Early endoscopic management of an infected acute necrotic collection misdiagnosed as a pancreatic pseudocyst: A case report

BACKGROUND Infected acute necrotic collection(ANC)is a fatal complication of acute pancre-atitis with substantial morbidity and mortality.Drainage plays an exceedingly important role as the first step in invasive intervention for infected necrosis;however,there is great controversy about the optimal drainage time,and better treatment should be explored.CASE SUMMARY We report the case of a 43-year-old man who was admitted to the hospital with severe intake reduction due to early satiety 2 wk after treatment for acute pancre-atitis;conservative treatment was ineffective,and a pancreatic pseudocyst was suspected on contrast-enhanced computed tomography(CT).Endoscopic ultra-sonography(EUS)suggested hyperechoic necrotic tissue within the cyst cavity.The wall was not completely mature,and the culture of the puncture fluid was positive for A-haemolytic Streptococcus.Thus,the final diagnosis of ANC in-fection was made.The necrotic collection was not walled off and contained many solid components;therefore,the patient underwent EUS-guided aspiration and lavage.Two weeks after the collection was completely encapsulated,pancreatic duct stent drainage via endoscopic retrograde cholangiopancreatography(ERCP)was performed,and the patient was subsequently successfully discharged.On repeat CT,the pancreatic cysts had almost disappeared during the 6-month fo-llow-up period after surgery.CONCLUSION Early EUS-guided aspiration and lavage combined with late ERCP catheter drainage may be effective methods for intervention in infected ANCs.

Subdural fluid collection rather than meningitis contributes to hydrocephalus after cervical laminoplasty:A case report

BACKGROUND Hydrocephalus following dural tear after spinal surgery is rare.Although a few cases of obstructive hydrocephalus caused by subdural fluid collection and communicating hydrocephalus associated with meningitis have been reported,the mechanism remains uncertain.Herein we describe a patient complicated with hydrocephalus after cervical laminoplasty in whom subdural fluid collection in the cervical spine and posterior cranial fossa rather than chronic meningitis was the main mechanism.CASE SUMMARY A 45-year-old man underwent cervical laminoplasty for cervical spondylotic myelopathy at a local hospital.Ten days postoperatively,a high fever occurred and magnetic resonance imaging(MRI)showed cerebrospinal fluid(CSF)leakage.Pseudomeningocele liquid test showed high levels of protein and white blood cell(WBC)count with negative bacterial culture.The patient was treated with shortterm intravenous antibiotic and discharged with normal body temperature.The patient was uneventful during the first 8 mo follow-up although repeated MRI showed persistent pseudomeningocele.At the 9th mo postoperatively,the patient gradually presented with dizziness and headache accompanied by recurrent weakness of his left arm.Imaging examinations demonstrated hydrocephalus and a cystic lesion around the cervical spinal cord.CSF test from lumbar puncture indicated chronic meningitis.MRI on 1 d after pseudomeningocele drainage showed a significant decrease in the cystic volume,suggesting that the cystic lesion would be subdural fluid collection rather than adhesive arachnoiditis.After dural defect repair,the patient’s symptoms completely resolved and hydrocephalus gradually disappeared.CSF analysis at the 21-mo follow-up revealed significantly decreased protein level and WBC count.CONCLUSION Subdural fluid collection rather than meningitis contributes to the hydrocephalus formation after cervical laminoplasty.

Interventional radiology followed by endoscopic drainage for pancreatic fluid collections associated with high bleeding risk: Two case reports

BACKGROUND Endoscopic ultrasound(EUS)-guided transluminal drainage is an advanced technique used to treat pancreatic fluid collections(PFCs). However, gastric varices and intervening vessels may be associated with a high risk of bleeding and are, therefore, listed as relative contraindications. Herein, we report two patients who underwent interventional embolization before EUS-guided drainage.CASE SUMMARY Two 32-year-old males developed symptomatic PFCs after acute pancreatitis and came to our hospital for further treatment. One patient suffered from intermittent abdominal pain and vomiting, and computed tomography(CT) imaging showed an encapsulated cyst 7.93 cm × 6.13 cm in size. The other patient complained of a mass inside the abdomen, which gradually became enlarged. Gastric varices around the ideal puncture site were detected by EUS when we evaluated the possibility of endoscopic drainage in both patients. Interventional embolization was recommended as the first procedure to decrease the risk of bleeding. After that, EUS-guided transluminal drainage was successfully conducted, without vascular rupture. No postoperative complications occurred during hospitalization, and no recurrence was detected at the last follow-up CT scan performed at 1 mo.CONCLUSION Interventional embolization is a safe, preoperative procedure that is performed before EUS-guided drainage in PFC patients with gastric varices or at high risk of bleeding.

Cystic low-grade collecting duct renal carcinoma with liver compression—A challenging diagnosis and therapy: A case report

BACKGROUND A collecting duct carcinoma is a very rare, malignant renal epithelial tumor.Distant metastases are present in one third of cases at the time of diagnosis. It is known to have a poor prognosis.CASE SUMMARY A 42-year-old male was sent to our surgery clinic for removal of a 119.2 mm ×108.3 mm encapsulated cystic mass, which was localized in the 8th segment of the right liver lobe. The lesion was first identified on ultrasonography. A computed tomography scan confirmed the presence of a Bosniak type Ⅲ cystic lesion,which affected the liver and convexity of the right kidney. Surgical intervention involved a right nephrectomy, with removal of the cystic mass. The patient was mobilized on the first postoperative day and was discharged after 7 d. The histological and immunohistochemical examination revealed a low-grade collecting duct renal carcinoma, which is a rare variant of papillary carcinoma,with low malignant potential. The patient did not receive chemotherapy and after 21 mo of follow-up, a radiological examination and laboratory analyses showed normal aspects. No relapse or other complications were reported.CONCLUSION To manage renal tumors properly, a correct histopathological diagnosis is crucial,as is early diagnosis and correct surgical treatment.

Renal Collecting Duct Cancer： a Report of 2 Cases

Renal collecting duct cancer is a rare malignant tumor, which accounts for 1% to 2% of epithelial kidney tumors. Its pathologial appearance has been easily misdiagnosed as a mammilliform renal cell carcinoma or as other tumors. The malignancy of renal collecting duct cancer is high, with early metastasis and poor prognosis. The clinical data for 2 cases of the tumor are discussed in this report, including reports on the histopathology and the changes in immunohistochemistry.

Overall clinical course of indeterminate dendritic cell tumor patients without skin lesions:A rare case report

BACKGROUND Indeterminate dendritic cell tumor(IDCT)is a rare tumor of immune cells,and IDCT patients without skin lesions are rarely reported.Therefore,the clinical course in this type of patient is unclear,and further research on the underlying pathological mechanisms and appropriate treatments is needed.CASE SUMMARY This study describes a female IDCT patient with bile duct lesions.The strong mimicry of IDCT lesions confused doctors,and consequently,this patient,who had no skin lesions,was first diagnosed with cholangiocarcinoma.Then,she presented with persistent abdominal distension without jaundice.Enlarged mesenteric lymph nodes along with massive ascites were observed in the subsequent imaging examination.However,no tumor cells or pathogens were found in the three subsequent ascites analyses.It took 2 years to reach the correct diagnosis,which was eventually obtained by performing surgery for biopsy of the patient’s abdominal lymph nodes.However,by then,she was already in a cachexic state.Finally,she received a cycle of cyclophosphamide therapy and was advised to visit a hospital specializing in rare diseases.CONCLUSION For IDCT patients without skin lesions,early biopsy is the key to obtaining a correct diagnosis.Moreover,the collective management of IDCT patients is important.Further histological and molecular biology studies based on human specimens are critical for understanding the pathological mechanism of dendritic cell tumors in the future.

Radiologic features of Castleman's disease involving the renal sinus: A case report and review of the literature

BACKGROUND We present a rare case of plasma cell type of Castleman's disease(CD) involving only the right renal sinus in a 65-year-old woman with a duplex collecting system(DCS).CASE SUMMARY The patient presented with a right renal sinus lesion after renal ultrasonography.Subsequent abdominal enhanced computed tomography(CT) and magnetic resonance imaging(MRI) of the kidneys showed DCS and a soft tissue mass with mild enhancement at the lower right renal sinus. The lesion was suspected to be a malignant renal pelvic carcinoma. Hence, the patient underwent a right radical nephrectomy. Histological examination revealed hyperplastic lymphoid follicles in the renal sinus. A detailed review of the patient's CT and MRI images and a literature review suggested that the lesion was hypointense on T2-weighted images and hyperintense on diffusion-weighted image manifestations, and showed mild enhancement, which distinguished the plasma cell type of CD from many other renal sinus lesions. Furthermore, peripelvic soft tissue masses with a smooth internal surface of the renal pelvis were on imaging findings, which suggests that the urinary tract epithelial system is invulnerable and can be used to differentiate the plasma cell type of CD from malignant lymphoma with a focally growth pattern to some extent.CONCLUSION Preoperative diagnosis is often difficult in such cases, as plasma cell type of CD involving only the right kidney is exceedingly rare. However, heightened awareness of this disease entity and its radiographic presentations may alert one to consider this diagnosis.

Management of massive fistula bleeding after endoscopic ultrasound-guided pancreatic pseudocyst drainage using hemostatic forceps: A case report

BACKGROUND Endoscopic ultrasound(EUS)-guided drainage is the optimal method for treatment of pancreatic fluid collections(PFCs),and is associated with ease,safety,and efficiency.Bleeding is one of the main procedure-related complications,and often requires surgery or radiologic interventions.Indeed,endoscopic management of this complication is limited.CASE SUMMARY A 42-year-old man presented for evaluation of abdominal pain and distention for approximately 2 wk.Abdominal computed tomography revealed a pancreatic pseudocyst located in the tail of the pancreas.EUS-guided pancreatic pseudocyst was performed.After stent placement,massive bleeding was noted from the fistula.Finally,hemostasis was successfully achieved using hemostatic forceps within the fistula.CONCLUSION Bleeding vessel grasp and coagulation may represent a successful treatment for a fistula hemorrhage during EUS-guided drainage for a PFC,which may be tried before application of balloon or stent compression.

Traditional Chinese Medicine -CLINICAL CASE STUDIES

By Chen Keji, 26 × 19cm 365 pages hardcover US $ 28.00,$10.00 for airmail Available from Beijing Yihailin bookshop, 18 Beixincang, Dongzhimen Nei, Beijing 100700, P.R. China This collection of traditional Chinese medicine clinical case studies contains a total of 140 most outstanding cases of numerous specialists of traditional medicine and integrated traditional and Western medicine practices. These cases encompass various medical specialities including medicine, surgery, obstetrics and gynecology, pediatrics, ENT and dermatology. Each

乡村治理中的集体选择机制建构——基于江西省两个村庄的比较案例分析

如何构建有效的乡村治理规则是一个关键的理论和实践问题,然而学界对乡村治理规则的层次结构和设计方式的研究尚不充分。在一个多层嵌套的制度规则体系中,集体选择规则通过上下贯通嵌套规则体系提升乡村治理绩效。设计集体选择机制需要三个关键要件,分别是利益相容安排、民主协商程序和多元监督体系。对江西省两个村庄的比较案例分析揭示了集体选择机制影响乡村治理效能的内在机制,并探索了建立集体选择机制的具体途径。聚焦集体选择机制的制度分析为国家与社会共治下的乡村治理体系现代化提供了新思路,也为丰富公共治理理论贡献了中国智慧。

农村集体经济组织成员代表诉讼释论

集体成员代表诉讼是《农村集体经济组织法》借鉴股东代表诉讼而设立的全新制度,对维护农村集体经济组织及其成员的合法权益具有重要意义。集体成员代表诉讼适用于农村集体经济组织理事会成员、监事会成员或者监事、主要经营管理人员,以及农村集体经济组织外部人员侵害农村集体经济组织合法权益的情形。集体成员提起代表诉讼须经过前置程序,但在紧急情况下,人民法院有权豁免该程序。集体成员代表诉讼的适格原告为10名以上具有完全民事行为能力的集体成员,适格被告为侵害农村集体经济组织合法权益的理事会成员、监事会成员或者监事、主要经营管理人员及其他外部人员,农村集体经济组织为辅助型无独立请求权的第三人。在集体成员代表诉讼的案件审理中,管辖法院的确定、诉讼时效的适用、诉讼权利的限制、诉讼结果的效力及诉讼费用的承担等,是需要重点关注的问题。

中国典型集体离职案例的思考与启示——基于事件理论分析改革开放40余年来的典型案例

企业员工集体离职对相关组织和员工群体影响深远。研究以1978年至2021年中国改革开放的43年为时间背景,从中国知网(CNKI)的5个子数据库中甄选出我国集体离职案例102个和典型集体离职案例16个。基于编码分析、事件分析等案例研究方法,主要发现:典型集体离职案例的事件强度在新颖度、中断度、重要度中占据其一,即具有代表性;事件空间主要受所在企业规模、行业地位、社会影响力等因素影响;事件时间主要受集体离职人员的层级、重要性、不可替代性等因素影响。分析典型集体离职案例既要考虑时代背景、法律变迁、文化冲突等宏观因素——这些因素可能诱发集体离职;更要考虑外部诱惑、股东更替、高管套现等微观因素——这些因素可能直接导致集体离职。集体离职的发生受到中国改革开放进程的影响:发生地呈现由沿海向内陆变迁的趋势;所涉行业多集中在制造业,这一点尤其在中国加入世贸组织后更加明显;离职人员所涉层级由高层向中层和基层扩展,同时涉及高层、中层和基层的连带离职对企业影响更大。研究还提炼出影响集体离职的宏观因素和微观因素的作用与特征模型,并有针对性地提出预防集体离职事件发生的意见建议。

市场型村干部助推乡村产业振兴——基于H村和Q村的双案例比较研究

乡村振兴战略下,产业兴旺是核心,是有效解决“三农”问题的“一剂良方”。文章以L市H村和Q村为研究对象,采用双案例比较研究方法,在全面呈现两个村庄产业发展历程和现状的基础上,探析市场型村干部对乡村产业振兴的作用。经研究发现:市场型村干部能够整合内外资源、做好利益联结与分配、培养“一懂两爱”人才队伍,更好助力乡村产业振兴;村干部市场经营能力越弱,乡村产业发展越差;村干部市场经营能力越强,乡村产业则发展越好。因此,培养市场型村干部是乡村产业振兴的重要抓手。

5G共建共享网络可视化安全态势感知研究

在5G共建共享网络中,海量安全日志和告警审计使得安全数据缺乏分析、安全事件处置效率低下.面对威胁感知能力缺失、安全管理困难等诸多痛点,提出了5G共建共享网络可视化安全态势感知模型和可视化解决方案.对空口、运维、系统、传输、配置核查5大领域面临的攻击检测进行全面安全态势感知,进行了测试验证.对安全事件进行关联分析,识别跨域攻击链,发现攻击者核心意图,帮助客户实现主动、动态、可度量、可视化的5G共建共享网络安全、稳定运营及安全产业的快速发展.

集体经营性建设用地入市案例分析与优化对策

集体经营性建设用地入市试点改革的主要任务是通过完善集体经营性建设用地产权制度,理顺入市途径,建立城乡统一交易市场和监管体系,以达到与国有建设用地同地同权、农民集体收益共享、土地流转顺畅的目的。本研究从集体经营性建设用地入市改革制度的演变入手,通过对北京开展的由镇村主导,解决城市“夹心层”租房难的集租房建设和福州、永泰集体建设用地入市试点案例和成效分析,剖析当前入市试点中存在的城乡用地同地同权机制未形成、收益分配制度不明确和集体建设用地零散化、碎片化等方面的问题,提出明晰产权完善主体职能、完善收益分配机制和优化规划管控盘活土地资源等优化对策,进一步完善集体经营性建设用地出让制度和服务监管。

解铃须从系铃处——Records与Archives概念正史(六)

笔者的“四正”,从名分、本义、学理、法律上已弄清Records的含义,但坚持“Records文件观”者依旧质疑:若Records是档案,那Archives是什么?两者并列时又怎么翻译?还有人说Records是记录。既然是英语和法语带来的问题,循着英法档案历史去寻找,才是解铃的关键:以英法八百年档案工作中重要人物和事件为主线,探求其档案的源流、本质、内含及演变,为档案概念正史。

解铃须从系铃处——Records与Archives概念正史(五)

笔者的“四正”,从名分、本义、学理、法律上已弄清Records的含义,但坚持“Records文件观”者依旧质疑:若Records是档案,那Archives是什么?两者并列时又怎么翻译?还有人说Records是记录。既然是英语和法语带来的问题,循着英法档案历史去寻找,才是解铃的关键:以英法八百年档案工作中重要人物和事件为主线,探求其档案的源流、本质、内含及演变,为档案概念正史。

解铃须从系铃处——Records与Archives概念正史(四)

笔者的“四正”,从名分、本义、学理、法律上已弄清Records的含义,但坚持“Records文件观”者依旧质疑:若Records是档案,那Archives是什么?两者并列时又怎么翻译?还有人说Records是记录。既然是英语和法语带来的问题,循着英法档案历史去寻找,才是解铃的关键:以英法八百年档案工作中重要人物和事件为主线,探求其档案的源流、本质、内含及演变,为档案概念正史。

基于Python的中医医案智能收集系统研究

随着数据挖掘技术在中医医案研究中被广泛采用,对医案收集的效率和质量提出更高要求,积极探索中医学与计算机、人工智能等相关学科的交叉融合,实现中医医案的半自动收集,以期为名中医经验传承作出贡献。基于Python编程语言的简洁性、开源性以及丰富的第三方扩展库,使用Python,采用OCR文本识别、自然语言处理Jieba中文分词、Fuzzy-Wuzzy模糊字符串匹配等第三方工具库,编码实现医案智能收集系统。通过与医案手工收集相比,智能收集系统极大地提高了医案收集的工作效率,解放人力,提升医案的可靠性。

档案征集的典型

档案征集是档案馆工作的重要一环,河南省南阳市卧龙区档案馆30多年来深耕名人档案资源建设、屡创档案征集佳绩的典型案例,引领我们走进了一个全新的档案征集世界,值得肯定、点赞和借鉴。新时期开展档案征集,应结合学习借鉴卧龙区档案馆经验和本地区工作实际,既要加强档案征集宣导工作、增强主动征集意识,还要广泛吸纳社会力量、注重组建档案征集合作联盟,更要创新档案征集新路径、着力拓展地方特色档案征集,努力做到有情怀、有方法、有定力,线上线下双向联动,持之以恒、久久为功,方能收到事半功倍的良好效果。