Bariatric surgery and endometrial pathology in asymptomatic morbidly obese women: a prospective, pilot study.

OBJECTIVE: To determine the prevalence of occult uterine pathology in asymptomatic, morbidly obese women before and after bariatric surgery-induced weight loss. DESIGN: Prospective, blinded, non-interventional cohort. SETTING: Urban teaching hospital. POPULATION: Morbidly obese women. METHODS: Endometrial biopsies were obtained at the time of Roux-en-Y gastric bypass and again 1 year later. Both the patient and the physician were blinded to the results of the initial biopsy until the conclusion of the study. Specimens were independently reviewed by two blinded pathologists. MAIN OUTCOME MEASURE: Effect of bariatric surgery-induced weight loss on the prevalence of endometrial pathology at 1 year. RESULTS: Fifty-nine women underwent an endometrial biopsy during bariatric surgery. The mean (range) age, weight, and body mass index (BMI) were 42 years (22-62 years), 127 kg (87-176 kg), and 46.8 kg/m(2) (36-64.3 kg/m(2) ), respectively. Four women had hyperplasia (three simple and one complex), for an overall prevalence of 6.8%. The prevalence among women not receiving some anti-estrogen therapy was 9.5%. Forty-six women (78%) underwent follow-up biopsy after a mean (range) weight loss of 42 kg (19-67 kg). Simple hyperplasia was identified in 3/46 women at the 1-year follow-up (6.5%). Two women had resolution of hyperplasia, two women had persistent, simple hyperplasia, and one had had a normal initial biopsy. No woman showed progressive pathology or cancer. At the end of the follow-up all but one patient had a documented resolution of endometrial pathology. CONCLUSIONS: Asymptomatic morbidly obese women are at relatively high risk of harbouring occult endometrial hyperplasia. Bariatric surgery-associated weight loss reduced but did not eliminate this risk for endometrial pathology.

The first attempt of an active integrated laboratory-based Salmonella surveillance programme in the north-eastern region of Nigeria.

AIM: To identify the sources of Salmonella contamination, distribution, prevalence and antimicrobial susceptibility patterns, which have significant impact on public and animal health, and international trade. METHODS AND RESULTS: A total of 1888 samples were collected by stratified random sampling from 2009 to 2011 from cattle, camels, poultry, fish, vegetables and humans. All identified Salmonella isolates were serotyped and tested for antimicrobial susceptibility by MIC determinations. A total of 149 Salmonella isolates comprising 17 different serovars were obtained (7·9% prevalence). Salmonella Hadar (37%), S. Eko (17%), S. Enteritidis (10%), S. Kentucky (7%) and S. Uganda (7%) were isolated from different sources. The occurrence of antimicrobial resistance was generally low, but S. Enteritidis and S. Eko showed variable antimicrobial resistance patterns, while all S. Kentucky isolates were resistant to seven of 17 tested antimicrobials, including ciprofloxacin and nalidixic acid. Three S. Hadar isolates revealed reduced susceptibility to ciprofloxacin and susceptibility to nalidixic acid and harboured the plasmid-mediated quinolone resistance gene qnrS1. CONCLUSIONS: Salmonella serovars Hadar, Enteritidis and the previously very rarely reported Eko were the major serovars associated with human infections, animal and environmental contamination in the north-eastern region of Nigeria. SIGNIFICANCE AND IMPACT OF THE STUDY: These serovars constitute a health risk to poultry, environment and human population in the region.

Stage I adenocarcinoma presenting in the pneumonectomy specimen at the time of single lung transplantation.

Two patients at our institution underwent single lung transplantation. The procedure and the patient's postoperative course were uncomplicated in each case. Pathological examination of each pneumonectomy specimen revealed a well-differentiated adenocarcinoma; both were less than 1 cm in size. The remainder of each lung showed no evidence of adenocarcinoma and all lymph nodes were negative. Work-ups for an occult malignancy before and after surgery were negative. This is believed to be the first report of a single lung transplant in a patient with a primary adenocarcinoma of the lung. The implications and management of these patients are discussed.

Surgical management of ventricular tachycardia.

BACKGROUND: Ventricular tachyarrhythmias are the leading cause of death from coronary artery disease. A small percentage of these arrhythmias originate in chronically ischemic myocardium, rather than acutely ischemic myocardium, and can be refractory to medical management. Epicardial mapping and focal cryoablation of foci demonstrating early activation may provide definitive therapy when pharmacologic management fails. We report a series of 42 consecutive patients with refractory ventricular tachycardia (VT) who were treated with open epicardial mapping and focal cryoablation after pharmacologic management failed. METHODS: We retrospectively reviewed the records of patients who underwent surgical treatment of malignant VT. For patients not recently seen in the clinic, we conducted telephone interviews. At the time of operation, epicardial mapping was performed to locate foci of early electrical activation. These foci were then cryoablated, using 2-minute applications of liquid nitrogen-cooled probes. All patients underwent postoperative electrophysiologic studies to test for inducible VT. RESULTS: Of these 42 patients, 34 (81%) were male, 8 (19%) female. Average age was 62.9 +/- 10.6 years; ejection fraction, 0.20 (range, 0.04 to 0.50); and number of foci ablated, 2.1 +/- 1.1 (range, 1 to 6). At the time of cryoablation, all patients underwent additional procedures, including aneurysmectomy, coronary artery bypass, or valve replacement. The 30-day operative mortality was 9.5% (4 of 42). Of the 38 survivors, 36 (94.7%) were clinically free of VT; the remaining 2 had spontaneous or inducible VT. CONCLUSIONS: Open cryoablation of foci propagating VT appears to be safe and effective. It may be the most definitive treatment for malignant VT.

In-vivo assessment of a photofixed bovine pericardial valve.

BACKGROUND AND AIM OF THE STUDY: The study aim was to assess the preclinical safety of a bioprosthetic cardiac valve in a large-animal model. The experimental pericardial valve was treated with a dye-mediated photooxidation process (PhotoFix) to enhance durability, and to reduce bioreactivity and mineralization potential. METHODS: Ten experimental (Sulzer Carbomedics PhotoFix pericardial valves, 25 mm) and three control valves (Carpentier-Edwards 2700, 25 mm) were placed in the mitral position of 13 juvenile sheep. Assessment criteria included animal survival, hematological analysis, host response, valve calcification and tissue stability. RESULTS: No significant differences were seen between the two groups for hematological analysis, weight or age. Ease of surgical handling was equivalent or superior to currently available technology. The PhotoFix valves had minimal leaflet calcification (mean 0.20 +/- 0.12 microg/mg) at 150 days. Two animals implanted with control valves were sacrificed at 173 and 227 days due to poor health; the control valves had massive thrombus and extensive leaflet mineralization (mean calcium content 18.2 +/- 3.8 microg/mg). For comparison with controls, two sheep with Photofix valves were sacrificed electively at 218 and 235 days. At 235 days, the experimental valve had a surgical suture looped over one commissure, restricting the motion of two leaflets and leading to massive inflow surface thrombosis. Despite this restriction, the animal remained healthy, with no noticeable regurgitation. The mean calcium content of the 218-day experimental valve leaflets was 6.28 microg/mg. Two experimental valves remain in place for long-term evaluation. CONCLUSION: In-vivo testing in juvenile sheep showed the PhotoFix pericardial valve to have no device-related mortality, no significant tissue degeneration, and minimal mineralization. In contrast, the control valves had significant valve mineralization and device-related morbidity.