Efficacy of bupropion in the indigenous Maori population in New Zealand

BACKGROUND: Smoking rates are high in indigenous populations and contribute to their poor health. In New Zealand the indigenous Maori population has a high rate of smoking, with around 50% of adults being smokers compared with 20% of the adult European population. A study was undertaken to determine whether bupropion is effective in the treatment of smoking cessation in the indigenous Maori population in New Zealand. METHODS: A randomised, placebo controlled, double blind, parallel group study was performed in 134 Maori smokers aged 16-70 years who smoked more than 10 cigarettes per day. The main outcome measures were continued abstinence from smoking at 3 and 12 months. RESULTS: At each time point continued abstinence was better for the subjects allocated to bupropion, with a risk ratio for abstinence over all time points of 2.44 (95% CI 1.22 to 4.88). The rates of continued abstinence in the bupropion and placebo groups at 3 months were 44.3% and 17.4%, respectively, with a risk ratio of 2.54 (95% CI 1.30 to 5.00). The corresponding figures at 12 months were 21.6% and 10.9%, respectively, with a risk ratio of 1.99 (95% CI 0.79 to 5.00). CONCLUSION: Bupropion is an effective treatment for smoking cessation in the indigenous Maori population in New Zealand.     

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.     

Familial abdominal aortic aneurysms in the Otago region of New Zealand

PURPOSE: To investigate the familial incidence and phenotypic characteristics of patients with abdominal aortic aneurysms (AAA) in the Otago region of New Zealand. METHODOLOGY: A retrospective audit based pilot study and a prospective study of patients having abdominal aortic aneurysm repair from September 1988 to September 1999 was performed. RESULTS: 248 probands were enrolled, of which 19.4% had one or more first degree relative affected. The age at diagnosis of the familial (70.2) and non-familial (70.5) patients was similar. The proportion of females was increased in the familial subgroup. Hypercholesterolaemia was the only phenotypic feature to differentiate familial from non-familial patients and was associated with an earlier age of presentation. In the familial families, brothers were the most common relative affected and 77% of the families had two patients with AAA. CONCLUSION: 19.4% of patients operated on in the Otago area for AAA had a familial component to their aneurysm.     

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.     

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 aneurysms after heart transplantation.

BACKGROUND: In recent years abdominal aortic aneurysms were diagnosed in several heart transplant recipients at our center. Only case reports or small series have been reported previously and little is known about abdominal aortic aneurysms after heart transplantation. Therefore, the goals of this study were to estimate the incidence of this condition after heart transplantation, to identify risk factors for its development, and to assess its clinical consequences. METHODS: Our investigation was a retrospective, single-center cohort study of 368 consecutive patients transplanted between 1984 and 1999. RESULTS: During a mean follow-up of 75 +/- 49 months, 37 of the 368 (10%) transplant recipients and 36 of 202 (18%) of the sub-group with a history of ischemic heart disease were found to have an abdominal aortic aneurysm. All patients were male, and all except 1 had a history of ischemic heart disease. A history of ischemic heart disease prior to heart transplantation was the sole independent risk factor for developing an aneurysm by multivariate analysis. Aneurysm-related events occurred earlier and more frequently in the 7 transplant recipients who already had a dilated abdominal aorta prior to transplantation. The abdominal aortic aneurysm was the direct or indirect cause of death in at least 9 patients. CONCLUSIONS: Abdominal aortic aneurysms are relatively frequent after heart transplantation, occur at a younger age than in the general population, and have serious clinical consequences. Close ultrasonographic follow-up of patients with a history of ischemic heart disease or with an abnormal abdominal aorta prior to heart transplantation seems indicated.     

Abdominal aortic aneurysms following orthotopic heart transplantation

The purpose of these authors' study was to analyze their center's experience with orthotopic heart transplantation (OHT) and abdominal aortic aneurysms (AAA) with particular attention to corticosteroid dosing, hemodynamic parameters, and aneurysm growth rate. A retrospective review of all patients (453) who underwent OHT at their university-affiliated medical center over an 18-year period (1981-1999) was undertaken. Nine (2%) patients who developed AAAs were identified and aneurysm growth was correlated with corticosteroid immunosuppression and hemodynamic parameters. The mean age of OHT patients was 44.5 +/-15 years and the majority were males (371 males, 82%). Median follow-up was 5.7 years. Ischemic cardiomyopathy (IC) was the most common indication for transplantation (45.5% of patients). All AAA patients were male (p=0.157), with a mean age of 58.4 +/-4.8 years (p=0.001), and had undergone OHT for IC (p=0.001). Mean arterial blood pressure and ejection fraction in the AAA patients had increased from pretransplant values of 107 mm Hg and 14.3 +/-5.7% to 142 mm Hg (p=0.017) and 54.1 +/-14.1% (p<0.001), respectively, before aneurysm repair. Mean aneurysm diameter at the time of repair was 6.0 +/-0.8 cm, and the average growth rate was 1.2 +/-0.4 cm/year in the 4 patients in whom it could be measured. Aneurysm repair was performed urgently in 2 patients and electively in 7 patients with 1 early postoperative death (11%). The extent of corticosteroid immunosuppression, corticosteroid pulses, and total corticosteroid dosing did not correlate with the rate of aneurysm growth. Improved hemodynamics and progressive posttransplant hypertension may contribute to aneurysm formation and growth in this group of patients.     

Abdominal aortic aneurysms and ureteric obstruction.

Ureteric obstruction is rarely encountered in abdominal aortic aneurysms and is due to perianeurysmal fibrosis. 3 cases are described in which aortic aneurysm and retroperitoneal fibrosis are found. Excision of the aneurysm and ureterolysis with intraperitonization of the ureter is the most appropriate surgical procedure but treatment must be individualized according to the patient's condition and the operative discoveries.     

Abdominal aortic aneurysms infected by Escherichia coli

Three cases of atherosclerotic abdominal aneurysms infected by Escherichia coli urinary tract sepsis are presented together with a review of four additional cases of E. coli-infected aneurysms. Pathophysiology and a current system of classification of aortic infection are discussed. Important clinical features of gram-negative aortic infection include a diagnostic triad and the tendency to early rupture. Resection of infected tissue and extra-anatomic bypass for revascularization are the cornerstones of operative management. The mortality rate of E. coli aortic infection is high, with one known survivor. Death is contributed to by the high frequency of preoperative rupture, the age of the patient, and the extent of atherosclerotic disease.     

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.     

Abdominal aortic aneurysm repair in the veteran population

Background: The aim of this study was to audit the outcome of elective open aortic aneurysm repair in a veteran hospital to determine whether age ≥80 years influenced the morbidity or mortality. Methods: All elective abdominal aortic aneurysm (AAA) repaired at Greenslopes Private (Repatriation) Hospital between January 1995 and July 2000 were reviewed. Operative details, premorbid condition, postoperative outcomes as well as length of admission were recorded. Patients were grouped according to age as ≥80 years or <80 years. Results: There were 251 open elective AAA (including infrarenal and suprarenal, as well as recurrent AAA) repairs carried out during this period, 64 of which were patients of age ≥80 years. Cardiovascular risks factors did not differ between groups nor did complication rates for patients ≥80 and <80 years of age (19.1 and 19.8%, respectively). Mortality rates were not significantly different between groups (≥80 years: 6.25%; <80 years: 4.8%; P > 0.6). Conclusions: Age ≥80 years should not be an exclusion criteria when contemplating open elective AAA repair.     

Abdominal aortic aneurysms presenting as renal colic.

In a 6-year period, 9 patients were referred by their General Practitioners to the urology unit with a clinical diagnosis of renal colic but were subsequently found to have leaking abdominal aortic aneurysms (AAA). In all cases of loin pain, especially in the elderly patient, the possibility of a leaking abdominal aneurysm must be considered. If no intrinsic urological cause for the pain is found or patterns suggestive of ureteric obstruction are seen on urography, ultrasound examination of the aorta-iliac vessels should be performed. Magnetic resonance imaging (MRI) and computed tomography (CT) scans may be useful adjuncts to this investigation.     

Abdominal aortic aneurysms. Results of surgical treatment

One hundred and twenty-one aneurysms of the abdominal aorta were operated on during a ten year period (1971-1981). Elective surgery was carried out in 89 patients (73.5%). Thirty-two patients were operated on for impending or frank rupture. Most of the patients treated electively had no symptoms on admission. The mortality of this group of patients was 6.7% (6 patients). All the patients treated as emergencies had acute abdominal or back pain. Six cases presented with shock and acute renal failure. The hospital mortality was high in this group of 11 patients (34.3%). Nine of them were operated on because of suspected rupture but this was not confirmed at operation. Only one patient in this group died after the operation (11.1%). The hospital mortality of the 23 patients with ruptured aneurysms was 43.4% (10 patients). Six of them died in the operating room. While elective surgery carries an acceptable mortality, the emergency procedure involves a high risk. All the aneurysms must be resected electively in spite of the absence of symptoms.