern. We have continued to offer CABG to those patients with acceptable risks who have either intractable angina, intractable ischemic heart failure and multi-vessel disease. Left main obstruction of a significant degree or those with threatening three vessel anatomy in association with a sentinel ischemic event are candidates for the CABG procedure. Substantial preoperative evaluation to include the family support substrate must be an important part of the decision process as well as open communication with concerned family members. We feel that the improved life style and enhanced survival justifies CABG in those elderly patients identified with severe coronary artery disease.

Transpleural resection of the first rib for repair of subclavian artery injury.

A technique is described for obtaining exposure of all three parts of the injured subclavian artery through a standard posterolateral thoracotomy and transpleural subperiosteal excision of the first rib. This technique should be considered for repairing injuries of the subclavian artery, especially when the injury is discovered at emergency thoracotomy done because of bleeding.

Cardiac valve replacement in children: comparison of tissue with mechanical prostheses.

Replacement of cardiac valves in children has been associated with high rates of mortality and morbidity in the past. We have compared 24 children from 2 to 18 years of age who have received mechanical valves with 24 children who have received porcine valves. The groups were similar except that (1) there were more mitral operations in the mechanical valve group and more aortic operations in the porcine valve group; (2) more porcine than mechanical valves were implanted in recent years; and (3) the porcine valve group comprised more young patients under 8 years and required more complex operations. Early and late mortality rates were higher in the mechanical than in the porcine valve group. Major late complications were seen in 50 percent of the mechanical valve group and 13 percent of the porcine group. Implantation of an adult-sized aortic valve was made possible in all patients by the use of aortic augmentation annuloplasty. Higher operative mortality rates in the mechanical valve group may have been related more to technique of myocardial preservation during operation than to type of valve. Although differing rates of late morbidity and mortality may also have been related to myocardial preservation and other technical factors, the type of valve used seemed to be an important determinant of the better results in the porcine group. Despite unknown durability of the porcine valve, our data suggest that the safest prosthetic valve to use in children at this time is the glutaraldehyde-fixed porcine prosthesis.