Patients have few emotional difficulties or disturbances of QoL after emergency or elective repair of AAA. Survivors after repair of ruptured AAA can expect as good a quality of life as those operated on electively. These results support an aggressive approach to the treatment of ruptured AAA.

No abstract

Little is known about hepatic T lymphocyte subpopulations in the human liver. The aim of this study was to document the various subpopulations present in the liver and compare them to peripheral T lymphocytes in the same patients. Normal hepatic tissue was obained at time of transplant from five patients, and a single cell suspension of lymphocytes were prepared by standard methods. Ceils were stained with monoclonal antibodies specific for CD8ct and CD8B chains, CD4, CD8, CD3, o~BTCR, and ySTCR, and analyzed by two and three colour flow cytometry. Of the hepatic CD3+ cells, 71% were CD8+ and 25% were CD4+, with a CD4/CD8 ratio of 1:3 in contrast to the peripheral CD4/CD8 ratio of 2:1.18% of the hepatic CD3+ cells expressed ySTCR. Significantly, CD8~ct accounted for 27% [mean] of the total hepatic CD8+ population. Conclusion: There is now evidence that the adult human gut can support extrathymic T cell differentation. A significant population of hepatic CD8txct cells would suggest that the liver is also a site of extrathymic differentiation, which may have important implications for the understanding of autoimmunity and graft tolerance.

No abstract

Patients were eligible if they presented within 24 hours of suspected acute myocardial infarction with no clear indications for, or contraindications to, the study treatments (although planned use of a few days of intravenous or oral nitrates was permitted). About 40% were within 6 hours of pain onset. 75% had ST elevation, 25% were aged 70% 15% had heart failure, and 2% had systolic blood pressure < 100 ramHgPatients were randomly allocated in a 2 x 2 x 2 factorial design between one month of oral captopril (6.25 mg initial dose, 12.5 rag 2 hours later, 25 mg 10-12 hours later and then 50 mg twice daily) versus placebo, one month of oral controlled-release isosorbide mouonitrate (lmdur: 30 mg initial dose, 30 mg 10-12 hours later and then 60 nag each morning) versus placebo, and 24 hours of intravenous magnesium sulphate (8 raraol initial bolus over 15 minutes followed by 72 mmcl)'versus open control. About 75% received fibrinolytic and almost all antiplatelet therapy.The main comparisons are to be of 5-week and longer-term mortality amongst all those allocated each active therapy versus all those allocated the corresponding control. Principal subsidiary comparisons involve subdivisun by planned nitrate at entry and by the other randomly allocated treatments. Mode of death and major morbidity results will also be considered. The decisions by a single cardiologist as to which of 308 consecutive patients to refer for angiography after treadmill testing were compared with their life expectancy gains from bypass surgery predicted by decision analysis. Neither patient age nor gender influenced the decision to perform angiography. The 94 patients sent for angiograms exercised for a significantly shorter time (p < 0.001 ), had more ST deviation (p < 0.001 ), more angina (p < 0.002) and were more likely to have had a prior myocardial infarction (p < 0.001) than the 214 patients not referred. The mean life expectancy gain predicted from bypass surgery was also greater (p < 0.001) in those referred (2.9 + 1.7 QALYs) than in those not referred for angiography (I.0 + 1,7 QALYs). However, 1~.3 patients not referred were predicted to gain up to 5.7 QALYs from bypass surgery. Consequently the overall predicted life expectancy gain from the cardiologist's 388 intuitive decisions was only 0. I + 2.5 QALYs per patient. Had the referral decision been solely directed by decision analysis the overall gain per patient would have been 1.9 4-1.6 QALYs, and 135 extra patients (229 in total) would have been sent for angiography. Use of decision analysis, therefore might help make referral for angiography more efficient and consistent. Persistent chest pain with normal cardiac investigations is not uncommon following treatment of coronary artery disease. Oesophageal problems are often suspected but to date evaluation has proved difficult. Eight patients who had previously undergone successful coronary artery bypass grafting or coronary angioplasty underwent 24hr ambulatory manoraetry, pH and ECG monitoring. Symptoms were correlated with ...