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PubMed2004

A supply-demand model of fetal energy sufficiency predicts lipid profiles in male but not female Filipino adolescents.

OBJECTIVE: To test the hypothesis that the balance between fetal nutritional demand and maternal nutritional supply during pregnancy will predict lipid profiles in offspring measured in adolescence. SUBJECTS AND METHODS: A total of 296 male and 307 female Filipino offspring (aged 14-16 y) and mothers enrolled in a longitudinal birth cohort study (begun in 1983-84) had lipid profiles measured. Data on maternal height (as a proxy for offspring growth potential and thus fetal nutritional demand) and third trimester maternal arm fat area (as a proxy for maternal supply) were used to create four groups hypothesized to reflect a gradient of fetal energy sufficiency. RESULTS: As fetal energy sufficiency increased among males, there was a decrease in total cholesterol (TC) (P<0.05 for trend), low-density lipoprotein cholesterol (LDL-C), and the ratios of TC/HDL-C cholesterol and LDL-C/HDL-C (all P<0.001), while HDL-C increased (P<0.05). Similar associations were identified when lipid levels were modeled as dichotomous 'high-risk' cut-points used in cardiovascular disease prevention in adolescents. These relationships were stronger, or only present, among offspring of mothers in the lower half of the third trimester energy intake distribution, and were independent of the child's current adiposity, dietary energy and fat intake, maturity, household income, and birth weight. In females, the supply-demand model did not predict any lipid outcome or clinical risk criteria. CONCLUSIONS: Our findings in males support the hypothesis that the balance between fetal nutritional demand and maternal nutritional supply has implications for future lipid profiles. The lack of significant associations in females adds to mounting evidence for sex differences in lipid metabolism programming, and may reflect sex differences in fetal nutritional demand. SPONSORSHIP: The National Science Foundation, the Mellon Foundation, the Nestle Foundation, and the Emory University Internationalization Program.

Adaptation, Physiological↗
PubMed2006

Avoiding hyperoxia in infants < or = 1250 g is associated with improved short- and long-term outcomes.

OBJECTIVE: To determine the rate and severity of short- and long-term morbidity in very low birth weight infants treated before and after the implementation of a change in clinical practice designed to avoid hyperoxia. METHODS: Analysis of a prospectively collected database of all infants < or = 1250 g admitted to two Emory University NICU's from January 2000 to December 2004. A change in practice was instituted in January 2003 with the objective of avoiding hyperoxia in preterm infants with target O2 saturation (SpO2) at 93 to 85% (Period II). Before the change in practice, SpO2 high alarms were set at 100% and low alarms at 92% (Period I). Statistical analysis included bivariate analyses and multivariate logistic regression comparing outcomes between the two periods. RESULTS: From January 2000 to December 2004, 502 infants met enrollment criteria and 202 (40%) were born in period II, after change in SpO2 targets. Birth weight, gestational age and survival were similar between both periods. The rates for any retinopathy of prematurity, supplemental oxygen at 36 weeks post-conceptional age and the use of steroids for chronic lung disease were significantly lower in the infants born in Period II. There was no difference in the rates of necrotizing enterocolitis, intraventricular hemorrhage and periventricular leukomalacia. At 18 months corrected age (CA), the infants treated during Period II had a higher Mental Developmental Index (MDI) scores (80.2 +/- 18.3 vs 89.2 +/- 18.5; P 0.02) and similar Psychomotor Developmental Index (PDI) scores (83.9 +/- 18.6 vs 89.4 +/- 17.2; P 0.08) than those treated during Period I. The proportion of infants with an MDI or a PDI less than 70 was similar between the periods. CONCLUSIONS: The change in practice to avoid hyperoxia is associated with a significant decrease in neonatal morbidity and does not have a detrimental effect on developmental outcomes at 18 months CA.

Child Development↗
PubMed2001

Response of atypical symptoms of gastro-oesophageal reflux to antireflux surgery.

BACKGROUND: Atypical manifestations of gastro-oesophageal reflux (GOR) include asthma, chest pain, cough and hoarseness. The effectiveness of antireflux surgery for these symptoms is uncertain. The present study compared symptomatic response rates for typical and atypical GOR symptoms after fundoplication. METHODS: Between October 1991 and January 1998, 324 patients underwent laparoscopic fundoplication at Emory University Hospital and returned postoperative questionnaires. Severity of typical (heartburn) and atypical (asthma, chest pain, cough and hoarseness) GOR symptoms was reported by patients on a 0-4 scale before surgery, and at 6 and 52 weeks after operation. Patients were stratified based on preoperative symptoms into three groups: group 1 (severe heartburn/minimal atypical symptoms), group 2 (severe heartburn/severe atypical symptoms) and group 3 (minimal heartburn/severe atypical symptoms). RESULTS: In group 1 (n = 173) heartburn improved in 99 per cent and resolved in 87 per cent. In group 2 (n = 95) heartburn improved in 95 per cent and resolved in 76 per cent, and atypical symptoms improved in 94 per cent and resolved in 42 per cent. In group 3 (n = 56) atypical symptoms improved in 93 per cent and resolved in 48 per cent. Although all symptoms were improved by fundoplication, resolution was more likely for heartburn than for atypical symptoms. CONCLUSION: Atypical symptoms of GOR are improved by fundoplication, but symptom resolution occurs in fewer than 50 per cent of patients.

Asthma↗
PubMed1999

Eccrine porocarcinoma treated with Mohs micrographic surgery: A report of five cases.

BACKGROUND: Eccrine porocarcinoma is a rare, locally aggressive, potentially fatal neoplasm. While wide local excision has traditionally been the treatment of choice, recurrences following excision are common. OBJECTIVE: The purpose of this study was to review the traditional treatments of eccrine porocarcinoma as well as to introduce Mohs micrographic surgery as an alternative to wide local excision. METHODS: We reviewed all cases of eccrine porocarcinoma seen at Emory University between 1985 and 1999. All cases were treated definitively with Mohs micrographic surgery. The clinical characteristics and outcome of each case are summarized. RESULTS: Five patients with eccrine porocarcinoma were treated with Mohs micrographic surgery. There have been no recurrences to date, with an average follow-up of 2.1 years (ranging from 5 months to 4 years). CONCLUSION: Follow-up of five patients supports the view that Mohs micrographic surgery may be an effective treatment for eccrine porocarcinoma.

Acrospiroma↗
PubMed2003

Acral lentiginous melanoma mimicking benign disease: the Emory experience.

BACKGROUND: Plantar and subungual melanoma exhibits a higher misdiagnosis rate relative to other anatomic sites. Misdiagnosis and delay in diagnosis are statistically associated with poorer patient outcome. Awareness of atypical presentations of acral melanoma may, thus, be important to decrease misdiagnosis rates and improve patient outcome. METHODS: We conducted a retrospective case review of plantar or lower-extremity subungual melanoma performed at Winship Cancer Center, a tertiary care, referral center affiliated with Emory University, between 1985 and 2001. RESULTS: A total of 53 cases of plantar or lower-extremity subungual melanoma were identified. Of 53 cases with a final diagnosis of melanoma, 18 were initially misdiagnosed. Misdiagnoses included wart, callous, fungal disorder, foreign body, crusty lesion, sweat gland condition, blister, nonhealing wound, mole, keratoacanthoma, subungual hematoma, onychomycosis, ingrown toenail, and defective/infected toenail. Of the 18 misdiagnosed cases, 9 were clinically amelanotic. CONCLUSION: Awareness that amelanotic variants of acral melanoma may assume the morphology of benign hyperkeratotic dermatoses may increase the rate of correct diagnosis and improve patient outcome.

Adult↗
PubMed2001

Vaginal creation for müllerian agenesis.

OBJECTIVE: The purpose of this study was to determine the effectiveness of passive vaginal dilation and McIndoe vaginoplasty in the creation of a neovagina for patients with müllerian agenesis. STUDY DESIGN: Fifty-one patients with Mayer-Rokitansky-Kuster-Hauser syndrome were treated for vaginal agenesis at either Johns Hopkins Hospital or Emory University. These historic prospective data were obtained by a review of medical records and a current office or telephone consultation. Initial office visits dated from November 18, 1983, through June 6, 1998. Their progress towards both anatomic and functional success was followed through August 1, 2000, which was a range of 2 to 16.8 years. One-way analysis of variance, Student t test, and logistic regression analysis were performed when appropriate. RESULTS: Four patients were lost to follow-up in various stages of the treatment. Ten patients refused vaginal dilation and proceeded to a successful modified McIndoe vaginoplasty. Of the 37 remaining patients, 91.9% anatomic and functional success was achieved from the Ingram method for vaginal dilation. Passive dilation failed in 8.1% of patients, who underwent a modified McIndoe vaginoplasty; all neovaginal creations were successful. All patients who underwent McIndoe vaginoplasty were compliant with postoperative vaginal form use. None of our patients lost vaginal space through contractions or loss of skin graft. Of those patients for whom dilation failed, only 1 patient discontinued the study because of bleeding and discomfort. In addition, only 1 patient from the 3 cases of failure had undergone a previous hymenotomy. Interestingly, 6 patients for whom dilation was successful (6/34 patients; 17.6%) had also undergone a previous hymenotomy. The mean follow-up time for all patients in this study was 111.1 +/- 7.2 months, with a range of 25 to 188 months. The mean follow-up time for those patients for whom dilation failed or who refused dilation was significantly lower at 64.5 +/- 9.5 and 65.3 +/- 18.5 months, respectively (P <.005). The mean time to successful dilation was 11.8 +/- 1.6 months with a range of 3 to 33 months. Although longer, no statistically significant difference was observed for dilation time in those patients for whom there was a failure to achieve anatomic or functional success (20.5 +/- 12.5 months; range, 8-33 months). CONCLUSION: These data reveal that passive dilation with the Ingram method is capable of creating an adequate vaginal canal in patients with vaginal agenesis, with respect to both function and anatomy even in those patients with a previous hymenotomy and resultant scar formation. Our modified McIndoe procedure has proved to be an excellent option for patients for whom conservative dilation techniques failed and who refuse to attempt any dilation. Interestingly, our data indicate that patients may now be trending toward immediate surgical correction rather than diligently using dilation techniques to create a vaginal space.

Dilatation↗
PubMed2002

Introduction of contextual legal issues in an interdisciplinary program for the study of ethical dilemmas in obstetrics and gynecology for third-year medical students.

OBJECTIVE: To introduce contextual legal issues, and the role of law in resolving ethical dilemmas, in a women's health ethics curriculum for third-year medical students. METHODS: Seventeen third-year medical students at Emory University School of Medicine, rotating on an 8-week obstetrics and gynecology clerkship, and 8 third-year law students from the Georgia State University College of Law attended four 1-hour ethics sessions conducted by an obstetrician and gynecologist, a law professor and an ethics fellow. Each student group completed a short survey to evaluate the effectiveness of the sessions. RESULTS: The overwhelming majority, 20 of 25 (80%) of the combined student group ranked the sessions a level 6 or 7 (the highest level) and suggested continuation of the interdisciplinary group format. The majority of the combined student group, 14 of 25 (56%), also viewed the multidisciplinary nature of the group as the most helpful aspect of the sessions. For the medical students, additional helpful aspects included having the legal perspective from persons who actually study the law. For the law students, other helpful aspects included the informal roundtable discussion format and the structured 4-quadrant model. CONCLUSION: Incorporation of medical and law students into a discussion group for resolving ethical dilemmas is a satisfying method for discussion of legal issues in the women's health ethics curriculum. It enriches the understanding of students from both disciplines.

Attitude of Health Personnel↗
PubMed2003

Effect of sleep deprivation on medical resident and student cognitive function: A prospective study.

OBJECTIVE: The purpose of this study was to determine whether cognitive function test results decrease after a typical night of on-call duty, on the basis of the amount of sleep that is obtained. STUDY DESIGN: Two standard cognitive functions tests (the Grooved Pegboard and California Verbal Learning Test II) were administered to the 30 participants who were members of the obstetrics and gynecology house staff and to medical students at Emory University School of Medicine. Each test was administered twice, before and after on-call duty. The data were analyzed with a paired two-tailed Student t test. RESULTS: For the California Verbal Learning Test II, trial 5 showed a decrease in score of 0.8 (P =.05) after on-call duty. Trials 1 through 5 showed a decrease in score of 3.5 (P =.01). CONCLUSION: This finding suggests that cognitive function test scores do decrease after on-call duty. Scrutiny of this issue by the Accreditation Council of Graduate Medical Education is justified, and the issue should continue to be evaluated. Our finding suggests that a change in our current educational structure is warranted.

Adult↗
PubMed2001

Age versus comorbidities as risk factors for complications after elective abdominal aortic reconstructive surgery.

PURPOSE: This study estimated the association between age and in-hospital postoperative complications, controlling for known or suspected risk factors, in a series of patients undergoing elective abdominal aortic reconstructive surgery (AAR). METHODS: This retrospective cohort study of outcome data with multivariate logistic regression analysis was conducted at Emory University Hospital, a tertiary care, university-affiliated hospital. All patients undergoing elective AAR between Jan 1, 1986, and Aug 1, 1996, were included (n = 856). An estimate of the odds ratio (OR) and 95% CI for the association between patient age and in-hospital major morbidity or mortality after elective AAR was made, controlling for significant risk factors. RESULTS: Among the 856 patients, 170 had a nonfatal complication (136 with major and 34 with minor complications), and 11 patients (1.3%) died. The final logistic regression model demonstrated a mild association between increasing age and rate of major postoperative complications, including death (for each increase in age of 10 years: OR, 1.23; 95% CI, 1.00-1.52; P =.052). Other significant covariates in the final model included cardiac disease (OR, 2.84; 95% CI, 1.18-6.86; P =.020), pulmonary disease (OR, 1.96; 95% CI, 1.35-2.84; P =.0004), and renal disease (OR, 2.57; 95% CI, 1.66-3.99; P =.0001). Increasing age was associated with a moderate increase in the rate of death (for each increase in age of 10 years: OR, 2.74; 95% CI, 1.22-6.16; P =.015) in a model with cardiac disease as the only significant covariate (OR, 14.67; 95% CI, 3.46-62.16; P =.0003). CONCLUSION: For patients undergoing elective AAR, increasing patient age is associated with a small increase in risk for in-hospital morbidity or mortality. However, significant cardiac, pulmonary, or renal disease is associated with a much greater risk of postoperative complications, and, therefore, advanced age should not be the sole basis of exclusion for otherwise suitable candidates for elective AAR.

Age Factors↗
PubMed1998

Risk of house staff tuberculin skin test conversion in an area with a high incidence of tuberculosis.

We prospectively evaluated rates of tuberculin skin test (TST) conversion from July 1992 to June 1997 among house staff in the Emory University Affiliated Hospitals Training Program following implementation of expanded infection control measures for tuberculosis at Grady Memorial Hospital (Atlanta), which cares for approximately 200 patients with tuberculosis per year. Over 5 years, documented TST conversions occurred for 52 (2.4%) of 2,144 house staff. Conversion rates decreased after the first 6 months from 5.98 to 1.09 per 100 person-years worked over the next 4.5 years (P < .001). Multivariate analysis revealed that risk factors for TST conversion included graduation from a foreign medical school and being part of the house staff in the Department of Medicine; race or ethnicity, gender, and age were not risk factors. Over the last 4.5 years, the TST conversion rate among U.S. medical school graduate house staff (n = 1,928) was 0.72 per 100 person-years worked, and there was no significant difference in conversion rates between house staff in the Department of Medicine and house staff in other departments. In summary, TST seroconversion rates decreased significantly following full implementation of expanded infection control measures for tuberculosis and were low (< 1% per year) among U.S. medical school graduates despite their caring for large numbers of patients with tuberculosis at an inner-city public hospital.

Female↗
PubMed1997

Laparoscopic management of gastroesophageal reflux disease.

This monograph provides a review of the contemporary surgical management of gastroesophageal reflux disease (GERD), drawing primarily on the experience at Emory University Hospital. We emphasize the importance of precise anatomic and physiologic preoperative evaluation to confirm the diagnosis of GERD, and stress technical aspects of laparoscopic fundoplication that have improved outcomes.

Fundoplication↗
PubMed1995

T-cell-rich B-cell lymphoma. A clinicopathologic study of eight cases.

Although T-cell-rich B-cell lymphoma (TCRBCL) is a recently recognized form of non-Hodgkin's lymphoma (NHL), limited information regarding its incidence, cellular origin, morphologic spectrum, and biologic behavior is currently available. In this study, the clinicopathologic features of eight patients with TCRBCL are presented. This neoplasm comprised about 1% of all NHLs seen at Emory University Hospital over 2 years. The male-to-female ratio was 1.6, and the mean age at diagnosis was 60 years. At presentation, TCRBCL was nodal in 88% of the patients and widely disseminated in 50% of the patients. A complete remission was seen in three of the five patients treated with combination chemotherapy that was directed at intermediate grade NHL. Three patients received inadequate or incomplete chemotherapy. One of these patients later achieved a complete remission with more intensive therapy. Two of the patients were not evaluable for response to therapy. The actuarial and disease-free survival rates of the group at 5 years were 72% and 21%, respectively. Morphologically, the lymph nodes in seven of eight cases were diffusely obliterated, whereas one had markedly expanded interfollicular zones that lead to an initial diagnosis of T-zone lymphoma. All tumors were characterized by no more than 25% large lymphoid cells, which were scattered in a background of small lymphocytes with round or irregular nuclei. The presence of numerous histiocytes imparted a lymphoepithelioid appearance in two cases. Although immunoperoxidase stains of frozen tissue were initially suggestive of a peripheral T-cell lymphoma in some cases, paraffin immunoperoxidase stains clearly established the B-cell nature of the large cells, whereas most of the small cells were T lymphocytes. The clonal nature of the large cells was confirmed in seven cases by monotypic immunoglobulin (Ig) light chain restriction or Ig gene rearrangements. Epstein-Barr virus genomic DNA was detected in two of the six cases tested by polymerase chain reaction or Southern blot analysis, but no evidence of a bcl-2 rearrangement was found in any of the five cases examined. These findings indicate that TCRBCL is an uncommon form of NHL with a therapeutic response and overall survival consistent with intermediate grade lymphoma. Paraffin immunoperoxidase stains and occasionally genotypic analysis are required to exclude the diagnosis of PTCL or diffuse lymphocyte predominant Hodgkin's disease. The authors found no morphologic or molecular evidence to support a follicular center cell origin in these cases of TCRBCL.

Adult↗
PubMed1999

Management of adolescent and adult inpatients with cystic fibrosis.

A program in which pharmacists help care for cystic fibrosis patients is described. The Egleston Cystic Fibrosis Center at Emory University houses outpatient clinic facilities and a 10-bed inpatient unit and is affiliated with Egleston Children's Hospital. The center provides full-service care for nearly 500 patients. Patients with mild to moderate exacerbations of pulmonary problems can receive their entire course of therapy at the center, and those with severe illness may complete their hospital stay there. A care team consisting of pharmacists, physicians, nurses, and others provides preventive and acute care. Patients can choose a "care partner" who will assist them with their care during any hospitalizations and at home. Both patient and care partner are taught drug administration, nutrition, and physical therapy and meet regularly with the care team. Patients must receive their medication education from a pharmacist before they can administer their own drugs. Pharmacists at the center also evaluate serum drug concentrations, stock the automated dispensing device, monitor for drug interactions, answer drug information questions, and attend multidisciplinary rounds. Pharmacy residents can work with the care team through rotations and clinic experience. Pharmacists at a cystic fibrosis center provide clinical services to patients and promote self-care.

Adolescent↗
PubMed1995

Guidelines for the prevention and treatment of B-virus infections in exposed persons. The B virus Working Group.

Cercopithecine herpesvirus 1 (B virus), enzootic among monkeys of the genus Macaca, causes minimal morbidity in its natural host. In contrast, human B-virus infection presents as rapidly ascending encephalomyelitis with a fatality rate of approximately 70%. This infection remains an uncommon result of macaque-related injuries, although the increase in the use of macaques for research on simian retrovirus infection and hepatitis has expanded the number of opportunities for human exposure. In response to this situation, Emory University and the Centers for Disease Control and Prevention jointly sponsored a B Virus Working Group to formulate a rational approach to the detection and management of human B-virus infection. The resulting guidelines are presented herein and are based upon information from published cases, unpublished cases managed by working-group members, knowledge of the behavior of herpes simplex virus, and--in the absence of hard data--the collective judgment of the group. Although consensus among the co-authors existed on the major points covered by these guidelines, opinions varied widely regarding specific recommendations.

Animals↗
PubMed1997

Cellulitis of the breast as a complication of breast-conserving surgery and irradiation.

Breast-conserving therapy (BCT) has become a standard treatment option for patients with early-stage breast cancer. We have observed cellulitis of the treated breast as a complication occurring before, during, and after breast irradiation. The cases of five women (median follow-up, 28 months; range, 24-65 months) who developed cellulitis before (n = 1), during (n = 2), or after (n = 2) breast irradiation were reviewed. A consecutive series of BCT patients at Emory University was reviewed to determine the incidence of this complication. Four of five women had an axillary dissection, yielding a median of 14 negative lymph nodes (range, 6-22 nodes). Two of four patients developed axillary seromas requiring aspiration. In these four patients, only the breast was irradiated. A fifth patient had no axillary dissection and had breast and supraclavicular/axillary irradiation. The median whole breast dose was 50 Gy (range, 46-50.4 Gy). The clinical features of cellulitis included erythema, edema, tenderness, and warmth in all patients. Cellulitis was a relapsing problem for four of the five patients. The incidence of this complication in our series of BCT patients was approximately 1%. Cellulitis in the ipsilateral breast can be a relapsing complication of BCT and can be seen before, during, or after breast irradiation. Axillary seromas and aspiration seem to indicate a subset of patients at risk of early cellulitis. Late cellulitis may be caused by a variety of factors related to modifications of vascular and skin integrity by surgery and radiotherapy. Prompt diagnosis and appropriate antibiotic therapy is recommended. This problem need not interrupt a course of breast irradiation, and does not necessarily lead to a poor cosmetic result.

Adult↗
PubMed1998

Emerging and reemerging infectious diseases: a multidisciplinary perspective.

Predictions that infectious diseases would be eliminated as a major threat to human health have been shattered by emerging and reemerging infections, among them acquired immunodeficiency syndrome (AIDS), hemorrhagic fevers, marked increases in infections caused by antimicrobial-resistant bacteria, and the resurgence of tuberculosis and malaria. Understanding the dynamics of emerging and reemerging infections is critical to efforts to reduce the morbidity and mortality of such infections, to establish policy related to preparedness for infectious threats, and for decisions on where to use limited resources in the fight against infections. In order to offer a multidisciplinary perspective, 23 infectious disease specialists, epidemiologists, geneticists, microbiologists, and population biologists participated in an open forum at Emory University on emerging and reemerging infectious diseases. As summarized below, the group addressed questions about the definition, the identification, the factors responsible for, and multidisciplinary approaches to emerging and reemerging infections.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Resistance to antimicrobial chemotherapy: a prescription for research and action.

The growing problem of resistance to antimicrobial chemotherapy was discussed by participants at the February 1995 workshop at Emory University on population biology, evolution, and control of infectious diseases. They discussed the nature and source of this problem and identified areas of research in which information is lacking for the development of programs to control of the emergence and spread of resistant bacteria. Particular attention was given to theoretical (mathematical modeling) and empirical studies of the within and between-host population biology (epidemiology) and the evolution of microbial resistance to chemotherapeutic agents. Suggestions were made about the kinds of models and data needed, and the procedures that could be employed to stem the ascent and dissemination of resistant bacteria. This article summarizes the observations and recommendations made at the 1995 meeting and in the correspondence between participants that followed. It concludes with an update on the theoretical and empirical research on the between- and within-host population biology and evolution of resistance to antimicrobial chemotherapy most of which has been done since that meeting.

Bacteria↗
PubMed1975

The surgical treatment of unstable angina pectoris.

Since the advent of saphenous vein bypass grafting as successful means of myocardial revascularization, a variety of coronary artery disease syndrome have come under surgical attack. The proper role of surgery in many of these coronary syndromes remains ill-defined. However, clear indications for surgical revascularization exist in patients with unstable angina pectoris, i.e., progressive angina and onset of rest pain and noctural angina in spite of adequate medical therapy. An analysis has been made of 100 consecutive patients with unstable angina pectoris who underwent myocardial revascularization over the past 2 years at the Woodruff Medical Center of Emory University. Included in this group are the following subgroups: 1) Emergency cases with pre-infarction angina (including Printzmetal angina); 2) Cases of combined valvular heart disease and coronary artery disease; and 3) Advanced coronary artery disease with certain complications of previous myocardial infarction. A discussion of the relative merits of saphenous vein grafts and internal mammary artery anastomoses is presented and indicates that the technique selected should be determined by the quality of the distal native coronary circulation. Surgical mortality and morbidity figures, patency rates of saphenous vein grafts and internal mammary artery anastomoses visualized postoperatively, and the number of patients wiht dramatic relief of angina pectoris in this series support current enthusiasms for available surgical techniques for myocardial revascularization.

Adult↗