Percutaneous transluminal angioplasty (PTA) has received widespread publicity as a safe, simple, and successful alternative to operation for the management of renal artery stenoses and renovascular hypertension (RVH). Although, in our institution, the primary management of RVH remains operative revascularization, with more than 750 such procedures having been done, we have had the opportunity to manage a spectrum of PTA failures in nine patients during the last 5 years. These include (1) acute dissection of atherosclerotic lesions and occlusion of the distal renal artery requiring emergency operation; (2) unilateral perforation and bilateral thrombosis of fibrodysplastic branch renal artery lesions requiring staged ex vivo reconstruction; (3) cholesterol embolization and recurrence to total occlusion of orificial atherosclerotic lesions with loss of excretory renal function; (4) chronic dissection from repeated "temporarily successful" PTAs of medial fibrodysplastic lesions; and (5) rapid recurrence and acceleration of hypertension in a 17-year-old girl with congenital renal artery stenoses. In each instance operation was complicated by an intense perivascular inflammatory response from the previous PTA and required a more complex reconstruction than would have been needed originally. These sequelae argue for moderating enthusiasm for the use of PTA and for limiting its routine use to nonorificial atherosclerotic lesions and fibrodysplastic lesions restricted to the main renal artery. Orificial atherosclerotic lesions, branch fibrodysplastic lesions, and congenital stenoses have a high probability of failure, complications, or both when treated by PTA and should be considered for primary operative intervention.
Introduction: The "Haves" and the "Have Nots" A large body of research literature on the college experience of residential college students (i.e., students who live on or near the campus and independent of their families) suggests that the traditional 18-to 21-year-old college student experiences a radical reformation of his or her identity, values, and beliefs during the first two years of college. Yet, that same body of literature paints a much less
Involvement in campus life and learning activities has long been recognized as a powerful contributor to persistence among college students. Much of the research on student involvement has focused on traditional, four-year college students, frequently comparing the academic and social integration of residential and commuter students. Research on involvement among community college students has not been as plentiful, although an increasing body of literature suggests that academic achievement and related activities are far more important for two-year students than social involvement, which seems to have little effect on persistence in community college environments.This study seeks to test the impact of various involvement activities on unit completion by "traditional" community college students, i.e., students entering college immediately following high school. Using the recently developed "Community College Student Experiences Questionnaire" (Friedlander, Pace, & Lehman, 1990) to assess students' "quality of effort," the study demonstrates that three activities significantly contribute to unit completion by traditional community college students: higher order library activities, counseling related to transfer, and participation in art, music, and theatre activities.
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