Citations

The hazard of rupture of asymptomatic splenic artery aneurysms in preg nancy is well known. Arterial dysplasia is an important etiologic basis of splenic artery aneurysms in women of child-bearing age, as exemplified by the two cases described. In one patient, multiple splenic artery aneurysms oc curred in association with hypoplasia of the aorta and visceral arteries. In another patient, a false aneurysm of the splenic artery occurred with coexisting fibromuscular dysplasia of the renal arteries.

Background: Although angina is a chronic disease, most clinical trials evaluating antiangi nal therapy are of a few weeks or months in duration. Methods and Results: To evaluate the effects of nicardipine, a second-generation dihydro pyridine calcium channel blocker, as long-term therapy, patients with chronic stable angina were treated for 1 year with open-label nicardipine. Anginal symptoms were controlled with 20 mg tid in 24%, 30 mg tid in 34%, and 40 mg tid in 42%. Of 72 patients completing the 1-year trial, only 14 (19%) had required the addition of long-acting nitrates for control of symptoms. The remaining 57 patients, who had anginal symptoms controlled with nicar dipine alone, were continued into the 3-week, double-blind period and were randomized to continue their usual dose of nicardipine or placebo. Throughout the 1-year, open-label treatment period, the number of anginal episodes and exercise parameters of angina were significantly reduced with nicardipine. Conclusions: During the double-blind period, the patients who continued on nicardipine had significantly greater exercise time and time to onset of angina than patients who were randomized to placebo. The exercise parameters in the patients randomized to placebo were improved over baseline after 1 year of therapy; however, the improvement with nicar dipine was significantly greater.

Parents' major concerns were bicycle and car accidents, head injuries, abduction, exposure to environmental poisons, appropriate discipline, values and morals, affection, finances, too much television, and eating properly. Schoolchildren's concerns differed from their parents' and, for boys, included having to eat food they did not like, finances, people telling lies about them, and other issues about failure and criticism. Girls were more concerned about such dangers as abduction, burglars, strange people following them, and death. Major concerns shared by both sexes were looking foolish, people telling lies about them, being in a big crowd, and failing tests. Parents have many often unfounded or exaggerated fears about their children that are fanned by news media. This has led to the speculation that parents' insecurity about raising children has made them less effective. Continued reassurances by health professionals are needed to help parents believe more in themselves and become more secure in bringing up their children.

The objective of this study was to assess growth patterns of hyperlipidemic children enrolled in a preventive cardiovascular health clinic. A retrospective chart review of hyperlipidemic children enrolled in the Mayo Clinic Cardiovascular Health Clinic for the Young was performed. All participants were counseled to eat an American Heart Association Step-One Diet and exercise regularly. Weight and height were measured every 3 months. Growth was assessed using attained heights and weights and body-mass index Z scores compared to standard distributions for North American children. Sixty-three patients (33 males and 30 females) were enrolled in the study. Mean age at clinic entrance was 7.8 ± 3.5 years (range: 2 to 16 years). We conclude that participation in a preventive health clinic is generally safe for hyperlipidemic children. However, medical management of hyperlipidemic children must include meticulous surveillance to detect the infrequent occurrence of excessive weight loss or weight stabilization resulting from inappropriate response to dietary counseling.

The diagnostic process consists of a series of steps in which the estimated probability of particular disease is increased or decreased until either treatment can be instituted or the diagnosis excluded. The history and physical exam play an important role. If a therapeutic decision cannot confidently be made on clinical grounds alone, a diagnostic test may confirm or exclude a diagnosis or clearly indicate the need for further testing. An inappropriately chosen test or misinterpreted test result, however, may mislead the clinician and possibly harm the patient or simply be wasteful. Estimating the predictive values of a diagnostic test will help to avoid these pitfalls. This article shows the clinician a simplified way to do this.