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1 Lampe FC, Walker M, Lennon LT, Whincup PH, Ebrahim S. Validity of a self-reported history of doctor-diagnosed angina. J Clin Epidemiol 1999; 52: 73-81. Lampe FC, Whincup PH, Shaper AG, Wannamethee SG, Walker M, Ebrahim S. Variability of angina symptoms and the risk of major ischemic heart disease events. J Epidemiol 2001; 153: 1173-82. Gardner K, Chapple A. Barriers to referral in patients with angina: qualitative study. BMJ 1999; 319: 418-21. Daviglus ML, Liao Y, Greenland P, Dyer AR, Liu K, Xie X, et al. Association of nonspecific minor ST-T abnormalities with cardiovascular mortality: the Chicago Western Electric study [see comments]. JAMA 1999; 281: 530-6. Hemingway H, Shipley M, Macfarlane P, Marmot M. Impact of socioeconomic status on coronary mortality in people with symptoms, electrocardiographic abnormalities, both or neither: the original Whitehall study 25 year follow up. J Epidemiol Community Health 2000; 54: 510-6. Last JM. The iceberg: "completing the clinical picture" in general practice. Lancet 1963; 28-31. Marmot MG, Davey Smith G, Stansfeld SA, Patel C, North F, Head J, et al. Health inequalities among British Civil Servants: the Whitehall II study. Lancet 1991; 337: 1387-93. Rose G, Blackburn H, Gillum RF, Prineas RJ. Cardiovascular survey methods. Geneva: World Health Organization, 1982. Tunstall-Pedoe H, Kuulasmaa K, Amouyel P, Arveiler D, Rajakangas AM, Pajak A. Myocardial infarction and coronary deaths in the World Health Organization MONICA project: registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation 1994; 90: 583-612. Stafford M, Hemingway H, Stansfeld S, Brunner E, Marmot M. Behavioural and biological correlates of physical functioning in middle aged office workers: the Whitehall II study. J Epidemiol Community Health 1998; 52: 353-8. McCormick A, Fleming D, Charlton G. Morbidity statistics from general practice: fourth national study 1991-1992. London: HMSO, 1995. Department of Health. National service framework for coronary heart disease: modern standards and service models. London: Stationery Office, 2000. Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, et al. ACC AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology American Heart Association task force on practice guidelines. J Coll Cardiol 2003; 41: 159-68 and psilocybin, for example, serevent. An SO-kg, 31-yr-old man presented with recurrent hemangiopericytoma for a left occipital craniotomy. Prior to this hospitalization, the patient had undergone two stereotactic brain biopsies with intravenous IV ; sedation fentanyl, midazolam, and propofol ; without complication. He had also received two reportedly uneventful general anesthetics, one for a craniotomy and one for a thoracotomy and pleurodesis. Subsequent review of anesthetic and hospital records from these procedures revealed no evidence of a MH episode. His medical history was negative other than for mild asthma treated with Provemtil inhaler Schering Corp., Kenilworth, NJ ; as needed. General anesthesia was induced at 8: 00 Day 1 ; with thiopental, vecuronium, and fentanyl IV and was maintained with oxygen, isoflurane, and intermittent IV boluses of fentanyl and pancuronium. Standard monitors for this procedure included radial arterial and central venous catheters and transesophageal echocardiography. He was positioned semi-sitting at 30". During the 8-h anesthetic, expiratory isoflurane concentrations ranged from 0.5% to 1.2% and end-tidal carbon dioxide ETco, ; ranged from 27 to 32 Hg. Esophageal temperature gradually rose from 35.4"C at induction to 37.1"C at the end of the procedure. Heart rate HR ; ranged from 70 to 90 bpm and arterial blood pressure BP ; remained stable throughout the procedure. Accepted for publication November 18, 1994. Address correspondence and reprint requests to Denise J. Wedel, MD, Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

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The University of Michigan Health System endorses the Guidelines of the Association of American Medical Colleges and the Standards of the Accreditation Council for Continuing Medical Education that the individuals who present educational activities disclose significant relationships with commercial companies whose products or services are discussed. Disclosure of a relationship is not intended to suggest bias in the information presented, but is made to provide readers with information that might be of potential importance to their evaluation of the information Team Member David Alvarez, DO Anthony Chiodo, MD Gregory Graziano, MD Andrew Haig, MD Van Harrison, PhD John McGillicuddy, MD Connie Standiford, MD Amy Tremper, MD Company none ; none ; none, for example, hfa medication proventil. Work Missed, Treatment Not Sought Due to Lack of Insurance Women who have missed work due to heavy periods are more likely than others to identify lack of health insurance as the reason why they have not sought treatment. Quality healthcare is a concern for this most vulnerable population, as these women are much less likely to have health insurance; one quarter 24 percent ; of women who say they have missed work do not have health insurance, versus 13 percent of those who have not missed work. When asked in an openended question to explain why they have not sought treatment, women who had missed work were more likely than others to say they have not talked to a doctor because they lack health insurance or access to quality healthcare 18 percent versus 9 percent and ritalin. Extracts of saw palmetto are unlikely to alter the disposition of coadministered medications primarily dependent on the CYP2D6 or CYP3A4 pathways for elimination. Reference: Markowitz JS; Donovan JL; Devane CL; Taylor RM; Ruan Y; Wang JS; Chavin KD 2003 ; Multiple doses of saw palmetto Serona repens ; did not alter cytochrome P450 2D6 and 3A4 activity in normal volunteers Clin Pharmacol Ther. 74 6: 536-542. 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