Open surgical repair persists as the gold-standard operation for thoracoabdominal aortic aneurysm; however, endovascular repair has become commonplace. Technical considerations in thoracoabdominal aortic aneurysm treatment are particularly complex, insofar as it involves critical branching arteries feeding the visceral organs. Newer, low-profile devices make total endovascular thoracoabdominal aortic aneurysm repair more feasible and, thus, appealing. For younger and low-risk patients, the choice between open and endovascular therapy remains controversial. Despite the advantages of a minimally invasive procedure, data suggest that endovascular aortic repair incurs a greater risk of spinal cord deficit, and the durability of endovascular aortic repair remains unclear. It is difficult to compare outcomes between endovascular and open thoracoabdominal aortic aneurysm repair, primarily because of the current investigational status of endovascular devices, the variety of approaches to endovascular repair, differing patient populations, lack of prospective randomized studies, and minimal medium- and long-tern follow-up data on endovascular repair. When deciding between open and endovascular approaches, one should consider which is more suitable for each patient. Older patients generally benefit from a less invasive approach. Open repair should be considered for young patients and those with heritable thoracic aortic disease. Infection and fistulae are best treated by open repair, although endovascular intervention as a lifesaving bridge to definitive repair has evolved to become a critical component of initial treatment. It is crucial to have technical expertise in both open and endovascular procedures to provide the best aortic repair for the patient. This may require dedicated aortic programs at tertiary institutions.

The author examines some aspects of the current situation concerning immigration to the United States. He predicts that the 1990s will witness the largest flow of immigrants into the population and labor force of any decade in the country's history; furthermore, since there is no universally accepted right to immigrate, the adoption of migration policy is one area of economic policymaking that is not controlled by market forces. He also notes that while the country's need is for a highly skilled, motivated, and educated labor force, the majority of current immigrants have low skill levels and relatively little education. The need to develop and implement a migration policy that is in tune with the country's economic objectives is stressed. He concludes that "the resurrection of mass immigration from out of the nation's distant past was a political accident; its perpetuation in the 1990s is contrary to national interest. Immigration reform, therefore, needs to be [in] the forefront of the nation's economic policy agenda."

The author investigates income distribution according to gender and race differences in mortality rates in the United States. "This study merges economic and epidemiological literatures. A more extensive application of the Paglin (1975) life cycle hypothesis is proposed. Not only are adjustments made for varying ages, they are also made for varying survival probabilities from one age to the next. Finally, some consideration is also given to the implications of varying morbidity rates across race and gender for the distribution of economic well-being."