Abdominal aortic aneurysm in high-risk patients. Outcome of selective management based on size and expansion rate.

Abstract:

:Low mortality rates for elective surgical treatment of abdominal aortic aneurysms justify an aggressive approach in most patients. However, in high-risk patients with small aneurysms and no symptoms, the decision to operate remains a delicate balance of risk and benefit. Our observations include 99 high-risk patients with asymptomatic abdominal aortic aneurysms initially measuring 3 to 6 cm in the largest transverse diameter, who have been followed 1 to 9 years (average 2.4 years) with serial echographic measurements. Elective operations were performed for aneurysmal enlargement greater than 6 cm or symptom development. An additional 11 patients with aneurysms initially greater than 6 cm, whose initial evaluation did not result in elective surgery, were also followed. Serial data documented a mean expansion rate of 0.4 cm/year for aneurysms smaller than 6 cm. Forty-one of these 99 high-risk patients with small aneurysms eventually underwent an elective resection with two deaths (4.9%). Thirty-four patients (34%) died from causes unrelated to their unoperated aneurysms, and 21 patients (21%) are alive without symptoms. Three of the 99 patients suffered aneurysm rupture and emergency operation with two deaths. Thus, of the 99 high-risk patients with small aneurysms, four have died of elective aneurysm surgery or rupture (4%). A protocol of re-echo (or computerized tomography) examination at 3-month intervals appears to define which of these high-risk patients require elective aneurysm surgery, and has limited rupture to less than 5%. Improved criteria may emerge from recent advances in high-resolution computerized tomography.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Bernstein EF,Chan EL

doi

10.1097/00000658-198409000-00003

subject

Has Abstract

pub_date

1984-09-01 00:00:00

pages

255-63

issue

3

eissn

0003-4932

issn

1528-1140

journal_volume

200

pub_type

杂志文章
  • Carotid Artery Reactivity Predicts Events in Peripheral Arterial Disease Patients.

    abstract:OBJECTIVE:Patients with peripheral arterial disease (PAD) have increased risk on future cerebro- and cardiovascular events. Our aim was to examine whether carotid artery reactivity (CAR; a novel, simple procedure to examine endothelial function) predicts cardiovascular events in PAD patients. BACKGROUND:Increased risk...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000002558

    authors: van Mil ACCM,Pouwels S,Wilbrink J,Warlé MC,Thijssen DHJ

    更新日期:2019-04-01 00:00:00

  • Coaching as a Mechanism to Challenge Surgical Professional Identities.

    abstract:BACKGROUND:The "surgical personality" is a mostly negative academic and cultural image of the surgeon as egotistical, paternalistic, and inflexible. Because of this image, surgeons have been viewed as resistant to change and some behaviors, vulnerability, for example, are viewed as "suspect" because they seemingly thre...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000003707

    authors: Byrnes ME,Engler TA,Greenberg CC,Fry BT,Dombrowski J,Dimick JB

    更新日期:2019-12-02 00:00:00

  • A manometric study of anal fissure treated by subcutaneous lateral internal sphincterotomy.

    abstract::A prospective, manometric trial of anal fissure treated by subcutaneous lateral internal sphincterotomy (SLIS) was designed to elucidate the pathophysiology of this condition. Anorectal manometry with a closed, precalibrated, water-filled microballoon using the station pull-through technique was performed on 13 patien...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-199002000-00017

    authors: McNamara MJ,Percy JP,Fielding IR

    更新日期:1990-02-01 00:00:00

  • Reframing Surgical Care: Understanding Complexity and Promoting Teaming.

    abstract::Reframing healthcare delivery in terms of the principles of complex adaptive systems has practical implications for addressing the challenges in improving surgical care. In an Integrated Practice Unit (IPU) - such as a surgical service line, a surgical in-patient floor, or an acute care unit - a diverse group of careg...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000001251

    authors: Dillon PW

    更新日期:2015-12-01 00:00:00

  • Ultrasound-guided radiofrequency-assisted segmental liver resection: a new technique.

    abstract::Segmental hepatectomy is appealing for several reasons including preservation of liver parenchyma, reduction of intraoperative blood loss, and blood replacement by dividing tissues along the anatomic planes. A simple technique guided by intraoperative ultrasound is described here using radio-frequency energy to create...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0b013e3181b0c38a

    authors: Curro G,Bartolotta M,Barbera A,Jiao L,Habib N,Navarra G

    更新日期:2009-08-01 00:00:00

  • Response to neoadjuvant chemotherapy best predicts survival after curative resection of gastric cancer.

    abstract:OBJECTIVE:In Western populations, long-term survival rates after curative resection of gastric cancer remain extremely poor. The lack of effective adjuvant therapy has prompted the evaluation of neoadjuvant approaches. Since 1988, we have conducted three separate phase II trials using neoadjuvant chemotherapy to treat ...

    journal_title:Annals of surgery

    pub_type: 临床试验,杂志文章

    doi:10.1097/00000658-199903000-00001

    authors: Lowy AM,Mansfield PF,Leach SD,Pazdur R,Dumas P,Ajani JA

    更新日期:1999-03-01 00:00:00

  • Prospective study of eukaryotic initiation factor 4E protein elevation and breast cancer outcome.

    abstract:OBJECTIVE:To validate the authors' initial hypothesis-generating observation that eukaryotic initiation factor 4E (eIF4E) protein elevation predicts a higher cancer recurrence rate in patients with stage 1 to 3 breast cancer. SUMMARY BACKGROUND DATA:Tumor size and nodal status continue to be the two most important ind...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-200205000-00016

    authors: Li BD,Gruner JS,Abreo F,Johnson LW,Yu H,Nawas S,McDonald JC,DeBenedetti A

    更新日期:2002-05-01 00:00:00

  • Nonfunctioning islet cell tumors.

    abstract::In nonfunctioning islet cell tumors of the pancreas, hormone production is not clinically evident. This type of tumor constituted 15% of all islet cell tumors seen at the Mayo Clinic from 1960 through 1978. Although identical to functioning islet cell tumors embryologically and histologically, the nonfunctioning tumor...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198102000-00010

    authors: Kent RB 3rd,van Heerden JA,Weiland LH

    更新日期:1981-02-01 00:00:00

  • Colon cancer cells that are not growth inhibited by TGF-beta lack functional type I and type II TGF-beta receptors.

    abstract:OBJECTIVE:The authors determined the molecular mechanisms for the failure of transforming growth factor-beta (TGF-beta) to inhibit the growth of SW1116 and SW48 colon cancer cell lines. BACKGROUND:Transforming growth factor-beta is a bifunctional regulator of cell growth that typically stimulates proliferation of mese...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-199506000-00015

    authors: MacKay SL,Yaswen LR,Tarnuzzer RW,Moldawer LL,Bland KI,Copeland EM 3rd,Schultz GS

    更新日期:1995-06-01 00:00:00

  • A randomized, controlled, double-blind crossover study on the effects of 1-L infusions of 6% hydroxyethyl starch suspended in 0.9% saline (voluven) and a balanced solution (Plasma Volume Redibag) on blood volume, renal blood flow velocity, and renal corti

    abstract:OBJECTIVE:We compared the effects of intravenous administration of 6% hydroxyethyl starch (maize-derived) in 0.9% saline (Voluven; Fresenius Kabi, Runcorn, United Kingdom) and a "balanced" preparation of 6% hydroxyethyl starch (potato-derived) [Plasma Volume Redibag (PVR); Baxter Healthcare, Thetford, United Kingdom] o...

    journal_title:Annals of surgery

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/SLA.0000000000000324

    authors: Chowdhury AH,Cox EF,Francis ST,Lobo DN

    更新日期:2014-05-01 00:00:00

  • The short-term outcomes of conventional and single-port laparoscopic surgery for colorectal cancer.

    abstract:OBJECTIVE:The aim of this study was to show the safety and feasibility of single-port laparoscopic surgery (SPLS) by comparing its short-term outcomes with those following conventional laparoscopic surgery. SUMMARY BACKGROUND DATA:Single-port laparoscopic surgery maximizes the advantages of laparoscopic surgery, and t...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0b013e318237826b

    authors: Kim SJ,Ryu GO,Choi BJ,Kim JG,Lee KJ,Lee SC,Oh ST

    更新日期:2011-12-01 00:00:00

  • The impact of prophylactic total gastrectomy on health-related quality of life: a prospective cohort study.

    abstract:BACKGROUND:The advice to individuals with identified CDH1 mutations is generally to undertake prophylactic total gastrectomy (PTG). This study evaluated the effect of PTG on health-related quality of life (HRQL) in asymptomatic individuals with identified CDH1 mutations at high risk for gastric cancer. METHODS:Individ...

    journal_title:Annals of surgery

    pub_type: 杂志文章,多中心研究

    doi:10.1097/SLA.0000000000000446

    authors: Worster E,Liu X,Richardson S,Hardwick RH,Dwerryhouse S,Caldas C,Fitzgerald RC

    更新日期:2014-07-01 00:00:00

  • Adenoid cystic carcinoma of the breast. Data from the Connecticut Tumor Registry and a review of the literature.

    abstract::The case records of the Connecticut Tumor Registry were reviewed from 1952-1982. There were 37 cases of adenoid cystic carcinoma of the breast (ACC) from a total of 40,350 invasive breast tumors. Patient survival, complications, and pathologic sections were reviewed. Only 14 of 27 surgical pathology slides available f...

    journal_title:Annals of surgery

    pub_type: 杂志文章,评审

    doi:10.1097/00000658-198703000-00013

    authors: Sumpio BE,Jennings TA,Merino MJ,Sullivan PD

    更新日期:1987-03-01 00:00:00

  • Experimental comparison of the thrombogenicity of fibrin and PTFE flow surfaces.

    abstract::Two types of 4 mm ID prostheses were studied in the carotid arteries of the dog. These were noncrimped polypropylene-supported filamentous velour knitted Dacron (PPSFV) and expanded polytetrafluoroethylene (e-PTFE, Gore-Tex). Thrombus-"Free" Surface TFS) areas and patency rates were determined at the end of the implan...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198003000-00016

    authors: Kenny DA,Berger K,Walker MW,Robel SB,Boguslavsky L,Ray LI,Lischko MM,Sauvage LR

    更新日期:1980-03-01 00:00:00

  • Natural History and Management of Blunt Traumatic Pseudoaneurysms of the Internal Carotid Artery: The Harborview Algorithm Based Off a 10-Year Experience.

    abstract:OBJECTIVE:To define the natural history of, and treatment strategy for, blunt traumatic internal carotid artery (ICA) pseudoaneurysms. BACKGROUND:The natural history and management of traumatic ICA pseudoaneurysms is controversial. METHODS:We retrospectively identified all traumatic ICA pseudoaneurysms diagnosed on h...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000001158

    authors: Morton RP,Levitt MR,Emerson S,Ghodke BV,Hallam DK,Sekhar LN,Kim LJ,Chesnut RM

    更新日期:2016-04-01 00:00:00

  • Clinical application of cytochrome a(plus a3) assay of mitochondria from liver specimens: an aid in determining metabolic tolerance of liver remnant for hepatic resection.

    abstract::Measurement of cytochrome a(+a(3)) contents in liver mitochondria was made on 52 biopsy specimens of patients with liver tumor. Patients having higher cytochrome a(+a(3)) contents in mitochondria from remaining liver than those of normal human liver mitochondria could survive well major liver resections whether or not...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-197412000-00013

    authors: Ozawa K,Yamaoka Y,Kitamura O,Nambu H,Kamiyama Y

    更新日期:1974-12-01 00:00:00

  • Impact of Surgical Quality Improvement on Payments in Medicare Patients.

    abstract:OBJECTIVE:To examine the financial impact of quality improvement using Medicare payment data. BACKGROUND:Demonstrating a business case for quality improvement--that is, that fewer complications translates into lower costs--is essential to justify investment in quality improvement. Prior research is limited to cross-se...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000001069

    authors: Scally CP,Thumma JR,Birkmeyer JD,Dimick JB

    更新日期:2015-08-01 00:00:00

  • Opioid Use After Discharge in Postoperative Patients: A Systematic Review.

    abstract:BACKGROUND:Over the past 2 decades, there has been an increase in opioid use and subsequently, opioid deaths. The amount of opioid prescribed to surgical patients has also increased. The aim of this systematic review was to determine postdischarge opioid consumption in surgical patients compared with the amount of opio...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000002591

    authors: Feinberg AE,Chesney TR,Srikandarajah S,Acuna SA,McLeod RS,Best Practice in Surgery Group.

    更新日期:2018-06-01 00:00:00

  • Institutional and individual learning curves for focused abdominal ultrasound for trauma: cumulative sum analysis.

    abstract:OBJECTIVE:To evaluate both institutional and individual learning curves with focused abdominal ultrasound for trauma (FAST) by analyzing the incidence of diagnostic inaccuracies as a function of examiner experience for a group of trauma surgeons performing the study in the setting of an urban level I trauma center. SU...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-200005000-00009

    authors: McCarter FD,Luchette FA,Molloy M,Hurst JM,Davis K Jr,Johannigman JA,Frame SB,Fischer JE

    更新日期:2000-05-01 00:00:00

  • Antibiotic prophylaxis in acute nonperforated appendicitis. The Danish Multicenter Study Group III.

    abstract::In a prospective, block-randomized, multicenter study, the safety and efficacy of cefoxitin in preoperative prophylaxis were studied. 1735 patients undergoing appendectomy were evaluable, and half of these patients received 2 g of cefoxitin before undergoing operation. The patients were divided into three groups: pati...

    journal_title:Annals of surgery

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1097/00000658-198903000-00010

    authors: Bauer T,Vennits B,Holm B,Hahn-Pedersen J,Lysen D,Galatius H,Kristensen ES,Graversen P,Wilhelmsen F,Skjoldborg H

    更新日期:1989-03-01 00:00:00

  • Surgical versus medical treatment of type 2 diabetes mellitus in nonseverely obese patients: a systematic review and meta-analysis.

    abstract:OBJECTIVE:To compare surgical versus medical treatment of type 2 diabetes mellitus (T2DM) remission and comorbidities in patients with a body mass index (BMI) less than 35 kg/m2. BACKGROUND:Obesity surgery can achieve remission of T2DM and its comorbidities. Metabolic surgery has been proposed as a treatment option fo...

    journal_title:Annals of surgery

    pub_type: 杂志文章,meta分析,评审

    doi:10.1097/SLA.0000000000001014

    authors: Müller-Stich BP,Senft JD,Warschkow R,Kenngott HG,Billeter AT,Vit G,Helfert S,Diener MK,Fischer L,Büchler MW,Nawroth PP

    更新日期:2015-03-01 00:00:00

  • Physiologic role of cholecystokinin in the intestinal phase of pancreatic polypeptide release.

    abstract::Release of pancreatic polypeptide (PP) after a meal is biphasic, with an early transient peak believed to be under cholinergic control, and a secondary, prolonged intestinal phase thought to be mediated by hormones. Endogenous release of PP was stimulated by intraduodenal oleate (6.8 mmol/hr) or by intravenous adminis...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198411000-00008

    authors: Fried GM,Ogden WD,Greeley GH Jr,Thompson JC

    更新日期:1984-11-01 00:00:00

  • Recurrent inguinal hernia.

    abstract::An analysis of 584 operations for recurrent inguinal hernia was made in an attempt to determine the cause of the recurrence based on the anatomic findings. The recurrence was indirect in 300, direct in 241, and various other in 43 operations. The causes of the indirect recurrences appeared to be an unrecognized hernia...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198512000-00019

    authors: Postlethwait RW

    更新日期:1985-12-01 00:00:00

  • Increased cardiac endocrine activity after common bile duct ligation in the rabbit. Atrial endocrine cells in obstructive jaundice.

    abstract:OBJECTIVE:This study investigated the pathogenesis of water and sodium metabolism derangements in obstructive jaundice. SUMMARY BACKGROUND DATA:Obstructive jaundice is associated with hypodipsia, depletion of extracellular water, alterations of the water and sodium regulating hormones, and an increased incidence of re...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-199401000-00012

    authors: Pereira JA,Torregrosa MA,Martínez-Ródenas F,Clària J,Pallarés L,Gubern JM,Ruano-Gil D,Sitges-Serra A

    更新日期:1994-01-01 00:00:00

  • Analysis of the First 217 Appendectomies of the German NOTES Registry.

    abstract:OBJECTIVE:To analyze the feasibility and safety of Natural Orifice Transluminal Endoscopic Surgery (NOTES) appendectomy, and to analyze separately the transvaginal appendectomy (TVAE) and the transgastric appendectomy (TGAE) procedures. BACKGROUND:Laparoscopic appendectomy has rare but relevant complications, namely i...

    journal_title:Annals of surgery

    pub_type: 杂志文章,多中心研究

    doi:10.1097/SLA.0000000000001742

    authors: Bulian DR,Kaehler G,Magdeburg R,Butters M,Burghardt J,Albrecht R,Bernhardt J,Heiss MM,Buhr HJ,Lehmann KS

    更新日期:2017-03-01 00:00:00

  • The LeVeen shunt in the elective treatment of intractable ascites in cirrhosis. A prospective study on 140 patients.

    abstract::One hundred and forty patients with an intractable ascites complicating a chronic liver disease received a peritoneovenous shunt (PVS) using the LeVeen valve. Operative mortality was ten per cent but was 25% in patients with severe liver failure. Intraoperative drainage of ascites sharply decreased postoperative compl...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198504000-00014

    authors: Smadja C,Franco D

    更新日期:1985-04-01 00:00:00

  • Registration rates, adequacy of registration, and a comparison of registered and published primary outcomes in randomized controlled trials published in surgery journals.

    abstract:OBJECTIVE:To determine the proportion of registered trials published in the surgical literature, to compare, in registered trials, the primary outcomes registered with those published and to determine whether outcome-reporting bias favored significant primary outcomes. BACKGROUND:Trial protocol registration before pat...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0b013e318299d00b

    authors: Killeen S,Sourallous P,Hunter IA,Hartley JE,Grady HL

    更新日期:2014-01-01 00:00:00

  • Individualized Metabolic Surgery Score: Procedure Selection Based on Diabetes Severity.

    abstract:OBJECTIVE:To construct and validate a scoring system for evidence-based selection of bariatric and metabolic surgery procedures according to severity of type 2 diabetes (T2DM). BACKGROUND:Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) account for >95% of bariatric procedures in United States in patients w...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000002407

    authors: Aminian A,Brethauer SA,Andalib A,Nowacki AS,Jimenez A,Corcelles R,Hanipah ZN,Punchai S,Bhatt DL,Kashyap SR,Burguera B,Lacy AM,Vidal J,Schauer PR

    更新日期:2017-10-01 00:00:00

  • Inhalation injury severity and systemic immune perturbations in burned adults.

    abstract:OBJECTIVE:We aimed to determine whether the severity of inhalation injury evokes an immune response measurable at the systemic level and to further characterize the balance of systemic pro- and anti-inflammation early after burn and inhalation injury. BACKGROUND:Previously, we reported that the pulmonary inflammatory ...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0b013e318275f424

    authors: Davis CS,Janus SE,Mosier MJ,Carter SR,Gibbs JT,Ramirez L,Gamelli RL,Kovacs EJ

    更新日期:2013-06-01 00:00:00

  • Validation of the simulated ward environment for assessment of ward-based surgical care.

    abstract:OBJECTIVE:To assess the feasibility of developing a simulated ward environment in which to assess the ward-based care of surgical patients by clinicians of varying levels of experience (construct validation). BACKGROUND:Increasing evidence points to the importance of the postoperative or ward-based phase of surgical c...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0b013e318288e1d4

    authors: Pucher PH,Aggarwal R,Srisatkunam T,Darzi A

    更新日期:2014-02-01 00:00:00