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Over a 25-year period 29 patients underwent 49 vascular procedures due to arterial insufficiency or vascular complications caused by Takayasu's arteritis. In bypass operations 36 grafts were inserted. The 5-year patency rates were 53% when grafts were used for patients with the active disease stage and 88% during the inactive disease stage (p = 0.059). The material of the graft, or postoperative warfarin or platelet-inhibitor drug treatment administered for at least 3 postoperative months had less bearing on graft patency. Ten out of the 11 graft occlusions occurred within the first 2 postoperative years. In operations due to lesions of the brachiocephalic arteries (20 patients), bypass procedures appeared to be superior to thromboendarterectomies; 67% (20/30) of the grafts and 17% (1/6) of the thromboendarterectomies remained patent. Five hypertensive patients underwent surgery because of renal artery stenosis. Hypertension was cured in one patient and in another the antihypertensive regimens could be reduced. There were 2 operative deaths, one due to myocardial infarction after aortic valve replacement and the other due to cerebral hemorrhage, probably because of excessive blood flow resulting from the insertion of an aorto-bicarotid bifurcation bypass graft. Four of the 7 late deaths occurring nine months to 15.7 years postoperatively were considered to be related to Takayasu's arteritis.

During a 10-year period, intraparenchymal aneurysms were found in 38 of 748 patients at selective abdominal angiography with magnification technique. According to strict criteria, 17 patients were classified as suffering from necrotizing vasculitis of the polyarteritis nodosa group (PAN), 7 from severe arterial hypertension, and 3 from rheumatoid arthritis. The diagnoses of 5 patients remained to be confirmed, and each of the remaining 6 patients suffered from various other diseases. PAN was diagnosed histopathologically in 2 patients without angiographic aneurysms. Based on the 156 patients in whom the indication for angiography was suspicion of arteritis, the angiographic diagnosis of PAN had a sensitivity of 89 percent and a specificity of 90 percent, a positive predictive value of 55 percent and a negative predictive value of 98 percent. The mean number of both renal and hepatic aneurysms was higher in patients with PAN than in the other patients (p < 0.01 and p < 0.05, respectively). Five PAN patients had numerous and large aneurysms, whereas the aneurysms of the other 12 PAN patients did not differ from those of patients with other diseases. Patients with PAN had renal infarcts more often than the other patients (p < 0.05). Our findings suggest that visceral angiography is useful in establishing the diagnosis of PAN, but the angiographic finding of aneurysms is not pathognomonic.

Summary: Even at low doses, alcohol has been reported to impair left ventricular pump function. To characterize further the effects of alcohol on the normal cardiovascular system, using the Swan-Ganz thermodilution catheter, we studied 6 healthy physicians, aged 27-36 years, while they were lightly intoxicated. Within a period of 30 min the subjects ingested 0.5 g/kg of ethanol diluted to 15% (w/v) in fruit juice. Hemodynamic measurements were obtained before the first ingestion and every half-hour thereafter for 2 hours. A peak blood ethanol concentration (meanfSE) of 13.3k1.6 mmol/l (0.61 nig/dl) was recorded at 60 min. Unexpectedly, pulmonary artery pressure rose during the early part of the increasing blood ethanol phase, probably due to pulmonary vascular constriction. At 30 min. the systolic pulmonary artery pressure had increased by 10% (p

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