Faculty Bibliography

OBJECTIVE: To determine whether patient preferences for the use of coronary revascularization procedures differ between white and black Americans. DESIGN: Cross-sectional survey. SETTING: Tertiary care Department of Veterans Affairs hospital. PATIENTS: Outpatients with and without known coronary artery disease were interviewed while awaiting appointments (n = 272). Inpatients awaiting catheterization were approached the day before the scheduled procedure (n = 80). Overall, 118 blacks and 234 whites were included in the study. MEASUREMENTS AND MAIN RESULTS: Patient responses to questions regarding (1) willingness to undergo angioplasty or coronary artery bypass surgery if recommended by their physician and (2) whether they would elect bypass surgery if they were in either of two hypothetical scenarios, one in which bypass surgery would improve symptoms but not survival and one in which it would improve both symptoms and survival. Blacks were less likely to say they would undergo revascularization procedures than whites. However, questions dealing with familiarity with the procedure were much stronger predictors of a positive attitude toward the procedure use. Patients who were not working or over 65 years of age were also less interested in procedure use. In multivariable analysis race was not a significant predictor of attitudes toward revascularization except for angioplasty recommended by their physician. CONCLUSIONS: Racial differences in revascularization rates may be due in part to differences in patient preferences. However, preferences were more closely related to questions assessing various aspects of familiarity with the procedure. Patients of all races may benefit from improved communication regarding proposed revascularization. Further research should address this issue in patients contemplating actual revascularization.

Paraffin-embedded tissue from all 17 autopsies performed following 56 stillbirths associated with maternal syphilis during a 3-year period (1987-1989) was reexamined to compare immunofluorescent antigen (IFA) testing with silver staining for the detection of Treponema pallidum. Congenital syphilis (CS) originally was diagnosed in 9 of the 17 cases of stillbirth, on the basis of positive silver stains (7 cases) or morphological findings alone (2). Upon review, silver staining revealed T. pallidum in 10 of 17 cases and IFA testing revealed the pathogen in 15 of 17 cases, enabling diagnosis of CS in 16 of 17 cases of stillbirth associated with a reactive maternal rapid plasma reagin (RPR) card test. Most stillbirths associated with a reactive maternal RPR test during this time period involved CS, and IFA testing for T. pallidum is superior to silver staining for the identification of treponemes.

Tissue irritation, as evidenced by phlebitis, associated with Optiva (Johnson & Johnson Medical) and Insyte (Becton Dickinson) polyurethane cannulae was studied. The integrity of the cannulae on removal, the incidence of infection at the cannula site and the factors which influence phlebitis were also examined. One thousand and eight patients had a polyurethane cannula placed for induction of anaesthesia for cardiac surgery. After surgery, the cannula was examined every 24 hours. If evidence of phlebitis occurred, the cannula was removed and sent for culture. All remaining cannulae were removed at 72 hours and the site examined daily for a further three days. There were 503 Optiva and 505 Insyte cannulae studied. The distributions between the two cannulae with respect to patient characteristics, gauge of cannula, number of attempts and difficulty of insertion, cannula site and anaesthetist inserting were similar. The early removal rate for both groups was 47%. Overall phlebitis rate with Optiva was 31% and Insyte 33%. This difference is not statistically significant. The cumulative phlebitis rate increased with time but did not differ between the two types of cannulae. Minor tip distortion or shaft kinking of the cannulae occurred in 16.2% of Optiva and 23.5% of Insyte. This difference is statistically significant and may relate to the slightly more acute taper at the Optiva cannula tip. Both cannulae were similar in clinical performance.

Oshinsky reviews "Abuse of Power: The New Nixon Tapes" edited by Stanley I. Kutler

David M. Oshinsky reviews the book "Mutual Contempt: Lyndon Johnson, Robert Kennedy, and the Feud That Defined a Decade" by Jeff Shesol

On a blistering August afternoon in 1948, a conservative journalist accused a liberal former government official of belonging to the Communist Party a decade before. The journalist was Whittaker Chambers, an editor at Time magazine; the former official was Alger Hiss, then president of the Carnegie Foundation for International Peace. Chambers' testimony before the rabidly right-wing House Un-American Activities Committee set off a political firestorm that smolders to this day. Was Hiss a traitor or the victim of a right-wing witch hunt? Was Chambers a liar or a born-again patriot with a crucial story to tell? Sam Tanenhaus devotes about half of his splendid biography to these questions, and his verdict is clear: Chambers told the truth. Yet it is the other half of his book, apart from the Hiss case, that constitutes the more interesting and original part of the story. The Whittaker Chambers we meet in these pages is a brooding loner who sees every human event as a struggle between good and evil, with nothing in between. He is both a relentless crusader and a perfect fatalist - always ready for battle, fully prepared for defeat. Born outside New York City in 1901, Chambers grew up amid lunacy and pain. His only sibling committed suicide, his grandmother roamed the house with a hatchet and his bisexual father often deserted the family for months. A talented but troubled young man, Chambers withdrew from Columbia University after writing a "blasphemous" play and then lost his job at the New York Public Library when stolen books were found in his locker. In 1925 he joined the infant Communist Party, barely 7,000 strong. "He was used to being outnumbered," writes Tanenhaus. "He had at last found his church."

On a blistering August afternoon in 1948, a conservative journalist accused a liberal former government official of belonging to the Communist Party a decade before. The journalist was Whittaker Chambers, an editor at Time magazine; the former official was Alger Hiss, then president of the Carnegie Foundation for International Peace. Chambers' testimony before the rabidly right-wing House Un-American Activities Committee set off a political firestorm that smolders to this day. Was Hiss a traitor or the victim of a right-wing witch hunt? Was Chambers a liar or a born-again patriot with a crucial story to tell? Sam Tanenhaus devotes about half of his splendid biography to these questions, and his verdict is clear: Chambers told the truth. Yet it is the other half of his book, apart from the Hiss case, that constitutes the more interesting and original part of the story. The Whittaker Chambers we meet in these pages is a brooding loner who sees every human event as a struggle between good and evil, with nothing in between. He is both a relentless crusader and a perfect fatalist always ready for battle, fully prepared for defeat. Born outside New York City in 1901, Chambers grew up amid lunacy and pain. His only sibling committed suicide, his grandmother roamed the house with a hatchet, and his bisexual father often deserted the family for months. A talented but troubled young man, Chambers withdrew from Columbia University after writing a "blasphemous" play, and then lost his job at the New York Public Library when stolen books were found in his locker. In 1925 he joined the infant Communist Party, barely 7,000 strong. "He was used to being outnumbered," writes Tanenhaus. "He had at last found his church."