This study identifies a region on chromosome 3 that is significantly associated with AAA in 2 distinct study populations.

Hidradenitis suppurativa (HS) is a chronic inflammatory condition affecting the apocrine glands of the axilla, groin, and perianal region. Although it is a common condition, it is rarely associated with squamous cell carcinoma (SCC). There have been only 41 reports of this uncommon complication of HS in the literature. This study includes two uncommon presentations of HS associated with SCC along with a literature review. The first patient developed diffuse abdominal carcinomatosis from SCC in the anogenital region arising from HS. This is a rare event in patients with perianal SCC, with only one case previously described in the literature. The second patient developed malignant hypercalcemia, an uncommon complication of cutaneous SCC. The current report represents the largest review of the literature of patients with SCC secondary to longstanding HS. A recurrence rate of 48 per cent was observed after “curative” resection. Approximately half of the patients succumbed to their disease, and the grade of carcinoma was the only predictor of mortality. These two new cases underline the importance of close follow-up and aggressive management of patients with HS. Although the development of carcinoma is an uncommon event in HS, the consequences can be devastating with mortality approaching 50 per cent.

Campath-1H induction for renal transplantation appears to have a low incidence of associated infectious complications when compared to historical regimens.

Introduction An anterior approach to lumbar interbody fusion is a widely utilized method of access to the lumbar spine. Due to the potential for vascular complications with spine exposure, vascular surgeons are frequently included in the care of these patients as part of a team-based approach. Identifying risk factors for such complications is difficult and not well-defined in the literature. In this investigation, we evaluate the potential risk factors for complications during anterior lumbar inter-body fusion (ALIF). Methods This is a retrospective review of 106 patients who underwent ALIF at a single institution between May 1, 2007, and April 30, 2017. Patients were identified through operating room case logs and Current Procedural Terminology (CPT) codes correlating with ALIF. Vascular surgeons performed all anterior exposures. Patient demographics and data regarding their surgical care and postoperative course were obtained from a review of operative and progress notes in the electronic medical record. Statistical methods employed included a t-test for normally distributed data and the Wilcoxon rank-sum test for non-normally distributed data. Categorical variables were compared using Fisher’s exact and chi-square tests. A logistic regression model was applied to predict complications by controlling other significant covariates. Results Of the 106 patients included in this analysis, 16 patients experienced a defined complication, giving an overall complication rate of 15%. Patients with complications were more likely to be of male gender (n=11, P=0.016), with older average age (54.6, P=0.017), with higher estimated blood loss, with higher use of blood products, and with higher use of cell-saver. A venous injury was the most common complication (n=11, 10.4%); ileus and nerve injury were the next most common (n=3, 2.8%). The 30-day mortality was 0%. Male gender demonstrated an odds ratio of 3.78 (P=0 .034) in a logistic regression model after adjusting for age and blood products. Conclusions Overall complication rates were comparable to those in the published literature and male gender was identified as a predictor for risk of complications in those undergoing ALIF. This is the first study to identify male sex as a risk factor for complications following ALIF. The results of this study will hopefully guide future studies in gaining more insight into the predictors of complications in larger series.

A 40-year-old woman sustained severe injuries in a subway accident in 1993. A Greenfield modified hook-titanium inferior vena cava filter (Boston Scientific, Maple Grove, Minn) was placed for pulmonary embolism prophylaxis. She presented with upper abdominal pain 15 years later. After a trial of agents for reflux failed to relieve symptoms, she underwent a more extensive workup.An esophagogastroduodenoscopy revealed metallic foreign bodies projecting into the lumen of the duodenum (A, arrow). A computed tomography scan demonstrated perforation of three filter struts (B, small arrows) through the full thickness of the duodenal wall. An additional strut perforated through the caval wall, without invading adjacent structures (B, white arrow). A single fractured strut migrated and then eroded into the third lumbar vertebral body, causing an intense sclerotic reaction (B, large arrow; Cover).The patient underwent abdominal exploration through an extended right subcostal incision. The duodenum was mobilized with a Kocher maneuver, and the vena cava was controlled above and below the renal veins. Cicatricial areas of inflammation were present at the sites of strut penetration (C).Each strut was cut to separate the intraduodenal segment from the intracaval segment, and the hooks were gently rotated to ease removal from the lumen of the duodenum (C, arrow). The fractured strut poised in the lumbar vertebral body was localized with a clip using fluoroscopy. The surrounding sclerotic tissue was divided and the strut removed. Finally, a longitudinal cavotomy was made, and the truncated filter was extracted from the caval endothelium. The duodenum and cava were repaired primarily, and an omental flap was placed between them. The patient recovered uneventfully and is free of abdominal pain in long-term follow-up. DISCUSSIONThe ease of inferior vena cava filter placement in concert with increased attention to venous thromboembolism prophylaxis in the trauma and critical care setting have broadened the relative indications for inferior vena cava filter placement. Although few severe late complications are reported, when they occur, they often require an invasive procedure to correct. 1 Filter designs have evolved to decrease penetration and migration, and examining the structural qualities of these devices is important. 2 Complication rates may be further reduced by improving rates of retrieval and strengthening guidelines for placement. 3 REFERENCES 1. Feezor RJ, Huber TS, Welborn MB, Schell SR. Duodenal perforation with an inferior vena cava filter: an unusual cause of abdominal pain. J Vasc Surg 2002;35:1010-2. 2. Greenfield LJ, Cho KJ, Proctor M, Bonn J, Bookstein JJ, Castaneda-Zuniga WR, et al. Results of a multicenter study of the modified hook-titanium Greenfield filter. J Vasc Surg 1991;14: 253-7. 3. Cuschieri J, Freeman B, O'Keefe G, Harbrecht BG, Bankey P, Johnson JL, et al. Inflammation and the host response to injury. A large-scale collaborative procedure for clinical care X. Guidelines for venous thromboembolism pro...