BACKGROUND Gallbladder rupture is common in laparoscopic cholecystectomy because the gallbladder is usually in acute or chronic inflammation status.The gallstones may sometime be spilled into the peritoneal cavity,res...BACKGROUND Gallbladder rupture is common in laparoscopic cholecystectomy because the gallbladder is usually in acute or chronic inflammation status.The gallstones may sometime be spilled into the peritoneal cavity,resulting in intra-abdominal ab-scess if the gallstones were not retrieved.The diagnosis of intra-abdominal ab-scess caused by unretrieved gallstone can usually be correctly identified in the routine imaging studies,such as abdominal ultrasonography or computed tomo-graphy(CT).Here we present a case of abscess formation from unretrieved gall-stone following laparoscopic cholecystectomy,which mimics the imaging findings of metastatic gallbladder ade-nocarcinoma.CASE SUMMARY This case described a 78-year-old man who received laparoscopic cholecystectomy and gallbladder adenocarcinoma was diagnosed after surgery.After adjuvant chemotherapy,the following up abdominal CT showed several small nodules at right upper abdomen and peritoneal carcinomatosis is considered.Repeated laparoscopic surgery for the excision of seeding tumor was conducted and the pathological diagnosis of the nodules and mass was inflammatory tissues and gallbladder stone.CONCLUSION Spilled gallstones are a common complication during laparoscopic cholecystectomy and some gallstones fail to be retrieved due to the size or the restricted view of laparoscopic surgery.For spilled gall bladder stones,surgeons may consider regular computerized tomography follow-up,and if necessary,laparoscopic examination can be used as a means of confirming the diagnostic and treatment.展开更多
A robotic fish, BASEMACK1, is designed and fabricated by mimicking the shape of a live mackerel. Three DC servo-motors are serially linked together and actuated to mimic the mackerel＇s Carangiform motion. Hydrodynami...A robotic fish, BASEMACK1, is designed and fabricated by mimicking the shape of a live mackerel. Three DC servo-motors are serially linked together and actuated to mimic the mackerel＇s Carangiform motion. Hydrodynamic characteristics of a fish-mimetic test model are experimentally identified and utilized in order to numerically simulate fish swimming. The discrete set of kinematic and dynamic parameters are obtained by considering required horizontal and lateral forces and minimum energy consumption. Using the optimized parameter set, optimal control of the robot is studied.展开更多
To the Editor:IgG4-related sclerosing cholangitis（IgG4-SC）has re cently been recognized as a biliary manifestation of IgG4-related disease（IgG4-RD）.Type 3 IgG4-SC pre sented biliary strictures in both the porta he...To the Editor:IgG4-related sclerosing cholangitis（IgG4-SC）has re cently been recognized as a biliary manifestation of IgG4-related disease（IgG4-RD）.Type 3 IgG4-SC pre sented biliary strictures in both the porta hepatis and the distal common bile duct（CBD）.;Its manifestation especially in the absence of autoimmune pancreatitis,is extremely rare and very similar to that of cholangiocarci noma（CC）.展开更多
Dear editor, We report a case of a 47-year-old female who presented with a toxic bupropion ingestion leading to cardiac arrest. She initially exhibited a loss of brainstem reflexes in conjunction with burst-suppressio...Dear editor, We report a case of a 47-year-old female who presented with a toxic bupropion ingestion leading to cardiac arrest. She initially exhibited a loss of brainstem reflexes in conjunction with burst-suppression pattern on EEG. Burst suppression is an EEG waveform pattern of alternating isoelectric suppressions and high voltage bursts, Our patient ultimately made a full neurologic recovery a few days later. While there are two other cases in the literature of bupropion overdose resulting in EEG burst-suppression and loss of brainstem reflexes, we believe this is the only reported adult case complicated by cardiac arrest.展开更多
Prostate cancer is the second most common cancer in men worldwide and the commonest cause of mortality in men. It is the commonest diagnosed cancer in African men. The earliest and common sites of metastasis are the a...Prostate cancer is the second most common cancer in men worldwide and the commonest cause of mortality in men. It is the commonest diagnosed cancer in African men. The earliest and common sites of metastasis are the axial skeleton and regional lymph nodes. Initial presentation of the metastatic disease with cervical or supraclavicular lymphadenopathy is rarely reported. We report 3 cases of metastatic cancer of the prostate presenting initially to physicians with huge cervical and supraclavicular lymph nodes enlargement which on biopsy revealed metastatic adenocarcinoma. On further evaluation, there were non-bothersome storage symptoms, elevated prostate specific antigen and abnormal digital rectal examination. Transrectal ultrasound (TRUS)-guided biopsy of hypoechoic nodules revealed high-grade adenocarcinoma of the prostate on histopathological examination. The cervical and supraclavicular lymphadenopathy resolved after commencement of androgen deprivation therapy. We advocate for prostate cancer screening in African men above 50 years of age presenting with cervical or supraclavicular lymphadenopthy to primary care physicians even in the absence of lower urinary tract symptoms.展开更多
Despite the considerable mortality and morbidity in metastasis cardiac mass, antemortem diagnosis is unusual. Here we report a case of a left atrial mass echocardiographically mimicking myxoma, in a patient with lung ...Despite the considerable mortality and morbidity in metastasis cardiac mass, antemortem diagnosis is unusual. Here we report a case of a left atrial mass echocardiographically mimicking myxoma, in a patient with lung carcinoma. The mass was pathologically confirmed to be metastatic carcinoma, which had entered the left pulmonary vein, illustrating the potential for unusual routes of tumor spread into tissue diagnosis in such cases atrium via direct invasion of left superior the heart and the importance of obtaining a展开更多
BACKGROUND Disc herniation refers to the displacement of disc material beyond its anatomical space.Disc sequestration is defined as migration of the herniated disc fragment into the epidural space,completely separatin...BACKGROUND Disc herniation refers to the displacement of disc material beyond its anatomical space.Disc sequestration is defined as migration of the herniated disc fragment into the epidural space,completely separating it from the parent disc.The fragment can move in upward,inferior,and lateral directions,which often causes low back pain and discomfort,abnormal sensation,and movement of lower limbs.The free disc fragments detached from the parent disc often mimic spinal tumors.Tumor like lumbar disc herniation can cause clinical symptoms similar to spinal tumors,such as lumbar soreness,pain,numbness and weakness of lower limbs,radiation pain of lower limbs,etc.It is usually necessary to diagnose the disease according to the doctor’s clinical experience,and make preliminary diagnosis and differential diagnosis with the help of magnetic resonance imaging(MRI)and contrast-enhanced MRI.However,pathological examination is the gold standard that distinguishes tumoral from non-tumoral status.We report four cases of disc herniation mimicking a tumor,and all the pathological results were intervertebral disc tissue.CASE SUMMARY The first case was a 71-year-old man with low back pain accompanied by left lower extremity radiating pain for 1 year,with exacerbation over the last 2 wk.After admission,MRI revealed a circular T2-hypointense lesion in the spinal canal of the L4 vertebral segment,with enhancement on contrast-enhanced MRI suggesting neurilemmoma.The second case was a 74-year-old man with pain in both knees associated with movement limitation for 3 years,with exacerbation over the last 3 mo.MRI revealed an oval T2-hyperintense lesion in the spinal canal at the L4–5 level,with obvious peripheral enhancement on contrast-enhanced MRI.Thus,neurilemmoma was suspected.The third case was a 53-year-old man who presented with numbness and weakness of the lumbar spine and right lower extremity for 2 wk.MRI revealed a round T2-hyperintense lesion in the spinal canal at the L4–5 level,with obvious rim enhancement on contrast-enhanced MRI.Thus,a spinal tumor was suspected.The fourth case was a 75-year-old man with right lower extremity pain for 2 wk,with exacerbation over the last week.MRI revealed a round T1-isointense lesion in the spinal canal of the L3 vertebral segment and a T2-hyperintense signal from the lesion.There was no obvious enhancement on contrast-enhanced MRI,so a spinal tumor was suspected.All four patients underwent surgery and recovered to ASIA grade E on postoperative days 5,8,8,and 6,respectively.All patients had an uneventful postoperative course and fully recovered within 3 mo.CONCLUSION Disc herniation mimicking a tumor is a relatively rare clinical entity and can be easily misdiagnosed as a spinal tumor.Examinations and tests should be improved preoperatively.Patients should undergo comprehensive preoperative evaluations,and the lesions should be removed surgically and confirmed by pathological diagnosis.展开更多
We present the case of a 74-year-old man with diabetes and hypertension who had to be rescued owing to a near-drowning syndrome at sea.When he was rescued,he complained of dyspnea and chest pain.An electrocardiogram(E...We present the case of a 74-year-old man with diabetes and hypertension who had to be rescued owing to a near-drowning syndrome at sea.When he was rescued,he complained of dyspnea and chest pain.An electrocardiogram(ECG)suggested acute coronary syndrome(ACS)affecting the left main coronary artery.Therefore,he was referred to our hospital for urgent coronary angiography.展开更多
Dear Sir, I am B. Spajic, the urologist from Clinical Department of Urology, Sestre Milosrdnice University Hospital, Zagreb, Croatia. Recently, we had a rare case of a cholesterol granuloma of the right epididymis at...Dear Sir, I am B. Spajic, the urologist from Clinical Department of Urology, Sestre Milosrdnice University Hospital, Zagreb, Croatia. Recently, we had a rare case of a cholesterol granuloma of the right epididymis at our department, showing clinical signs of acute scrotum. The case described here appears to be the second reporting cholesterol granuloma in the epididymis and the first one presenting with clinical signs of acute scrotum.展开更多
BACKGROUND： Pyogenic hepatic abscess may mimic primary or secondary carcinoma of the liver on contrast-enhanced computed tomography（CECT）. The present study was to explore the usefulness of the analysis of multisli...BACKGROUND： Pyogenic hepatic abscess may mimic primary or secondary carcinoma of the liver on contrast-enhanced computed tomography（CECT）. The present study was to explore the usefulness of the analysis of multislice-based texture acquired from CECT in the differentiation between pyogenic hepatic abscesses and malignant mimickers.METHODS： This retrospective study included 25 abscesses in 20 patients and 33 tumors in 26 subjects who underwent CECT. To make comparison, we also enrolled 19 patients with hepatic single simple cyst. The images from CECT were analyzed using a Laplacian of Gaussian band-pass filter（5 filter levels with sigma weighting ranging from 1.0 to 2.5）. We also quantified the uniformity, entropy, kurtosis and skewness of the multislice-based texture at different sigma weightings. Statistical significance for these parameters was tested with oneway ANOVA followed by Tukey honestly significant difference（HSD） test. Diagnostic performance was evaluated using the receiver operating characteristic（ROC） curve analysis.RESULTS： There were significant differences in entropy and uniformity at all sigma weightings（P〈0.001） among hepatic abscesses, malignant mimickers and simple cysts. The significant difference in kurtosis and skewness was shown at sigma 1.8 and 2.0 weightings（P=0.002-0.006）. Tukey HSD testshowed that the abscesses had a significantly higher entropy and lower uniformity compared with malignant mimickers（P=0.000-0.004）. Entropy（at a sigma 2.0 weighting） had the largest area under the ROC curve（0.888） in differentiating abscesses from malignant mimickers, with a sensitivity of 81.8% and a specificity of 88.0% when the cutoff value was set to 3.64.CONCLUSION： Multislice-based texture analysis may be useful for differentiating pyogenic hepatic abscesses from malignant mimickers.展开更多
Mycosis fungoides, the most common primary cutaneous lymphoma, may present with a broad spectrum of clinical features. As both clinical and dermatopathological findings in mycosis fungoides occasionally closely imitat...Mycosis fungoides, the most common primary cutaneous lymphoma, may present with a broad spectrum of clinical features. As both clinical and dermatopathological findings in mycosis fungoides occasionally closely imitateother dermatoses, correct diagnosis may be a challenge both for clinicians as well as dermatopathologists. As a consequence, diagnosis of cutaneous lymphoma may be initially missed and, therefore, prompt and adequate therapeutic measures delayed. Hence, the purpose of our article was to give an overview of hitherto published "mimickers" of mycosis fungoides with a review of its diverse clinical features to alert the clinicians about the wide spectrum of this dissimulating disease. By integrating our own encountered atypical cases of mycosis fungoides we provide a comprehensive illustrated histological and moleculargenetic workup thereof and thereby critically revise the different available diagnostic tools of daily routine. Finally, we derive a practical algorithm to obtain the correct diagnosis even in such ambiguous cases of mycosis fungoides.展开更多
文摘BACKGROUND Gallbladder rupture is common in laparoscopic cholecystectomy because the gallbladder is usually in acute or chronic inflammation status.The gallstones may sometime be spilled into the peritoneal cavity,resulting in intra-abdominal ab-scess if the gallstones were not retrieved.The diagnosis of intra-abdominal ab-scess caused by unretrieved gallstone can usually be correctly identified in the routine imaging studies,such as abdominal ultrasonography or computed tomo-graphy(CT).Here we present a case of abscess formation from unretrieved gall-stone following laparoscopic cholecystectomy,which mimics the imaging findings of metastatic gallbladder ade-nocarcinoma.CASE SUMMARY This case described a 78-year-old man who received laparoscopic cholecystectomy and gallbladder adenocarcinoma was diagnosed after surgery.After adjuvant chemotherapy,the following up abdominal CT showed several small nodules at right upper abdomen and peritoneal carcinomatosis is considered.Repeated laparoscopic surgery for the excision of seeding tumor was conducted and the pathological diagnosis of the nodules and mass was inflammatory tissues and gallbladder stone.CONCLUSION Spilled gallstones are a common complication during laparoscopic cholecystectomy and some gallstones fail to be retrieved due to the size or the restricted view of laparoscopic surgery.For spilled gall bladder stones,surgeons may consider regular computerized tomography follow-up,and if necessary,laparoscopic examination can be used as a means of confirming the diagnostic and treatment.
文摘A robotic fish, BASEMACK1, is designed and fabricated by mimicking the shape of a live mackerel. Three DC servo-motors are serially linked together and actuated to mimic the mackerel＇s Carangiform motion. Hydrodynamic characteristics of a fish-mimetic test model are experimentally identified and utilized in order to numerically simulate fish swimming. The discrete set of kinematic and dynamic parameters are obtained by considering required horizontal and lateral forces and minimum energy consumption. Using the optimized parameter set, optimal control of the robot is studied.
基金supported by a grant from the National Natural Science Foundation of China(81270544)
文摘To the Editor:IgG4-related sclerosing cholangitis（IgG4-SC）has re cently been recognized as a biliary manifestation of IgG4-related disease（IgG4-RD）.Type 3 IgG4-SC pre sented biliary strictures in both the porta hepatis and the distal common bile duct（CBD）.;Its manifestation especially in the absence of autoimmune pancreatitis,is extremely rare and very similar to that of cholangiocarci noma（CC）.
文摘Dear editor, We report a case of a 47-year-old female who presented with a toxic bupropion ingestion leading to cardiac arrest. She initially exhibited a loss of brainstem reflexes in conjunction with burst-suppression pattern on EEG. Burst suppression is an EEG waveform pattern of alternating isoelectric suppressions and high voltage bursts, Our patient ultimately made a full neurologic recovery a few days later. While there are two other cases in the literature of bupropion overdose resulting in EEG burst-suppression and loss of brainstem reflexes, we believe this is the only reported adult case complicated by cardiac arrest.
文摘Prostate cancer is the second most common cancer in men worldwide and the commonest cause of mortality in men. It is the commonest diagnosed cancer in African men. The earliest and common sites of metastasis are the axial skeleton and regional lymph nodes. Initial presentation of the metastatic disease with cervical or supraclavicular lymphadenopathy is rarely reported. We report 3 cases of metastatic cancer of the prostate presenting initially to physicians with huge cervical and supraclavicular lymph nodes enlargement which on biopsy revealed metastatic adenocarcinoma. On further evaluation, there were non-bothersome storage symptoms, elevated prostate specific antigen and abnormal digital rectal examination. Transrectal ultrasound (TRUS)-guided biopsy of hypoechoic nodules revealed high-grade adenocarcinoma of the prostate on histopathological examination. The cervical and supraclavicular lymphadenopathy resolved after commencement of androgen deprivation therapy. We advocate for prostate cancer screening in African men above 50 years of age presenting with cervical or supraclavicular lymphadenopthy to primary care physicians even in the absence of lower urinary tract symptoms.
基金Supported by Natural Science Foundation of Chongqing in China (Grant No 30700822)
文摘Despite the considerable mortality and morbidity in metastasis cardiac mass, antemortem diagnosis is unusual. Here we report a case of a left atrial mass echocardiographically mimicking myxoma, in a patient with lung carcinoma. The mass was pathologically confirmed to be metastatic carcinoma, which had entered the left pulmonary vein, illustrating the potential for unusual routes of tumor spread into tissue diagnosis in such cases atrium via direct invasion of left superior the heart and the importance of obtaining a
基金Supported by Chinese People’s Liberation Army Medical Technology Youth Training Program,No. 20QNPY071
文摘BACKGROUND Disc herniation refers to the displacement of disc material beyond its anatomical space.Disc sequestration is defined as migration of the herniated disc fragment into the epidural space,completely separating it from the parent disc.The fragment can move in upward,inferior,and lateral directions,which often causes low back pain and discomfort,abnormal sensation,and movement of lower limbs.The free disc fragments detached from the parent disc often mimic spinal tumors.Tumor like lumbar disc herniation can cause clinical symptoms similar to spinal tumors,such as lumbar soreness,pain,numbness and weakness of lower limbs,radiation pain of lower limbs,etc.It is usually necessary to diagnose the disease according to the doctor’s clinical experience,and make preliminary diagnosis and differential diagnosis with the help of magnetic resonance imaging(MRI)and contrast-enhanced MRI.However,pathological examination is the gold standard that distinguishes tumoral from non-tumoral status.We report four cases of disc herniation mimicking a tumor,and all the pathological results were intervertebral disc tissue.CASE SUMMARY The first case was a 71-year-old man with low back pain accompanied by left lower extremity radiating pain for 1 year,with exacerbation over the last 2 wk.After admission,MRI revealed a circular T2-hypointense lesion in the spinal canal of the L4 vertebral segment,with enhancement on contrast-enhanced MRI suggesting neurilemmoma.The second case was a 74-year-old man with pain in both knees associated with movement limitation for 3 years,with exacerbation over the last 3 mo.MRI revealed an oval T2-hyperintense lesion in the spinal canal at the L4–5 level,with obvious peripheral enhancement on contrast-enhanced MRI.Thus,neurilemmoma was suspected.The third case was a 53-year-old man who presented with numbness and weakness of the lumbar spine and right lower extremity for 2 wk.MRI revealed a round T2-hyperintense lesion in the spinal canal at the L4–5 level,with obvious rim enhancement on contrast-enhanced MRI.Thus,a spinal tumor was suspected.The fourth case was a 75-year-old man with right lower extremity pain for 2 wk,with exacerbation over the last week.MRI revealed a round T1-isointense lesion in the spinal canal of the L3 vertebral segment and a T2-hyperintense signal from the lesion.There was no obvious enhancement on contrast-enhanced MRI,so a spinal tumor was suspected.All four patients underwent surgery and recovered to ASIA grade E on postoperative days 5,8,8,and 6,respectively.All patients had an uneventful postoperative course and fully recovered within 3 mo.CONCLUSION Disc herniation mimicking a tumor is a relatively rare clinical entity and can be easily misdiagnosed as a spinal tumor.Examinations and tests should be improved preoperatively.Patients should undergo comprehensive preoperative evaluations,and the lesions should be removed surgically and confirmed by pathological diagnosis.
文摘We present the case of a 74-year-old man with diabetes and hypertension who had to be rescued owing to a near-drowning syndrome at sea.When he was rescued,he complained of dyspnea and chest pain.An electrocardiogram(ECG)suggested acute coronary syndrome(ACS)affecting the left main coronary artery.Therefore,he was referred to our hospital for urgent coronary angiography.
文摘Dear Sir, I am B. Spajic, the urologist from Clinical Department of Urology, Sestre Milosrdnice University Hospital, Zagreb, Croatia. Recently, we had a rare case of a cholesterol granuloma of the right epididymis at our department, showing clinical signs of acute scrotum. The case described here appears to be the second reporting cholesterol granuloma in the epididymis and the first one presenting with clinical signs of acute scrotum.
基金supported by grants from Medical Engineering Cross Research Foundation of Shanghai Jiaotong University(YG2013MS37 and YG2012MS16)the National Natural Science Foundation of China(81201172,81371660 and 81371622)
文摘BACKGROUND： Pyogenic hepatic abscess may mimic primary or secondary carcinoma of the liver on contrast-enhanced computed tomography（CECT）. The present study was to explore the usefulness of the analysis of multislice-based texture acquired from CECT in the differentiation between pyogenic hepatic abscesses and malignant mimickers.METHODS： This retrospective study included 25 abscesses in 20 patients and 33 tumors in 26 subjects who underwent CECT. To make comparison, we also enrolled 19 patients with hepatic single simple cyst. The images from CECT were analyzed using a Laplacian of Gaussian band-pass filter（5 filter levels with sigma weighting ranging from 1.0 to 2.5）. We also quantified the uniformity, entropy, kurtosis and skewness of the multislice-based texture at different sigma weightings. Statistical significance for these parameters was tested with oneway ANOVA followed by Tukey honestly significant difference（HSD） test. Diagnostic performance was evaluated using the receiver operating characteristic（ROC） curve analysis.RESULTS： There were significant differences in entropy and uniformity at all sigma weightings（P〈0.001） among hepatic abscesses, malignant mimickers and simple cysts. The significant difference in kurtosis and skewness was shown at sigma 1.8 and 2.0 weightings（P=0.002-0.006）. Tukey HSD testshowed that the abscesses had a significantly higher entropy and lower uniformity compared with malignant mimickers（P=0.000-0.004）. Entropy（at a sigma 2.0 weighting） had the largest area under the ROC curve（0.888） in differentiating abscesses from malignant mimickers, with a sensitivity of 81.8% and a specificity of 88.0% when the cutoff value was set to 3.64.CONCLUSION： Multislice-based texture analysis may be useful for differentiating pyogenic hepatic abscesses from malignant mimickers.
文摘Mycosis fungoides, the most common primary cutaneous lymphoma, may present with a broad spectrum of clinical features. As both clinical and dermatopathological findings in mycosis fungoides occasionally closely imitateother dermatoses, correct diagnosis may be a challenge both for clinicians as well as dermatopathologists. As a consequence, diagnosis of cutaneous lymphoma may be initially missed and, therefore, prompt and adequate therapeutic measures delayed. Hence, the purpose of our article was to give an overview of hitherto published "mimickers" of mycosis fungoides with a review of its diverse clinical features to alert the clinicians about the wide spectrum of this dissimulating disease. By integrating our own encountered atypical cases of mycosis fungoides we provide a comprehensive illustrated histological and moleculargenetic workup thereof and thereby critically revise the different available diagnostic tools of daily routine. Finally, we derive a practical algorithm to obtain the correct diagnosis even in such ambiguous cases of mycosis fungoides.
