Prevalence of abdominal aortic aneurysm in a hypertensive population.

Two studies were undertaken to estimate the prevalence of abdominal aortic aneurysm in a hypertensive population. The initial study screened hypertensive people from three local general practices. In this study 918 patients underwent ultrasound scanning of the abdominal aorta (498 men and 420 women). A total of 24 abdominal aortic aneurysms were identified; 20 in men (4%) and four in women (0.9%). Of these, 11 were > 4 cm in transverse diameter. Following this study, only hypertensive men over the age of 60 years and women over the age of 65 years were screened from a total of 29 general practices. Regular scanning sessions were held at each practice and 1328 patients attended (744 men and 584 women). A total of 43 abdominal aortic aneurysms were detected; 39 in men (5.2%) and four in women (0.7%). Hypertensive men are at increased risk of developing abdominal aortic aneurysms and should be offered an initial ultrasound scan at 60 years of age. Female hypertensives yield a much lower detection rate and screening hypertensive females would probably be an inappropriate use of available resources.     

Cyclical mastalgia: clinical and mammographic observations in a screened population

The incidence of cyclical mastalgia in well women presenting for breast screening was 69 per cent. The incidence of cyclical mastalgia increases with age up to the menopause. There was a higher incidence of 'high risk' mammographic patterns and a lower incidence of 'low risk' patterns, according to the Wolfe classification, in women with cyclical mastalgia compared with the rest of the screened population. This finding correlated with the severity, duration and need for treatment. The differences in breast pattern did not persist after the menopause. The question of whether or not cyclical mastalgia can be regarded as a risk factor for breast cancer is uncertain and needs further evaluation.     

The role of the aortic aneurysm diameter aortic diameter ratio in predicting the risk of rupture

This study was performed to examine the ratio between the size of an infrarenal aortic aneurysm and the normal aorta proximal to it, in the hope of identifying a high-risk group of patients. All patients underwent a computed tomography scan of the abdomen, at which time the diameters of the largest aneurysm and of the normal proximal aorta were measured. The ratio was calculated by dividing the diameter of the normal aorta (in centimetres) into the diameter of the aneurysm. One hundred and thirty patients were assessed. One hundred asymptomatic patients had a mean ratio of 2.0. The 30 symptomatic patients were subdivided into 2 groups; 17 were symptomatic but had no evidence of rupture (mean ratio 2.7), and the remaining 13 had a contained rupture (mean ratio 3.4). There was a significant difference between the asymptomatic patients and the two symptomatic groups (P less than 0.001). The results suggest that the aneurysm/aorta ratio may be helpful in identifying the high-risk aneurysm. Patients with a ratio of 2.7 or greater are likely to become symptomatic, whereas those with a ratio of 3.4 or greater are at risk of rupture.     

The relationship between aortic diameter and body habitus.

Nine hundred and six men between the ages of 65 and 74 years were screened to determine whether there was a correlation between abdominal aortic diameter and body size. There was no correlation between aortic diameter and weight or obesity but there was a significant correlation with height and age. Sequential enlargement of the aorta was observed in 57 men with aortic diameters above the normal range, none of these were characterised by one particular body habitus: it is suggested that patients in this group should be rescanned regularly.     

The epidemiology of abdominal aortic diameter

BACKGROUND: The diameter of the abdominal aorta is central to the diagnosis of abdominal aortic aneurysm. This study aimed to determine the associations between the diameter of the abdominal aorta at three distinct locations and the traditional cardiovascular disease risk factors as well as calcified atherosclerosis. METHODS: A total of 504 patients (41% women) underwent whole body scanning by electron beam computed tomography (EBCT) and a standardized assessment for cardiovascular disease risk factors. The resulting EBCT images were retrospectively interrogated for the diameter of the abdominal aorta just inferior to the superior mesenteric artery (SMA), just superior to the aortic bifurcation, and at the midpoint between the SMA and bifurcation. RESULTS: Mean patient age was 57.8 years. The mean (SD) diameter was 21.3 (2.9) mm at the SMA, 19.3 (2.5) mm at the midpoint, and 18.6 (2.2) mm at the bifurcation. In a model containing the traditional cardiovascular disease risk factors, age (standardized beta = 0.96), male sex (beta = 3.06), and body mass index (standardized beta = 0.68) were significantly associated with increasing aortic diameter at the SMA (P < .01 for all). The significance of the associations for these variables was the same for aortic diameter at the midpoint and bifurcation. Furthermore, a 1-unit increment in the calcium score in the abdominal aorta and iliac arteries was associated with 0.13-mm (P < .01) and 0.09-mm (P = .02) increases, respectively, in aortic diameter at the SMA. The results were similar for the midpoint (beta = 0.19, P < .01; beta = 0.12, P = .01, respectively) and bifurcation (beta = 0.09, P < .04; beta = 0.09, P = .03, respectively). CONCLUSIONS: Age, sex, body mass index, and the presence and extent of calcified atherosclerosis in both the abdominal aorta and iliac arteries are significantly associated with increasing aortic diameter independent of the other cardiovascular disease risk factors.     

Prevalence, treatment modalities and prognosis of familial prostate cancer in a screened population

PURPOSE: A family history of prostate cancer is an important risk factor for this disease. The clinical presentation and prognosis of familial disease remain uncertain. In this study these entities are evaluated in the first and second rounds of a screening program in The Netherlands. MATERIALS AND METHODS: Of all men randomized in the Rotterdam section of the ERSPC, 19,970 men were eligible for screening. Information regarding the family history was obtained by a self-administered questionnaire at baseline. RESULTS: In the prevalence screen the cancer detection rate in 1,364 men (7.1%) with a positive family history was 7.7% (106 cancers in 1,364 screened men with a positive family history) while the positive predictive value of the biopsies was 32.2% (154 cancers of 532 biopsies). In 12,803 sporadic cases the detection rate was 4.7% and the positive predictive value was 23.6% (p <0.0001 and 0.003, RR 1.63). No clinicopathological differences were found in the 1,559 men diagnosed in the first and second rounds. The overall biochemical-free survival rate after a mean followup of 56.8 months (range 0 to 129.9) was 76.8%, and was not significantly different in familial and sporadic cases (p = 0.840). These findings were consistent for the specific treatment modalities as well. CONCLUSIONS: Although screened men 55 to 75 years old with a father or a brother having prostate cancer themselves are at a substantially greater risk for the disease, the clinical presentation, treatment modalities and prognosis by biochemical progression are not different compared to sporadic cases.     

Relation between male obesity and male infertility in a Tunisian population

Obesity is associated with significant disturbance in the hormonal milieu that can affect the reproductive system. Male infertility affects approximately 6% of reproductive‐aged men. It has been suggested that overweight men or men with obese body mass index (BMI) experience prolonged time to pregnancy, although the influence of male BMI on fertility remains understudied. We hypothesised that BMI is inversely correlated with fertility, manifested by reduced sperm concentration and varicocele. Males of mean age 32.74 ± 6.96 years with semen analyses and self‐reported BMI were included (n = 98). Patient parameters analysed included age, BMI, pubertal timing, the development of varicocele, and leutinizing hormone, follicle‐stimulating hormone and testosterone (n = 18). The mean age of the study population was 32.74 ± 6.96 years. The incidence of azospermia, oligozoospermia, normospermia and the development of varicocele did not vary across BMI categories. Male obesity is not associated with the incidence of sperm concentration and the development of varicocele.     

Reproducibility of thoracic aortic diameter measurement using computed tomographic scans.

OBJECTIVES: Decisions to recommend elective surgical repair of thoracic aortic aneurysms (TAA) may be based on size or expansion rate, which are used as indices of the risk of rupture. Measurement error may thus affect clinical decision-making. In order to evaluate the reproducibility of aortic diameter measurements of TAA, we assessed departmental inter- and intra-observer variability of measurement of pre-selected computed tomographic scan images of aneurysmal segments of the thoracic aorta. METHODS: We compared measurements of minimum aortic diameter made by four observers in 50 pre-selected scans and at different times by two observers using a calliper method and a measurement tool within the scan. Differences in measured dimension were analysed using Wilcoxon's signed ranks test and the repeatability assessed using the method of Bland and Altman. RESULTS: There were no significant inter-observer differences among three observers but there were significant differences between another observer and two other observers (P < 0.05). No significant intra-observer differences existed. The best intra-observer repeatability was 2.25 while the worst inter-observer repeatability was 4.37. The mean and maximum difference in measurement were +/-0.88 mm and +/-8.0 mm, respectively. Variability of measurement increased with aortic diameter. CONCLUSIONS: Calliper measurement of TAA is an acceptable measurement method for surveillance of TAA but appears most accurate with a single observer. Increasing error is seen with increasing diameter which may compound error in estimation of expansion rate. Standardisation of technique is advisable for multiple observers and aortic units should adopt quality assurance protocols to minimise error.     

Preoperative magnetic resonance imaging evaluation of the aortic annular diameter in aortic valve stenosis

Accurate preoperative knowledge of the aortic annular diameter is a great value in determining the appropriate procedure for aortic valve stenosis. We have successfully used magnetic resonance imaging (MRI) to evaluate the size of the aortic annular diameter preoperatively. Between October 1997 and October 1998, 5 aortic valve replacements were performed in patients with aortic valve stenosis. MRI was performed preoperatively in all cases. All images were gated to the R-wave of the electrocardiogram. Images representing 5 mm slices were acquired in the plane which is parallel to the line through the center points of the aortic root and left ventricle outflow tract. The maximum diameter of the aortic annulus (D) was measured at the point just below the attachment of the aortic valve leaflets. This diameter was compared to the maximum diameter of the prosthetic valve sizer (D 1) which could be easily inserted into the aortic annulus intraoperatively, and to the diameter of the prosthetic valve (D 2) that ultimately was implanted. Twenty-five minutes were required to scan each patient. There were no complications related to scanning. Mean values were D = 23.4 mm, D 1 = 22.3 mm and D 2 = 21.4 mm. There was a significant correlation between D and D 1, and D 2 was approximately 2 mm smaller than D. MRI evaluation is an accurate, noninvasive method for determining the aortic annular diameter preoperatively. We highly recommend this method for measuring the aortic annular diameter in case of aortic valve stenosis as part of the preoperative evaluation.     

Is assessment of popliteal artery diameter in patients undergoing screening for abdominal aortic aneurysms a worthwhile procedure.

PURPOSE: The aim of this study was to assess whether screening of popliteal arteries in patients undergoing ultrasound screening of their abdominal aortas was worthwhile. METHODS: All male patients undergoing ultrasound screening for abdominal aortic aneurysm (AAA) during the period February 2000 to June 2002 were offered scanning of their popliteal arteries. All scans were performed by a single, trained operator using a Sonosite 180. RESULTS: Four hundred and forty-nine patients underwent screening and thus 898 popliteal arteries were assessed. The mean aortic diameter was 2.1 standard deviations (SD) 0.5 cm and the upper limit of normal (2 SD) was 2.7 cm. The mean diameter of the popliteal arteries was 0.74 SD 0.11 and the upper limit of normal was 0.96 cm. Thirty patients had aortic diameters greater than 2.5 cm (ectatic or aneurysmal aortas) but based on a popliteal diameter of 2 cm, no popliteal aneurysms were detected. However, 39 (4.3%) popliteal arteries measured > or = 1 cm (> mean+2 SD); 3/60 (5%) in the ectatic/AAA subgroup and 36/838 (4.3%) in the non-AAA subgroup. CONCLUSIONS: This study has shown that, using conventional definitions, the imaging of popliteal arteries during screening for AAAs does not detect any popliteal aneurysms and is thus of limited value. However, if a definition of popliteal aneurysm of > or = 1 cm (based on mean+2 SD) is used then 39/898 (4.3%) of arteries would be regarded as having abnormal diameters and may require surveillance.     

Maximal aortic diameter affects outcome after endovascular repair of abdominal aortic aneurysms

Objective

The purpose of this study was to evaluate whether maximal aortic diameter affects outcome after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA).

Morphology and diameter of infrarenal aortic aneurysms: a prospective autopsy study

PURPOSE: To determine the diameter and morphology of infrarenal aortic aneurysms in 78 fresh autopsy specimens. METHODS: To avoid underestimation of the arterial diameter postmortem and to re-establish aneurysm morphology, a device was designed and introduced into the vessel, inflated to 80 mm Hg, and the largest external diameter was measured. RESULTS: The ages of the individuals ranged from 40 to 97 yr (mean 70). Thirty-eight aneurysms were ruptured with diameters ranging from 5.3 to 17.0 cm (mean 7.97), and 40 aneurysms were nonruptured with variations in diameters from 2.8 to 6.1 cm, mean 4.02 cm (P<0.01). Fusiform aneurysms were more frequent, and when they ruptured their diameters were smaller than the diameters of the spherical aneurysms (P<0.05). Aneurysms ruptured more frequently in the posterior wall (67%) and in the inferior portion (61%). A mural thrombus was found at the site of rupture in 80% of the specimens. CONCLUSION: In our samples, rupture was found solely in those aneurysms with a diameter over 5.0 cm, ruptures occurred earlier in fusiform aneurysms, mural thrombus was not a protective factor, and finally, aneurysms ruptured mainly in the posterior and inferior portions.     

Sleep disorders and aortic dissection in a working population

The aim of the present study was to assess the relationship between acute aortic dissection (AAD) and sleep disorders in a working population. Seventy (50.4%) of 139 younger subjects with AAD suffered from sleep disorders. Insomnia was reported by 35 patients (50%), sleep deprivation by 31 patients (44.3%), and sleep apnea syndrome was present in 43 patients (61.4%). The average apnea–hypopnea index was 22.0 ± 7.5 points, requiring appropriate treatment. Most of these patients had irregular daily schedules due to job pressure. Sixty-six (94.3%) complained of severe mental and physical stress in daily life. Sleep disorders are considered one of the risk factors for the occurrence of AAD at younger active ages. In primary care for patients with mental or physical stress due to their daily life, it is important to assess these individuals for the presence of sleep disorders.