Median arcuate ligament syndrome (MALS), is a rare abdominal vascular compression syndrome caused by the compression of the proximal celiac trunk by the median arcuate ligament. According to many authors, a low insert...Median arcuate ligament syndrome (MALS), is a rare abdominal vascular compression syndrome caused by the compression of the proximal celiac trunk by the median arcuate ligament. According to many authors, a low insertion of the diaphragmatic crura or an abnormally high origin of the celiac trunk from the aorta can cause compression of the celiac artery. Usually, patients with MALS are asymptomatic. Computed tomography (CT) angiography of the abdomen is the main imaging modality to confirm the diagnosis. The coexistence of celiac trunk and superior mesenteric artery compression by the median arcuate ligament is rarely described in the literature. To our knowledge, until now, a simultaneous combination of three abdominal vascular compressions by the median arcuate ligament has never been described. From this case, we report a simultaneous compression of the celiac trunk, superior mesenteric artery, and renal arteries by the median arcuate ligament.展开更多
BACKGROUND Primary hepatic leiomyosarcoma(PHL)is a rare tumor with a very low incidence of about 0.2%.CASE SUMMARY A 48-year-old diabetic,hypertensive,and morbidly obese female patient presented with a history of abdo...BACKGROUND Primary hepatic leiomyosarcoma(PHL)is a rare tumor with a very low incidence of about 0.2%.CASE SUMMARY A 48-year-old diabetic,hypertensive,and morbidly obese female patient presented with a history of abdominal pain and weight loss for 2 mo.She had no history of fever,jaundice,or other liver disease(s).Clinical examination revealed a palpable mass in the epigastrium.Imaging evaluation with a contrast-enhanced computed tomography(CT)scan of the abdomen and pelvis revealed an illdefined enhancing hyper vascular hepatic mass of 9.9 cm×7.8 cm occupying the left hepatic lobe with evidence of central necrosis,compression effect on the left hepatic vein,and partial wash-out on delayed images.On further workup,the maximum standardized uptake value on positron emission computed tomography scan was 6.4,which was suggestive of malignancy.The remaining part of the liver was normal without any evidence of cirrhosis.Ultrasound-guided biopsy of the mass showed smooth muscle neoplasm suggestive of leiomyos-arcoma.After optimization for co-morbidities,an extended left hepatectomy was planned in a multidisciplinary team meeting.On intraoperative ultrasound,the left hepatic lobe was entirely replaced by a large tumor extending to the caudate lobe with a compression effect on the middle and left hepatic veins.Final histopathology showed nodular and whorled white tumor comprised of spind-led/fascicular cells with moderate to severe pleomorphism and focal necrosis.The mitotic index was greater than 20 mitoses per 10 high-power fields.The resection margins were free of tumor.Immunohistochemistry(IHC)depicted a desmin-positive/caldesmon-negative/discovered on gastrointestinal stromal tumor 1-negative/cluster of differentiation 117-negative profile,confirming the definitive diagnosis as PHL.CONCLUSION This case report highlights the rare malignant mesenchymal hepatic tumor.To confirm PHL diagnosis,one requires peculiar histopathological findings with ancillary IHC confirmation.Management options include adequate/complete surgical resection followed by chemotherapy and/or radiotherapy.展开更多
This article focuses on the application of coupling both river dynamic and river diffusive modeling techniques that can be used with distributed water balance model. In an upstream watershed, both overland and river d...This article focuses on the application of coupling both river dynamic and river diffusive modeling techniques that can be used with distributed water balance model. In an upstream watershed, both overland and river diffusive flows are routed by diffusive wave approximation of the free surface flow equations. In river downstream reaches, the river dynamic flow is routed by one-dimensional dynamic wave equations （full dynamic St. Venant equations with lateral flow）. The developed model is applied in a part of Arakawa River basin, Kanto area, Japan. The geographic data of river cross sections could be accurately represented by an 11-point cross-section approximation. The effects of both the grid size and lateral flow on the simulated results of the river dynamic flow model were studied. The grid size should be greater than the average width of the river cross-sections. The lateral flow from small drainage systems has significant effects on the simulated results using the river dynamic flow model. The simulated results show good and acceptable agreements with the observed flow discharges and water depths. Both the river discharge and water depth at any location of river network of compound channels with one/two complex floodplains could be correctly estimated.展开更多
文摘Median arcuate ligament syndrome (MALS), is a rare abdominal vascular compression syndrome caused by the compression of the proximal celiac trunk by the median arcuate ligament. According to many authors, a low insertion of the diaphragmatic crura or an abnormally high origin of the celiac trunk from the aorta can cause compression of the celiac artery. Usually, patients with MALS are asymptomatic. Computed tomography (CT) angiography of the abdomen is the main imaging modality to confirm the diagnosis. The coexistence of celiac trunk and superior mesenteric artery compression by the median arcuate ligament is rarely described in the literature. To our knowledge, until now, a simultaneous combination of three abdominal vascular compressions by the median arcuate ligament has never been described. From this case, we report a simultaneous compression of the celiac trunk, superior mesenteric artery, and renal arteries by the median arcuate ligament.
文摘BACKGROUND Primary hepatic leiomyosarcoma(PHL)is a rare tumor with a very low incidence of about 0.2%.CASE SUMMARY A 48-year-old diabetic,hypertensive,and morbidly obese female patient presented with a history of abdominal pain and weight loss for 2 mo.She had no history of fever,jaundice,or other liver disease(s).Clinical examination revealed a palpable mass in the epigastrium.Imaging evaluation with a contrast-enhanced computed tomography(CT)scan of the abdomen and pelvis revealed an illdefined enhancing hyper vascular hepatic mass of 9.9 cm×7.8 cm occupying the left hepatic lobe with evidence of central necrosis,compression effect on the left hepatic vein,and partial wash-out on delayed images.On further workup,the maximum standardized uptake value on positron emission computed tomography scan was 6.4,which was suggestive of malignancy.The remaining part of the liver was normal without any evidence of cirrhosis.Ultrasound-guided biopsy of the mass showed smooth muscle neoplasm suggestive of leiomyos-arcoma.After optimization for co-morbidities,an extended left hepatectomy was planned in a multidisciplinary team meeting.On intraoperative ultrasound,the left hepatic lobe was entirely replaced by a large tumor extending to the caudate lobe with a compression effect on the middle and left hepatic veins.Final histopathology showed nodular and whorled white tumor comprised of spind-led/fascicular cells with moderate to severe pleomorphism and focal necrosis.The mitotic index was greater than 20 mitoses per 10 high-power fields.The resection margins were free of tumor.Immunohistochemistry(IHC)depicted a desmin-positive/caldesmon-negative/discovered on gastrointestinal stromal tumor 1-negative/cluster of differentiation 117-negative profile,confirming the definitive diagnosis as PHL.CONCLUSION This case report highlights the rare malignant mesenchymal hepatic tumor.To confirm PHL diagnosis,one requires peculiar histopathological findings with ancillary IHC confirmation.Management options include adequate/complete surgical resection followed by chemotherapy and/or radiotherapy.
文摘This article focuses on the application of coupling both river dynamic and river diffusive modeling techniques that can be used with distributed water balance model. In an upstream watershed, both overland and river diffusive flows are routed by diffusive wave approximation of the free surface flow equations. In river downstream reaches, the river dynamic flow is routed by one-dimensional dynamic wave equations （full dynamic St. Venant equations with lateral flow）. The developed model is applied in a part of Arakawa River basin, Kanto area, Japan. The geographic data of river cross sections could be accurately represented by an 11-point cross-section approximation. The effects of both the grid size and lateral flow on the simulated results of the river dynamic flow model were studied. The grid size should be greater than the average width of the river cross-sections. The lateral flow from small drainage systems has significant effects on the simulated results using the river dynamic flow model. The simulated results show good and acceptable agreements with the observed flow discharges and water depths. Both the river discharge and water depth at any location of river network of compound channels with one/two complex floodplains could be correctly estimated.
