Abdominal aortic screening programme.
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Biomedical subjects
Publications and source records attributed to R K Winter.
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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.
Ninety-three adult patients with benign esophageal stricture were randomized to receive balloon or bougie dilatation. Eighty-five patients were eligible for analysis and were followed prospectively for a year. Twenty-four patients required repeat dilatation within a year, but 50 patients completed a year's follow-up without further dilatation. The bougie group initially had a better symptomatic result, experiencing significantly less dysphagia at five months, although this difference had disappeared at one year. Eighteen patients in the balloon group required redilatation for symptoms compared with six in the bougie group. The bougie group had a significantly greater increase in their stricture diameter, and this was still present at one year after dilatation. There was no significant difference in safety or patient acceptability. Balloons are probably more costly to use than bougies. Bougie dilatation is to be preferred to balloon dilatation in adults except in special circumstances.
A case of bilateral, non-mycotic, giant intracavernous carotid aneurysms occurring in a hypertensive 16-year-old boy is reported. The pathogenesis of such aneurysms is discussed.
Four cases of in-utero diastematomyelia are presented and the ultrasonic features described. Characteristic findings are localised widening of the posterior ossification centres with a central echogenic focus at the point of widening, visible on coronal scanning, and absence of a posterior defect or soft tissue mass on transverse scanning. The aetiology and management of the condition is discussed. The cases illustrate that widening of the posterior ossification centres can occur in the absence of overt spina bifida and the prenatal detection of diastematomyelia will allow for early postnatal investigation and treatment.
Seventy one patients with benign oesophageal strictures were randomised to receive balloon or bougie dilatation. Sixty five patients were eligible for analysis. At the end of five months the balloon group had significantly more dysphagia and the calibre of the strictures in the balloon group had narrowed by a greater degree. The methods were equally safe and acceptable to patients. While the choice of the method of dilatation depends on the individual patient's needs and operator experience, bougie dilatation is more effective in reducing dysphagia and maintaining stricture patency.