Neointimal hyperplasia and thrombosis initiated by platelet activity may contribute to the failure of femoropopliteal Dacron bypass grafts. We have therefore undertaken a randomised prospective double blind trial comparing the efficacy of a combination of acetyl salicylic acid (ASA) 330 mg and dipyrida mole (DPM) 75 mg three times daily, with placebo in maintaining the patency of femoropopliteal Dacron bypass grafts implanted to relieve disabling claudica tion. Patients received either ASA/DPM or placebo commencing pre-opera tively and continuing for 12 months. Seventy-three double velour (Microvel) grafts in 65 patients were studied, 38 grafts in the placebo group and 35 grafts in the active group. The following were measured pre-operatively and at 3, 6, 9 and 12 months postoperatively: maximum walking distance (MWD); ankle/bra chial systolic pressure index (ABSPI); graft patency; platelet adhesion and ag gregation; template bleeding time; ASA and DPM levels. After 1 year, 10 patients had been withdrawn (9 ASA/DPM: 1 placebo) and 4 out of 26 grafts in the active group and 15 out of 37 in the placebo group had occluded ( P < 0.05 Chi square test). We conclude that inhibition of platelet function by the use of a combination of ASA and DPM improved the patency rate of femoropopliteal Dacron bypass grafts.

Exogenous anabolic androgen steroid use is associated with adverse cardiovascular outcomes. A 53‐year‐old bodybuilder presented with 3 months of exertional dyspnoea. Physical examination showed tachycardia and pan‐systolic murmur; an echocardiogram showed a left ventricular ejection fraction (EF) of 15%. Evaluations included normal coronary angiogram, iron panel and thyroid studies, a negative viral panel (human immunodeficiency virus, Lyme disease, and hepatitis), and urine toxicology. He admitted to intramuscular anabolic steroid use; his testosterone level was 30 160.0 ng/dL (normal 280–1100 ng/dL). In addition to discontinuation of anabolic steroid use, he was treated with guideline‐directed heart failure medical therapy. Repeat echocardiogram at 6 months showed an EF of 54% and normalized testosterone level of 603.7 ng/dL. Anabolic steroid use is a rare, reversible cause of cardiomyopathy in young, otherwise healthy athletes; a high index of suspicion is required to prevent potentially fatal side effects.

A method for measuring blood flow below the knee during reactive hyperaemia induced by 3 min of arterial occlusion has been developed. Subjects are positioned with lower limbs within the field of view of a gamma camera and pneumatic cuffs are placed below the knees to isolate the blood and induce a hyperaemic response. The remaining blood pool is labelled with 99Tcm-labelled red cells. Blood flows have been derived from the initial gradients of time-activity curves and from equilibrium blood sampling. The technique has been validated using a tissue-equivalent leg phantom and peristaltic pump. The method has been applied to a small group of patients with peripheral vascular disease and to normal controls. The mean value (+/- SD) of limb perfusion for normal controls was found to be 16.4 +/- 3.0 ml/100 ml/min and for patients with intermittent claudication was 5.1 +/- 2.6 ml/100 ml/min. Flow measurements are found to correlate with clinical findings and with symptoms. Reproducibility (established by repeated measurements) is high. The method is well tolerated even by patients suffering from rest pain.

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