Laparoscopic remnant cholecystectomy for calculi in the remnant gallbladder following subtotal-cholecystectomy: a report of two cases

Two cases of laparoscopic remnant cholecystectomy using near-infrared fluorescence cholangiography (NIFC) for remnant gallbladder calculi following subtotal-cholecystectomy are reported. Case 1: a 36-year-old woman was referred to our hospital with acute abdomen. Computed tomography showed remnant gallbladder calculi, with detected no other findings as the cause of the abdominal pain. For intraoperative exploration of the biliary anatomy, 0.25 mg/kg of indocyanine green (ICG) was administered intravenously the day before the operation. NIFC clearly showed the common bile duct and enabled safe laparoscopic remnant cholecystectomy. She was free from symptoms after the operation. Case 2: a 40-year-old woman was referred to our hospital with epigastralgia due to remnant gallbladder calculi after open cholecystectomy. ICG was administered intravenously the day before the operation. Severe adhesions were observed in the upper abdominal cavity and there was tight adherence of the duodenum to the remnant gallbladder. NIFC showed a clear margin that appeared to be the margin between the duodenum and remnant gallbladder. However, dissection of the margin observed by NIFC caused perforation of the duodenum. The clear margin seen with NIFC was likely due to visualization of the gallbladder through the duodenum. Although NIFC is a useful modality for confirming the intraoperative biliary anatomy, it is important not to rely too heavily on NIFC alone, which may lead to misinterpretation of the anatomy.

Phyllodes tumor in an adolescent female

Phyllodes is a tumor of breast. This fibro-epithelial lesion occurs in less than 1% of all breast tumors in female. They can be benign, borderline or malignant. It commonly occurs in age group of 45-50 years. It is also known as cystosarcoma phyllodes/ serocystic disease of Brodie. Treatment can be either wide local excision or mastectomy to achieve histologically clear margin. Palpable axillary lymphadenopathy can be identified in up-to 10-15% of patients but less than 1% has pathological positive nodes. Mammography and ultrasonography are main imaging modalities. Here, we present a case of a 14-year-old female presenting with a rapidly enlarging breast mass, which was ultimately found to be a Phyllodes tumor.

Graph Consistency Based Mean-Teaching for Unsupervised Domain Adaptive Person Re-Identification

Recent works show that mean-teaching is an effective framework for unsupervised domain adaptive person re-identification. However, existing methods perform contrastive learning on selected samples between teacher and student networks, which is sensitive to noises in pseudo labels and neglects the relationship among most samples. Moreover, these methods are not effective in cooperation of different teacher networks. To handle these issues, this paper proposes a Graph Consistency based Mean-Teaching (GCMT) method with constructing the Graph Consistency Constraint (GCC) between teacher and student networks. Specifically, given unlabeled training images, we apply teacher networks to extract corresponding features and further construct a teacher graph for each teacher network to describe the similarity relationships among training images. To boost the representation learning, different teacher graphs are fused to provide the supervise signal for optimizing student networks. GCMT fuses similarity relationships predicted by different teacher networks as supervision and effectively optimizes student networks with more sample relationships involved. Experiments on three datasets, i.e., Market-1501, DukeMTMCreID, and MSMT17, show that proposed GCMT outperforms state-of-the-art methods by clear margin. Specially, GCMT even outperforms the previous method that uses a deeper backbone. Experimental results also show that GCMT can effectively boost the performance with multiple teacher and student networks. Our code is available at https://github.com/liu-xb/GCMT .

Giant Mesenteric Hemangioma without Small Intestinal Involvement Report of a Case and Review of Literature

there were approximately twenty cases reported in the English literature, of which five cases were designated as giant hemangioma. We reported another giant mesenteric hemangioma, measuring 35x20x11 cm. with a weight of 5,5 Kilograms. The etiology of mesenteric hemangioma was still debatable. In our case, the patient only experienced mild abdominal pain, without gastrointestinal hemorrhage. Therefore, we were in favor of mesenteric origin as opposed to gastrointestinal origin. The symptoms were non-specific, ranging from abdominal pain, nausea, vomiting, and gastrointestinal bleeding if Gastrointestinal tract was involved. Preoperative diagnosis was very challenging despite the modern images’ technics have become available, such as computed tomography magnetic resonance and ultrasonography. The final diagnoses of mesenteric hemangioma have been exclusively established by histological examination after surgical removal of the tumor. Surgical resection with clear margin is the treatment of choice.

Position-Aware Recalibration Module: Learning From Feature Semantics and Feature Position

We present a new method to improve the representational power of the features in Convolutional Neural Networks (CNNs). By studying traditional image processing methods and recent CNN architectures, we propose to use positional information in CNNs for effective exploration of feature dependencies. Rather than considering feature semantics alone, we incorporate spatial positions as an augmentation for feature semantics in our design. From this vantage, we present a Position-Aware Recalibration Module (PRM in short) which recalibrates features leveraging both feature semantics and position. Furthermore, inspired by multi-head attention, our module is capable of performing multiple recalibrations where results are concatenated as the output. As PRM is efficient and easy to implement, it can be seamlessly integrated into various base networks and applied to many position-aware visual tasks. Compared to original CNNs, our PRM introduces a negligible number of parameters and FLOPs, while yielding better performance. Experimental results on ImageNet and MS COCO benchmarks show that our approach surpasses related methods by a clear margin with less computational overhead. For example, we improve the ResNet50 by absolute 1.75% (77.65% vs. 75.90%) on ImageNet 2012 validation dataset, and 1.5%~1.9% mAP on MS COCO validation dataset with almost no computational overhead. Codes are made publicly available.

Temporally Grounding Language Queries in Videos by Contextual Boundary-Aware Prediction

The task of temporally grounding language queries in videos is to temporally localize the best matched video segment corresponding to a given language (sentence). It requires certain models to simultaneously perform visual and linguistic understandings. Previous work predominantly ignores the precision of segment localization. Sliding window based methods use predefined search window sizes, which suffer from redundant computation, while existing anchor-based approaches fail to yield precise localization. We address this issue by proposing an end-to-end boundary-aware model, which uses a lightweight branch to predict semantic boundaries corresponding to the given linguistic information. To better detect semantic boundaries, we propose to aggregate contextual information by explicitly modeling the relationship between the current element and its neighbors. The most confident segments are subsequently selected based on both anchor and boundary predictions at the testing stage. The proposed model, dubbed Contextual Boundary-aware Prediction (CBP), outperforms its competitors with a clear margin on three public datasets.

Paediatric mucormycosis: tailoring surgical strategies to compliment antifungal chemotherapy. Different strokes for different folks

Children manifesting soft-tissue fungal infections are uncommonly seen, more so the subgroup of invasive soft-tissue mucormycosis. Invasive fungal infections in various organs respond differently and are often complicated by an immune-compromised host. Repeated and aggressive clearance of disease till an infection-clear margin is obtained is the mainstay of surgical therapy. This is coupled with appropriate antifungal therapy and the management of any underlying medical conditions. From our experience, we propose a surgical algorithm for therapy of soft-tissue mucormycosis in children.

Primary Conjunctival Pigmented Basal Cell Carcinoma with Increased Numbers of Intra-Tumour Melanocytes, Mimicking Melanoma: A Case Report and Review of the Literature

A 60-year-old, South-Asian male patient presented with a dark brown lesion on his left conjunctiva surface near the limbus for 2 years. Examination showed a globular, dark brown-coloured mass near the temporal limbus at 4 to 5 o’clock position, measuring 3 × 3 × 2 mm. There were a few scattered flat pigmented lesions near the mass and also a few prominent vessels. The mass underwent wide local excision, with a clear margin, followed by double freeze cryotherapy of the conjunctival margins along with the application of Mitomycin C. The bare sclera was covered by amniotic membrane. Histology surprisingly revealed a nodular basal cell carcinoma (BCC) containing melanin. The melanin was present in the tumour cell cytoplasm, within melanophages and within dendritic, Melan A-positive melanocytes. The BCC was immunohistochemically positive for BerEP4 and negative for EMA. The clinically observed smaller nodules flanking the main pigmented BCC corresponded histologically to pigmented superficial growth pattern BCC connected to the under surface of the conjunctival epithelium. This is the first report of a pigmented BCC of the conjunctiva, mimicking a conjunctival melanoma. Pigmented BCC should be considered in the differential diagnosis of pigmented tumours of the conjunctiva.