Biomedical subjects

E W Henneberg

Publications and source records attributed to E W Henneberg.

At least 19 recordsLinked to original sources

PubMed2006

Preliminary ten year results from a randomised single centre mass screening trial for abdominal aortic aneurysm.

BACKGROUND: At present, several regions and countries are considering screening for abdominal aortic aneurysm (AAA). However, The Chichester Aneurysms Screening Trial has reported poor long term benefit of screening for AAA. We therefore supplement previously published data with a preliminary analysis of the ten-year mortality from AAA, based upon population-based data until 2002 (7 years) and incomplete hospital-based information on deaths until 2005 (10 years). METHODS AND MATERIAL: In 1994 we started a randomised screening trial of 12,639 64-73 year-old males; 6,306 were controls, and 6,333 were invited to an abdominal ultrasound scan at their district hospital. Information on all deaths until 15.3.2005 was obtained from the Office of Civil Registration. Information on AAA related deaths was obtained from the national registry of Causes of Deaths from 1.4.1994 to 31.12.2001, and supplemented with AAA deaths known to the Danish National Patient Registry until 15.3.2005. Operations were obtained from the Danish National Vascular Registry from 1.4.1994 to 15.3.2005. Death certificates and medical records were reviewed by two independent assessors. The analyses were based on "intention to treat" from the date of randomisation. RESULTS: The attendance rate was 76.6% and 191 (4.0%) had an AAA. The median observation time was 9.58 years. In the invited group 13 subjects were acutely operated on compared to 40 in the control group (Risk ratio: 0.32 (95% C.I. 0.17-0.60, P<0.001)), and 14 died due to AAA compared to 51 in the control group (Hazard ratio: 0.27 (95% C.I.: 0.15-0.49, P<0.001). CONCLUSION: Over ten years, screening reduced mortality from AAA by 73%, and the frequency of emergency operations by 68%.

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PubMed2006

Cost-effectiveness analysis of screening for abdominal aortic aneurysms based on five year results from a randomised hospital based mass screening trial.

BACKGROUND: The aim of this study was to estimate the cost effectiveness of screening for abdominal aortic aneurysm (AAA). MATERIAL AND METHODS: All 12,639 men born in the years 1921-1933 (aged 64-73) living in Viborg County, Denmark, were randomly allocated either to receive an invitation to abdominal ultrasound scanning for AAA or to be controls. Costs for screening and surveillance were assessed prospectively. Diagnosis Related Group (DRG) costs from 1999 were used concerning admissions with uncomplicated and complicated operations. Admissions for AAA surgery were retrospectively classified according to complications in patient records. RESULTS: Mean follow-up time was 52 months. 76.6% of invited men attended screening, and 191 (4.0%) had an AAA. As previously reported, the cumulative 5-year AAA-specific mortality in the invited group was significantly reduced by 67% compared to the control group (P = 0.003). The costs were estimated to be Euro 11.23 per scan. The costs per life-year saved were Euro 9057 (Euro 5872-20,063) after 5 years, and were expected to decrease to Euro 2708 (Euro 1758-6031) after 10 years and to Euro 1825 (Euro 1185-4063) after 15 years. CONCLUSION: Screening of 64-73 years old males in Denmark seems cost effective.

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PubMed2003

Systemic levels of cotinine and elastase, but not pulmonary function, are associated with the progression of small abdominal aortic aneurysms.

OBJECTIVE: to study whether smoking and impaired pulmonary function are associated with the expansion of abdominal aortic aneurysms (AAA). METHODS AND MATERIAL: seventy-nine men with small (3-5 cm), screen-detected AAA underwent a simple 5-step smoking history, measurement of the forced first second expiratory volume (FEV1), venepuncture and annual ultrasound scan for mean follow-up period of 3.5 years. RESULTS: all but one patient had a significantly reduced FEV1 (p<0.05, Mann-Whitney). The FEV1/expected FEV1 ratio (rFEV1) was not related to AAA expansion but was negatively correlated with P-elastase-alpha1-antitrypsin-complexes (P-Elastase). P-Elastase was positively correlated with smoking and S-cotinine. Smoking, S-cotinine, and P-elastase were positively correlated with the mean annual AAA expansion rate but not rFEV1. CONCLUSION: in general, patients with AAA have impaired pulmonary function. A simple five step smoking classification is as predictive of AAA-expansion as S-cotinine. Smoking may cause elastase secretion leading to pulmonary and aortic elastin degradation but the lack of association between AAA-expansion and rFEV1 suggest that other mechanisms are important.

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PubMed2003

Relationships between activators and inhibitors of plasminogen, and the progression of small abdominal aortic aneurysms.

OBJECTIVE: plasmin is a common activator of the known proteolytic systems involved in the aneurysmal degradation, and is reported to be associated with the expansion of abdominal aortic aneurysms (AAA). The aim of this study was to study the activating pathways of plasminogen as predictors of the progression of AAA. MATERIALS AND METHODS: one hundred and twelve of 122 male patients with a small AAA (def.: +3cm) were interviewed, examined, had blood samples taken at diagnosis, and scanned annually for 1-5 years (mean 3.5 years), and referred for surgery if the AAA exceeded 5cm in diameter.A random sample of 70 of the 112 cases had plasma levels of urokinase-like-plasminogen activator (uPA), tissue-type-plasminogen activator (tPA), plasminogen-activator-inhibitor-1 (PAI-1), macrophage inhibiting factor (MIF), tumour-growth-factor-beta1 (TGF-beta1), homocysteine, and serum levels of IgA-antibodies against Chlamydia pneumoniae (IgA-CP) and Cotinine (a nicotine metabolite) measured. Spearmans correlation analysis was used for statistics. RESULTS: the annual expansion rate correlated positively with tPA, IgA-CP and S-Cotinine; r =0.37 (p=0.002), 0.29 (p=0.006) and 0.24 (p=0.038), while PAI1, uPA, TGF-beta1, homocysteine, and MIF did not. S-Cotinine did also correlate positively with tPA, r=0.24 (p=0.049). CONCLUSION: the aortic matrix degradation in AAA may be partly caused by an activation of plasminogen by tPA, but apparently not by uPA, which usually dominates matrix degradation. Smoking seems to be a factor for this pathway, while the pathways of IgA-CP and MIF, a new marker of aneurysmal progression, seem different. The latter observations suggest that other proteolytic pathways are involved in the aortic wall degradation in AAA.

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PubMed2002

Hospital costs and benefits of screening for abdominal aortic aneurysms. Results from a randomised population screening trial.

OBJECTIVES: to analyse the hospital costs and benefits of screening older males for abdominal aortic aneurysm (AAA). MATERIALS AND METHODS: in 1994 a hospital-based screening trial of 12 658 65-73-year-old males was started. AAA >5 cm were referred for surgery. The remaining AAA were offered annual scans. Those with aortic ectasia were rescreened at 5 yearly intervals. AAA-operations and hospital AAA-related deaths were researched. The costs of screening, surveillance, and treatment were also registered. RESULTS: the attendance rate was 76%; of whom 191 (4.0%) had AAA. Mean observation time was 5.13 years. Sixty in the screened and 41 in the control group were operated (p=0.06), of which 7 and 27 respectively were operated as an emergency (p<0.001), and 6 and 19 respectively died due to AAA (p=0.009). The costs per scan were 83.50 DKK, 81 400 DKK per emergency operation (71 485 DKK after screening), and 117 000 DKK per emergency operation. The cost per prevented hospital death was 67 855 DKK, equivalent to approximately life year saved approx. 7540 DKK (GBP1=12 DKK). CONCLUSION: screening appears to reduce hospital AAA mortality and to be cost-effective.

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PubMed2002

Immunoblotting analysis of abdominal aortic aneurysms using antibodies against Chlamydia pneumoniae recombinant MOMP.

OBJECTIVES: antibodies against Chlamydia pneumoniae have been associated with atherosclerosis and with expansion of abdominal aortic aneurysms (AAA). C. pneumoniae has been demonstrated in coronary arteries, AAA and the carotid arteries by use of polymerase chain reactions (PCR), immunohistochemical procedures and electron microscopy. However, the correlation between demonstrating C. pneumoniae DNA or antigen in tissue from plaque material or aneurysms and the antibody titres in serum is controversial. The specificity of immunohistochemical procedures is unknown. The aim of this study was to assess the possibility of potential non-specific findings for methods based on immunostaining. MATERIALS AND METHODS: twenty patients undergoing infrarenal AAA repair were studied. Full AAA thickness tissue was collected from the anterior wall of the aneurysm. Analysis was performed using polyacrylamide gelelectrophoresis, immunoblotting and mass spectrometric protein identification. RESULTS: C. pneumoniae antigen was not demonstrated in any of the AAA samples, whereas a major cross-reacting protein was present in all AAA samples. The protein was identified as the human haemoglobin beta chain. CONCLUSION: we were not able to find C. pneumoniae antigens reacting with an anti C. pneumoniae major outer membrane protein (MOMP). Direct detection of C. pneumoniae by immunohistostaining procedures should be interpreted with caution due to potential crossreaction with non chlamydial proteins.

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PubMed2001

[What are the direct costs of an abdominal aortic aneurysm repair in a Danish hospital?].

INTRODUCTION: The aim of the study was to estimate the direct cost of an abdominal aortic aneurysm (AAA) repair and to validate it against the national Diagnostic Related Group (DRG) costs. MATERIAL: Over a three-year period, between January 1996 and December 1998, a total of 100 men were selected at random from a series of 197 patients treated with open surgery for (AAA) at the Department of Vascular Surgery, Viborg Hospital. RESULTS: The total cost of an AAA operation without complications was estimated to be 70,000 DKK, compared to the DRG price of 79,000 DKK. Complications were significantly more frequent after emergency repair (odds ratio = 4.3 (95% CI; 1.9-10.1)). A statistically significant difference was seen in the cost of AAA repair between elective and emergency operations with rupture (p < 0.05), mainly because of the longer stay in hospital. DISCUSSION: The estimated cost is sufficiently reliable to be used in analysis of cost-effectiveness.

Aortic Aneurysm, Abdominal↗

PubMed2001

[Optimal interval screening and observation of abdominal aortic aneurysms].

INTRODUCTION: Screening and observation of abdominal aortic aneurysms (AAA) produce psychological stress. Consequently, safe and optimal intervals of rescreening and observation must be developed. METHOD: In a randomised, mass screening trial of 6,339 men aged, 65-73 years from 1994 to 1998, 76% attended, and 191 (4%) had AAA > or = 3 cm. Twenty-four (0.5%) had AAA above 5 cm in diameter and were referred for surgery, while the rest were offered annual control. Later, all 348 (7.5%) men who, 3 to 5 years before, had had an ectatic aorta (an infrarenal aortic diameter of 25-29 mm or a distal/renal aortic diameter ratio of > 1.2) were offered rescreening, together with a control group of 380 men. RESULTS: None of the controls had developed AAA. Of those who initially had an aortic diameter of 25-29 mm aorta, 28.5% had developed AAA (size range 30-48 mm), whereas only 3.5% with a ratio > 1.2 developed AAA (size range 30-34 mm). During the fourth year of surveillance some AAA initially sized below 3.5 cm expanded to above 5 cm, whereas this occurred in some sized 3.5-3.9 cm during the second year and in most above 4 cm did during the first year of observation. CONCLUSION: Rescreening for AAA can be restricted to initially ectatic aortas sized 25-29 mm at five-year intervals. Observation of small AAA can be restricted to 1-4 year intervals.

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PubMed2001

Incident thromboembolism in the aorta and the renal, mesenteric, pelvic, and extremity arteries after discharge from the hospital with a diagnosis of atrial fibrillation.

BACKGROUND: The impact of atrial fibrillation (AF) on risk of peripheral arterial thromboembolism is unknown. METHODS: We analyzed the risk of thromboembolism (embolus and/or thrombosis) in the aorta and the renal, mesenteric, pelvic, and extremity arteries in a cohort of patients discharged from the hospital with an incident diagnosis of AF relative to the risk of thromboembolism in these vessels in the Danish population. In a random sample of half of the Danish population, 14 917 men and 14 945 women aged 50 to 89 years were identified in the Danish National Hospital Discharge Register with a diagnosis of AF from January 1, 1980, through December 31, 1993. Patients were followed up from diagnosis of AF in the Danish National Hospital Discharge Register and the Causes of Death Register until the first diagnosis of a thromboembolic event, death, or the end of 1993. Risk of a thromboembolic event relative to the risk in the Danish population was analyzed by means of Poisson regression modeling. RESULTS: Patients with a hospital diagnosis of AF had an increased risk of thromboembolic events in the aorta and the renal, mesenteric, pelvic, and extremity arteries (relative risk, 4.0 [95% confidence interval, 3.5-4.6] in men; and relative risk, 5.7 [95% confidence interval, 5.1-6.3] in women) compared with the Danish population. CONCLUSION: A hospital diagnosis of AF is an important risk factor for peripheral arterial thromboembolic complications.

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PubMed2001

Randomized double-blind controlled trial of roxithromycin for prevention of abdominal aortic aneurysm expansion.

BACKGROUND: Macrolide treatment has been reported to lower the risk of recurrent ischaemic heart disease. The influence of macrolides on the expansion rate of abdominal aortic aneurysms (AAAs) remains unknown. The aim was to investigate the effect of roxithromycin on the expansion rate of small AAAs. METHODS: A total of 92 subjects with a small AAA were recruited from two populations. One population consisted of 6339 men aged 65-73 years who were offered a hospital-based mass screening programme for AAA. From this population 66 subjects were recruited. The remaining 26 men were recruited from among 49 subjects diagnosed at interval screening for an initial aortic diameter between 25 and 29 mm. Subjects were randomized to receive either oral roxithromycin 300 mg once daily for 28 days or matching placebo, and followed for a mean of 1.5 years. RESULTS: During the first year the mean annual expansion rate of AAAs was reduced by 44 [corrected] per cent in the intervention group (1.56 mm per year), compared with 2.80 mm per year following placebo (P = 0.02). During the second year the difference was only 5 per cent [corrected]. Multiple linear regression analysis showed that roxithromycin treatment and initial AAA size were significantly related to AAA expansion when adjusted for smoking, diastolic blood pressure and immunoglobulin A level of 20 or more [corrected]. Logistic regression analysis confirmed a significant difference in expansion rates above 2 mm annually between the intervention and placebo groups: odds ratio = 0.09 (95 per cent confidence interval 0.01-0.83) [corrected]. CONCLUSION: In comparison to placebo, roxithromycin 300 mg daily for 4 weeks reduced the expansion rate of AAAs.

Administration, Oral↗

PubMed2001

Cystatin C deficiency is associated with the progression of small abdominal aortic aneurysms.

BACKGROUND: The cysteine protease inhibitor cystatin C may play a role in the development and progression of abdominal aortic aneurysms (AAAs). METHODS: From a mass screening trial of men aged 65-73 years, 151 small AAAs were followed for a mean of 2.9 years. Of these patients, 142 had serum samples taken to determine the levels of cystatin C, creatinine and C-reactive protein (CRP). RESULTS: Serum cystatin C concentration correlated negatively with AAA size (r = - 0.22 (95 per cent confidence interval (c.i.) - 0.59 to - 0.02)) and annual expansion rate (r = - 0.24 (95 per cent c.i. - 0.75 to - 0.05)), persisting after adjustment for renal function, smoking, diastolic blood pressure, CRP, age and AAA size. Creatinine clearance and CRP did not correlate with size or expansion rate. Thirty-one AAAs had expanded to over 50 mm, when operation was recommended. The serum level of cystatin C was a significant predictor of this occurrence, with a sensitivity and specificity of 61 and 57 per cent respectively. However, initial AAA size had the optimal sensitivity and specificity (both 81 per cent) in this regard. CONCLUSION: Deficiency of cystatin C was associated with increased aneurysm size and expansion rate, possibly due to lack of inhibition of cysteine proteases.

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PubMed2001

Smoking, but not lipids, lipoprotein(a) and antibodies against oxidised LDL, is correlated to the expansion of abdominal aortic aneurysms.

OBJECTIVES: to study the role of smoking, lipids, lipoprotein (a), and autoantibodies against oxidised low density lipoprotein (Ab-oxLDL) in the expansion of small abdominal aortic aneurysms (AAA). To study the role of Ab-oxLDL and lp(a) in the progression of lower limb atherosclerosis. METHODS AND MATERIALS: one hundred and thirty-eight male patients with AAA were interviewed, examined, and their serum lipids and S-Ab-oxLDL determined. Of these, 117 were followed annually with ultrasound and underwent control scans and blood pressure measurements for a mean of 2.5 (range 1-5) years. RESULTS: initial AAA size, smoking and level of triglycerides were positively correlated to increased aneurysmal expansion, while beta-blocker medication was associated with decreased expansion. Besides initial AAA size, only smoking had persisting significance after adjustment of the other significant variables. Initial ankle brachial pressure index (ABI) and Lp(A) but not ab-oxLDL were significantly correlated to ABI change. CONCLUSION: smoking cessation may inhibit aneurysmal expansion. Lipids seem to play a minor role in the progression of AAA.

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PubMed2001

Five-year results of elastin and collagen markers as predictive tools in the management of small abdominal aortic aneurysms.

OBJECTIVE: small abdominal aortic aneurysms (AAAs) do rupture and only half of AAAs above 5 cm would have ruptured unoperated. Furthermore, conservative treatment of AAAs may cause psychological side effects and impaired quality of life. To optimise the indication and time for operation for AAAs, we analysed whether serum elastin peptides (EP), procollagen-IIIN-terminal propeptide (PIIINP), and the initial AAA size could predict operation for AAAs in initially conservatively treated AAA. MATERIAL AND METHODS: in 1994, 4404 65-73 year old males were invited to hospital-based screening for AAAs by ultrasonography. Seventy-six percent attended. One hundred and forty-one (4.2%) had AAAs (def: +30 mm). Nineteen were offered operation (AAA +50 mm), and 112 were followed with annual control scans for 1-5 years (mean 2.5 years). Of these, 99 had their EP (ng/ml) and PIIINP (ng/ml) determined using ELISA and RIA techniques. Two observers and one scanner were used. RESULTS: the mean expansion rate was 2.7 mm/year. The initial AAA size (r =0.46; 0.26-0.61), EP ( r =0.31; 0.11-0.49), and NPIIIP ( r =0.24; 0.02-0.44) was independently significant associated to expansion rate in a multiple linear regression analysis including the three mentioned variables. The multivariate formula could by ROC curve analysis predict cases reaching 5 cm in diameter within 5 years with a sensitivity and specificity of 91% and 87%, respectively, increasing to 91% and 94%, respectively, by accepting a 2 mm variation in those measurements. Twenty-three were lost to follow up, 21 of these due to death or severe illness. Of these, seven would have been predicted to reach an AAA size recommendable for surgery. If all 23 were included in the analysis, the sensitivity and specificity would have been 87% and 85%, respectively. CONCLUSION: a predictive model using EP, PIIINP, and initial AAA size seems capable of predicting nine out of 10 AAAs that will be operated on within 5 years. However, a larger sample size is needed for clinical recommendations.

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PubMed2001

Antibodies against Chlamydia pneumoniae predict the need for elective surgical intervention on small abdominal aortic aneurysms.

OBJECTIVE: to compare the ability of two independent Chlamydia pneumoniae antibody tests to predict need for small abdominal aortic aneurysm (AAA) repair. PATIENTS AND METHODS: annual scans were offered to 149 screening diagnosed small AAA (<5 cm). Serum samples were collected for measuring IgA and IgG-antibodies to C. pneumoniae by microimmunofluorescence (MIF) test and the new ELISA (Labsystems). RESULTS: a significant concordance was found between MIF and ELISA titres with Kappa values of 0.29 for S-IgA and 0.42 for S-IgG. IgG antibodies measured by ELISA were most predictive for cases expanding operation recommendable sizes with a sensitivity and specificity of 80% and 66%, respectively. CONCLUSION: the simpler EIA has a high correlation with the MIF test and both were predictive for the natural history of AAA. Chlamydia antibody test may be used to identify individuals who might benefit from follow-up and anti-chlamydia treatment.

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PubMed2001

Plasma levels of plasmin-antiplasmin-complexes are predictive for small abdominal aortic aneurysms expanding to operation-recommendable sizes.

OBJECTIVE: Three proteolytic systems seem involved in the aneurysmal degradation of the aortic wall. Plasmin is a common activator of the systems and could thus be predictive for the progression of abdominal aortic aneurysms (AAAs). METHODS AND MATERIALS: In 1994, 112 of 141 male patients with AAA diagnosed through population screening (defined as 3 cm or more) were interviewed and examined and had blood samples taken. One hundred twelve cases were scanned annually for 1 to 5 years (mean, 2.5 years) and referred for surgery if the AAA exceeded 5 cm in diameter. A random sample of 70 of the 112 cases had P-plasmin-antiplasmin-complexes (PAPs), P-plasminogen, and S-elastin-peptides (SEPs). RESULTS: PAP was positively correlated with annual expansion rate (r = 0.39, 0.16-0.56), persisting after adjustment for initial AAA size, SEP, age, and smoking. However, PAP levels did not correlate with the initial AAA size or SEP. Furthermore, PAP levels were significantly predictive for cases expanding to operation-recommendable AAA sizes. Combined with the initial AAA size, both optimal sensitivity and specificity were 82%, increasing to 95% and 96%, respectively, excluding those lost to follow-up and accepting 2 mm of interobserver variation. CONCLUSION: The progression of AAA is correlated with the PAP level, which seems to have a predictive value similar to the best serologic predictor known, serum-elastin-peptides.

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PubMed2000

[Iliac aneurysm compared with abdominal aorta aneurysm].

The aim of the study was to compare the epidemiology, risk factors and manifestations of iliac and abdominal aortic aneurysm (AAA). Two studies were used: 1. Five thousand four hundred and seventy 65-73 year old men invited to screening for AAA. 2. Review of all 350 patients operated for central aneurysms in the county of Viborg in Denmark 1989-1997. Four thousand one hundred and seventy-six attended screening. One hundred and seventy (4.0%) had an AAA. Twenty-one (0.56%) required operation, while the prevalence of operation-requiring iliac aneurysm (IA) was 0.17%. The operative incidence of IA was 18.4 per mill. per year, and 92.4 per mill. per year were operated for AAA. Patients with IA had lower cholesterol-levels, and urological symptoms were present in 42% of cases with isolated IA, and 25% of combined aneurysms compared to 8% of isolated AAA (p < 0.05). Fifty-eight percent of the isolated IAs were ruptured, while only 27% of AAAs were ruptured (p < 0.05). The per- and postoperative mortality was 57% in ruptured isolated IA, 47% in ruptured combined aneurysms, and 31% in ruptured isolated AAA (p < 0.05). IA seems to be more under-diagnosed than AAA, and are often diagnosed because of clinical manifestations, especially urological or rupture. They seem more lethal in ruptured cases.

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PubMed2000

Apolipoprotein E genotype is associated with differential expansion rates of small abdominal aortic aneurysms.

BACKGROUND: The common polymorphism of the apolipoprotein E (APOE) gene is associated with differential risk of atherosclerosis; the gene could be a candidate gene in abdominal aortic aneurysms (AAA). METHODS: APOE genotypes were determined in 57 men aged 65-73 years with a small AAA (30-50 mm). The patients were included in a population ultrasonographic screening programme and were followed with at least two examinations during an interval of 2-4.5 years. The AAA expansion rates in patients with four different APOE genotypes were studied, with adjustment for initial AAA size and smoking. RESULTS: APOE genotype was a significant determinant of AAA expansion rate (P = 0.001). The adjusted mean (95 per cent confidence interval) rate was 2.1 (1.7-2.6) mm/year in 31 men with genotype E3E3, 1.3 (0.7-1.9) mm/year in 17 men with E3E4, 3.1 (2.0-4. 1) mm/year in six men with E2E3 and 4.2 (2.7-5.6) mm/year in three men with E2E4. The mean expansion rate was 2.2 (1.5-2.8) mm/year in non-smokers and 3.0 (2.5-3.6) mm/year in smokers (P = 0.014). CONCLUSION: APOE genotype seems to influence AAA expansion rate, but the effects of the individual genotypes, in particular E3E3 and E3E4, are contradictory when compared with the effects of the genotypes on risk of atherosclerosis.

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PubMed2000

Psychological consequences of screening for abdominal aortic aneurysm and conservative treatment of small abdominal aortic aneurysms.

OBJECTIVE: To describe the potential psychological consequences of screening for abdominal aortic aneurysms (AAAs). METHODS: The participants were prospectively and randomly sampled from a randomised screening trial for AAA and asked to complete a validated generic and global anonymous quality of life (QL) questionnaire by self-assessment (ScreenQL). Material case-control study: ScreenQL was completed once by 168 (48%) of 350 non-responders to screening, 271 (81%) of 335 attenders before screening, 286 (85%) of 335 attenders after screening, 127 (85%) of 149 with a small AAA diagnosed at screening, and 231 (66%) of 350 who were randomised not to be offered screening for AAA (controls). Prospective study (paired data): 127 men having a small AAA diagnosed. Twenty-nine (81%) of 36 men operated after initial conservative treatment. RESULTS: Initially, the QL score was 5% lower among men with a small AAA compared to the controls (p<0.05), mainly because of poorer health perception. The QL score declined significantly further to 7% below control values during the period of conservative treatment. This impairment was mainly due to a 21% and 15% reduction in scores relating to health perception and psychosomatic distress, respectively. However, all scores improved to control levels in patients operated on. The QL of attending men for screening was significantly lower than that of the controls and the attenders after the screening. No differences were noticed concerning the non-attenders. CONCLUSION: The offer of screening causes transient psychological stress in subjects found not to have AAA. However, diagnosis of an AAA seems to impair QL permanently and progressively in conservatively treated cases. This impairment seems reversible by operation. Nevertheless, the impairment seems considerable, and must be considered in the management of AAA and in the final evaluation of screening for AAA.

Adaptation, Psychological↗