Application value analysis of magnetic resonance imaging and computed tomography in the diagnosis of intracranial infection after craniocerebral surgery

BACKGROUND Intracranial infection is a common clinical disease.Computed tomography(CT)and magnetic resonance imaging(MRI)have certain sensitivity and have good diagnostic efficacy.AIM To study the application value of MRI and CT in the diagnosis of intracranial infection after craniocerebral surgery.METHODS We selected 82 patients who underwent craniocerebral surgery(including 40 patients with intracranial infection and 42 patients without infection)during the period from April 2016 to June 2019 in our hospital.All 82 patients received CT and MRI examinations,and their clinical data were reviewed.A retrospective analysis was performed,and the coincidence rate of positive diagnosis and the overall diagnosis coincidence rate of different pathogenic infection types were measured with the two examination methods.The diagnostic sensitivity and specificity as well as the positive and negative predictive values of the two examination methods were compared.RESULTS For all types of pathogenic infections(Staphylococcus aureus,Staphylococcus hemolyticus,Staphylococcus epidermidis,and others),MRI scans had higher positive diagnostic coincidence rates than CT scans;the overall diagnostic coincidence rate,sensitivity,specificity,positive predictive value,and negative predictive values were significantly higher with MRI examinations than with CT examinations,and the differences were statistically significant(P<0.05).CONCLUSION MRI examination can accurately diagnose intracranial infection after clinical craniocerebral surgery.Compared with CT,MRI had higher diagnostic efficiency.The diagnostic sensitivity and specificity,the diagnostic coincidence rate,and the positive and negative predictive values were significantly higher with MRI than with conventional CT,which can be actively promoted.

Visual function alterations in cavernous hemangioma of the orbital apex after surgery

Dear Editor,I am Dr.Kang Xue,from the Department of Ophthalmology at the Eye,Ear,Nose and Throat Hospital of Fudan University in Shanghai,China.I am writing to present three case reports of the removal of visual function alterations in cavernous hemangioma of the orbital apex after surgery.Cavernous hemangioma is a relatively common primary benign orbital tumor in adults.

The neurofibromatosis type 1 and skin and soft-tissue tumors forum of the 23rd international congress of plastic and reconstructive surgery was successfully held in Shanghai

On March 23,2024,at the 23rd Shanghai International Congress of Plastic and Reconstructive Surgery,a Neurofibromatosis Type 1 and Skin and Soft-Tissue Tumors Forum was unveiled.This forum aimed to foster multidisciplinary cooperation to standardize the diagnosis and treatment of neurofibromatosis and skin and soft-tissue tumors,attracting leading experts and scholars from across the nation.It served as a pivotal platform for sharing advancements in pathology,clinical practices,and surgical techniques related to these conditions,alongside discussions on standardized care and precision medicine,marking a significant step forward in the field.

Chylothorax following posterior low lumbar fusion surgery:A case report

BACKGROUND Postoperative chylothorax is usually regarded as a complication associated with cardiothoracic surgery;however,it is one of the rare complications in orthopedic surgery.This case report describes a female patient who developed chylothorax after a successful L4-S1 transforaminal lumbar interbody fusion surgery.The etiology,diagnosis,and treatment were analyzed and discussed.CASE SUMMARY A 50-year-old woman was admitted with repeated back and leg pain.She was diagnosed with L4 degenerative spondylolisthesis,L4/L5 and L5/S1 intervertebral disc herniation and L5 instability,and underwent successful posterior L4-S1 instrumentation and fusion surgery.Unfortunately,thoracic effusion was identified 2 d after operation.The thoracic effusion was finally confirmed to be chylous based on twice positive chyle qualitative tests.The patient was discharged after 12-d persisting drainage,3-d total parenteral nutrition and fasting,and other supportive treatments.No recurring symptoms were observed within 12 mo follow-up.CONCLUSION Differential diagnosis is crucial for unusual thoracic effusion.Comprehensive diagnosis and treatment of chylothorax are necessary.Thorough intraoperative protection to relieve high thoracic pressure caused by the prone position is important.

Diagnosis and treatment of emergency surgeries in otorhinolaryngology, head and neck surgery during the covid-19 outbreak: A single center experience

The 2019 Novel Coronavirus(2019-nCoV,SARS-CoV-2)infection has already been assigned as a Class B infectious disease requiring Class A management strategy according to“the Law on the Prevention and Control of Infectious Diseases of the People’s Republic of China”and become a global pandemic.The incidence of emergencies in otorhinolaryngology,head and neck surgery such as foreign bodies in the esophagus and the respiratory tract,epistaxis,laryngeal obstruction with dyspnea,and head and neck trauma are relatively high.Emergency surgeries are required as some of these diseases progress rapidly and probably be life-threatening.In this article,we drafted the recommendations for diagnosis and treatment of emergency surgeries in otorhinolaryngology,head and neck surgery in the epidemic area of novel coronavirus pneumonia based on“Novel Coronavirus Pneumonia Diagnosis and Treatment Plan(Provisional;7th Edition Revisions)”and WHO guidelines,combined with the experience of emergency surgeries in the Department of Otorhinolaryngology,Wuhan Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,which is at the center outbreak area of the SARS-CoV-2 pneumonia(COVID-19)in China,to improve the success rate of treatment for otorhinolaryngology,head and neck surgery emergency surgeries and to reduce the SARS-CoV-2 infection rate in the perioperative period.

Eyelid malposition after orbital fracture surgery

Orbital fractures generally do not cause eyelid malposition.Studies have shown that mostly eyelid malposition is mainly due to the choice of surgical approaches of orbital fracture repair.Approaches are divided into transcutaneous and transconjunctival ones.The application of orbital fracture approaches depends on fractures’range and the surgeons’preferences.Eyelid malposition after orbital fracture surgery is not only an aesthetic concern but also a functional complication,which will cause eyes discomfort,such as corneal exposure and ocular irritation.Some patients may have multiple types of eyelid malposition.In this review,we summarized the surgical approaches of orbital fractures and the complications including scar,ectropion,retraction,entropion,flattening,laceration and lacrimal canaliculus avulsion and notch deformity that associated with eyelid,especially the lower eyelid.Reports revealed that the scar usually occurred in infraorbital incisions compared with subtarsal and subciliary incisions,and the transconjunctival approach had a higher incidence of entropion and flattening,and less ectropion than the transcutaneous approach.Meanwhile,pathogenesis of eyelid malposition after orbital fracture surgery are discussed.Furthermore,to prevent eyelid malposition complications,doctors should choose the appropriate orbital fracture approach according to the patient’s needs,and delicate tissue management,technical expertise,and meticulous hemostasis are necessary.Conservative treatment with taping,lubricating ointment,and steroid for eyelid malposition complications should be performed first,and then surgical intervention when the conservative treatment fails.

Progress in research of liver surgery in China

INTRODUCTIONLiver surgery,was started in the late 1950s in Chinaand has developed rapidly in the past 40 years.The study on the diagnosis and treatment of primaryliver cancer in China underwent four stages:①Inthe 1950s,the anatomical study of the liver lay asolid foundation for liver resection.①In

Treatment for isolated loco-regional recurrence of gastric adenocarcinoma: Does surgery play a role?

AIM： To evaluate the role of surgical treatment for isolated Ioco-regional recurrences of operated gastric adenocarcinoma. METHODS： Among the 837 patients operated for gastric adenocarcinoma between December 1979 and April 2004, 713 （85%） underwent resection with curative intent. A retrospective review of a prospectively collected gastric cancer database was carried out. Overall recurrence rate was 44% （315 cases）, with 75% occurring within the first 2 years from the operation. Isolated L-R recurrences were observed in 38 （12%） patients. Symptomatic lesions were observed in 27 （71%）. RESULTS： Six （16%） patients were macroscopically resected with curative intent. The recurrence was located in the gastric stump after a STG in three patients, in the esophagojejunal anastomosis after a TG in two patients and in the gastric bed after a TG in one patient. Surgical procedures consisted of three secondary TG, two esophagojejunal resection and one excision of an extraluminal recurrence. Postoperative complications occurred in two patients （33%）, including one anastomotic leakage and one hemorrhage. The latter patient died of sepsis 35 d after the surgery （mortality rate 17%）. All patients died of recurrent gastric cancer： 2 within 1 year from surgery （8 and 11 mo, respectively）, 2 after 16 and 17 mo respectively and 1 after 28 mo from the second operation. CONCLUSION： Surgery plays a very limited role in the treatment for isolated Ioco-regional recurrence of gastric adenocarcinoma.

Oesophageal surgery

INTRODUCTIONThe origins of oesophageal surgery ,like most surgical treatments ,are based in the treatment of traumatic injury .The Smith Surgical Papyrus describes the examination, diagnosis and treatment of 'a gaping wound of throat, penetrating the gullet' [1].

Recent advances in computerized imaging and its vital roles in liverdisease diagnosis, preoperative planning, and interventional liversurgery: A review

The earliest and most accurate detection of the pathological manifestations of hepatic diseases ensures effective treatments and thus positive prognostic outcomes.In clinical settings,screening and determining the extent of a pathology are prominent factors in preparing remedial agents and administering approp-riate therapeutic procedures.Moreover,in a patient undergoing liver resection,a realistic preoperative simulation of the subject-specific anatomy and physiology also plays a vital part in conducting initial assessments,making surgical decisions during the procedure,and anticipating postoperative results.Conventionally,various medical imaging modalities,e.g.,computed tomography,magnetic resonance imaging,and positron emission tomography,have been employed to assist in these tasks.In fact,several standardized procedures,such as lesion detection and liver segmentation,are also incorporated into prominent commercial software packages.Thus far,most integrated software as a medical device typically involves tedious interactions from the physician,such as manual delineation and empirical adjustments,as per a given patient.With the rapid progress in digital health approaches,especially medical image analysis,a wide range of computer algorithms have been proposed to facilitate those procedures.They include pattern recognition of a liver,its periphery,and lesion,as well as pre-and postoperative simulations.Prior to clinical adoption,however,software must conform to regulatory requirements set by the governing agency,for instance,valid clinical association and analytical and clinical validation.Therefore,this paper provides a detailed account and discussion of the state-of-the-art methods for liver image analyses,visualization,and simulation in the literature.Emphasis is placed upon their concepts,algorithmic classifications,merits,limitations,clinical considerations,and future research trends.

Clinical practice guideline for diagnosis and treatment of hyperplasia of the mammary glands:Chinese Society of Breast Surgery(CSBrS)practice guideline 2021

Hyperplasia of the mammary glands(HMG)is a noninflammatory and non-tumorous lesion.[1]It is a structural disorder of the mammary glands due to different degrees of hyperplasia and subinvolution of the mammary parenchyma and stroma.In the literature,HMG is also called mastopathy,fibroadenosis,fibrocystic breast disease,mastalgia,fibrocystic change,benign mammary dysplasia,or sclerosing adenosis.

Clinical practice guidelines for diagnosis and treatment of patients with non-puerperal mastitis: Chinese Society of Breast Surgery (CSBrS) practice guideline 2021

The term non-puerperal mastitis(NPM)refers to a group of benign breast diseases of unknown cause that occur in non-puerperal women.The main pathological types are periductal mastitis(PDM)and granulomatous lobular mastitis(GLM).The main clinical manifestations of NPM are breast masses and breast abscesses.Associated fistulas,sinuses,or ulcers can form in the later stages;these tend to be persistent and to fail to heal.The natural course of these conditions is about 9 to 12 months and they frequently recur.There is currently no standard treatment.To help clinicians to make the correct diagnosis and formulate an appropriate treatment plan,the Chinese Society of Breast Surgery has reviewed published reports and conducted discussions between experts to determine the key issues to be included in clinical practice guidelines for NPM.This group has also studied the grading of recommendations assessment,development,and evaluation system,evaluated the relevant evidence,and formulated the following clinical practice guidelines(2021 version)for the diagnosis and treatment of NPM,the aim being to provide a reference standard for breast clinicians.

Clinical practice guidelines for diagnosis and treatment of invasive breast cancer:Chinese Society of Breast Surgery(CSBrS)practice guidelines 2021

The survival of patients with breast cancer has been greatly improved by comprehensive treatment including surgery,radiotherapy,and systemic treatment,among which surgical treatment remains the mainstay.Breast surgeons must not only master surgical skills but also develop the ability to treat disease comprehensively.To improve the ability of breast surgeons in China to diagnose breast cancer early,perform reasonable surgical treatment,and provide comprehensive treatment orientation,the Chinese Society of Breast Surgery(CSBrS)has reported the key issues in the diagnosis and treatment of invasive breast cancer through opinion collection and expert discussion.

One stop shop approach for the diagnosis of liver hemangioma

Hepatic hemangioma is usually detected on a routine ultrasound examination because of silent clinical behaviour.The typical ultrasound appearance of hemangioma is easily recognizable and quickly guides the diagnosis without the need for further investigation.But there is also an entire spectrum of atypical and uncommon ultrasound features and our review comes to detail these particular aspects.An atypical aspect in standard ultrasound leads to the continuation of explorations with an imaging investigation with contrast substance[ultrasound/computed tomography/or magnetic resonance imaging(MRI)].For a clinician who practices ultrasound and has an ultrasound system in the room,the easiest,fastest,non-invasive and cost-effective method is contrast enhanced ultrasound(CEUS).Approximately 85%of patients are correctly diagnosed with this method and the patient has the correct diagnosis in about 30 min without fear of malignancy and without waiting for a computer tomography(CT)/MRI appointment.In less than 15%of patients CEUS does not provide a conclusive appearance;thus,CT scan or MRI becomes mandatory and liver biopsy is rarely required.The aim of this updated review is to synthesize the typical and atypical ultrasound aspects of hepatic hemangioma in the adult patient and to propose a fast,non-invasive and cost-effective clinical-ultrasound algorithm for the diagnosis of hepatic hemangioma.

Intestinal Behçet's disease: A review of clinical diagnosis and treatment

Behçet's disease(BD)is a chronic inflammatory disorder prone to frequent re-currences,with a high predilection for intestinal involvement.However,the ef-ficacy and long-term effects of surgical treatment for intestinal BD are unknown.In the current issue of World J Gastrointest Surg,Park et al conducted a retrospec-tive analysis of 31 patients with intestinal BD who received surgical treatment.They found that elevated C-reactive protein levels and emergency surgery were poor prognostic factors for postoperative recurrence,emphasizing the adverse impact of severe inflammation on the prognosis of patients with intestinal BD.This work has clinical significance for evaluating the postoperative condition of intestinal BD.The editorial attempts to summarize the clinical diagnosis and treatment of intestinal BD,focusing on the impact of adverse factors on surgical outcomes.We hope this review will facilitate more precise postoperative management of patients with intestinal BD by clinicians.

Clinical practice guidelines for the diagnosis and treatment of inflammatory breast cancer:Chinese Society of Breast Surgery(CSBrS)Practice Guidelines 2022

To improve the diagnosis and treatment of inflammatory breast cancer(IBC),the Chinese Society of Breast Surgery(CSBrS)of the Chinese Medical Association identified the key clinical issues for clinical practice guidelines through literature research and evaluated the relevant evidence with reference to the Grading of Recommendations Assessment,Development and Evaluation(GRADE).[1]Level of evidence standard and recommendation strength criteria are shown in previous publication.[2]Recommendation strength review committee was comprised of 31 members and all the members are breast surgeons.The target audience are Chinese breast disease specialists.The recommendation is shown in Table 1.

Sigmoid colon endometriosis treated with laparoscopy-assisted sigmoidectomy:Significance of preoperative diagnosis

We present a female patient with sigmoid colon endometriosis who was diagnosed correctly preoperatively and underwent minimally invasive surgery. She was admitted to our hospital with rectal bleeding and constipation. We performed several workups. Colonoscopy and endoscopic ultrasonography showed sigmoid colon stenosis caused by submucosal tumor, and magnetic resonance imaging revealed a sigmoid colon tumor displaying signal hy- pointensity on both T1- and T2-weighted imaging. However, colonoscopic ultrasonography-assisted needle aspiration biopsy could not specify tumor characteristics. From these examinations, the lesion was diagnosed as sigmoid colon endometriosis and laparoscopy-assisted sigmoidectomy was performed. Pathological diagnosis from the resected specimen was identical to preoperative diagnosis, i.e., colonic endometriosis. Since differential diagnosis of intestinal endometriosis seems difficult, a cautious preoperative diagnosis is required to select treatments including minimally invasive surgery.

Diagnosis and Treatment Value of Ultrasound for Hepatobiliary and Pancreatic Disease

As an innovative technology, ultrasound has been applied to agriculture, medical, military, aerospace, machinery and other fields widely, as well as the medical industry, such as ultrasound diagnosis, ultrasound therapy. Ultrasonic technology has many advantages, and it certainly will promote the progress in medical area as a new method.

Current perspectives on pancreatic serous cystic neoplasms:Diagnosis, management and beyond

Pancreatic cystic neoplasms have been increasingly recognized recently. Comprising about 16% of all resected pancreatic cystic neoplasms, serous cystic neoplasms are uncommon benign lesions that are usually asymptomatic and found incidentally. Despite overall low risk of malignancy, these pancreatic cysts still generate anxiety, leading to intensive medical investigations with considerable financial cost to health care systems. This review discusses the general background of serous cystic neoplasms, including epidemiology and clinical characteristics, and provides an updated overview of diagnostic approaches based on clinical features, relevant imaging studies and new findings that are being discovered pertaining to diagnostic evaluation. We also concisely discuss and propose management strategies for better quality of life.

Diagnosis and surgical treatment of primary hepatic lymphoma

AIM: To assess the benefi ts and limits of surgery for primary hepatic lymphoma (PHL), and probability of survival after postoperative chemotherapy. METHODS: A retrospective analysis was undertaken to determine the results of surgical treatment of PHL over the past 8 years. Only nine patients underwent such treatment. The detailed data of diagnosis, treatment, and prognosis were carefully studied. RESULTS: All patients were mistaken as having α-fetoprotein-negative hepatic cancer before pathological diagnosis. The mean delay time between initial symptoms and final diagnosis was 26.8 d (range:14-47 d). Hepatitis B virus infection was noted in 33.3% of these patients. Most of the lesions were found to be restricted to a solitary hepatic mass. The surgical procedure performed was left hepatectomy in five cases, including left lateral segmentectomy in three. Right hepatectomy was performed in three cases and combined procedures in one. One patient died on the eighth day after surgery,secondary to hepatic insufficiency. The cumulative 6-mo, 1-year, and 2-year survival rates after hepatic surgery were, respectively, 85.7%,71.4%, and 47.6%. One patient survived for>5 years after surgery without any signs of recurrence until latest follow-up, who received routine postoperative chemotherapy every month for 2 years and then regular follow-up. By univariate analysis, postoperative chemotherapy was a significant prognostic factor that influenced survival (P=0.006). CONCLUSION: PHL is a rare entity that is often misdiagnosed, and has a potential association with chronic hepatitis B infection. The prognosis is variable, with good response to early surgery combined with postoperative chemotherapy in strictly selected patients.