Patient Characteristics, Patterns, and Repair of Aneurysms in Human Immunodeficiency Virus-Positive Patients.

BACKGROUND: Human immunodeficiency virus (HIV) is a multisystem disease and is associated with vascular complications including aneurysm formation. HIV-associated aneurysms are well documented and may present in unusual locations with concerning features. However, the literature regarding aneurysms in HIV-positive patients is limited to case series with limited data regarding aneurysm patterns. Furthermore, several small series have documented poor outcomes with surgical repair. Thus, our aim was to investigate the characteristics, patterns, and repair of aneurysms in HIV-positive patients in a multicenter study. METHODS: All patients with a diagnosis of aneurysms and HIV were retrospectively identified from 2013 to 2018 across 2 institutions. Comorbidities, HIV-related characteristics, aneurysm characteristics, and repair were reviewed. RESULTS: There were a total of 104 HIV-positive patients with 129 aneurysms. The mean age at the time of diagnosis was 57.7 ± 10.3 years, 80.8% of patients were male, and 32.0% had a history of acquired immunodeficiency syndrome. The average time from HIV diagnosis to aneurysm diagnosis was 14.1 ± 10.1 years. There were 53 (41.1%) ascending aortic, 25 (19.4%) abdominal aortic, 14 (10.9%) cerebral artery aneurysms, 13 (10.1%) descending thoracic, 9 (7.0%) iliac, 6 (4.7%) femoropopliteal, 4 (3.1%) visceral, 3 (2.9%) axillosubclavian, 1 (0.8%) carotid, and 1 (0.8%) coronary artery aneurysms. There were 23 (22.1%) patients with aneurysms in multiple vascular beds, 10 (9.6%) saccular aneurysms, and 1 (0.8%) inflammatory aneurysm. There were 7 ruptures (cerebral, descending thoracic, and iliac), 3 type A dissections (ascending aorta), and 1 thrombosis (popliteal). There were 26 (25.0%) patients who underwent surgical repair. This included 8 endovascular aneurysm repairs for abdominal aortic aneurysms, 6 endovascular coiling, clipping, and stent procedures for cerebral aneurysms, 4 open ascending aorta repairs, 2 bypasses for popliteal artery aneurysms, 2 endovascular stents for axillosubclavian artery aneurysms, 1 open descending aortic aneurysm repair, 1 endovascular aneurysm repair for an iliac aneurysm, 1 endovascular coiling for a renal artery aneurysm, and 1 open repair of a femoral artery aneurysm. Perioperative complications were common at 46.2%, although mortality was low at 3.8%. CONCLUSIONS: Although aneurysms were widespread, most HIV-positive patients had large vessel aneurysms in this study. There was a high prevalence of saccular and multiple aneurysms, and repair was associated with low rates of mortality despite high rates of complications. Additional studies are necessary to characterize this rare entity.

Have We Come as Far as We Had Hoped? Discrimination in the Residency Interview.

OBJECTIVE: The primary objective was to use a pilot survey of fourth-year medical students at our institution to determine if female residency applicants were asked potentially illegal questions regarding family status and childbearing more frequently than male applicants. Secondary objectives included comparing the use of potentially illegal questions in surgical versus nonsurgical specialties and between community and academic residency programs. DESIGN: A 20-item questionnaire was distributed to all fourth-year medical students at the University of Kansas School of Medicine. Data were analyzed in SPSS using descriptive statistics, bivariate analysis, and multivariate analysis. SETTING: University of Kansas Health System, Tertiary Care Center. PARTICIPANTS: Fourth-year medical students from the University of Kansas School of Medicine. RESULTS: There were 57 survey respondents (51% male and 49% female). Female applicants were more likely to report being asked about their desire to have a family than male applicants (32% vs. 3%, respectively, p = 0.041). However, male and female students were equally likely to report being asked specifically if they had or intended to have children (p = 0.194). No significant differences were found in potentially illegal question-asking between surgical and nonsurgical specialties or between community-based and academic programs. CONCLUSIONS: Although women now represent 47% of the applicant pool, gender discrimination in the residency interview has not been eradicated. Women are more likely to report potentially illegal questions regarding their desire to have a family on residency interviews than men. Community and academic programs appear to ask similar numbers and types of potentially illegal questions. Further study is warranted to determine if these findings apply to the entire applicant pool. Further education of interviewers is necessary regarding potentially illegal questions during the residency interview process.

Appendiceal perforation, necrotizing groin infection and spermatic cord necrosis in a case of Amyand's hernia.

INTRODUCTION: Inguinal hernias containing the appendix are described as Amyand's hernias. The surgical approach to these types of hernias is dependent on the type present and associated intra-operative findings. PRESENTATION OF CASE: We present a case of complicated type IV Amyand's hernia, which was managed though combined abdominal and inguinal approach. Though the patient had a prolonged post-operative course due to pulmonary embolism, he progressed to full recovery. DISCUSSION: The different grades of Amyand's hernia are repaired in varying ways, including laparoscopic and open approaches with or without mesh. The type of repair must be tailored to the patient and disease process. CONCLUSION: Primary repair of a perforated Amyand's hernia provides adequate strength with decreased risk of infection due to synthetic material.