European Stars And Stripes (Newspaper) - August 24, 1988, Darmstadt, Hesse                                Technique changes in bypass surgery by Lawrence k. Altman new York times heart surgeons in the unite states Are increasingly turning to a technique for coronary bypass surgery that promises longer term Success and fewer complications than the method that has been common for decades. Rather than using sections of a leg vein to bypass blocked coronary arteries the doctors Are turning to a blood vessel in the Chest. For reasons that defy explanation these internal mammary arteries rarely develop the fatty deposits that characterize atherosclerosis the artery blocking condition that makes the surgery necessary. Surgeons Are using the arteries also known As internal thoracic arteries whenever possible in the operation that is commonly done to relieve the Chest pains from angina. Humans have two internal mammary arteries one on each Side behind the ribs near the breastbone. The object of bypass surgery is to take a vessel from elsewhere in the body and sew it into a coronary artery to develop a flow of blood around the blocked area and to Supply vital nutrients to the heart. But the benefits last Only As Long As the new vessels stay open. In Many patients vein grafts function Well 15 or More years after the surgery. But in other patients the grafts can have a More limited life Span because the thinner Walls of the veins Are less Able to withstand the pressures that an artery goes through. Further the transplanted veins much like the arteries they replace can become blocked by plaques. Many bypass patients require another operation and in some cases suffer heart attacks and die. The wave of enthusiasm for internal mammary arteries reflects studies showing that grafts from these vessels can stay open much longer than those from leg veins. The studies have also found that patients who undergo such grafts live longer take longer to develop recurrences of angina and have fewer heart attacks fewer repeat bypass operations and fewer complications than did those who had vein grafts. Several decades ago doctors used internal mammary arteries in a different Type of operation for angina in which the mammary artery was linked directly to the heart muscle in Hopes of increasing the blood flow to the heart. The current use of internal mammary arteries for coronary bypass surgery was pioneered in the late 1960s by or. George e. Green then at new York University and now at St. Luke s Roosevelt Hospital Center in new York. At the time Many experts believed that the internal mammary artery often Only two Millimetres in diameter was too Small for splicing into the coronary arteries. But Green recalled in an interview that he shifted his research from other vessels to the internal mammary artery after another surgeon made him aware that the limiting Factor was the Eye not the  by using the operating Microscope to magnify the vessel Green was Able to accomplish the mammary artery graft successfully. . Surgeons used internal mammary arteries in 6,000 of 188,000 coronary bypass operations in 1983 and in 67,000 of 284,000 such operations in 1986, according to the american heart association. Several leading heart surgeons and cardiologists estimated in interviews that 80 percent of coronary bypass operations now involved the use of internal mammary arteries or a combination of the artery and the vein. Internal mammary artery graft operations take longer and Are technically More difficult than leg vein grafts. Surgeons often aided by microscopes or magnifying loupes must take care not to tear the Small artery or its Many tiny branches. Even with these aids a slight lapse in technique can produce poor results. Because the artery is so Small an improperly placed suture can narrow it enough to limit the blood flow. Thus Many surgeons wanted convincing data before they were willing to turn from vein grafts to the internal mammary artery grafts. When Only Short term results were available the benefits of mammary artery grafts were Only slightly better than those of vein grafts. But the benefits generally right internal mammary artery left internal mammary artery not became clearer five or More years after the bypass operation. The mammary artery graft often produces More Chest pain in the first two weeks or so after the operation because the procedure involves More trauma to the Chest Wall than does the vein graft operation. Because the size of the thin artery varies among different people some surgeons Are unwilling to perform the procedure on All patients needing coronary bypass operations. Also the procedure generally takes about five hours up to an hour longer than the vein graft. Thus surgeons tend to avoid using the mammary artery graft on older patients and those who Are having emergency bypass surgery during a heart attack. Having a coronary bypass modestly improves the chances of Lon term survival among patients who Are considered at High risk according to a european study of More than 750 men published in the new England journal of Medicine. During the years soon after the operation bypass patients do considerably better than those treated with Medicine alone but for unknown reasons the differences Between the two groups fade As time goes by the report said. Whether the surgery helps people live longer has Long been debated. Two Long running . Studies have found no Benefit on survival. Researchers say differences in the health of patients in the three studies probably explain Why the european outcome was better. Byj Annescott los Angeles times can carbohydrates lift your spirits a Page 16 the stars and stripes bowl of Spaghetti a plate of grits or a meal heavy in other carbohydrates can lift a person s spirits by increasing the amount of a powerful chemical in the brain according to a researcher. Or. Richard Wurtman a professor at the Massachusetts Institute of technology discussed the findings at the american psychological association s annual conference. According to the research some depression obesity and even symptoms of premenstrual stress May be caused by shortages of the brain chemical serotonin. Serotonin is synthesized in the brain and is known to play a crucial role in mood,.depression, appetite and wednesday August 24,1988 sleep among other things. Eating foods High in carbohydrates enhances the production of serotonin Wurtman said. They do that by triggering the secretion of insulin in the body which in turn reduces the level of certain amino acids in the blood. It then becomes possible for More of a competing amino acid which is essential for production of serotonin to reach the brain. To be absolutely banal about it if you had grits Sweet Roll Toast and Coffee for breakfast. Then you Are at this moment releasing More serotonin Wurtman who specializes in Neur endocrine regulation told the audience. A High protein breakfast of eggs and sausage would have the opposite effect. Wurtman and his research group initially used rats to examine whether carbohydrate consumption affected serotonin and thus regulated appetite. After three to four