Latest Updates

Coronaviruses: HCoV, SARS-CoV, MERS-CoV, and COVID-19

    • Specific features on high resolution CT imaging for the more severe coronavirus syndromes are now accepted for clinical diagnosis in the appropriate context, followed by RT-PCR confirmation. This includes ground-glass opacity, with lower-lobe and bilateral involvement, and septal thickening. Other characteristics make diagnosis more or less likely.
    • Molecular studies of the evolution of the S protein affinity for COVID-19 allow more complete understanding of the mechanism of transmission and predisposing factors. These attachment proteins have highest affinity for ACE2 receptors on type II pneumocytes. What remains to be explained is the presence of virus in saliva, blood, urine and gastrointestinal tract: Are these potential modes of transmission?
    • Two clinical trials have demonstrated promise for SARS-CoV-2 immunization; humoral and cellular immune responses are elicited. The preliminary data of these studies were published on July 20, 2020.

Viral Infections in Pregnancy – Part 2: Viral Influenza, Mononucleosis, Mumps, Parvovirus, Rubella, Rubeola. Varicella-Zoster, and Zika Virus

Patrick Duff, MD
    • Viral influenza – Immunization is 70-90% effective in prevention or diminishing severity of influenza infection. Annual vaccination with the quadrivalent influenza vaccine is recommended for every pregnant patient. It does not cause congenital anomalies and can be administered in any trimester of pregnancy.
    • Parvovirus – Maternal parvovirus B19 infection cannot be prevented. Once maternal infection is confirmed (by detecting IgM and viral DNA in maternal serum by PCR), the fetus should be evaluated weekly for a minimum of 8 weeks for evidence of anemia using sonographic middle cerebral artery Doppler velocimetry.
    • Rubella – Individuals are contagious from several days before to 7 to 10 days after the appearance of the rash. Detailed ultrasound examination is the best test to determine whether serious fetal injury has occurred as a result of maternal rubella infection, although injury can be missed antenatally.
    • Varicella zoster – A history of chickenpox infection as a child is reassuring since second infections are extremely unlikely and, should it occur, the risk to the fetus is negligible. Varicella vaccine is a live attenuated vaccine and, as such, is contraindicated during pregnancy.                 
    • Zika virus– A mosquito borne disease, Zika virus is asymptomatic or causes a mild febrile illness in the mother, but is associated with a significant risk of birth defects, including microcephaly and other neurologic abnormalities.

Minimally Invasive Esophageal Procedures

Jon O. Wee, MD, FACS

    Gastroesophageal Junction Cancer

      • There are trials accruing to establish if there is a role (HerFLOT – phase II adding trastuzumab to perioperative FLOT, NCI phase III trial looking at trastuzumab in addition to induction chemo radiotherapy). 
      • There is evidence that residual tumor outside the confines of the clinical target volume is a poor prognostic factor for locoregional recurrence and survival in esophageal cancer85
      • The advent of minimally invasive esophagectomy (MIE) has permitted patients to undergo a transthoracic approach who previously may not have been considered candidates for this approach due to the significant postoperative morbidity potentia

    Professionalism in Surgery

    Sylvia Botros-Brey, MD, MSCI, K. Christopher McMains, MD, PhD, MS, Jo Shapiro, MD, FACS
      • The central feature of medical ethics is the primacy of the patient’s interests.
      • The ethical obligations of a for-profit corporation include maximizing profit and growth.
      • The rise of entrepreneurialism and the growing corporatization of medicine also challenge the traditions of virtue-based medical care. When these processes are allowed to dominate medicine, health care becomes a commodity.
      • The different obligations of business and medical ethics call the appropriateness of applying industrial models to provision of health care into question. It is no less than each of our professional duties to address these tensions where they exist.

    Professionalism in Surgery

    Sylvia Botros-Brey, MD, MSCI, K. Christopher McMains, MD, PhD, MS, Jo Shapiro, MD, FACS
      • The central feature of medical ethics is the primacy of the patient’s interests.
      • The ethical obligations of a for-profit corporation include maximizing profit and growth.
      • The rise of entrepreneurialism and the growing corporatization of medicine also challenge the traditions of virtue-based medical care. When these processes are allowed to dominate medicine, health care becomes a commodity.
      • The different obligations of business and medical ethics call the appropriateness of applying industrial models to provision of health care into question. It is no less than each of our professional duties to address these tensions where they exist.

    Critical Care: Diagnostic Imaging Techniques 

    Phuong-Anh T. Duong, MD, Gerald W. Staton Jr, MD, FACP
      • Recently developed dual-energy chest radiographs can detect calcium in lesions or remove overlapping bone to confirm the presence of a lesion
      • Automatic tube current and tube potential modulation reduces computed tomography radiation risk by optimizing the radiation dose to the patient size and scan region
      • Positron emission tomography has limited applicability in low-grade adenocarcinoma and carcinoid tumors owing to poor fluorodeoxyglucose uptake in these clinical concerns

    Surgical Treatment of Stage I Rectal Cancer

    Julio Garcia-Aguilar, MD, PhD
      • Minimally invasive platforms facilitate removal of rectal tumors that are beyond the reach of conventional transanal excision techniques.
      • The use of neoadjuvant chemoradiotherapy may make local excision a viable option for T2 rectal tumors.
      • Outcomes for immediate salvage surgery are generally better than for delayed salvage surgery.
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