Getting key players to work together and defending against diversion--California.

In 1988, Californians passed Proposition 99, which raised the tobacco tax from 10 cents to 35 cents and allocated 20% of the resulting revenues, approximately $100 million, for tobacco education and 5% for tobacco-related research. Seventy percent was allocated for health care costs and 5% for the environment. In this report, the authors provide an overview of the process of implementing the tobacco education program, which is followed by a more detailed review and analysis of the major impediments to the program, i.e., the diversion of a significant portion of the funding voters had earmarked for tobacco education and research and the battles for legislative reauthorization of Proposition 99 in the 1990s.

Hazards of angioscopic examination: documentation of damage to the arterial intima.

The fiberoptic scope is increasingly used in the coronary and peripheral arteries to quantitate the degree and type of arterial obstructive disease and to inspect the results of procedures such as bypass grafting and laser irradiation of obstructive lesions. Since little is known about this instrument's potential complications, we passed a variety of fiberoptic scopes (1.8 to 3.6 mm outer diameter) in fresh postmortem pig coronary arteries and live monkey and canine peripheral arteries, and observed the intraluminal anatomy through the angioscope. No perforations were created, but ridges rising from the vascular luminal surface, avulsion of the endothelial lining, and small flaps attached at one end to the vessel wall were observed. Histologically, subintimal and medial tears were evident. Inserting large diameter scopes or making frequent passes (10 to 100) in coronary arteries increased intravascular injury. The use of small diameter flexible scopes or infrequent passes (less than 10) in the larger iliac and femoral arteries of live monkeys and dogs resulted in a lower frequency of myointimal sloughing or flap formation. Current fiberoptic scopes are not ideal angioscopes; they have a rigid tip, cannot be steered adequately, and are relatively stiff, resulting in a high probability of intraluminal injury, especially when used in small tortuous arteries. To decrease the risk of such injury, we recommend gentle manipulations while passing the scope and use of the smallest diameter scope possible. We further suggest limited use of the fiberscope, or at least limiting the number of passes in small vessels such as coronary arteries.