SUMMARYTwo hundred and seventeen patients presenting with abdominal aneurysms in the Department of Surgery at the Manchester Royal Infirmary between the years 1958-69 were surveyed retrospectively.One hundred and eighty-seven of the patients underwent operation for resection of their aneurysms ; of these, 19 (10 per cent) showed excessive thickening of the aneurysm walls and perianeurysmal adhesions at operation.Subsequent histological examination of the walls of these unusual aneurysms showed extensive active chronic inflammatory changes, including plasma-cell infiltration.This group of patients whose aneurysms we describe as 'inflammatory ' presented with different clinical features in comparison with the atherosclerotic group. Retrospective investigation has not yet revealed any aetiological factors. We feel that 'inflammatory' aneurysms are a discrete entity with significant differences from atherosclerotic aneurysms and previously described arteritis.T w o hundred and seventeen patients presented with abdominal aortic aneurysms at the University Department of Surgery at the Manchester Royal Infirmary over the period 1958-69 and of these, 187 underwent operative treatment with the intention of resection of their aneurysms.One hundred and sixty-eight patients were found to have aneurysms of the atherosclerotic type. I n the remaining 19 cases the aneurysms were unusually thick walled and surrounded by extensive fibrous adhesions which made operative procedures much more difficult. On 2 occasions aneurysms described at operation as 'surrounded by dense fibrous tissue' and ' densely adherent ', respectively, were encountered before this investigation was undertaken. These 2 cases were probably of the 'inflammatory' type, but owing to the lack of histological verification have not been included in the series. Specimens of the aneurysm walls from this group of 19 cases were subjected to detailed histological examination and bacterial culture, the case records of all 19 patients were reviewed, and haematological, biochemical, and immunological investigations were carried out on the surviving patients.Despite their striking operative appearance and significant incidence these aortic lesions, as far as we are aware, have not been previously described.* Requests for reprints to be sent to Mr.

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SUMMARY In a survey of 7,044 necropsies there were 99 cases of aneurysm of the abdominal aorta and 523 cases of peptic ulceration. The incidence of peptic ulceration in the general necropsy population was 7.2 % whilst in cases with aneurysm it was 22.6 % .There was a significant increase in duodenal ulceration in males with abdominal aortic aneurysms. The possible causes for this increased incidence are discussed.An association between abdominal aortic aneurysms and peptic ulceration has not been previously described. It was noted by one of us (K.B.) that there appeared to be an increased incidence of symptoms of peptic ulceration in patients presenting with aneurysms of the abdominal aorta. As a result of this observation we decided to carry out a retrospective survey of necropsy material to investigate the possibility of such an association. Method and Results METHODThe necropsy reports of a general teaching hospital for the years 1954-1966 inclusively were examined and all cases of abdominal aortic aneurysm and established peptic ulceration were extracted. The age, sex, reason for admission to hospital, and principal causes of death were noted in each case. Since aneurysms frequently present in conjunction with other diseases such as hypertension and ischaemic heart disease, and as these other diseases might be the reason for admission to hospital or might be significant factors in producing an apparent association between aneurysm and peptic ulcer, it was decided that the incidence of any associated disease which occurred frequently should also Received for publication 19 December 1969.be noted. The number of necropsies per year and the distribution of aneurysms and peptic ulcers are given in Table I, together with the annual and overall incidence. During this 13-year period there were 99 aneurysms and 553 peptic ulcers. In the ulcer group 30 people had both a gastric and duodenal ulcer thus making 523 cases of peptic ulceration in all. ANEURYSMThe majority of the aneurysms were situated below the level of origin of the renal vessels with some of them also involving the aortic bifurcation. As. ar as could be ascertained, all the aneurysms, except for that in one woman aged 28, were atherosclerotic in type. None of the cases showed macroscopic or histological evidence of syphilis nor was there any evidence of a primary aortitis, and there were no mycotic aneurysms. Three cases were associated with an aneurysm of the descending thoracic aorta and in five cases there were associated aneurysms of the iliac arteries.As has been shown in previous reports, abdominal aortic aneurysms are lesions dependent on age, and this is borne out in the present survey where 96 % of the cases were over the age of 50. The highest incidence of aneurysms in males is in the eighth decade, and in females in the ninth decade. The distribution of the aneurysms by age and sex is shown in Table II.The reasons for admission to hospital of the on 12 May 2018 by guest. Protected by copyright.

Thirty-one patients with thoracic outlet syndrome have been studied in detail in the neurological and vascular clinics at this hospital. The patients were classified on the basis of their presenting symptoms into four groups--predominantly vascular, neurological, combined vascular and neurological, and pain and paraesthesiae alone. The majority of patients had radiological abnormalities and all had structural lesions in the superior thoracic aperture seen at operation. All operations were carried out through a standard supraclavicular approach, enabling the compressive structures to be visualized. This would not have been the case had the commoner trans-axillary approach for first rib resection been followed and in fact none of the operations included removal of the first rib. The results of operation were evident in our patients with a marked relief in their vascular symptoms, their pain and paraesthesiae and a slight but definite improvement in muscle bulk and power.

A series of twenty-eight aneurysms of the popliteal artery is reviewed. The cases were collected from the records of two large hospitals each with a unit with a special interest in vascular surgery. They are uncommon--only 1 popliteal aneurysm to every 17 aneurysms of the abdominal aorta--but one-third of our patients had both types of aneurysm present. The majority of patients had symptoms and 7 lost a leg as a direct result of thrombosis or rupture. The results of treatment were best when saphenous vein was used to replace an uncomplicated aneurysm and, since the behaviour of aneurysms is unpredictable, we conclude that this is the treatment of choice.