Prevalence of unsuspected abdominal aortic aneurysms in male veterans.

Abdominal aortic aneurysms (AAA) are potentially lethal arterial lesions that are best managed by elective surgical repair. However, asymptomatic AAAs may go undetected on routine physical examination or patients with such lesions may not consult a physician. To determine the prevalence of asymptomatic AAAs in a high-risk population, we retrospectively reviewed all abdominal CT scans on veterans > 50 years of age that had been ordered for indications other than aneurysmal disease during a recent 10-month period. Of the 111 patients studied, 15 (13.5%) had suprarenal and/or infrarenal AAAs (one patient had both). Patients with AAAs were significantly older (p = 0.0001) and were heavier tobacco users (p = 0.003). For patients > 60 years of age with peripheral vascular occlusive disease and a history of tobacco use, there was a 29.2% prevalence for AAA compared with 0% in those without any of these risk factors (p = 0.04). There was a very definite trend suggesting that patients with peripheral vascular disease (p = 0.06) were more likely to have an AAA. Because of the high prevalence of AAAs found in this population we then conducted a prospective study over a 24-month period during which patients > 60 years of age with known peripheral vascular disease and a history of smoking who presented to the vascular laboratory for evaluation of problems not related to AAA were asked to undergo an abdominal CT scan. Fifty-six volunteers agreed to participate in the study. Seven patients had AAAs and one patient had an isolated iliac aneurysm, for a 14.3% overall prevalence of aneurysms.2+ d

Effect of the 21-aminosteroid U-74006F on cerebral vasospasm following subarachnoid hemorrhage.

The purpose of this study was to use a new 21-aminosteroid (U-74006F) with in vitro antioxidant and antilipolytic properties as a pharmacological probe to assess the role of lipid hydrolysis and peroxidation in a rabbit model of subarachnoid hemorrhage (SAH)-induced vasospasm. Cerebral angiograms were performed on 15 rabbits. Eighteen hours later, 1 cc/kg of autologous blood was infused into the cisterna magna of all 15 animals. Six rabbits received no treatment, six received U-74006F starting 30 minutes after SAH, and three rabbits received the vehicle for U-74006F starting 30 minutes after SAH. At 72 hours post-SAH, a second angiogram was obtained. Digital subtraction angiographic techniques were used to measure the diameter of and contrast material flow through the basilar artery. At 72 hours post-SAH, vasospasm was evident in all untreated and vehicle-treated rabbits. The diameter of and the flow through the basilar artery were significantly reduced 42.3% +/- 6.6% and 46.8% +/- 5.8%, respectively, below pre-SAH levels (means +/- standard error of the means). Treatment with U-74006F eliminated the SAH-induced vasospasm; in treated animals, both the flow through and the diameter of the basilar arteries were at pre-SAH levels. These findings indicate that: 1) membrane lipid changes (that is, hydrolysis with eicosanoid production and/or peroxidation) contribute to the chronic vasospasm resulting from SAH, and 2) U-74006F prevents the SAH-induced chronic vasospasm in this model by limiting these pathological membrane events.

Some extra-articular manifestations of arthritis and complications of therapy. A pictorial essay.

More than 100 years ago Lasegue wrote, "Rheumatic fever licks at the joint but bites at the heart." This truth may be expanded to include nearly every joint ailment on one hand, and nearly every organ system on the other hand. In connective tissue disorders, bleeding diasthesias and metabolic and endocrine disorders, the joint manifestations are only one part of the total picture. This article shows a few examples of cardiopulmonary, gastrointestinal, and other manifestations. A few examples of iatrogenic complications are also described. The list of the examples described in this article is far from complete.