Months Of Follow-up Study Research Articles

A Prospective Multicenter Study of Hepatocellular Carcinoma in Italian Hemophiliacs With Chronic Hepatitis C

AbstractTo assess the risk factors, natural history, and eligibility for curative treatment of early-detected hepatocellular carcinoma (HCC), 385 hemophiliacs who were treated with blood or plasma derivates for at least 10 years and had persistently elevated aminotransferase values underwent an annual screening with an abdominal ultrasound examination and measurement of the serum alpha-fetoprotein (AFP) level. Of these, 355 had serum antibody to hepatitis C virus (anti-HCV), 29 had anti-HCV and hepatitis B surface antigen (HBsAg), and one had HBsAg alone; 141 had serum antibody to human immunodeficiency virus (anti-HIV). During 48 months of follow-up study, six patients developed HCC. All HCC patients had a HCV-related cirrhosis and had been exposed to HCV risk at a median age of 40 years. All patients had a multicentric tumor, which was not eligible for curative treatment. Univariate analysis showed age, cirrhosis, and baseline AFP levels to be significantly associated with an increased risk of HCC. By multivariate analysis, the risk of HCC was infinite in patients with cirrhosis, 31.0 for those with baseline AFP higher than 11 ng/mL, and 17.9 for those more than 45 years of age. In conclusion, the risk of cancer was greater for patients infected later in life, particularly those with cirrhosis and high AFP. Annual screening of hemophiliacs with ultrasound and AFP fails to identify potentially curable tumors because the diagnosis is made at a late stage of the disease.

Analysis of the efficacy and safety of naloxegol administered to patients with cancer and opioid-induced constipation with laxative-inadequate response: A real-world 12 months of follow-up study.

e24155 Background: Naloxegol is a peripherally acting, µ-opioid receptor antagonist for treatment of opioid-induced constipation (OIC). The main objective of this study was to analyze the efficacy and safety of naloxegol in patients with cancer in a real-world 12-month follow-up study. Methods: An observational prospective study was conducted in 16 Spanish centers. Patients older than 18 years, with active oncological disease who were under treatment with opioids for pain control and Karnofsky ≥ 50 were selected. OIC with inadequate response to treatment with laxative (s) was the main diagnostic. All the patients received treatment with naloxegol according to clinical criteria. Efficacy was measured by the response rate and symptoms evolution measured by means of PAC-SYM questionnaire. Intensity of pain was measured by a 0-10-point visual analogue scale (VAS). Intent to treat last observation carried forward was applied. Results: A total of 126 patients were included in the study. About 58.7% were men, with a mean age of 61.5 years (34-89). Lung cancer was observed in 35.7%, breast cancer in 16.7%, 10.3% digestive cancer and 8.7% had prostate cancer. About 67.5% had metastases. Naloxegol at doses of 25 mg/day was administered to 88.1% and with concomitant laxatives in 48.4%. At 12 months, 77.8% of the patients were responders to naloxegol treatment: 78.6% at doses of 12.5 mg/day, and 78.4% with 25 mg/day. Furthermore, response was observed in 78.5% of patients without concomitant laxative treatment and 77% of patients with any concomitant laxative. PAC-SYM total score and all the dimensions improved from baseline (p < 0.0001). VAS pain intensity was reduced and controlled from baseline onwards (Baseline-12 months: 4.6 to 3.6, p < 0.001). A total of 28 adverse reactions mainly gastrointestinal were observed in 15.1% of the patients (19/126), 75% (21) mild, 17.9% (5) moderate and 7.1% (2) severe. Most adverse reactions (67.9%) were observed the first 15 days of treatment with naloxegol. Conclusions: The results of this first real-world-data study in patients with cancer confirm the long-term efficacy of naloxegol for the treatment of OIC in this group of patients. Naloxegol is safe and well tolerated in patients with cancer while maintaining pain control.

ENDOSCOPIC SUBMUCOSAL DISSECTION AS CHOICE OF TREATMENT OF EARLY GASTRIC CANCER

The authors evaluated the efficacy of endoscopic submucosal dissection in treatment of early gastric cancer. The study included 60 patients who underwent endoscopic submucosal dissection in cases of differentiated early gastric cancer. RESULTS. The radical surgeries were performed on 59 (98,3%). Complications were noted in 9 (14,9%) of cases and they were removed by endoscopic method. The early recovery period consisted of 24 hours. There weren’t observed any local recurrence or progression of the disease during 6-48 months of follow-up study. The method efficacy was 98,3%. The authors have taken into account the results of the study and a literature analysis. Endoscopic submucosal dissection is the choice of treatment strategy in case of early gastric cancer T1aN0M0 and T1bN0M0 in differentiated adenocarcinoma. The method is highly effective and relatively safe. This approach corresponds with oncological principles of radicalism, thus it reduces the rate of postoperative complications and the period of social rehabilitation of patients. The surgery maintains the high quality of life after treatment without decline of long term results.

Pedal bypass with deep venous arterialization: the therapeutic option in critical limb ischemia and unreconstructable distal arteries

Heavily calcified and severely stenotic distal arteries defined as unreconstructable, precludes the possibility of revascularization, resulting in major amputation in patients with critical limb ischemia. However, providing blood supply to the ischemic foot through the venous system instead of the arterial system may improve the circulation adequately for the healing process in the vascular compromised distal tissue. This study aimed to assess the safety and efficacy of pedal bypass with deep venous arterialization, one of the possible procedures to improve the circulation through the venous system in critically ischemic limbs and unreconstructable distal arteries. Twenty-six patients with critical limb ischemia and an unreconstructable distal artery of the lower extremities were included for the surgical procedure. Arterial bypass with distal anastomosis at the paramalleolar deep vein was carried out through a composite graft combined with adequate destruction of valve competency in the distal vein. The primary endpoint was complete healing of ischemic ulcer with amelioration of rest pain within six months. The secondary endpoints were the outcomes of survival, limb salvage and primary graft patency rate at six-month intervals to 24 months. Nineteen patients (73.1%) had complete healing of ischemic ulcer and disappearance of rest pain within six months. Six patients (23.1%) underwent major amputation. Perioperative mortality was 3.8%. After 24 months of follow-up study, the survival rate was 87.5%, whereas the limb salvage and graft patency rates were 76.02 and 49.17%, respectively. Pedal bypass with deep venous arterialization may be another therapeutic option to enhance the healing of ischemic ulcer and limb salvageability in patients with critical limb ischemia and unreconstructable distal artery.

Overfeeding in identical twins: 5-year postoverfeeding results

From a total of 12 pairs of young male identical twins who were overfed by an estimated 84,000 kcal over a period of 100 days, several pairs (eight to 11, depending on variables) were remeasured for body weight, body composition with the underwater weighing technique, regional fat distribution from skinfolds, girths, computed tomography (CT) fat areas in the abdominal region, and fasting plasma glucose, insulin, total cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides 4 months and 5 years after completion of the overfeeding protocol. At 4 months, the twins had lost approximately 7 of 8 kg that they had gained with overfeeding. However, 5 years later, body weight had increased by 5 kg over the preoverfeeding level. Fluctuations in fat mass were greater than those in fat-free mass. The younger twins gained approximately twice as much as the older twins in the late recovery period, a difference attributed to the late phase of growth in body mass in the former. Upper-body fat was reduced at 4 months of follow-up study, but was increased in the late recovery phase. All blood values were normalized in the postoverfeeding periods. A within-pair resemblance was generally observed for the changes noted in the recovery periods, but it was more striking when variations between preoverfeeding and 4-month or 5-year values were considered. We conclude from these observations that there were no persistent effects of exposure to the overfeeding protocol over the expected age-associated increases in body mass, body fat, upper-body fat, abdominal visceral fat (AVF), and metabolic variables predictive of risk for common diseases in individuals of normal body weight and with no family history of obesity. The intrapair resemblance suggests that the genotype contributes to the alterations observed in the recovery from overfeeding and in the age-associated changes.

Relationship among self-esteem, internal-external locus of control, and weight change after participation in a weight reduction program.

This report covers 15 to 47 months of follow-up study of 66 obese women who participated in a 10-week weight reduction program. Subjects were divided into three self-esteem groups and into two groups of "internal" and "external" subjects. The average weight regain during the follow-up period was 3.1 kg, although all subjects remained below their pretreatment weight. The higher the self-esteem score, the lower the average weight regain during follow-up (1.7 kg, 2.6 kg, and 3.5 kg, respectively). For internals the average weight regain was 1.8 kg and for externals 3.4 kg. Implications are discussed, and suggestions for improved weight reduction programs are presented.

Radiofrequency catheter ablation of incessant, medically resistant supraventricular tachycardia in infants and small children

Objectives. This study retrospectively evaluates initial experience with radiofrequency catheter ablation in a group of seven infants and small children with a history of incessant, medically resistant supraventricular tachycardia.Methods. Before attempted catheter ablation, all patients had had unsuccessful conventional medical therapy (with digoxin or propranolol, or both) and, in addition, each continued to have daily episodes of supraventricular tachycardia while taking amiodarone or a class IC antiarrhythmic agent alone or in combination. The average patient age was 10 months (range 1 to 27) and the average patient weight was 6 kg (range 3 to 13). Electrophysiologic diagnosis included reentrant supraventricular tachycardia in six patients and atrial ectopic tachycardia in one patient.Results. These seven patients underwent a total of nine catheter ablation procedures. The atrial approach to ablation was employed in eight of the nine procedures. Overall, radiofrequency catheter ablation was totally successful in five of the seven patients, partially successful in one patient and unsuccessful in the remaining patient. The combination of radiofrequency catheter ablation and surgical ablation was successful in controlling tachycardia in all patients; with at least 5 months of follow-up study, no patient has had a recurrence of supraventricular tachycardia or reappearance of a delta wave.Conclusions, Surgical ablation of arrhythmogenic substrates in the pediatric age group, although rarely indicated, has been found in the past to be safe and effective. Our initial experience with radiofrequency catheter ablation in infants and small children demonstrates that this procedure is a promising nonpharmacologic therapeutic alternative to surgical ablation.

Constrained total elbow arthroplasty

In 1972, the senior author designed a condylar-sparing constrained hinge elbow prosthesis with a high-density polyethylene bushing. The condylar-sparing design allows both intercondylar and intramedullary fixation of the humeral component with methylmethacrylate cement. Reattachment of the muscles and collateral ligaments to the preserved condyles provides further stability. The clinical experience spans more than 16 years in 42 elbows with a relatively low loosening rate of 7%. The implant was removed and not replaced in three elbows: one for late infection, one for posttraumatic comminuted fracture of the distal humerus, and one for loosening of a humeral component. A series of 27 patients (31 elbows) with 24–204 months of follow-up study (average, 77 months) had excellent pain relief and an average range of motion of 129° flexion, −44° extension, 69° pronation, and 61° supination.

Indications for modification of coexisting dual atrioventricular node pathways in patients undergoing surgical ablation of accessory atrioventricular connections

Concomitant susceptibility to atrioventricular (AV) node reentrant tachycardia has been demonstrated in certain patients having reentrant tachycardia utilizing accessory AV connections. For those patients undergoing accessory connection ablation, AV node surgical modification may be warranted during the same operative procedure. To assess indications for a combined operative procedure, this study evaluated potential predictors of subsequent spontaneous AV node reentrant tachycardia in patients undergoing ablation of accessory AV connections.Among 62 consecutive patients undergoing surgical ablation of an accessory AV connection, 13 (21%) manifested dual AV node pathways. The latter were identified preoperatively in five patients (four with concealed and one with bidirectional accessory connections) and postoperatively in seven (all seven with bidirectional accessory connections). In one patient with a bidirectional accessory connection, dual AV node pathways could not be demonstrated preoperatively, but AV node reentrant tachycardia was induced. Operative ablation of an accessory connection was successful in all patients. However, postoperatively, 2 of the 13 patients had inducible AV node reentrant tachycardia, 5 had AV node “echo” beats and 6 had no inducible arrhythmia.During 26 ± 7 months of follow-up study, the two patients with inducible AV node reentrant tachycardia postoperatively had symptomatic AV node reentrant tachycardia. In addition, the one patient with inducible AV node reentrant tachycardia preoperatively had recurrence of this tachycardia 4 months after attempted surgical modification of the AV node. Consequently, although dual AV node pathways appear to be common in patients undergoing surgical ablation of an accessory AV connection (21%), only a small group (3 of 13) of these patients are at risk for subsequent clinical AV node reentrant tachycardia.The presence of dual AV node pathways either alone or in conjunction with AV node echoes does not predict occurrence of AV node reentrant tachycardia. However, induction of sustained AV node reentrant tachycardia appears to be associated with a greater likelihood of spontaneous symptomatic tachycardia and therefore warrants consideration of AV node modification at the time of surgical ablation of an accessory connection.

Threaded acetabular components for primary and revision total hip arthroplasty

A clinical and radiographic review of 48 total hip arthroplasty patients with threaded acetabular components was undertaken at 24–44 months of follow-up study. Twenty-five patients had primary hip arthroplasties and 23 had revision procedures. Clinical scores revealed good to excellent results in 60% of primary and 30% of revision procedures. Radiographic analysis revealed stable acetabular components in 88% of primary and 61% of revision procedures. Potentially loose acetabular components were noted in 8% of primary and 4.3% of revision procedures and loose acetabular components in 4% of primary and 34.7% of revision procedures. The rate of acetabular component loosening was considered unacceptably high in revision cases and an area of concern in primary cases. Discretionary use of these components is advised.

Predictive value of electrophysiologic studies during treatment of ventricular tachycardia with the beta-blocking agent nadolol

Sixty patients with recurrent inducible sustained ventricular tachycardia were prospectively treated with nadotol (40 or 80 mg/day). Old myocardial infarction was present in 43 patients and dilated cardiomyopathy in 12. In group I (n = 36), nadolol was given alone, whereas in group II (n = 24), previously ineffective treatment with amiodarone was continued in combination with nadolol. Left ventricular ejection fraction was higher in patients in group I (0.40 ± 0.12) than in group II (0.30 ± 0.10, p < 0.01) patients. Electro-physiologic study was repeated after short-term treatment with nadolol, which was continued regardless of the results of this test, according to the scheme of the parallel approach.Recurrence of spontaneous tachycardia or sudden death occurred in 21 patients after 10 ± 9.2 months; sustained tachycardia was inducible in 19 on nadolol therapy. The remaining 39 patients (of whom 21 had inducible tachycardie while taking the drug) have had no recurrence of tachycardia after 27.8 ± 9.3 months of follow-up study. Sensitivity, specificity and predictive value of a positive and negative test were 90.5%, 46%, 47.5% and 90%, respectively. The results diner between group I and group II patients, the latter having a high percent of false positive responses. This difference is even more obvious with respect to left ventricular ejection fraction: the predictive value of a positive test was 86% when ejection fraction was >0.40 and 39% when it was < 0.40. A long (>400 ms) cycle length of the induced ventricular tachycardia seems more predictive of recurrence or sudden death (11 of 14 compared with 9 of 26 faster tachycardias, p < 0.01).Electrophysiologic studies are suitable for evaluation of the antiarrhythmic effect of a beta-blocker on the ventricular tachycardia substrate, with the same restrictions as for other drugs in patients with low left ventricular ejection fraction. A beta-blocker should be included in serial drug testing in patients with sustained ventricular tachycardia.

Experience with the Hemasite vascular prosthesis.

A 3-year experience with the no-needle vascular prosthesis Hemasite, implanted in 10 patients who underwent hemodialysis and have a long history of multiple vascular access failures, is described. During 182 months of follow-up study, 30 thromboses occurred, while nine of 10 patients did not receive any antiplatelet aggregant treatment. Hemasite was declotted 12 times with a local infusion of urokinase and 12 more times by thrombectomy. A surgical procedure was performed only in the other cases, and the rate of surgical intervention fell from 0.18 interventions per patient per month before Hemasite implantation to 0.027 after implantation.

Cefazolin Versus Cefamandole for Prophylaxis During Total Joint Arthroplasty

A prospective, randomized, double-blind comparison of cefazolin versus cefamandole was carried out to evaluate safety and efficacy and to determine bone and serum antibiotic concentrations in patients undergoing total joint arthroplasty. Dosages were 1 g of cefazolin before surgery followed by 500 mg every eight hours for six doses, versus 2 g of cefamandole before surgery followed by 1 g every eight hours for six doses. Intraoperative doses were given during prolonged procedures. No significant adverse drug reactions were clearly attributable to either drug. Among 48 patients receiving cefazolin there was one postoperative wound infection and one distant site infection. Among 49 patients receiving cefamandole, there were two postoperative wound infections and two distant site infections. No deep wound infections occurred in either group during at least 48 months of follow-up study. In hip specimens removed at surgery, the mean antibiotic concentrations were 1.6 +/- 1.4 micrograms/g for cefazolin recipients, compared with 5.7 +/- 5.9 micrograms/g for cefamandole recipients (p less than .001). In knee specimens, the mean antibiotic concentrations were 0.64 +/- 0.57 microgram/g for cefazolin recipients compared to 3.8 +/- 3.4 micrograms/g for cefamandole recipients (p = .004). Cefazolin given at one-half the dose of cefamandole appeared to be equally safe and effective but resulted in lower bone concentrations of antibiotic.

Results of Transtrochanteric Rotational Osteotomy for Femoral Head Osteonecrosis

Eighteen transtrochanteric rotational osteotomies have been performed in 17 patients for femoral head osteonecrosis (15 patients, Ficat Stage III disease; three patients, Ficat Stage IV disease) during a 51-month period and have 18 to 63 months of follow-up study. The best results were in the posttraumatic and nonsteroid-associated idiopathic cases in patients with small necrotic segments in the weight-bearing region, with no degenerative changes. Failures occurred in patients with large necrotic fragments, preexisting degenerative changes, and steroid- and alcohol-associated etiologies. Although joint arthroplasty was eventually required in ten hips, a period of temporization was achieved sufficient to bring them into the era of cementless hip arthroplasties. Indications for this operation should be restricted to those patients under 40 years of age with late Ficat Stage II or Stage III disease, in which the articular involvement in the lateral roentgenogram is 50% or less.

Immediate and short-term benefit of multilesion coronary angioplasty: Influence of degree of revascularization

The safety and short-term therapeutic benefit of multilesion percutaneous transluminal coronary angioplasty was assessed in 135 patients, 66 of whom had a minimum of 6 months of follow-up study. Primary success, defined as successful dilation of the most critical lesion or all lesions attempted without major in-hospital complications was obtained in 117 (87%) of the 135 patients. Cardiac complications associated with the procedure were uncommon; prolonged angina occurred in 5% and myocardial infarction in 3%; emergency coronary bypass surgery was performed in 4% of the patients. There were no deaths. Complete revascularization was achieved in 46% of the 117 patients with a primary success. Of the 66 patients eligible for 6 month follow-up, 80% had an uncomplicated course and required no further procedures. Clinical improvement by at least one angina functional class was observed in 90% of the patients. Cardiac events such as the need for a second revascularization procedure were significantly more common in patients who had incomplete versus complete revascularization (35 versus 9%; p = 0.018). Repeat coronary angiography performed an average of 5 months after angioplasty revealed restenosis in 18 of 22 symptomatic patients and 3 of 9 asymptomatic patients. Restenosis occurred at the site of a single dilation in 12 patients, at two sites in 8 patients and at three sites in 1 patient. Thus, multilesion coronary angioplasty is an important therapeutic option for selected patients with multivessel disease and can be performed with relatively low risk. Improvement in angina status can be expected even in patients who have incomplete revascularization.(ABSTRACT TRUNCATED AT 250 WORDS)

The Use of Allografts to Reconstruct Intercalary Defects of Long Bones

The problems involved in the use of freeze-dried and fresh frozen allografts in the reconstruction of large bony defects were caused by the treatment of a variety of conditions. Twenty-four patients served as a basis for the review with an average of 34.7 months of follow-up study. Fifteen of these patients had, in addition, massive supplemental autografts. Rigid internal fixation consisting of either an intramedullary fluted rod or some combination of AO plate fixation was used in most cases, except in one instance in which no internal fixation was used. There was no difference in the time to incorporation of the freeze-dried and fresh frozen allografts into the host bone bed. No appreciable differences were noted in the group that had massive supplemental autografts, except that there was improvement in the quality of the union. The average time to radiographic union was 14 months. The complication rate in this series of patients was 54%. Most of the complications were minor and resolved with little residual. The overall results produced nine excellent, eight good, three fair, and four poor results. Considering the magnitude of the procedures involved, allografts appeared to have a distinctive place in the surgeon's armamentarium for reconstruction of large bony defects.

Early Motion with Cast-Brace After Modified Coventry High Tibial Osteotomy

The records of 31 patients who were treated by a modified Coventry high tibial osteotomy were reviewed, and the early results of postoperative management with a cylinder cast were compared with those with early motion in a cast-brace. Thirteen patients (15 knees) who had immobilization in a cylinder cast after surgery for an average of 44.3 days had lost a mean of 10 degrees of flexion at three months of follow-up study. Their average total hospitalization was 15.5 days. Eighteen patients (19 knees) treated by early motion in a cast-brace had not lost any preoperative flexion at three months of follow-up study. The two most recent of these patients received continuous passive motion in the immediate postoperative period. The average total hospitalization for this group was 10.7 days. One patient in the cast-brace group had a significant loss of correction at the osteotomy site during healing. Eleven of the patients treated by a cylinder cast (84.6%) and 17 of the patients managed with a cast-brace (94.4%) stated that they had been improved by the surgery at this early stage. There were no nonunions or loss of internal fixation in either of the two groups. Early motion in a cast-brace (with a continuous passive motion machine, if available) is safe and is comfortable for and well accepted by patients.

Activation mapping in patients with coronary artery disease with multiple ventricular tachycardia configurations: Occurrence and therapeutic implications of widely separate apparent sites of origin

Catheter or intraoperative activation mapping studies, or both, were performed in 17 patients with coronary artery disease with two to four distinct configurations of ventricular tachycardia, resistant to a mean of 12.1 +/- 6.0 antiarrhythmic drug trials per patient. Mapping studies were performed to guide anticipated surgical ablation of arrhythmias. Activation map data were adequate to determine sites of origin of 30 (64%) of 47 observed tachycardia configurations. These 30 ventricular tachycardias (26 observed clinically) were mapped to 22 separate endocardial sites of origin. Sites of origin of distinct tachycardias were identical or closely adjacent (within 3 cm) in six patients and widely separate (greater than or equal to 4 cm) in eight patients (47% of the group). Activation maps were not adequate to determine sites of origin of 17 (36%) of the 47 tachycardias, including all configurations in three patients. Fifteen patients underwent surgery for control of ventricular tachycardia: aggressive, map-guided endocardial resection (mean 26.5 +/- 14.2 cm2) in 12 patients with identified sites of tachycardia origin and extensive resection of visible endocardial scar (2 patients) or encircling endocardial ventriculotomy (1 patient) in those in whom the sites of origin of all clinical tachycardias remained undetermined. Two inoperable patients were treated with amiodarone. During postoperative electrophysiologic tests (11 of 13 surgical survivors), ventricular tachyarrhythmias were initially uninducible in only 4 of 11 patients. However, in two patients only nonclinical arrhythmias (ventricular flutter) were induced. Six (21%) of 29 clinical tachycardias whose sites of origin were either not determined or not resected (right septum or papillary muscle) remained inducible in five patients. Using previously ineffective antiarrhythmic drugs, initially inducible arrhythmias became uninducible (two patients), or harder to induce than preoperatively (five patients). As a result of surgical resections alone or in combination with previously ineffective drugs (and amiodarone in two inoperable patients), there were no recurrences of ventricular tachycardia in 14 (93%) of 15 patients discharged during 19.0 +/- 14.3 months of follow-up study. Thus, activation mapping may commonly reveal separate apparent sites of origin for clinically observed, morphologically distinct, highly drug-refractory ventricular tachycardias in patients with coronary artery disease with multiple tachycardia configurations. Extensive surgical resection of identified sites of origin may be required to ablate arrhythmias in these patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Surgical versus medical therapy for treatment of unstable angina: Changes in work status and family income

Employment and income status of 96 patients randomized into the Alabama portion of the National Cooperative Unstable Angina Study were evaluated before the patients' admission to the study and in 1977. All patients had at least 12 months of follow-up study (mean 38 months). The ratio of patients fully employed at the time of follow-up to those fully employed at entry into the study (baseline) was 0.68 for medically treated patients, 0.53 for surgically treated patients and 0.53 for patients in whom medical therapy failed and who later underwent operation. The changes in annual family income were +$1,111 for medical patients, −$2,447 for surgical and +$875 for those later undergoing surgery. Regression analysis revealed that nonwork income, initial work status, initial income, severity of angina while the patient was in the unstable angina study and the procedural variable (that is, persistent medical, early surgical or late surgical treatment) were associated with return to full-time employment. Changes in family income were related to change in work status, the procedural variable, the patient's education, initial work status, the spouse's income, occurrence of a myocardial infarction after entry into the unstable angina study, duration of angina before entry into the unstable angina study, marital status and sex. Patients who underwent initial surgery had the largest reduction in family income, related to the change in nonworking status at the time of follow-up interview.

Second attacks of acute glomerulonephritis

The cases of 12 Negro children with two clinically and histologically similar attacks of acute glomerulonephritis are reported. The absence of clinical and histologic evidences of chronic glomerulonephritis during a period of 6 to 108 months of follow-up study is emphasized. Lobular mesangial hyperplasia constituted the major persistent histologic abnormality; focal thickening of Bowman's capsule was less frequently observed. The cases of 12 Negro children with two clinically and histologically similar attacks of acute glomerulonephritis are reported. The absence of clinical and histologic evidences of chronic glomerulonephritis during a period of 6 to 108 months of follow-up study is emphasized. Lobular mesangial hyperplasia constituted the major persistent histologic abnormality; focal thickening of Bowman's capsule was less frequently observed.