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Twenty female regular smokers were tested in four sessions while performing a 20-mm rapid in Formation processing task (RIP) twice. According to a 2 x 2 crossover design they were requited to abstain from smoking or not on the mornings before the session and allowed or not allowed to smoke between the two RIP trials. Pre-session abstinence, as compared with non-abstinence, showed the expected withdrawal symptoms in terms of decreased cognitive performance, electrocorticat and cardiovascular arousal increased pre-session anxiety, craving to smoke and ratings of cigarette strength, nausea and dizziness after smoking a cigarette during the session. Smoking during the session, as compared with non-smoking, on the other hand, showed some beneficial effects in terms of increased cognitive performance, electrocortical and cardiovascular arousal. Whereas these effects were antagonistic for most of the assessed parameters, there were also some significant interactions. The increases in processing rate, heart rate and stroke volume and the decreases in finger pulse amplitude, left-ventricular ejection time and state anxiety due to smoking were greater after preceding abstinence than non-abstinence. This reflects the great impact of the acute tolerance to nicotine. Finally, no positive effects of smoking on the RIP-task-induced physiological stress reactions were round, suggesting that smoking as a coping aid is of only restricted value. [ABSTRACT FROM AUTHOR]

SUMMARY Transluminal angioplasty can be used to relieve symptomatic lower extremity arterial disease with minimal morbidity. This prospective study compares the accuracy of colour-coded duplex ultrasonography with intra-arterial digital subtraction angiography in selection of femoro-popliteal lesions for angioplasty. Isolated, short (<6cm) and haemodynamically significant stenosis (>50% reduction in diameter) were considered for angioplasty. Colour-duplex selection and exclusion was in agreement with angiography in 68 out of 86 lower limbs (79%). The sensitivity, specificity, positive and negative predictive value of colour duplex compared with angiography yielded values of 60.9, 87.5, 60.9 and 85.7%, respectively. The discrepancy between colour duplex and digital subtraction angiography can be partly explained by the tendency of duplex to underestimate the severity and length of disease. It is concluded that colour-coded duplex can be used as a screening tool for lower extremity arterial disease to select appropriate lesions for endovascular procedures. The accuracy of duplex in the present study was not perfect and the decision for further intervention should be based on clinical grounds. [ABSTRACT FROM AUTHOR]

Three patients, two adults and one child, developed an acute compartment syndrome of the lower leg. Due to delay in diagnosis, severe complications developed, resulting in two transfemoral amputations. In the youngest patient, the lower leg was able to be saved after extensive reconstructive surgery. In most cases, acute compartment syndrome of the lower leg is seen in combination with a fracture (40%), although other causes (minor trauma or vascular surgery) are also known. Moreover, patient history (pain out of proportion to the associated injury) and physical examination are central to the diagnosis. In some cases, however, a reliable diagnosis cannot be made clinically, as in the case of unconscious, intoxicated or intubated patients, as well as small children. Under these circumstances, intra-compartmental pressure measurement can be of great assistance. After confirmation of the diagnosis, immediate fasciotomy of all lower leg compartments should be performed. The eventual outcome of this syndrome is directly related to the time elapsed between diagnosis and definitive treatment. Although the diagnosis can be difficult, delays in treatment should be avoided at all costs. The acute compartment syndrome of the lower leg is a surgical emergency and should be dealt with immediately.