Symptom combinations defined by age have greater diagnostic value than single symptoms alone.

Ann R Coll Surg Engl 2008; 90: 477-482 477Ruptured abdominal aortic aneurysm (AAA) accounts for about 2% of all deaths in men older than 65 years. 1 Several randomised controlled trials have shown that ultrasound screening and planned elective surgical treatment significantly reduces AAA-related mortality in men aged 65-74 years [1][2][3] and is cost effective. 4,5 Operative intervention is recommended in AAA larger than 5.5 cm, 6 but the majority of the AAAs detected by screening are classified as small (i.e. less than 5.5 cm in diameter). Randomised controlled trails have shown that surgical repair of small AAAs does not confer any additional survival advantage over periodic ultrasound surveillance. 7,8 Although in many screening trials AAA is defined as maximal aortic diameter of ≥ 3 cm, in many patients the ABSTRACT INTRODUCTION Some studies have considered abdominal aortas of 2.6-2.9 cm diameter (ectatic aortas) at age 65 years as being abnormal and have recommended surveillance, whereas others have considered these normal and surveillance unnecessary. It is, therefore, not clear how to manage patients with an initial aortic diameter between 2.6-2.9 cm detected at screening. The aim of this study was to evaluate growth rates of ectatic aortas detected on initial ultrasound screening to determine if any developed into clinically significant abdominal aortic aneurysms (AAAs; >5 .0 cm) and clarify the appropriate surveillance intervals for these patients.

Measurement of leg ulcer area using computer-aided tracing of digital camera images is more accurate and quicker than contact tracing provided that appropriate care is taken when taking the pictures. Digital images offer considerable advantages in the shared hospital-community care of patients with leg ulcers.

Acute compartment syndrome is uncommon but cases have been reported after prolonged pelvic procedures in the lithotomy position and it is a preventable condition. More research is required to set clear guidelines on patient positioning during surgery.

Arterial stenoses exhibit flow-dependent resistance irrespective of their geometry. The effect of stenosis asymmetry can only be ignored if anatomical severity is expressed as a percentage area reduction. A clinically useful measure of stenosis severity is the maximum flow for a given inflow pressure.