Amid the urban tapestry of many small cities across China,a striking sign commands attention,accompanied by bright window walls that offer a glimpse of neatly arranged shelves.Within,an assortment of snacks in every c...Amid the urban tapestry of many small cities across China,a striking sign commands attention,accompanied by bright window walls that offer a glimpse of neatly arranged shelves.Within,an assortment of snacks in every conceivable color beckons,enticing onlookers to step inside and explore the wonders.展开更多
Amid the urban tapestry of many small cities across China,a striking sign commands attention,accompanied by bright window walls that o"er a glimpse of neatly arranged shelves.Within,an assortment of snacks in eve...Amid the urban tapestry of many small cities across China,a striking sign commands attention,accompanied by bright window walls that o"er a glimpse of neatly arranged shelves.Within,an assortment of snacks in every conceivable colour beckons,enticing onlookers to step inside and explore the wonders.展开更多
A 26-year-old man presented with migrated right lower abdominal pain and without any history of hematological systemic diseases.Blood routine test showed a leukocyte count of 22.74 × 109/L, with91.4% neutrophils,...A 26-year-old man presented with migrated right lower abdominal pain and without any history of hematological systemic diseases.Blood routine test showed a leukocyte count of 22.74 × 109/L, with91.4% neutrophils, and a platelet count of 4 × 109/L before admission.The case question was whether the team should proceed with surgery.Obviously, a differential diagnosis is essential before making such a decision.Acute appendicitis was easily diagnosed based on clinical findings, including migrating abdominal pain, a leukocyte count of 22.74 × 109/L and the result of abdominal computed tomography scan.However, it was not clear whether the severe thrombocytopenia was primary or secondary.So smear of peripheral blood and aspiration of bone marrow were ordered to exclude hematological diseases.Neither of the tests indicated obvious pathological hematological changes.There was no hepatosplenomegaly found by ultrasound examination of the liver and spleen.Therefore, operative intervention may be a unique clinical scenario in acute severe appendicitis patients with secondary thrombocytopenia.展开更多
This work aims to facilitate diagnosing Aspergillus appendicitis, which can be missed clinically due to its rarity, by proposing a clinical pentad for Aspergillus appendicitis based on literature review and one new ca...This work aims to facilitate diagnosing Aspergillus appendicitis, which can be missed clinically due to its rarity, by proposing a clinical pentad for Aspergillus appendicitis based on literature review and one new case. The currently reported case of pathologicallyproven Aspergillus appendicitis was identified by computerized search of pathology database at William Beaumont Hospital, 1999-2014. Prior cases were identified by computerized literature search. Among 10980 pathology reports of pathologically-proven appendicitis, one case of Aspergillus appendicitis was identified(rate = 0.01%). A young boy with profound neutropenia, recent chemotherapy, and acute myelogenous leukemia presented with right lower quadrant pain, pyrexia, and generalized malaise. Abdominal computed tomography scan showed a thickened appendiceal wall and periappendiceal inflammation, suggesting appendicitis. Emergent laparotomy showed an inflamed, thickened appendix, which was resected. The patient did poorly postoperatively with low-grade-fevers while receiving antibacterial therapy, but rapidly improved after initiating amphotericin therapy. Microscopic examination of a silver stain of the appendectomy specimen revealed fungi with characteristic Aspergillus morphology, findings confirmed by immunohistochemistry. Primary Aspergillus appendicitis is exceptionally rare, with only 3 previously reported cases. All three cases presented with(1)-neutropenia,(2)-recent chemotherapy,(3)-acute leukemia, and(4)-suspected appendicitis;(5)-the two prior cases initially treated with antibacterial therapy, fared poorly before instituting antiAspergillus therapy. The current patient satisfied all these five criteria. Based on these four cases, a clinical pentad is proposed for Aspergillus appendicitis: clinically-suspected appendicitis, neutropenia, recent chemotherapy, acute leukemia, and poor clinical response if treated solely by antibacterial/anti-candidial therapy. Patients presenting with this proposed pentad may benefit from testing for Aspergillus infection by silver-stains/immunohistochemistry and considering empirical anti-Aspergillus therapy pending a tissue diagnosis.展开更多
Kidnapped is a novel writte n by Robert Louis Steve nson of Scotland.The story started from a boy called David Balfour.His parents died in 1751 when he was only 17,and he had to leave the house and find a new place to...Kidnapped is a novel writte n by Robert Louis Steve nson of Scotland.The story started from a boy called David Balfour.His parents died in 1751 when he was only 17,and he had to leave the house and find a new place to live.展开更多
Amid the urban tapestry of many small cities across China,a striking sign commands attention,accompanied by bright window walls that offer a glimpse of neatly arranged shelves.Within,an assortment of snacks in every c...Amid the urban tapestry of many small cities across China,a striking sign commands attention,accompanied by bright window walls that offer a glimpse of neatly arranged shelves.Within,an assortment of snacks in every conceivable color beckons,enticing onlookers to step inside and explore the wonders.展开更多
文摘Amid the urban tapestry of many small cities across China,a striking sign commands attention,accompanied by bright window walls that offer a glimpse of neatly arranged shelves.Within,an assortment of snacks in every conceivable color beckons,enticing onlookers to step inside and explore the wonders.
文摘Amid the urban tapestry of many small cities across China,a striking sign commands attention,accompanied by bright window walls that o"er a glimpse of neatly arranged shelves.Within,an assortment of snacks in every conceivable colour beckons,enticing onlookers to step inside and explore the wonders.
基金Supported by National Key Technology Research and Development Program of the Ministry of Science and Technology,No.2012BA141 B01the Air Force General Hospital Annovation Fund,No.KZ2013035
文摘A 26-year-old man presented with migrated right lower abdominal pain and without any history of hematological systemic diseases.Blood routine test showed a leukocyte count of 22.74 × 109/L, with91.4% neutrophils, and a platelet count of 4 × 109/L before admission.The case question was whether the team should proceed with surgery.Obviously, a differential diagnosis is essential before making such a decision.Acute appendicitis was easily diagnosed based on clinical findings, including migrating abdominal pain, a leukocyte count of 22.74 × 109/L and the result of abdominal computed tomography scan.However, it was not clear whether the severe thrombocytopenia was primary or secondary.So smear of peripheral blood and aspiration of bone marrow were ordered to exclude hematological diseases.Neither of the tests indicated obvious pathological hematological changes.There was no hepatosplenomegaly found by ultrasound examination of the liver and spleen.Therefore, operative intervention may be a unique clinical scenario in acute severe appendicitis patients with secondary thrombocytopenia.
文摘This work aims to facilitate diagnosing Aspergillus appendicitis, which can be missed clinically due to its rarity, by proposing a clinical pentad for Aspergillus appendicitis based on literature review and one new case. The currently reported case of pathologicallyproven Aspergillus appendicitis was identified by computerized search of pathology database at William Beaumont Hospital, 1999-2014. Prior cases were identified by computerized literature search. Among 10980 pathology reports of pathologically-proven appendicitis, one case of Aspergillus appendicitis was identified(rate = 0.01%). A young boy with profound neutropenia, recent chemotherapy, and acute myelogenous leukemia presented with right lower quadrant pain, pyrexia, and generalized malaise. Abdominal computed tomography scan showed a thickened appendiceal wall and periappendiceal inflammation, suggesting appendicitis. Emergent laparotomy showed an inflamed, thickened appendix, which was resected. The patient did poorly postoperatively with low-grade-fevers while receiving antibacterial therapy, but rapidly improved after initiating amphotericin therapy. Microscopic examination of a silver stain of the appendectomy specimen revealed fungi with characteristic Aspergillus morphology, findings confirmed by immunohistochemistry. Primary Aspergillus appendicitis is exceptionally rare, with only 3 previously reported cases. All three cases presented with(1)-neutropenia,(2)-recent chemotherapy,(3)-acute leukemia, and(4)-suspected appendicitis;(5)-the two prior cases initially treated with antibacterial therapy, fared poorly before instituting antiAspergillus therapy. The current patient satisfied all these five criteria. Based on these four cases, a clinical pentad is proposed for Aspergillus appendicitis: clinically-suspected appendicitis, neutropenia, recent chemotherapy, acute leukemia, and poor clinical response if treated solely by antibacterial/anti-candidial therapy. Patients presenting with this proposed pentad may benefit from testing for Aspergillus infection by silver-stains/immunohistochemistry and considering empirical anti-Aspergillus therapy pending a tissue diagnosis.
文摘Kidnapped is a novel writte n by Robert Louis Steve nson of Scotland.The story started from a boy called David Balfour.His parents died in 1751 when he was only 17,and he had to leave the house and find a new place to live.
文摘Amid the urban tapestry of many small cities across China,a striking sign commands attention,accompanied by bright window walls that offer a glimpse of neatly arranged shelves.Within,an assortment of snacks in every conceivable color beckons,enticing onlookers to step inside and explore the wonders.
