Rheumatic Fever: Natural History and Treatment

Major advances in clinical and laboratory research methods have significantly clarified the identification and natural course of rheumatic fever in the past two decades

A History of Quality of Life Measurements

Purpose: To review the origins and early development of quality of life measurements in the medical literature. Methods: A comprehensive literature review of Medline from 1966-1986 examining articles with quality of life as a subject heading. Studies were included if they were the original article describing a scales development or used scales developed in the social science literature. Results: The measurements have been derived from two separate sources: a transfer and expansion of medical appraisals for health status, and an application of sociometric and psychometric methods for populational assessment of happiness, well-being, and other affects. Neither source of measurements used the basic principle that a persons quality of life is a state of mind, not a state of health, and that a suitable personal expression should allow the opportunity to cite distinctive individual feelings. In addition, the existing approaches are often unsatisfactory for denoting changes. Conclusions: Since quality of life of individual patients was not directly sought with the two original sources, its appraisal may be improved with an old clinical method of asking patients what they believe

Complications of peripheral arteriography:A new system to identify patients at increased risk

AbstractPurpose: The most quoted literature on arteriographic complications is based on self-reports collected during the mid 1970s. We sought to determine whether those results remain valid despite changes in arteriographic practice and whether patient subgroups at increased risk could be identified.Methods: Five hundred forty-nine consecutive patients were examined after arteriography and twice over 72 hours. Patients were telephoned at least 2 weeks later to identify delayed complications. The sample was divided into two groups to allow independent validation of suspected prognostic factors.Results: The rate of major complications was 2.9% (16/549), but varied from 0.7% to 9.1% among three strata of relative risk. Rates were highest in patients studied for suspected aortic dissection, mesenteric ischemia, gastrointestinal bleeding, or symptomatic carotid artery stenosis and lowest in patients with trauma or aneurysmal disease. Patients studied for claudication or limb-threatening ischemia had intermediate risk (2.0%). Within these strata, congestive heart failure and furosemide use were the only variables independently associated with a significantly increased complication rate.Conclusions: Previous reports have overestimated the risk of arteriography for trauma or aneurysm but substantially underestimate the risk for patients with other common conditions. Such stratified complication rates are essential to understand relative costs and benefits of arteriography and other vascular imaging modalities in specific clinical situations. (J VASC SURG 1995;22:787-94.