To explore the feasibility of using indocyanine green(ICG) visualizing the deep infiltrating endometriosis (DIE) during robotic surgery.

A patient with DIE in Department of Genecology and Obstetrics, Chinese PLA General Hospital was selected and underwent total hysterectomy with bilateral adnexectomy and endometriosis lesion excision with perfect preoperative examination and no surgical contraindication. Near-infrared fluorescence imaging with indocyanine green was used in the operation to visualize the endometriosis lesions.

The location of the lesions were accurate and the patient discharged from hospital successfully.

Near-infrared fluorescence imaging system with indocyanine green may clearly visualize the deep infiltrating endometriosis during robotic surgery. It is characterized by brief operation, accuracy and real time. With this technique, we can comprehensively evaluate the scope of our surgery.

To explore the classification of splenic trauma and methods for treatment selection.

Clinical data of 260 patients with splenic trauma admitted to the First People's Hospital of Chenzhou from January 2020 to January 2025 were analyzed retrospectively. Among them, 188 patients were male and 72 female, aged from 2 to 75 years, with a median age of 39 years. Among 188 patients, 161 cases experienced traffic accident injuries, 48 cases of falling injuries, 12 cases of stab injuries and 39 cases of blunt injuries. 69 patients were diagnosed with splenic rupture alone, 163 cases of spleen rupture complicated with brain trauma, multiple fractures, chest trauma and other extraperitoneal organ injuries, 16 cases of splenic rupture complicated with liver rupture, 8 cases of splenic rupture complicated with pancreatic rupture and 4 cases of splenic rupture complicated with gastrointestinal perforation. The splenic trauma was graded to the grading standards of splenic injury of Chinese Medical Association, according to the grading, kinetic energy of patients' injury, the changes of vital signs after injury and the involved organs, the diagnosis and treatment regimens for splenic trauma were formulated. Treatment methods included conservative treatment, interventional treatment, laparoscopic and open splenectomy, etc. For those complicated with other organ injuries, corresponding surgery or conservative treatments were performed.

Twelve patients were assessed as grade Ⅰ, 24 cases of grade Ⅱ, 159 cases of grade Ⅲ and 65 cases of grade Ⅳ, respectively. The success rate of treatment for splenic trauma was 98.8%(257/260), including 226 cases of surgery, 32 cases of conservative treatment and 2 cases of interventional treatment. Surgical methods included splenectomy combined with splenic tissue autotransplantation in 191 cases, partial splenectomy in 3 cases, laparoscopic splenectomy in 29 cases and laparoscopic partial splenectomy in 3 cases, respectively. 16 patients complicated with liver rupture were simultaneously treated with partial hepatectomy and repair of liver rupture, 8 cases complicated with pancreatic rupture were simultaneously treated with partial pancreatectomy and repair, and 4 cases complicated with gastrointestinal perforation were simultaneously treated with gastrointestinal repair.

The diagnosis and treatment regimen of splenic trauma should be formulated based on the grading, kinetic energy of splenic injury, the changes of patients' vital signs after injury and the involved organs, and appropriate treatment methods should be adopted. Splenectomy is the most effective treatment for emergent patients.

To analyze the characteristics of patients with osteonecrosis of the femoral head (ONFH) who achieved long-term success with conservative treatment and to summarize clinical experience in the conservative management of ONFH.

A retrospective analysis was conducted on patients with ONFH who received conservative treatment at the First Affiliated Hospital of Guangzhou University of Chinese Medicine from October 2009 to October 2024, with a continuous follow-up of more than five years. The Association Research Circulation Osseous (ARCO) stage, Japanese Investigation Committee (JIC) classification, and percentage of femoral head involvement were recorded and descriptively analyzed. According to the imaging outcomes, the cases were classified into three types: long-term stable type, medial collapse type, and subchondral fracture repair type.

A total of 16 patients were included, with a follow-up duration of 8 (7, 12) years. Among them, 10 cases were classified as long-term stable type, five as medial collapse type, and one as subchondral fracture repair type. In the long-term stable group, one patient with JIC type C1 had mild femoral head involvement, three patients had severe involvement but with lesions located medially (JIC type A), and the remaining six patients had mild or moderate involvement with JIC type A or B. All the five medial collapse cases had severe femoral head involvement, and four of them exhibited a "collapse-arrest-repair" process. The single subchondral fracture repair case was JIC type C1 with moderate femoral head involvement and preserved lateral cortex; the subchondral fracture line disappeared within eight years.

JIC types A and B are the most suitable candidates for conservative treatment, generally achieving long-term stability. Even when collapse occurs due to a large necrotic area, it tends to be self-limiting or even repair, with a favorable prognosis. For patients with JIC type C1, if the percentage of femoral head involvement is mild or moderate and the lateral cortex is preserved, long-term stability or even healing of subchondral fracture is still possible. However, identification is more difficult. It is recommended to combine quantitative assessments such as the preserved angle of the lateral wall or the China-Japan Friendship Hospital (CJFH) classification.

Mesh infection is a postoperative complication following laparoscopic hernia repair, which is generally associated with mesh materials, surgical techniques and other factors. Such infections are often complicated by enteric fistulas and cutaneous fistulas, whereas concurrent bladder fistulas are extremely rare. This article reports the treatment course of one patient who developed mesh infection combined with enteric fistula and bladder fistula after laparoscopic hernia repair. The patient had a previous history of laparoscopic hernia repair, and presented with gross hematuria and dull hypogastric pain as chief complaints. After admission, comprehensive examinations including abdominal computed tomography (CT) and colonoscopy were completed. The patient underwent transurethral pneumatic lithotripsy for bladder calculi, transurethral electroresection of bladder lesions, and cecectomy to remove bladder stones and the infected mesh. By reporting this rare case, this paper discusses its potential pathogenesis, so as to avoid misdiagnosis and missed diagnosis of similar conditions.

To summarize the clinical characteristics, treatment strategies and prognosis of pediatric eosinophilic gastroenteritis (EGE) in children presenting with edema and hypoproteinemia as the main clinical manifestations.

A total of 8 children with EGE (labeled as child 1 to child 8) presenting with edema and hypoproteinemia as the main clinical manifestations, who were diagnosed and treated at the Capital Center for Children′s Health, Capital Medical University from January 2015 to December 2022, were selected as the research subjects. Clinical medical records and follow-up data of all patients were retrospectively analyzed to summarize the clinical characteristics of EGE. This study was approved by the Ethics Committee of the Capital Center for Children′s Health, Capital Medical University (Approval No. SHERLLM2024010).

The diagnosis, treatments, follow-up and prognosis of the 8 children with EGE in this study were as follows. ① Among 8 children with EGE, 4 cases were boys and 4 cases were girls, with an average age of 4 years and 7 months. ② Every child initially presented with edema as the primary symptom: 3 cases had isolated edema; 3 cases had edema with vomiting, abdominal pain, diarrhea and bloating; 1 case had edema with pale complexion; 1 case had edema with black stools. ③ Laboratory testing showed that all patients had reduced serum albumin (14.0-23.4 g/L) and serum globulin (9.1-14.5 g/L). We also found elevated peripheral blood eosinophil (EOS) counts in 7 children, elevated total serum immunoglobulin (Ig)E in 2 children, and low protein levels with anemia in 4 children. ④ Imaging and endoscopic workups revealed that 5 children had lesions in the stomach and duodenum, 1 child in the ileocecal area, and 2 children in the colon and rectum. Endoscopic results were non-specific across the cohort, with the most common findings being mucosal congestion, swelling, redness and erosions; 1 child had no remarkable findings on endoscopy. ⑤ Biopsies taken from multiple parts of the digestive tract demonstrated chronic inflammation of the mucosa in the stomach, duodenum, colon and rectum, with EOS infiltrating the lamina propria in all cases. ⑥ All 8 children required albumin infusions during their hospital stay. For first-line treatment, 7 children were managed with dietary therapy, including 5 children followed a targeted elimination diet based on allergy testing, 2 children avoided 6 common high-allergy foods including seafood, red meat, nuts, eggs and shellfish, and child 7 was given an amino acid-based formula due to his young age. Alongside first-line treatment, 7 children were also prescribed glucocorticoids once EGE was definitively diagnosed. ⑦ Within 1 to 4 weeks of starting these treatments regimen, all children had complete resolution of edema and other gut symptoms, and their peripheral blood EOS levels dropped back to normal.⑧ We followed the 8 children for 12 to 18 months, 7 children had sustained improvement in their clinical symptoms, while child 8 continued to have symptom flares after 15 months of follow-up.

For children with EGE presenting with edema and hypoproteinemia as the main clinical manifestations, no specific clinical symptoms or endoscopic signs can be observed. The diagnosis of this disease mainly relies on the histopathological examination of the gastrointestinal mucosa, for which multiple deep biopsies from different sites should be performed to avoid missed diagnosis. Patient with this disease have a favorable therapeutic response to dietary avoidance therapy and glucocorticoid therapy.

To explore the clinical manifestations, diagnosis, and treatment of recurrent endometriosis (EMS) that has undergone malignant transformation into vaginal stump adenosarcoma.

A patient with vaginal stump adenosarcoma arising from recurrent EMS, who was treated at West China Second University Hospital, Sichuan University, in December 2024 (patient 1), was selected into this study. A retrospective analysis of the patient′s clinical records was conducted, including medical history, clinical presentation, imaging findings, pathological characteristics, treatment, and follow-up results. Using Chinese and English keywords such as " adenosarcoma" " vaginal stump" and " endometriosis", we searched the CNKI, Wanfang, and VIP databases, as well as PubMed and Web of Science (WoS), for relevant literature on the malignant transformation of endometriosis into vaginal stump adenosarcoma, and conducted a comprehensive analysis of the medical history, clinical manifestations, imaging findings, pathological characteristics, treatment, and follow-up outcomes of these patients. The procedures followed in this study complied with the standards set by the Ethics Committee of West China Second University Hospital, Sichuan University, and were approved by the Ethics Committee [Approval No.2025(315)].

① Patient 1, a 51-year-old woman (G₃P₁), presented to the Gynecology Department of our hospital on December 18, 2024, with a chief complaint of " a mass at the vaginal stump discovered over a year ago". Patient 1 has a history of EMS and was admitted to our hospital due to a gradually enlarging mass at the vaginal stump accompanied by vaginal bleeding. A pelvic MRI performed prior to admission revealed multiple nodular and mass-like lesions in the vaginal stump and the left pelvis. Elevated levels of carbohydrate antigens (CA) 125 and CA19-9 were observed; however, a needle biopsy of the vaginal stump lesion did not reveal any definitive evidence of malignancy. Following admission, the patient underwent resection of the vaginal stump lesion by laparotomy. Postoperative pathological examination confirmed that the polypoid EMS had undergone malignant transformation into adenosarcoma, with the sarcomatous component consisting of endometrial stromal sarcoma and rhabdomyosarcoma. Postoperatively, the patient received pelvic external beam radiation therapy combined with six cycles of chemotherapy. Seven months after the last cycle of chemotherapy, no residual tumor or recurrence was observed. ②Literature review results: Using the literature search strategy established in this study, a total of 7 research articles related to the malignant transformation of EMS into vaginal stump adenosarcoma were identified. Including patient 1, a total of 8 relevant patients were included in the study. A comprehensive analysis of their medical histories, clinical presentations, imaging findings, pathological characteristics, treatment, and follow-up results is presented below.The median age of these 8 patients was 48.5 years old. The primary clinical manifestation was vaginal bleeding (patients 1-3, and 5); pelvic masses were present in 3 cases (patients 6-8); and urinary incontinence and vaginal mass prolapse were present in 1 case (patient 4). In addition, three cases (patients 1, 5, and 8) exhibited heterotopic differentiation of the sarcomatous component, and two cases (patients 2 and 3) showed overgrowth of the sarcomatous component. All 8 patients underwent surgical treatment. One patient (patient 2) died following a recurrence; 3 patients (patients 5, 6, and 8) achieved remission following treatment after recurrence; and the remaining 4 patients (patients 1, 3, 4, and 7) did not experience recurrence during the follow-up period after their initial treatment.

Vaginal stump adenosarcoma arising from the malignant transformation of EMS is a relatively rare clinical condition, and lacks specific clinical and imaging features. Definitive diagnosis mainly relies on histopathological examination. Surgical resection remains the primary treatment, and the decision to administer adjuvant radiation therapy and/or chemotherapy after surgery should be made based on a comprehensive assessment of pathological characteristics and individual patient circumstances.

This article reports a case of posterior left retroperitoneal Ewing sarcoma complicated by renal vein and inferior vena cava tumor thrombus.The patient was admitted due to "left-sided abdominal pain for one month". PET-CT scan revealed a large mass in the left adrenal region, the left adrenal gland was indistinct, and the tumor boundaries with the gastric fundus, pancreatic tail, and upper pole of the left kidney were unclear; tumor thrombus formation was suspected in the left renal vein and inferior vena cava, pulmonary artery tumor thrombus was suspected in the main trunk of the right pulmonary artery, right middle pulmonary artery, and right lower pulmonary artery. After discussion by the multidisciplinary team at Nanfang Hospital, Southern Medical University, a combined thoracoabdominal left retroperitoneal mass resection, renal vein and inferior vena cava tumor thrombus removal, and pulmonary artery tumor thrombus removal were performed. Postoperative pathology results indicated Ewing sarcoma. After a multidisciplinary consultation of difficult cases in Guangdong Urological Association, It was ultimately determined to administer adjuvant chemotherapy first postoperatively, with a regimen of VDC/IE (vincristine + doxorubicin + cyclophosphamide alternating with ifosfamide + etoposide). Retroperitoneal masses complicated by renal vein and inferior vena cava tumor thrombus present significant surgical challenges and high risks, as tumor thrombus detachment can lead to serious complications such as pulmonary artery embolism. These patients require multidisciplinary discussion before surgery, thorough preoperative preparation, multidisciplinary collaboration during surgery, and individualized postoperative adjuvant treatment.