Abdominal aortic aneurysms in the New Zealand Maori population

BACKGROUND: Abdominal aortic aneurysm (AAA) is believed to be a rare disease in people of non-European descent. Maori, New Zealand's indigenous people, are thought to originate from South East Asia, so their incidence of AAA might also be expected to be low. The aim was to investigate the incidence and phenotypic factors associated with AAA in the New Zealand Maori population. METHODS: A retrospective study was performed using the audit database of the New Zealand Society of Vascular Surgeons. Age-standardized rates of admission and death were calculated for Maori and non-Maori. RESULTS: Maori comprised 3.9 per cent of the population who had an AAA repaired, similar to the percentage of the Maori population aged over 65 years. However, the death rate from AAA in Maori was 2.4 times the rate in non-Maori. Maori were younger at diagnosis than non-Maori (65.2 versus 71.8 years; P < 0.001), had more emergency procedures (46.6 versus 30.2 per cent; P = 0.018) and a significantly higher proportion of Maori admissions were for a ruptured aneurysm. CONCLUSION: Maori had a higher mortality rate from AAA than non-Maori New Zealanders. Although admission rates between Maori and non-Maori were similar, the earlier age of onset and the increased proportion of ruptured aneurysms may indicate that the disease is more severe in Maori.     

Lynch syndrome in a predominantly Afrocentric population: a clinicopathological and genetic study

Background

We investigated the prevalence of Lynch syndrome as a hereditary cause of colon cancer in the young Jamaican colorectal cancer (CRC) population.

Methods

We identified patients aged 40 years or younger in whom primary CRC was diagnosed at the University Hospital of the West Indies from January 2004 to December 2008. We reviewed the medical records and hematoxylin and eosin (H&E)–stained histopathology slides. Tumour blocks were tested for microsatellite instability (MSI). Patients with MSI–high phenotype (MSI-H) tumours had genetic counselling, after which genomic DNA was extracted from peripheral blood to test for MLH1 and MSH2 germline mutations. Patients also had pedigree mapping.

Results

There were 25 patients with CRC aged 40 years or younger with no history of hereditary colon cancer syndrome. The patients’ mean age was 33 (range 21–40) years. Histopathologic review confirmed CRC in all patients; 8 of 25 (32%) showed morphologic features suggestive of MSI. We detected MSI-H in 5 of 23 (22%) tumour blocks tested. Review with H&E staining correctly identified 80% of cases positive for MSI-H. The false-positive rate and positive predictive value on H&E review was 50%. The negative predictive value of histomorphologic H&E review was 94%. Three patients were available for and had mutational analysis of DNA mismatch repair genes; 2 were positive for mutations in keeping with Lynch syndrome and 1 had MLH1 alterations of uncertain significance. All 3 met the Amsterdam criteria for hereditary nonpolyposis CRC.

Conclusion

Thirteen percent of the population had mutations in keeping with Lynch syndrome. This prevalence is similar to that reported for white populations.     

Abdominal aortic aneurysms: a review of current problems

This review examines the aetiology and possible methods of prevention of abdominal aortic aneurysm. The natural history of the lesion is discussed. Given its poor prognosis, surgery should be considered even when the patient is over 80 years of age, has stable cardiovascular disease and has a small aneurysm. The case for population screening is reviewed and potential areas of advance in management are outlined.     

Unoperated ruptured abdominal aortic aneurysms: a retrospective clinicopathological study over a 10-year period.

A series is described of 41 cases of unoperated ruptured abdominal aortic aneurysm in 9894 consecutive autopsies performed in two large general hospitals in Glasgow between 1964 and 1974. The preceding clinical presentations are discussed. These show the difficulaties in diagnosing the condition correctly and quickly and the liability to confusion with other intra-abdominal conditions. The correct diagnosis was established before death in only 11 cases, it was suspected in 6 cases and was completely missed in 24 cases. Pathologically, all the cases were atheromatous and measured more than 5 cm in diameter, and the most common site of rupture was through the lateral wall. Resection would appear to have been technically possible without undue difficulties in the majority of the cases. An analysis of all the findings indicates the necessity for greater clinical awareness of this condition and its variable mode of presentation. Only in this way will early diagnosis and safer surgical intervention be possible.     

Abdominal aortic aneurysms: case report

A 71-year-old male presented to a chiropractic clinic with subacute low back pain. While the pain appeared to be mechanical in nature, radiographic evaluation revealed an abdominal aortic aneurysm, which required the patient to have vascular surgery. This case report illustrates the importance of the history and physical examination in addition to a thorough knowledge of the features of abdominal aortic aneurysms. The application of spinal manipulative therapy in patients with (AAA) is also discussed.     

General practice-based population screening for abdominal aortic aneurysms: a pilot study

All 1195 male patients aged between 65 and 74 years on the Family Practitioner Committee register for the four group practices in Stroud, UK were invited for a health screening check. The examinations included abdominal ultrasonography to measure maximum aortic diameter, measurement of blood pressure and recording of smoking habits. An attendance rate of 76 per cent was achieved (906 patients). Seventy-one patients (7.8 per cent) were found to have aortic diameters greater than 2.5 cm and 14 (1.5 per cent) had aortic diameters greater than 4.0 cm. Aneurysms were more common in smokers and in hypertensive patients. However, restriction of screening to patients with these risk factors would have led to a number of aneurysms remaining undiscovered. We recommend therefore that ultrasound screening for abdominal aortic aneurysms should be offered to all men between the ages of 65 and 74 years.     

Abdominal aortic aneurysms.

The dangers of any abdominal aortic aneurysm are discussed, and the disastrous combination of an aneurysm and abdominal pain emphasised. These anerysms can be divided into 4 groups. The presentation and operative mortality for each group is discussed, as is the long term survival, state of the peripheral circulation and general health after operation. How results can be improved is considered. It is concluded that all such aneyrysms should be operated upon because of the good immediate and long term results in comparison with those not operated upon.     

Abdominal aortic aneurysms: some controversial points

A retrospective review of the surgical treatment of 51 abdominal aortic aneurysms is reported. Thirty-five (69%) patients were operated on electively, and 16 (31%) had emergency surgery. Fissurated aneurysms were included in the elective surgery group. The operative death rate was respectively 2.7% and 50%. Controversial points about diagnosis, treatment of associated diseases, surgical technique, and selection of the patients for surgery are presented and discussed.     

Abdominal aortic aneurysms in a district general hospital.

The management of all patients with abdominal aortic aneurysms attending a district general hospital over a 6-year period is reviewed. The hazards of delaying surgical treatment are emphasised. An operative mortality of 12% for non-leaking and 55.6% for leaking aneurysms is discussed with reference to other published results. Attention is drawn to the relatively high proportion of patients not undergoing surgical treatment. Some ways in which the mortality of the condition might be reduced are considered.     

A clinicopathological study of dissecting aneurysms of the intracranial vertebral artery

Five autopsied cases of dissecting aneurysms of the intracranial vertebral artery are reported and the literature is reviewed to clarify the clinicopathological correlations. In an autopsy series of 110 patients with subarachnoid hemorrhage (SAH), the incidence of this entity was 4.5%, with all five cases progressing rapidly to death from massive SAH. Cases of intracranial vertebral dissection can be divided clearly into two groups based on the clinical and pathological features. In the first group, the dissection is confined to the vertebral artery and a massive SAH develops caused by the rupture of the arterial wall. The plane of dissection is mainly subadventitial. In the second group, brain-stem infarction develops resulting from luminal occlusion by intramural hematoma. The plane of dissection is mainly subintimal, with the dissection extending to the basilar artery. The condition in the second group affects patients at a younger age. If the lesion is localized within the vertebral artery and does not extend to the basilar artery, the disease seems not to be fatal. The clinical features of the vertebral dissection are largely determined by the plane and extension of dissection. Vertebral artery dissection is due to many causative factors including hypertension, congenital or degenerative changes in the arterial wall, and anatomical and pathological characteristics of the vertebral artery.     

Abdominal aortic aneurysms: the changing natural history

The records of all patients with abdominal aortic aneurysms (AAAs) in a Midwest city with a stable population over a 30-year period were reviewed. There were 296 patients (196 men and 100 women) for an incidence of 21.1 aneurysms/100,000 person-years. The median age at diagnosis was 69 years for men and 78 years for women. Seventy-eight percent of patients were asymptomatic at the time of diagnosis; their aneurysms were incidental findings. Rupture occurred in 60 patients (20.3%). Thirty-six patients (12.2%) had rupture of the aneurysm as the presenting complication. For previously diagnosed aneurysms that subsequently ruptured, the average period from diagnosis to rupture was 48.7 months. Rupture occurred in only two aneurysms smaller than 5 cm. The overall mortality rate from rupture was 15.5%. Evaluation of data (including autopsy reports) by decade revealed an absolute increase in the incidence of AAAs in the population under study. More aneurysms of all sizes occurred from 1971 to 1980 than in the previous two decades combined. Although ultrasound examination has increased the detection of small aneurysms, the incidence of aneurysms 7 cm or larger at the time of diagnosis has also increased; the frequency of rupture was greatest in the last decade. To compare the data of the population-based study with the statistics for patients seen in a referral practice, the records of 616 patients from a referral population were also reviewed. In the referral population the ratio of men to women was 5:1, and the age at diagnosis was lower for both groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

Abdominal aortic aneurysm: incidence in a population at risk

One hundred twenty patients aged fifty years and over underwent screening by ultrasound for abdominal aortic aneurysms as part of their routine follow-up visit to a cardiologist. The overall incidence of aneurysm greater than or equal to 4 centimeters in diameter was 5%. In the 84 men with aortas less than 4 centimeters, the average aorta size was 2.4 centimeters. In the 30 women with aortas less than 4 centimeters, the average aorta size was significantly smaller, 1.9 centimeters (p less than .001). It was discovered that men who smoke and have hypertension have a statistically significant increase in aorta size compared to those men without these risk factors (less than .05). The results indicate that the incidence of abdominal aortic aneurysm is probably high enough in this population to justify screening by ultrasound.     

Chordoma in early childhood: a clinicopathological study

A case of clival chordoma in a 4-year-old girl is presented. The tumor regrew rapidly after it was partially removed, and the patient died after a clinical course of 11 months. An autopsy revealed a massive clival mass and widespread metastases in the dura mater, skull bone, bilateral lungs, liver, sternum, left humerus, and vertebrae. Pathological findings showed that the tumor cells were poorly differentiated, with a rare, but typical, physaliphorous appearance. The presence of epithelial differentiation proteins, mitochondria surrounded by rough endoplasmic reticulum, and desmosomes was demonstrated in the tumor cells both immunohistochemically and ultrastructurally. Thus, the tumor was diagnosed as a chordoma. The literature pertaining to intracranial chordoma in early childhood is reviewed. Rapid growth and distant metastases may occur in chordomas at a young age.