Evaluating Possible Mechanisms Linking Obesity to COVID-19: a Narrative Review

Obesity Surgery - Currently, pneumonia caused by the coronavirus disease 2019 (COVID-19) is a pandemic. To date, there is no specific antiviral treatment for the disease, and universal access to...     

Blood cultures for women hospitalized with acute pelvic inflammatory disease. Are they necessary?

OBJECTIVE: To determine the incidence of positive blood cultures and if the results affect the clinical management or the duration of hospital stay in patients with acute pelvic inflammatory disease (PID). STUDY DESIGN: Retrospective study of all patients hospitalized with a diagnosis of acute PID from January 1, 1996, to December 31, 1997. RESULTS: Of 93 patients in the study, 3 had significant bacterial growth from blood culture specimens. The results of blood culture specimens did not affect clinical management. CONCLUSION: Routine specimens for blood culture may not be needed from patients hospitalized with acute PID.     

Leiomyosarcoma after uterine artery embolization. A case report

BACKGROUND: Hysterectomy is the most common treatment for relieving symptoms attributable to uterine leiomyomas; however, alternatives to hysterectomy are becoming increasingly available. Uterine artery embolization is being used more frequently in this clinical setting. CASE: A leiomyosarcoma was diagnosed incidentally in a 51-year-old, nulliparous woman who underwent uterine artery embolization for symptomatic leiomyomata and subsequent total abdominal hysterectomy/bilateral salpingo-oophorectomy due to unsatisfactory results of the embolization procedure. CONCLUSION: While the occurrence of preoperatively undiagnosed uterine leiomyosarcomas among patients undergoing hysterectomies has been reported, there are no reports of unsuspected leiomyosarcomas after uterine artery embolization. Criteria for selection of patients for the procedure should consider the possibility of leiomyosarcoma. With the increasing popularity of uterine artery embolization, cases like this are likely to be encountered in the future.     

Response of camels to intradermal inoculation with smallpox and camelpox viruses.

Young camels were inoculated intradermally with either camelpox or smallpox virus and the courses of infection, including serological response, were compared. Camelpox virus was highly infectious; generalized disease resulted which was transmitted naturally to contact animals. Smallpox virus produced only transient lesions at the inoculation site and a less marked serological response. Nevertheless, the camels inoculated with smallpox virus subsequently resisted a severe challenge with camelpox virus, and the possibility that limited replication of smallpox virus took place is discussed. The differences demonstrated between the behavior of the vituses is discussed in the light of their otherwise close relationship and the limited information available about camelpox infections in man.     

Use of three‐dimensional transesophageal echocardiography to evaluate mitral valve morphology for risk stratification prior to mitral valvuloplasty

Mitral stenosis is often managed percutaneously with an interventional procedure such as balloon commissurotomy. Although this often results in an increased mitral valve area and improved clinical symptoms, this procedure is not benign and may have serious complications including the development of hemodynamically significant mitral valve regurgitation. Multiple scoring systems have been developed to attempt to risk stratify these patients prior to their procedure. Case: A 64‐year‐old patient underwent an emergent mitral valve replacement after having percutaneous mitral balloon commissurotomy complicated by development of severe mitral regurgitation. Prior to valvuloplasty, her mitral valve was evaluated by traditional methods including calculation of a Wilkins score. Her mitral valve was evaluated after valvuloplasty and preoperatively with three‐dimensional transesophageal echocardiography. This examination demonstrated heterogeneous distribution of calcification affecting the mitral valve commissures more than the leaflets, which is consistent with the noncommissural leaflet tearing that occurred during her procedure, causing severe mitral regurgitation. In the future, careful 3D evaluation of mitral valve morphology including leaflets, annular calcification, and subvalvular apparatus may help risk stratify patients prior to intervention.     

Reliability of frozen section of uterine curettings in evaluation of possible ectopic pregnancy

STUDY OBJECTIVE: To assess the accuracy of frozen section evaluation of uterine curettings to look for chorionic villi and rule out ectopic pregnancy before laparoscopy. DESIGN: Retrospective review (Canadian Task Force classification III). SETTING: Northeastern medical school-affiliated teaching hospital. PATIENTS: Thirty-six women. Intervention. Dilatation and curettage, laparoscopy, and laparotomy. MEASUREMENTS AND MAIN RESULTS: Of 36 cases, 13 showed evidence of intrauterine pregnancy, either chorionic villi or implantation site, on final permanent sections. Five false negatives were identified in which no villi were identified on frozen section, although villi or evidence of an implantation site was noted on permanent sections (sensitivity 62%, 95% CI 0.32, 0.86). CONCLUSION: Frozen section evaluation of uterine curettings can produce false negative diagnoses, and this should be considered in the operative planning of women with suspected ectopic pregnancy.