In most studies, aspirin has been shown to be effective for a period of 1 year in reducing the frequency of saphenous vein bypass graft occlusion when begun 1 day before surgery, on the day of surgery, or the day after surgery. Effective doses of aspirin range from 100 to 975 mg/d. Aspirin in combination with dipyridamole is effective in the prevention of saphenous vein bypass graft occlusion if aspirin and dipyridamole therapy is started 1 or 2 days before surgery or aspirin therapy is started on the day of surgery but dipyridamole therapy is started before surgery or if treatment with both aspirin and dipyridamole is started 1 day after surgery. Aspirin in combination with dipyridamole is not more effective than aspirin alone in the prevention of saphenous vein graft occlusion. Bleeding is higher among patients treated with aspirin alone than among controls if aspirin therapy is started 1 day before surgery. Bleeding is not greater in comparison to controls if aspirin therapy is started the day of surgery or 1 day after surgery. When aspirin and dipyridamole are used in combination, bleeding is higher than in controls, and bleeding is higher than with aspirin alone. The continued use of aspirin for 2 additional years after an initial year of aspirin therapy for the prevention of saphenous vein bypass graft occlusion showed no additional long-term benefit on graft patency at the end of the third year.

A 6-year-old boy with massive sand aspiration was effectively treated with femoral vein to femoral artery cardiopulmonary bypass (CPB), saline bronchial lavage, and exogenous surfactant. The patient was discharged the 9th hospital day without apparent sequelae. CPB should be considered for cases of sand or gravel aspiration when gas exchange is compromised.

The incidence of pneumothorax in HIV-infected children has not been reported. In adults with AIDS, pneumothorax has been described exclusively in association with Pneumocystis carinii pneumonia (PCP). We report the cases of three children with AIDS, one with lymphoid interstitial pneumonitis (LIP) without evidence of PCP and two with PCP, all of whom developed spontaneous pneumothorax (SP). On presentation, none of the children had any risk factors for the development of pneumothorax, but all had radiographic evidence of subpleural cystic lesions and bilateral pleural adhesions. None of the patients responded to conservative medical management, which included chest tube thoracostomy and chemical pleurodesis. Two patients underwent pleurectomy that resulted in resolution of the pneumothorax. Both patients with PCP who developed pneumothorax died, but the patient with LIP and SP has had no recurrences of any serious respiratory problems 3 years after pleurectomy and excision of the intrathoracic cysts.