Supervised exercise programs provide superior increased walking ability in the noninterventional therapy of arterial claudication, and both supervised and home based exercise therapy result in improved SF-36 functional measures. The lack of intergroup differences in these measures may be a result of the high degree of interaction with healthcare providers in the HOMEX group. Although a supervised program results in optimal walking benefits, a highly structured home-based program provides similar functional improvement and may be a satisfactory alternative for patients with lesser walking requirements.

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Patients with claudication realize symptomatic and functional improvement with supervised exercise programs. Those who continue to exercise will potentially maintain these benefits and experience improved health-related quality of life.

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Digital artery embolization and ulnar artery thrombosis are consequences of repetitive trauma and can lead to digit loss and debility from ischemia and cold intolerance. We postulate that an arterial autograft is a theoretically superior conduit to traditional saphenous vein, and report reconstruction with inferior epigastric artery. Three adult male smokers, ages 39 to 49 years, had severe digital ischemia and cold-induced vasospasm. Arteriograms confirmed occlusion of the distal ulnar artery without direct perfusion of the superficial palmar arch, distal digital artery embolization, and normal proximal vasculature. All reconstructions were performed from the distal most patent ulnar artery at the wrist to the superficial palmar arch (1 patient) or sequentially to the involved common digital arteries (2 patients), with inferior epigastric artery. Handling characteristics and size match between the arterial autografts and bypassed arteries was excellent. Patency has been confirmed with duplex scanning at follow-up of 8 to 24 months, with resolution of cold intolerance and successful digital preservation.

We proposed to (a) replicate earlier findings that human subjects could voluntarily control peripheral skin temperature, (b) test the hypothesis that hyponotic susceptibility and the capacity for absorbed, imaginative attention will enhance autonomic learning and performance, and (c) demonstrate a learning effect, if one exists. We compared seven subjects who scored high with seven subjects who scored low on both a modified version of the Harvard Group Scale of Hypnotic Susceptibility and the Tellegen Absorption Scale. Auditory feedback was used to train subjects to produce a difference in skin temperature in one hand relative to the other in a direction specified by the experimenter. Large and reliable performance and learning effects were found, but they were unrelated to hypnotic susceptibility or the capacity for absorbed, imaginative attention. Variables that might account for individual differences in learning and performance are discussed.Although large differences in the ability to learn autonomic control have been noted (cf. Miller, 1974), there have been few attempts to systematically investigate personality traits that might be associated with these individual differences (Roessler, 1972;Wenger, 1966; Bell & Schwartz, Note 1). Historically, the earliest reports of voluntary autonomic control have almost always been related to hypnosis, meditation, altered states of consciousness, or similar phenomena (cf. Dalai & Barber, 1969). Miller (1969) noted that his laboratory animals that had been paralyzed by curare learned to control normally involuntary functions significantly better than did noncurarized controls. He suggested that it might be worthwhile to try to use hypnotic suggestion to achieve similar results in human subjects.

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