Traumatic brain injury in Finland 1991-2005: a nationwide register study of hospitalized and fatal TBI

Primary objective: To examine the epidemiology of traumatic brain injury (TBI) in Finland in 1991-2005.

Research design: Nationwide population based data of hospitalized and fatal TBI collected from the national registers of Finland. The incidence, age and gender distribution, aetiology, external causes, cursory outcome and mortality are presented.

Methods and procedures: The data were collected from the National Hospital Discharge Register of Finland and from the official cause-of-death register of Statistics Finland.

Main outcome and results: The average incidence of hospitalized TBI was 101/100 000 population and the mortality rate 18.1/100 000. The incidence increased by 59.4% in the patients aged 70 years or older while the incidence decreased by 2.4% in the younger age groups. The mortality rate decreased in men. The most common external causes were falls. The oldest patients needed 6.8-times longer stay in the hospital than the youngest. After discharge 54% of the patients needed at least occasional care.

Conclusions: TBI prevention should be focused to the main groups at risk. The need for further care, rehabilitation and increasing the awareness of TBI is obvious.     

The low incidence of surgery for non-cardiac vascular disease in UK Asians may be explained by a low prevalence of disease.

AIMS: Firstly, to compare rates of surgery for non-cardiac vascular disease in Caucasians and Asians and secondarily to assess the prevalence of peripheral arterial disease (PAD) and abdominal aortic aneurysm (AAA) in the male UK Asian population. METHODS: Analysis of a prospective database followed by an epidemiological survey of 100 unselected Pakistani males, in which demographic and anthropometric data were collected alongside aortic ultrasonography and measurement of ankle: brachial pressure index (ABPI). RESULTS: Although 14.1% of our catchment area is Asian, after correction for age, they only accounted for 64/2268 (2.8%) of procedures for PAD and AAA. Specifically, Asians were 10 times less likely to undergo AAA repair and 3 times less likely to undergo procedures for lower limb peripheral bypass, amputation and endovascular intervention. In the epidemiological study, 26 subjects had a significant history of ischaemic heart disease, 21 were diabetic, 32 had hypertension and 60 were current or ex-smokers. Median aortic diameter [IQR] was 17.6 mm [16.3-19.1 mm] and no subject had an AAA. In 200 limbs, median ABPI [IQR] was 1.12 [1.04-1.21]. Only 2 patients had an ABPI < 0.9. CONCLUSION: Despite a high prevalence of cardiovascular risk factors and ischaemic heart disease, the prevalence of PAD and AAA is much lower than would have been expected in an age- and sex-matched Caucasian population. These data suggest that the reduced incidence of surgery for PAD and AAA in UK Asians is due to a low prevalence of disease.     

Prevalence of abdominal aortic aneurysm in Chinese patients with severe coronary artery disease

Background: The Asian population is believed to have lower incidence of abdominal aortic aneurysm (AAA), and hence, the benefit of screening is uncertain. The size of native aorta in Asians, which shall affect the definition of AAA, has also never been reported. Our study investigated the prevalence of AAA and the infra‐renal aortic diameter (AD) in Chinese patients with severe coronary artery disease. Methods: This is a prospective observational study of infra‐renal aortic size for patients who had coronary artery bypass surgery by ultrasound. The patients' demographics, important co‐morbidities and maximum AD were recorded. Results: The study included 624 consecutive Chinese patients (mean age = 63.2 years). The mean maximum infra‐renal AD was 17.5 mm for men and 14.8 mm for women. The presence of AAA was defined as maximum AD greater than 30 mm. The result was also compared with an alternate definition that defines AAA as maximum AD of greater than 1.5 times of the group's mean. Eleven patients had an AD greater than 30 mm, and the prevalence of AAA was only 1.8%. With AAA defined as maximum AD of 1.5 times greater than the group's mean, 19 patients had AAA. The prevalence of AAA in this high‐risk group would become 3% overall. Conclusion: The prevalence of AAA in Chinese patients was low, and the result did not support routine screening. The smaller mean infra‐renal AD in Chinese merits validation by large‐scale study and consideration when deciding threshold for small AAA repair in our locality.     

Hip fractures in northern Sweden 1973-1984. A comparison of rural and urban populations

The hip-fracture incidence in persons aged 50 years and older in the two northernmost counties of Sweden was studied during three periods between 1973 and 1984. The mean age rose from 75 to 78 years, and the annual number of fractures increased from 511 to 754. Half of this increase could be attributed to demographic aging. For persons 80 years and older, the fracture incidence in 1983/84 was higher (P less than 0.01) than the fracture incidence in 1973/74. The women/men ratio was approximately 2:1 during the survey, while the ratio cervical/trochanteric fracture type changed from 1.7:1 to 1.8:1. The crude fracture incidence rate rose from 4.4 to 5.8 fractures per 1,000 women 50 years and older; the corresponding figures for men were 2.3 and 3.4. Comparison of a rural mountain population with an urban population revealed a lower age-adjusted hip-fracture incidence rate in the rural area during the final part of the study (P less than 0.001). In the rural population, there was no change in age-specific incidence during the survey, while in the urban area the age-specific incidence in person 75 years and older was higher in 1983/84 compared with 1973/74.     

Epidemiology of Osteoporotic Pelvic Fractures in Elderly People in Finland: Sharp Increase in 1970–1997 and Alarming Projections for the New Millennium

The purpose of our epidemiologic study was to determine the current trend in the number and incidence of osteoporotic pelvic fractures in Finland, a country with a Caucasian population of 5 million. Thus, all Finns 60 years of age or older who were admitted to hospitals in 1970–1997 for primary treatment of a first osteoporotic pelvic fracture were selected from The National Hospital Discharge Register. In each year of the study, the number and the age-specific and age-adjusted incidences of fractures were expressed as the number of patients per 100 000 individuals. The total number of osteoporotic pelvic fractures increased considerably in Finland during the study period, from 128 in 1970 to 913 in 1997, an average increase of 23% a year. The corresponding fracture incidence (per 100 000 persons 60 years of age or older) was 20 in 1970 and 92 in 1997. The mean age of the patients also increased, from 74 years (1970) to 80 years (1997). Despite this, the age-adjusted incidence of osteoporotic pelvic fractures also showed a steady increase from 1970 to 1997: in women, from 31 to 103, and in men, from 13 to 38 (relative increases were 232% and 192%, respectively). If this trend continues, the current number of osteoporotic pelvic fractures in this country (about 900 fractures per year) may treble by the year 2030 (about 2700 fractures per year). We conclude that the number of osteoporotic pelvic fractures in elderly Finns is increasing at a rate that cannot be explained simply by demographic changes and therefore effective preventive measures should be urgently initiated to control the increasing burden of these age-related fractures. Received: 5 July 1999 / Accepted: 9 November 1999     

Persistent increase in the incidence of abdominal aortic aneurysm in Scotland, 1981-2000

BACKGROUND: In the 1970s and 1980s, mortality and morbidity rates for abdominal aortic aneurysm (AAA) increased throughout the developed world. As AAAs are associated with similar risk factors to other cardiovascular diseases that have recently decreased in incidence, the incidence of AAA should show a similar declining trend. METHODS: Routinely collected data were obtained on all primary diagnoses of aortic aneurysm resulting in death or hospital discharge in Scotland between 1981 and 2000. Trends in the data were analysed according to sex and age, aneurysm site and type of hospital admission. RESULTS: Between 1981 and 2000, 42.3 per cent of the 10 822 deaths from aortic aneurysm in Scotland were attributed to the abdominal aorta. Age-adjusted mortality rates for AAA increased 2.6-fold from 2.62 deaths per 100 000 in 1981 to 6.82 per 100 000 in 2000. Hospital admissions for AAA also rose threefold, with increases in both elective admissions (from 3.05 to 7.80 per 100 000) and emergency admissions (from 7.44 to 11.23 per 100 000). CONCLUSION: The incidence of AAA has increased over the past 20 years in Scotland. This is unlikely to be due simply to changes in detection and diagnosis, data inaccuracies, coding or ageing of the population. The incidence of both elective and emergency admission for AAA increased, suggesting that a genuine and persistent rise in the incidence of AAA has probably occurred.     

Should endovascular surgery lower the threshold for repair of abdominal aortic aneurysms?

PURPOSE: Because endovascular repair of abdominal aortic aneurysms (AAAs) is less invasive, some investigators have suggested that this increasingly popular technique should broaden the indications for elective AAA repair. The purpose of this study was to calculate quality-adjusted life expectancy rates after endovascular and open AAA repair and to estimate the optimal diameter for elective AAA repair in hypothetical cohorts of patients at average risk and at high risk. METHODS: A Markov decision analysis model was used in this study. Assumptions were made on the basis of published reports and included the following: (1) the annual rupture rate is a continuous function of the AAA diameter (0% for <4 cm, 1% for 4.5 cm, 11% for 5.5 cm, and 26% for 6.5 cm); (2) the operative mortality rate is 1% for endovascular repair (excluding the risk of conversion to open repair) and 3.5% for open repair at age 70 years; and (3) immediate endovascular-to-open conversion risk is 5%, and late conversion rate is 1% per year. The main outcome measure in this study was the benefit of AAA repair in quality-adjusted life years (QALYs). The optimal threshold size (the AAA diameter at which elective repair maximizes benefit) was measured in centimeters. RESULTS: The benefit of endovascular repair is consistently greater than that of open repair, but the additional benefit is small-0.1 to 0.4 QALYs. For men in average health with gradually enlarging AAAs with initial diameters of 4 cm, endovascular surgery reduces the optimal threshold diameter by very little: from 4.6 to 4.6 cm (no change) at age 60 years, from 4.8 to 4.7 cm at age 70 years, and from 5.1 to 4.9 cm at age 80 years. For older men in poor health, endovascular surgery reduces the optimal threshold diameter substantially (8.1 to 5.7 cm at age 80 years), but the benefit of repair in this population is small (0.2 QALYs). CONCLUSION: For most patients, the indications for AAA repair are changed very little by the introduction of endovascular surgery. Only for older patients in poor health does endovascular surgery substantially lower the optimal threshold diameter for elective AAA repair.     

Endoluminal graft repair for abdominal aortic aneurysms in high-risk patients and octogenarians: is it better than open repair?

OBJECTIVE: To analyze the short-term and midterm results of open and endoluminal repair of abdominal aortic aneurysms (AAA) in a large single-center series and specifically in octogenarians. METHODS: Between January 1997 and October 2000, 470 consecutive patients underwent elective repair of AAA. Conventional open repair (COR) was performed in 210 patients and endoluminal graft (ELG) repair in 260 patients. Ninety of the patients were 80 years of age or older; of these, 38 underwent COR and 52 ELG repair. RESULTS: Patient characteristics and risk factors were similar for both the entire series and the subgroup of patients 80 years or older. The overall complication rate was reduced by 70% or more in the ELG versus the COR groups. The postoperative death rate was similar for the COR and ELG groups in the entire series and lower (but not significantly) in the ELG 80 years or older subgroup versus the COR group. The 36-month rates of freedom from endoleaks, surgical conversion, and secondary intervention were 81%, 98.2%, and 88%, respectively. CONCLUSION: The short-term and midterm results of AAA repair by COR or ELG are similar. The death rate associated with this new technique is low and comparable, whereas the complication rate associated with COR in all patients and those 80 years or older in particular is greater and more serious than ELG repair. Long-term results will establish the role of ELG repair of AAA, especially in elderly and high-risk patients.     

Two decades of abdominal aortic aneurysm repair: have we made any progress?

PURPOSE: Over the past 20 years, there have been numerous advances in our ability to detect and to treat abdominal aortic aneurysms (AAAs). We hypothesized that these advances would lead to (1) an increase in the rate of elective repair and a decrease in the incidence of ruptured AAA (rAAA) and (2) a decrease in operative deaths for both elective AAA (eAAA) and rAAA. METHODS: To test these hypotheses, we investigated the incidence and outcomes of eAAA and rAAA surgery between 1979 and 1997, using the National Hospital Discharge Survey. This data set is a randomized, stratified sample representing discharges from the nation's acute care, nonfederally funded hospitals. Codes from the International Classification of Diseases, Ninth Revision were used to identify our study population. RESULTS: Over the past 19 years, there has been no change in the incidence rate of eAAA repair (range, 44.1-77.9 per 100,000). Moreover, the incidence of rAAAs presenting to the nation's hospitals has not changed (range, 6.6-16.3 per 100,000). There has been no consistent improvement over time in operative deaths associated with either eAAA or rAAA repair (average rates over the study period: eAAA, 5.6%; rAAA, 45.7%). Significant predictors of death from eAAA in patients included an age older than 80 years, African American race, congestive heart failure (CHF), and diabetes (P<.0001 for all). Significant predictors of death from rAAA in patients included age older than 70 years, African American race, female sex, renal failure, and a hospital bed size more than 500 (P<.05 for all). CONCLUSION: On a national level, over the past 19 years, our ability to identify and to treat patients with AAA has not improved. Advances in technology and critical care have not affected outcome. Regionalization of care, screening of high-risk populations, and endovascular repair are strategies that might allow further improvement in the outcome of patients with aneurysmal disease.     

The Incidence of Hip Fracture in Four Asian Countries: The Asian Osteoporosis Study (AOS)

The Asian Osteoporosis Study (AOS) is the first multicenter study to document and compare the incidence of hip fracture in four Asian countries. Hospital discharge data for the year 1997 were obtained for the Hong Kong SAR, Singapore, Malaysia and Thailand (Chiang Mai). The number of patients who were 50 years of age and older and who were discharged with a diagnosis of hip fracture (ICD9 820) was enumerated. The age-specific incidence rates were deduced and were directly adjusted to the US white population in 1989. The age-adjusted rates for men and women (per 100 000) are as follows: Hong Kong, 180 and 459; Singapore, 164 and 442; Malaysia, 88 and 218; Thailand, 114 and 289; compared with US White rates of 187 in men and 535 in women, published in 1989. We conclude that there is moderate variation in the incidence of hip fracture among Asian countries. The rates were highest in urbanized countries. With rapid economic development in Asia, hip fracture will prove to be a major public health challenge. Received: 14 March 2000 / Accepted: 17 October 2000     

Project PROMIS: Peoria Regional Outpatient Medical Imaging Study

BACKGROUND: Abdominal aortic aneurysm (AAA) accounts for > 15,000 reported deaths annually. Early screening in high-risk populations is important to decrease morbidity and mortality from rupture. METHODS: A prospective, population-based study of free ultrasound-based AAA screening was conducted from July 2004 to December 2006. Before examination, subjects completed surveys asking their medical history, including known AAA risk factors. Incidence rates and comparison analyses were performed. RESULTS: The final analysis included 979 patients, of whom AAA was discovered in 27 (2.8%). AAA was found in only male patients > 60 years old (4% of the male population). AAA size ranged from 3 to 10 cm. Of patients diagnosed with AAA, 85% were current or past smokers, and 70% had hypercholesterolemia. There was a 6% incidence of AAA in male smokers > or = 60 years old who had hypercholesterolemia. CONCLUSIONS: Four factors were predominant in our population of patients with AAA: patient age, male sex, smoking history, and hypercholesterolemia.     

Epidemiology of organising pneumonia in Iceland

BACKGROUND: Cryptogenic organising pneumonia (COP) has also been called idiopathic bronchiolitis obliterans organising pneumonia. In secondary organising pneumonia (SOP) the causes can be identified or it occurs in a characteristic clinical context. The aim of this study was to determine the incidence and epidemiological features of COP and SOP nationwide in Iceland over an extended period. METHODS: A retrospective study of organising pneumonia (OP) in Iceland over 20 years was conducted and the epidemiology and survival were studied. All pathological reports of patients diagnosed with or suspected of having COP or SOP in the period 1984-2003 were identified and the pathology samples were re-evaluated using strict diagnostic criteria. RESULTS: After re-evaluation, 104 patients fulfilled the diagnostic criteria for OP (58 COP and 46 SOP). The mean annual incidence of OP was 1.97/100 000 population (1.10/100 000 for COP and 0.87/100 000 for SOP). The mean age at diagnosis was 67 years with a wide age range. The most common causes of death were lung diseases other than OP, and only one patient died from OP. Patients with OP had a lower rate of survival than the general population, but there was no statistical difference between COP and SOP. CONCLUSIONS: The incidence of OP is higher than previously reported, suggesting that OP needs to be considered as a diagnosis more often than has been done in the past.     

Epidemiology of cervical and trochanteric fractures of the proximal femur in 1996 in Kaohsiung City, Taiwan

The goal of this study was to determine the incidence of cervical and trochanteric fractures of the proximal femur in 1996 in Kaohsiung City, Taiwan. Kaohsiung City is the industrial and commercial center of southern Taiwan, with a population of 1 433 621 in 1996. The number of individuals over 65 years of age accounted for 6.2% of the total population. Data from the archives of reimbursement of the National Health Insurance program were used to investigate the incidence of fractures of the proximal femur. This study detected 580 cervical and trochanteric fractures (40.5 fractures per 100 000 population per year) in 261 males (35.8 fractures per 100 000 men per year) and 319 females (45.3 fractures per 100 000 women per year), with 420 (72%) of these fractures occurring in individuals over 65 years of age. The age-specific incidences of cervical and trochanteric fractures increased exponentially with age in both genders. The overall ratio of cervical to trochanteric fractures was 1 : 1.04. The mean ages of women with cervical or trochanteric fractures (71.6 and 74.0 years, respectively) were significantly higher than those of males (59.9 and 64.8 years, respectively; P < 0.01). The age-adjusted incidences of fractures of the proximal femur in Kaohsiung City were higher than in other Asian countries, but were lower than in Western countries such as the United States and Norway. The urban lifestyle and low daily calcium intake may be responsible for this increased incidence of proximal femoral fractures in Kaohsiung City. Received: Dec. 22, 1998 / Accepted: July 6, 1999     

Endovascular repair or surveillance of patients with small AAA.

OBJECTIVE: To compare the outcome of patients with small abdominal aortic aneurysms (AAA) treated in a prospective trial of endovascular aneurysm repair (EVAR) to patients randomized to the surveillance arm of the UK Small Aneurysm Trial. METHOD: All patients with small AAA (< or = 5.5 cm diameter) treated with a stent graft (EVARsmall) in the multicenter AneuRx clinical trial from 1997 to 1999 were reviewed with follow up through 2003. A subgroup of patients (EVARmatch) who met the age (60-76 years) and aneurysm size (4.0-5.5 cm diameter) inclusion criteria of the UK Small Aneurysm Trial were compared to the published results of the surveillance patient cohort (UKsurveil) of the UK Small Aneurysm Trial (NEJM 346:1445, 2002). Endpoints of comparison were aneurysm rupture, fatal aneurysm rupture, operative mortality, aneurysm related death and overall mortality. The total patient years of follow-up for EVAR patients was 1369 years and for UK patients was 3048 years. Statistical comparisons of EVARmatch and UKsurveil patients were made for rates per 100 patient years of follow up (/100 years) to adjust for differences in follow-up time. RESULTS: The EVARsmall group of 478 patients comprised 40% of the total number of patients treated during the course of the AneuRx clinical trial. The EVARmatch group of 312 patients excluded 151 patients for age < 60 or > 76 years and 15 patients for AAA diameter < 4 cm. With the exception of age, there were no significant differences between EVARsmall and EVARmatch in pre-operative factors or post-operative outcomes. In comparison to the UKsurveil group of 527 patients, the EVARmatch group was slightly older (70 +/- 4 vs. 69 +/- 4 years, p = 0.009), had larger aneurysms (5.0 +/- 0.3 vs. 4.6 +/- 0.4 cm, p < 0.001), fewer women (7 vs. 18%, p < 0.001), and had a higher prevalence of diabetes and hypertension and a lower prevalence of smoking at baseline. Ruptures occurred in 1.6% of EVARmatch patients and 5.1% of UKsurveil patients; this difference was not significant when adjusted for the difference in length of follow up. Fatal aneurysm rupture rate, adjusted for follow up time, was four times higher in UKsurveil (0.8/100 patient years) than in EVARmatch (0.2/100 patient years, p < 0.001); this difference remained significant when adjusted for difference in gender mix. Elective operative mortality rate was significantly lower in EVARmatch (1.9%) than in UKsurveil (5.9%, p < 0.01). Aneurysm-related death rate was two times higher in UKsurveil (1.6/100 patient years) than in EVARmatch (0.8/100 patient years, p = 0.03). All-cause mortality rate was significantly higher in UKsurveil (8.3/100 patient years) than in EVARmatch (6.4/100 patient years, p = 0.02). CONCLUSIONS: It appears that endovascular repair of small abdominal aortic aneurysms (4.0-5.5 cm) significantly reduces the risk of fatal aneurysm rupture and aneurysm-related death and improves overall patient survival compared to an ultrasound surveillance strategy with selective open surgical repair.     

Prevalence of overactive bladder in Asian men: an epidemiological survey

OBJECTIVE: To study the epidemiology of overactive bladder (OAB) and the influence of demographic factors on its incidence in Asian men. SUBJECTS AND METHODS: A survey based on a self-administered questionnaire (locally translated in participating countries) was conducted between March 1998 and May 1998 to quantify the prevalence of OAB in a random sample of men (2369, aged 18-70+ years) visiting other than urology clinics in 26 centres in 11 Asian countries. The questionnaire was divided into two parts, i.e. social and demographic factors, and OAB symptoms. For OAB the questionnaire primarily focused on symptoms, degree of bother and treatment measures. The degree of bother was quantified by classifying it as mild, moderate and severe. The statistical relationship between demographics and OAB was assessed using the chi-square independent test. RESULTS: The prevalence of OAB was 29.9% (709 men); OAB was more common in professional workers (43%), the high-income group (26%, income of > US$ 800) and urban dwellers (64%). With increasing age the incidence of OAB increased, i.e. the prevalence was 53% in men aged > 70 years; the family history and type of toilets used had some relationship with OAB. Frequency (37%), urgency (34%), and frequency and urgency (10%) were the most common symptoms of OAB. Urge incontinence symptoms were reported by 13%. Some degree of bother was recorded in 32% of those with OAB, of whom only 5.9% received treatment for their OAB, with general practitioners and specialists being preferred equally. CONCLUSIONS: The prevalence of OAB in Asian men is high and more common in older patients. The treatment rate for the symptoms was much lower than in western countries, suggesting a need for better education of patients and more research for effectively managing the OAB.     

Gall bladder cancer,extrahepatic bile duct cancer and ampullary carcinoma in New Zealand: Demographics,pathology and survival

Introduction: The aim of present paper was to document the incidence of gall bladder cancer, cancer of the extrahepatic bile ducts and ampullary carcinoma in New Zealand. Methods: Data were collected from the New Zealand Cancer Registry from 1980 to 1997 and combined with national census statistics to give crude and age standardized incidence rates. Results: Over the 18‐year study period, 226 carcinomas of the ampulla of Vater, 608 gall bladder cancers, and 486 extrahepatic cholangiocarcinomas were registered. The age standardized incidence rates for gall bladder carcinoma in all New Zealanders were 0.41/100 000 in men and 0.74/100 000 in women. The age standardized incidence rates for gall bladder cancer in Maori were 1.49/100 000 in Maori men and 1.59/100 000 in Maori women. The corresponding age standardized incidence rates for extrahepatic bile duct cancers were 0.67/100 000 in men and 0.45/100 000 in women. There were insufficient cases to calculate an age standardized incidence in Maori or Pacific Islanders. For carcinoma of the ampulla, the age standardized rates were 0.34/100 000 in men and 0.25/100 000 in women. There were insufficient cases to calculate an age standardized incidence rate for Maori or Pacific Islanders. When histology was defined adenocarcinoma was the most common form of cancer occurring in 66% of gall bladder cancers, 91% of extrahepatic bile duct cancers and 70% of ampullary cancers. Most tumours were advanced at presentation with regional or distant metastases present in 72% of gall bladder cancers, 63% of extrahepatic bile duct cancers and 69% of ampullary tumours at diagnosis. Survival was poor with median survivals of 86 days, 151 days and 440 days recorded for gall bladder cancer, extrahepatic bile duct cancer and ampullary cancer, respectively. Conclusions: The demographic profile, pathology and survival of patients with gall bladder cancer, extrahepatic bile duct cancer and ampullary carcinoma are similar in New Zealand to that of other Western countries. However New Zealand Maori have a relatively high incidence of gall bladder cancer, and the incidence is equal in both Maori men and women, while cancers of the extra­hepatic bile duct and ampulla of Vater are rare in Maori. In comparison, cancers of the gall bladder, extrahepatic bile ducts and ampulla are rare in Pacific Islanders.     

Screening for abdominal aortic aneurysms in cardiovascular patients

BACKGROUND: The objective of the study was to determine the incidence of Abdominal Aortic Aneurysms (AAA) in a population of symptomatic cardiac patients. A retrospective cohort study of investigations was done at the cardiology clinic, Beaumont Hospital, Dublin. MATERIALS AND METHODS: There were 415 men and women recruited by referral to the cardiology clinic. All participants underwent routine ultrasound screening for AAA, and full assessment of all cardiac risk factors. Data were analyzed and correlated with age, sex, and diagnosis. RESULTS: Ultrasonographic diagnosis of aneurysm was based on an anteroposterior diameter of 3 cm or more. Of the 415 patients screened, 47 aneurysms were detected. Total incidence of AAA was 9.9% (male 14.1%, female 3.95%). All aneurysms were detected in patients over 60 years, detection rate 11.7% (male 16.3%, female 3.9%). The incidence of AAA was significantly higher in those who were subsequently proven to have cardiovascular disease, 13.8% (male 18%, female 5.15%). CONCLUSION: Screening the general population for those at risk of AAA is an ongoing debate. This study supports the concept of screening a higher risk population of patients over 60 years with cardiovascular disease.     

Cutaneous melanoma in New Zealand: 2000–2004

Background: In 2004, we published data on the trends in New Zealand (NZ) cutaneous melanoma (CM) for the period 1995–1999. The present report documents the trends in the next period from 2000 to 2004. Method: Data were obtained from the New Zealand Cancer Registry by way of a computerized search of CM ICD‐10 (172) codes from 2000 to 2004. Only one registration per person was made to avoid including patients with metastatic melanoma. The exclusion criteria were: incorrect or absent data; benign naevi; and melanoma in situ. Incidence rates were age standardised to the Segi world population. Results: The total study population was 8262 patients. There was no increase found in the overall incidence rate over the time period, but men had a statistically higher overall incidence rate (P= 0.0002) and thicker CMs (P= 0.003) compared with women. This gender difference was particularly marked in those patients aged greater than 59 years. Breslow thickness increased from 0.7 to 0.8 mm. The incidence rates varied quite significantly among District Health Boards, with Taranaki having the highest rate (70.3/100 000/year) and Southland had the lowest rate (20.1/100 000). Overall, NZ had a CM incidence rate of 41.2/100 000/year). Conclusion: The current study confirmed that NZ has the highest overall CM incidence rate in the world. Elderly men (>59 years old) have the highest risk of developing melanoma. The increase in melanoma thickness with its associated higher mortality risk is of grave concern.     

Epidemiology of abdominal aortic aneurysms in the Asian community

BACKGROUND: Studies relating to the ethnic origin of patients with an abdominal aortic aneurysm (AAA) are few and are mainly concerned with the differences between black and white Americans. The purpose of this study was to determine whether the incidence of AAA among the Asian population of Bradford is different from that in the Caucasian population. METHODS: A retrospective study of patients with an AAA was carried out between 1990 and 1997 using data collected by the Patient Administrative Service, personal databases of the vascular consultants and theatre records. Information about the ethnic composition of the population of Bradford was obtained from the 1991 national census. Demographic data, including ethnic origin and clinical details, were obtained from patient notes. RESULTS: Two hundred and thirty-three patients with an AAA were identified during the study interval. The Asian population comprised 14.0 per cent of the total population of Bradford. Twenty-eight AAAs would be expected per year. All of the aneurysms identified occurred in the Caucasian population and none in the Asian community. CONCLUSION: These early results suggest that AAA is rare among the Asian population.     

Morbidity and mortality of coronary artery surgery after the age of 70 years

From January, 1977, to December, 1983, 102 patients aged 70 years or more underwent isolated aortocoronary bypass surgery. They were compared with a group of 100 consecutive patients of less than 70 years of age who underwent the same surgical procedure in 1983. The older group was consistently more diseased in regard to clinical incapacity, unstable angina, the number of coronary arteries involved, and the number of coronary bypasses performed. The incidence of substantial stenosis of the left main coronary artery among the older patients was twice that in the younger ones. There were 7 early deaths in the older group and none in the younger patients. The cause of death was cardiac in 3 patients and noncardiac in 4. A total of 54 complications occurred in 39 older patients and 32 in 27 younger patients. The incidence of cardiac complications was similar in both groups (18 in the older and 17 in the younger). However, noncardiac complications were significantly (p less than 0.0001) more common in older patients (32) than in the younger patient group (7). The most frequent in the older group were cerebral (14), sternal (6), and respiratory (5) complications. Thus, the operative risk of aortocoronary bypass grafting is increased after the age of 70 years, particularly because of noncardiac complications, which are responsible for more than half of the early deaths. Careful selection of candidates for surgical treatment in this age group is mandatory, and particular attention should be given preoperatively to the search for noncardiac disorders to decrease the incidence of these operative complications.