The value of screening in siblings of patients with abdominal aortic aneurysm.

OBJECTIVES: This study aimed to determine the incidence of abdominal aortic aneurysm (AAA) in a large group of siblings of Australian AAA patients to determine if screening in this group is justified. METHODS: 1254 siblings of 400 index AAA patients were identified and offered aortic ultrasound screening. An age and sex matched control group was recruited from patients having abdominal CT scans for non-vascular indications. AAA was defined by an infrarenal aortic diameter of > or =3 cm or a ratio of the infrarenal to suprarenal aortic diameter of > or =2.0. A ratio of 1.0-1.5 was considered normal, and a ratio of >1.5 to <2.0 was considered ectatic. Aortic enlargement was defined as ectasia or aneurysm. RESULTS: 276 (22%) siblings could be contacted and agreed to screening or had previously been diagnosed with AAA. All 118 controls had normal diameter aortas. 55/276 siblings had previously been diagnosed with AAA. The remaining 221 siblings underwent ultrasound screening. Overall, 30% (84/276) had enlarged aortas (5% ectasia, 25% aneurysmal); 43% of male siblings (64/150) and 16% of females siblings (20/126). The incidence was 45% in brothers of female index patients, 42% in brothers of male patients, 23% in sisters of female patients, and 14% in sisters of male index patients. CONCLUSIONS: The overall incidence of aortic enlargement of 30% found in this study warrants a targeted screening approach with ultrasound for all siblings of patients with AAA. A similar targeted approach for screening of the children of AAA patients would also seem advisable.

The practice of carotid endarterectomy in Australasia.

BACKGROUND: Carotid endarterectomy (CEA) is a frequently performed surgical procedure and there are variations in the preoperative, operative and postoperative management related to this operation. METHODS: Questionnaires were sent to all 191 members of the Division of Vascular Surgery, Royal Australasian College of Surgeons, and the Australasian Chapter of the International Society of Cardiovascular Surgery. RESULTS: The questionnaire was returned by 179 surgeons (94%). One hundred and fifty-nine were vascular surgeons, of whom 139 perform CEA. Most surgeons reported performing more CEA than 5 years previously. Surgery for asymptomatic carotid stenosis was performed by 78% of surgeons at the time of the survey. Routine carotid angiography is performed pre-operatively for symptomatic patients by 61% of surgeons and for asymptomatic patients by 56%. Intra-operative shunting is used routinely by 37% of surgeons, selectively by 58% and never by 5%. Arteriotomy patch closure is performed routinely by 16%, usually by 30%, rarely by 52% and never by 3%. The favoured patch material is Dacron 39%, PTFE 19%, ankle long saphenous vein (LSV) 22%, thigh LSV 18% or other materials 2%. Compared to their practice 5 years previously, arterial patch closure is used more often by 42% of surgeons, the same by 51% and less by 7%. Postoperatively, patients are nursed mainly in intensive care (34%) or a high-dependency unit (33%). CONCLUSIONS: The practice of CEA by Australasian vascular surgeons reflects the recent trends reported in the world literature. Most Australasian surgeons perform CEA for asymptomatic disease. Forty per cent are performing CEA on the basis of duplex scanning alone. There is a trend towards increased use of patch closure. Most patients are managed in intensive care or high-dependency units.

Are analgesics necessary for women at home following laparoscopic gynaecological day surgery?

This study sought to discover whether day-surgery patients found it necessary to take analgesics to relieve the pain and discomfort experienced after discharge following gynaecological laparoscopic procedures. Pre-operative anxiety was also assessed as a possible contributory factor to post-operative nausea and headaches. The results showed that 65 per cent of the sample required analgesics post-operatively for up to three days, and a minority for nearly a week. Of those taking analgesics, 50 per cent recorded pain or discomfort in more than one of the four body areas monitored, namely the abdomen, shoulders, back and head. On assessment by anaesthetists, 82 per cent of the sample showed some degree of pre-operative anxiety, but the study was unable to show any obvious link between anxiety and post-operative headaches or nausea.

PIP: A nurse followed 50 patients at the outpatient unit of Ipswich Hospital in Ipswich, England for 3 weeks. They underwent either laparoscopy, laparoscopy/hydrotubation, or laparoscopic sterilizations. She wanted to determine whether the women felt a need to take analgesics for pain and discomfort after discharge. Only 37 women completed the questionnaire. Anesthetists found 82% of the women exhibited some degree of anxiety. Further women who had a sterilization were less anxious than the other 2 groups. No significant association existed between preoperative anxiety and postoperative headache or nausea, however. 19 women experienced nausea upon the return home or at bedtime. The man distance between the hospital and home was 10.3 miles. 7 women still felt nauseous 3 days after leaving the hospital. Further 2 patients had nausea for 2 weeks. 1 woman stayed in the hospital overnight since she was nauseous and dizzy. 3 women had headaches right after laparoscopy. The next day, 11 patients had headaches. 5 women wanted to spend 1 night in the hospital. 24 (65%) women needed analgesics for up to 3 days after laparoscopy, 20 of whom had pain in 1 location (head, back, shoulders, and abdomen). The analgesics included omnopon, fentanyl, cocodaprin, and alfentanil. 13 women who experienced pain, but did not use any analgesics. The study did not consider several factors, e.g., whether the women had a headache before laparoscopy. Neither did it take into account the home environment or the number of children to tend to when they returned home. Further the study did not look at patient mobility and activity at home, reasons for talking the analgesics (specific pain or generalized discomfort), or use of nitrous oxide which has an emetic effect. The researcher ended with recommendations such as further research on the effects of the trip home on pain, nausea, or headaches.