A rare inguinal mass: Round ligament leiomyoma

INTRODUCTIONLeiomyoma of the round ligament is a rare condition and usually appears like an inguinal hernia.PRESENTATION OF CASEWe report a case of a 40 year-old women found to have an inguinal mass which it was finally diagnosed as leiomyoma.The patient was admitted to our hospital with a history of painless groin mass. The mass was thought to be irreducible inguinal hernia. Surgical exploration demonstrated a round ligament leiomyoma.DISCUSSIONA smooth muscle tumor in the round ligament of the uterus in the inguinal region is a rare entity and can be mistaken for an irreducible inguinal hernia. It is a rare condition occurring predominantly in premenopausal middle-aged women. Abdominal, inguinal, and vulvar locations have been described. Surgical excision is the curative treatment.CONCLUSIONLeiomyoma of the round ligament should be entertained as a possible etiology of inguinal mass.     

Coronary artery thromboembolism: Unexpected presentation of left atrial myxoma covered with thrombus

Cardiac myxomas are benign primer cardiac tumors of the heart. They can be fatal with a thromboembolic presentation. Myocardial infarction is one of these unusual thromboembolic presentations. We report a patient who presented with cardiac arrest due to ventricular fibrillation related to myocardial infarction. After successful resuscitation, coronary angiography and transthoracic echocardiography were performed. A left atrial mass was observed and interpreted as a possible cause of coronary embolism leading to myocardial infarction. After surgical excision, the pathological examination confirmed myxoma, which was the essential cause of the tendency to arterial embolism.     

COVID-19 in solid organ transplant recipients: a single-center experience

Solid organ transplant (SOT) recipients may be at risk for severe COVID-19. Data on the clinical course of COVID-19 in immunosuppressed patients are limited, and the effective treatment strategy for these patients is unknown. We describe our institutional experience with COVID-19 in SOT. Demographic, clinical, and treatment data were extracted from the electronic patient files. A total of 23 SOT transplant recipients suffering from COVID-19 were identified (n = 3 heart; n = 15 kidney; n = 1 kidney-after-heart; n = 3 lung, and n = 1 liver transplant recipient). The presenting symptoms were similar to nonimmunocompromised patients. Eighty-three percent (19/23) of the patients required hospitalization, but only two of these were transferred to the intensive care unit. Five patients died from COVID-19; all had high Clinical Frailty Scores. In four of these patients, mechanical ventilation was deemed futile. In 57% of patients, the immunosuppressive therapy was not changed and only three patients were treated with chloroquine. Most patients recovered without experimental antiviral therapy. Modification of the immunosuppressive regimen alone could be a therapeutic option for SOT recipients suffering from moderate to severe COVID-19. Pre-existent frailty is associated with death from COVID-19.     

Lung mucociliary clearance in rheumatoid disease.

Lung mucociliary clearance rates were measured in 11 patients with rheumatoid disease and found to be unaltered when compared with those of a group of matched control subjects. The results are discussed in relation to the increased incidence of respiratory infection in patients with rheumatoid disease and also to the recently reported finding of increased airways obstruction in these patients.     

Impact of perioperative acute ischemic stroke on the outcomes of noncardiac and nonvascular surgery: a single centre prospective study

Background

Although ischemic stroke is a well-known complication of cardiovascular surgery it has not been extensively studied in patients undergoing noncardiac surgery. The aim of this study was to assess the predictors and outcomes of perioperative acute ischemic stroke (PAIS) in patients undergoing noncardiothoracic, nonvascular surgery (NCS).

Methods

We prospectively evaluated patients undergoing NCS and enrolled patients older than 18 years who underwent an elective, non-daytime, open surgical procedure. Electrocardiography and cardiac biomarkers were obtained 1 day before surgery, and on postoperative days 1, 3 and 7.

Results

Of the 1340 patients undergoing NCS, 31 (2.3%) experienced PAIS. Only age (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.01–3.2, p < 0.001) and preoperative history of stroke (OR 3.6, 95% CI 1.2–4.8, p < 0.001) were independent predictors of PAIS according to multivariate analysis. Patients with PAIS had more cardiovascular (51.6% v. 10.6%, p < 0.001) and noncardiovascular complications (67.7% v. 28.3%, p < 0.001). In-hospital mortality was 19.3% for the PAIS group and 1% for those without PAIS (p < 0.001).

Conclusion

Age and preoperative history of stroke were strong risk factors for PAIS in patients undergoing NCS. Patients with PAIS carry an elevated risk of perioperative morbidity and mortality.