Disease conditions most frequently evaluated among the homeless in Dallas.

Responding to the medical needs of the homeless population across the United States exact large costs on the health care system. To provide effectively for such vulnerable populations, health care systems require creative and efficient strategies of service organization tailored to the specific needs of the homeless. However, such needs often vary by geographic region due to the inherent diversity of the population. Currently, no published medical evaluation of the urban homeless in Texas exists. Therefore, this study examines 93,074 diagnoses given to 20,331 homeless patients seen in a seven-year period in a primary care mobile and fixed clinic system. The most frequent disease conditions evaluated in this cohort of patients are reported. These findings may be useful to clinical site managers and health care planners contemplating an outreach program for the homeless.

Percutaneous transluminal coronary angioplasty: the early Dunedin experience.

Since May 1981 39 men and 11 women (mean age 55 years) have undergone percutaneous transluminal coronary angioplasty at Dunedin Hospital. Angioplasty was performed in 34 (68%) patients with stable angina, 13 (26%) with unstable angina and in three (6%) patients with acute myocardial infarction. Primary success (reduction in angiographic stenosis without associated myocardial infarction or emergency coronary bypass) was achieved in 77% of those patients with single vessel coronary disease (27 of 35 procedures) and of 62% in those patients with multiple vessel disease (16 of 26 procedures). Successful angioplasty was obtained in 81% (25/31) of those patients with anterior descending disease, 67% (4/6) of those with circumflex disease and 58% 14/24) of patients with right coronary disease. Thirty-four patients (68%) following successful angioplasty were rendered asymptomatic. Five (10%) underwent emergency coronary bypass grafting and one of these patients died. Percutaneous transluminal coronary angioplasty is a useful alternative to coronary artery bypass surgery and may be performed in a majority of patients with symptomatic single vessel coronary artery disease and in selected individuals with multiple vessel coronary disease.

Isometric exercise following myocardial infarction.

Twenty-six consecutive patients had measurement of ejection fraction by gated blood-pool imaging at rest and during isometric exercise, following recovery from an uncomplicated myocardial infarction. We found there was a highly significant fall in ejection fraction at rest from 56 +/- 3% to 43 +/- 3% during isometric exercise (p less than 0.0001). There was a dramatic fall in ejection fraction during isometric exercise in some patients with a normal resting value. These patients may be a cause for concern. Our preliminary findings suggest these latter patients are at risk for future cardiac events such as, unstable angina, further myocardial infarction and future coronary bypass surgery.

Family history, cigarette smoking and other risk factors in patients with myocardial infarction.

All patients entering a coronary care unit had data collected and stored prospectively on a computer file. Family history and risk factor data have been abstracted for those with confirmed myocardial infarction. These data are compared between those aged less than 50 years and those aged between 50 and 70 years. Cigarette smoking habits are compared with age matched data from the 1976 census population study of cigarette smoking habits. The risk factors of hypercholesteolaemia, obesity, diabetes, hypertension and cigarette smoking greater than 20 per day, do not separate the two age groups although cigarette smoking is more prevalent in the patient groups compared with the census population. Age of fathers' death is not different between the two age groups but death from myocardial infarction, presence of ischaemic heart disease during life in fathers and fewer nonsmokers in the younger age group clearly separate them from older age group patients. This study serves to emphasise that in order to prevent the development of myocardial infarction special attempts sould be made to prevent cigarette smoking in those whose fathers have died of a myocardial infarction or have symptoms of ischaemic heart disease.