A Mixed-Initiative Approach to Reusing Infographic Charts.

Infographic bar charts have been widely adopted for communicating numerical information because of their attractiveness and memorability. However, these infographics are often created manually with general tools, such as PowerPoint and Adobe Illustrator, and merely composed of primitive visual elements, such as text blocks and shapes. With the absence of chart models, updating or reusing these infographics requires tedious and error-prone manual edits. In this paper, we propose a mixed-initiative approach to mitigate this pain point. On one hand, machines are adopted to perform precise and trivial operations, such as mapping numerical values to shape attributes and aligning shapes. On the other hand, we rely on humans to perform subjective and creative tasks, such as changing embellishments or approving the edits made by machines. We encapsulate our technique in a PowerPoint add-in prototype and demonstrate the effectiveness by applying our technique on a diverse set of infographic bar chart examples.

An Ultra-Low Power Smart Headband for Real-Time Epileptic Seizure Detection.

In this paper, the design of a smart headband for epileptic seizure detection is presented. The proposed headband consists of four key components: 1) an analog front-end circuitry; 2) an epileptic seizure detection tag (ESDT); 3) a Bluetooth low-power chip; and 4) customized electrodes. All the above components are integrated into a fabric headband with only 50.3 g. The smart headband system dissipates 55.89 mW. The epileptic seizure detection algorithm inside ESDT is validated by using Boston Children's Hospital's CHB-MIT scalp EEG clinical database with the detection rate of 92.68% and the false alarm of 0.527/h. We develop a service APP connected to the cloud so that the patients' health condition can be recorded and then referenced by doctors for further diagnosis or research.

Brown-Sequard syndrome caused by ossification of the ligamentum flavum.

Ossification of the ligamentum flavum (OLF) commonly occurs in the thoracic and lumbar regions. We present a patient with OLF at the C4-5 level with presentation as Brown-Sequard syndrome. Symptoms were relieved following a laminectomy and total lesion excision. The relevant literature is reviewed to discuss the racial distribution, unique presentation and pathogenesis of OLF.

Primary angiosarcoma of the spleen.

BACKGROUND AND OBJECTIVES: Primary splenic angiosarcoma is a very rare and aggressive neoplasm with a high metastatic rate and dismal prognosis. Since only a few cases have been adequately reported in the medical literature, we report here a further six cases. METHODS: The records of all cases of primary splenic angiosarcoma treated at Chang Gung Memorial Hospital from April 1991 to July 2004 were retrospectively reviewed. RESULTS: Of the six cases identified (three men and three women; range, 7-69 years; median, 44 years), four presented with palpable abdominal masses or left upper quadrant abdominal pain. Other systemic symptoms, such as bleeding gums, fatigue, fever, body weight loss, and gastrointestinal bleeding were noted. An abnormal hematogram was found in five patients, with all of these five showing anemia, and three thrombocytopenia. Splenomegaly was present in all patients. Hemoperitoneum due to splenic rupture was noted in one patient. Three patients had distant metastasis to the liver (n = 2), bone (n = 1), bone marrow (n = 1), and small bowel (n = 1) at diagnosis. Liver (n = 3), bone (n = 1), and bone marrow (n = 1) metastases were found in four patients after initial therapy. Five of the six cases underwent a splenectomy, one underwent partial hepatectomy, and one received chemotherapy. The respective 1-, 3- and 5-year survival rates were 60%, 40%, and 40%, and the median survival time was 36 months. One patient was disease-free 162 months after splenectomy. CONCLUSIONS: The clinical presentations of splenic angiosarcoma were similar to those of previous reports apart from the higher rate of splenomegaly observed in this study. In contrast to reported pediatric cases, our patient achieved long-term disease-free survival after splenectomy alone.

A peculiar site of chondroma: the epiglottis.

Chondroma of the laryngeal cartilage is an uncommon benign cartilaginous neoplasm. The commonest location is the posterior lamina of the cricoid cartilage, followed by the thyroid cartilage. The occurrence of chondroma in the epiglottis is extremely rare. Depending on the size and location of epiglottic chondroma the clinical manifestations are variable and include a lump in the neck, difficulty in swallowing fluids and dyspnea. In this study, an additional rare case of chondroma arising in the epiglottis is reported. The mass was located over the tip of the epiglottis and caused no significant clinical manifestations except for a foreign body sensation in the throat. Endoscopic excision with an adequate free margin was achieved via suspension laryngoscopy under general anesthesia with intubation. The patient was disease-free during a 1-year follow-up period. We present this case to highlight the occurrence of this rare benign lesion in the epiglottis, and stress that it should not be neglected in the differential diagnosis of an epiglottic mass. Conservative surgical excision is the initial treatment of choice and long-term follow-up is necessary.

Symptomatic hematoma of cervical ligamentum flavum: case report.

STUDY DESIGN: A case of symptomatic hematoma of cervical ligamentum flavum. OBJECTIVE: To report the first ligamentum flavum hematoma in the cervical spine and review the reported cases. SUMMARY OF BACKGROUND DATA: A herniated nucleus pulposis, spondylosis, epidural hematoma or abscess, neoplasm, or some pathology of the ligamentum flavum, such as hypertrophy, ossification, or calcification, are the most common causes of spinal cord and nerve root compression. A ligamentum flavum hematoma has also been reported as a cause of compression of the cauda equina and lumbar nerve roots but has never been found in the cervical spine. METHODS: A 72-year-old man presented with left upper arm pain and left hemiparesis following traditional massage therapy. Admission magnetic resonance images showed a posterior oval-shaped mass that was continuous with the ligamentum flavum at C3-C4 level. RESULTS: A C3-C4 laminectomy for decompression and resection of the lesion was performed. One year after surgery, the patient remained neurologically intact and symptom-free. CONCLUSIONS: Hematoma of the ligamentum flavum occurring in the cervical spine has never been reported previously. Repeated trivial injury on a degenerative ligamentum flavum might be the leading predisposing factor. Spine surgeons should be aware of a hematoma in the ligamentum flavum as a possible cause of spinal cord or root compression, especially in the mobile cervical and lumbar spine.

Clinicopathological features, surgical management, and disease outcome of perforated gastric cancer.

BACKGROUND AND OBJECTIVES: Perforated gastric cancer is rare and generally not diagnosed preoperatively or intraoperatively, if a frozen section is unavailable. Therefore, the elucidation of its clinicopathological features and disease outcomes will help surgeons manage perforated gastric cancer. PATIENTS AND METHODS: The clinicopathological features, surgical management, and disease outcomes of 13 patients with perforated gastric cancer from March 1989 to May 2003 were retrospectively analyzed. Disease outcomes were analyzed in-depth based on tumor stage, depth of tumor invasion, operative curability, and three treatment groups. RESULTS: All 13 patients (median age of 72 years) received emergent laparotomy. Malignant gastric perforation was diagnosed intraoperatively in eight (61.5%) patients. Four patients whose frozen sections exhibited perforated gastric cancer underwent radical surgery with curative intent and were assigned to Group 1. Another four patients with overt distal metastases underwent palliative surgery and were assigned to Group 2. The remaining five patients were misdiagnosed as having benign gastric perforation and underwent local surgery; these patients were assigned to Group 3. All patients received follow-up for a median of 26 months. The survival rates for Stage I disease (P = 0.0342), T1/T2 tumors (P = 0.0342), and curative resection (P = 0.0012) significantly exceeded those of Stage III/IV, T3/T4 tumors, and non-curative resection. Additionally, the survival rates of Group 1 (P = 0.0067) and Group 3 (P = 0.0067) significantly exceeded those of Group 2. Stepwise logistic regression analysis revealed no significant predictor of prognosis. CONCLUSIONS: In resectable cases, one-stage radical gastrectomy with possible extensive lymphadenectomy should be encouraged if conditions allow. In cases of misdiagnosis, non-radical local surgery with curative resection is sufficient to treat early-stage cancer.

Primary testicular actinomycosis mimicking metastatic tumor.

We report a rare case of right primary testicular actinomycosis presenting as multiple testicular lesions mimicking a metastatic tumor in a 71-year-old patient with gastric adenocarcinoma. Preoperative diagnosis is difficult. The enlarged and inflamed testis was removed by orchiectomy and testicular actinomycosis was diagnosed after pathological examination. The patient had not received any further antibiotic prescription and there was no recurrent or other site involvement after orchiectomy. We illustrate this case, though it is rare, to alert pathologists and clinicians to the possible occurrence of primary testicular actinomycosis mimicking metastatic lesions in a cancer patient. To diagnose, extensive sampling of the tissue specimens may be needed. We also reviewed the published literature and found that the treatment of choice for testicular actinomycosis was orchiectomy. The usage of penicillin after orchiectomy does not seem to affect the outcomes of the disease.

Reversible renin-dependent renovascular hypertension successfully treated with percutaneous transluminal renal angioplasty and stenting.

A 37-year old woman was suspected of having renovascular hypertension because of recent onset severe hypertension (blood pressure 220/135 mmHg; compared to 132/65 mmHg two years earlier) and an abdominal bruit. A captopril renal scan indicated the presence of right renal artery stenosis. Additionally, a captopril plasma renin activity (PRA) provocation test showed a positive result for renovascular hypertension (baseline PRA = 291 microU/mL; 1 hour post-captopril PRA = 1444 microU/mL). Selective renal angiography demonstrated a severe critical stenotic lesion at the distal portion of the right renal artery. Blood pressure (BP) decreased to 136/80 mmHg one day after successful percutaneous transluminal renal angioplasty and stenting. Repeat renal angiography six months after the procedure revealed no evidence of in-stent restenosis. Blood pressure (BP = 137/76 mmHg) and plasma renin profile (baseline PRA = 23.8 microU/mL; 1 hour post-captopril PRA=22.3 microu/mL) also were normal six months following initial revascularization. Moreover, blood pressure (137/84 mmHg) and renin profile remained normal 2.5 years after the procedure (baseline PRA = 24.3 microU/mL; 1 hour post-captopril = 25.6 microU/mL). The results of this study have thus demonstrated a case of renin-dependent renovascular hypertension in which both the blood pressure and plasma renin activity profile normalized following successful percutaneous transluminal angioplasty and stenting.

Ileal angiomyolipoma as an unusual cause of small-intestinal intussusception.

Angiomyolipomas are benign mesenchymal tumors, but those that arise from the small intestine are exceedingly rare. We report on a 48-year-old woman who had an ileal angiomyolipoma, who presented clinically with vague abdominal pain and bloody stool. Small-bowel intussusception was shown on an abdominal computed tomography (CT) scan. We discuss the clinical manifestations and clinicopathological and immunohistochemical findings of this benign tumor which appeared in this rare location.

Splenic angiosarcoma metastasis to small bowel presented with gastrointestinal bleeding.

Primary splenic angiosarcoma is a very rare, aggressive neoplasm with a high metastatic rate and dismal prognosis. This neoplasm usually presents with abdominal pain, splenomegaly, anemia, and thrombocytopenia. Splenic angiosarcoma with bleeding gastrointestinal metastases is extremely rare. The literature contains only two case reports. This study reported a 44-year-old male patient with splenic angiosarcoma with sustained repeated gastrointestinal bleeding due to small bowel metastases. Salvage surgery was performed by splenectomy and resection of the metastatic small bowel tumors. The post-operative course was uneventful; the patient survived with the disease and had no GI bleeding, 7 mo after surgery.

Concurrent hepatic and ruptured renal angiomyolipoma in tuberous sclerosis complex.

Angiomyolipoma of the liver or kidney is one of the clinical manifestations of tuberous sclerosis complex. However, concurrence of angiomyolipoma in both liver and kidney associated with tuberous sclerosis complex is a rare entity. Renal angiomyolipomas with large aneurysms confer a higher probability of rupture as compared to small aneurysms. Herein, we document a case of tuberous sclerosis coexisting with hepatic and renal angiomyolipoma in a 37 year-old woman who presented with an acute abdomen due to ruptured tumor. Computed tomography of the abdomen revealed multiple tumors over the bilateral kidneys and liver. A right nephrectomy was performed. During surgery, a liver biopsy was performed from which a preliminary diagnosis of necrosis was established. However, immunoreactivity staining using monoclonal antibody HMB-45 (Human Melanoma, Black) led to the final diagnosis of angiomyolipoma. We emphasized that pathologists and clinicians should be aware that cases of tuberous sclerosis complex may be associated with renal and hepatic angiomyolipoma. To avoid an inappropriate diagnosis, before diagnosing liver necrosis, immunohistochemical staining for HMB-45 is recommended.

Transitional cell carcinoma metastasis to arm skin from the renal pelvis.

Metastases of renal pelvic transitional cell carcinoma (TCC) to the skin and subcutaneous tissues are extremely rare. Similar to metastases from other genitourinary tract organs, they commonly affect middle-aged or elderly men, generally herald a rapid progression, and are associated with a poor outcome. Skin metastatic lesions present as painful or nontender nodules, and a vascular or even a zosteriform appearance may occasionally be noted. The latter is often confused with herpes zoster infection. The diagnosis is usually confirmed by histopathological findings of biopsy specimens. Cutaneous metastases generally carry a dismal prognosis, with survival of only several months. We herein present a case of renal pelvic TCC with cutaneous metastases to the bilateral arms and epigastric region 1.5 years after diagnosis of the primary lesion. The patient's condition rapidly deteriorated, and she expired 4 weeks later. We present this rare case to highlight the possibility of cutaneous metastases from renal pelvis TCC and with the hope to increase awareness of the rapidly fatal course of such patients.

Schwannoma of the upper lip: case report and literature review.

Schwannomas, arising from nerve-sheath Schwann cells, rarely occur in the lip area. A Medline search in English literature from 1966 to 2002 revealed only 6 documented cases of schwannomas of the lip. We report the unusual case of a 22-year-old female patient who developed a schwannoma of the upper lip. Histopathological examination and immunohistochemical staining studies were performed, with the relevant literature for this clinical rarity also reviewed. Complete enucleation of the schwannoma usually achieves cure. Although very rare, schwannoma should be taken into consideration in the differential diagnosis of any upper lip mass.

Primary intraspinal mesenchymal chondrosarcoma: a case report and literature review.

Mesenchymal chondrosarcomas are rare malignant tumors of the bone and soft tissue. Extraskeletal mesenchymal chondrosarcomas, especially those that arise in the central nervous system, are even rarer. Most of those described were intracranially located, with only a very few cases having been reported in an intraspinal region. Therapeutic experience with primary spinal mesenchymal chondrosarcomas is also extremely limited. We report on a case of a 21-year-old man with back pain and bilateral progressive weakness and numbness of the lower extremities. A T1-weighted magnetic resonance image revealed a hypointense tumor located at the T8 level. The tumor was completely excised through a posterior approach. Microscopic examination and immunohistochemical studies confirmed the diagnosis of mesenchymal chondrosarcoma. Spinal irradiation and chemotherapy were also administered for prevention of local recurrence and metastasis. The patient has been symptom-free for 1 year after surgery. Herein, we review the 22 cases of primary intraspinal mesenchymal chondrosarcomas in the literature and discuss their clinical presentations, pathology, imaging studies, treatments, and outcomes.

Primary malignant melanoma of the nasal cavity.

Malignant melanoma is a highly lethal melanocytic neoplasm, usually affecting the skin. Primary malignant melanoma of the nasal cavity is rarely seen. Clinically, most patients display initial nonspecific symptoms of unilateral nasal obstruction or epistaxis. The prognosis is generally poor, with a mean survival time of 3.5 years. Extensive local invasion and distant metastasis to other organs may occur. The usual treatment of choice is radical excision. Radiotherapy and chemotherapy appear to have little effect. We report a fatal case of intranasal cavity malignant melanoma in which the patient initially presented with blood-tinged sputum, productive cough, and intermittent fever. Preoperative hepatic metastasis was found. Palliative surgery was performed to excise the nasal cavity tumor. Then, 6 courses of chemotherapy were further administered. Unfortunately, regional cervical nodal involvement and pancreatic head metastases occurred 1.5 years after the diagnosis. The patient's condition rapidly deteriorated, followed by death. We have chosen to discuss this aggressive condition because of its rarity and also to emphasize the importance of its early detection through vigilant attention to nonspecific nasal symptoms. A review of the literature concerning intranasal malignant melanoma is presented. We further discuss its possible etiology, site of origin, incidence, clinical presentations, principles of management, and outcome.

Detection of Enterobius vermicularis eggs in the submucosa of the transverse colon of a man presenting with colon carcinoma.

We report a case of a chronic infiltrate of the intestinal wall of the transverse colon by the eggs of Enterobius vermicularis in a man who had immigrated to Taiwan from mainland China 50 years ago. During surgery for suspected transverse colon carcinoma, histologic examination of the tumor mass revealed eggs of E. vermicularis embedded in granulation tissue in the submucosa of the transverse colon. Results of a stool examination were negative for eggs but strongly positive for occult blood. The mass in the transverse colon was completely removed during surgery. At the present time, the patient remains asymptomatic.

Squamous cell carcinoma arising in an epidermal inclusion cyst.

An epidermal inclusion cyst is a widespread benign intradermal lesion and may occur anywhere in the body. Normally, it appears as a non-tender, soft mass of variable size. Dissection usually reveals grayish-white or whitish gelatinous materials and a smooth inner surface. The overlying skin almost always shows unremarkable changes. On occasion, the cyst may rupture and induce an inflammatory reaction. It rarely turns malignant or displays a firmer mass. This study reports on a rare case of squamous cell carcinoma arising from the lining cells of an epidermal inclusion cyst, which was located in the left axillary region of a 68-year-old male patient. Clinically, it is difficult to differentiate between a benign and malignant cystic lesion. Histological examination normally yields the diagnosis. Once a diagnosis is confirmed, the tumor should be widely excised with a free margin. The outcome is always excellent. We therefore emphasize that all resected skin cystic specimens should undergo further microscopic examination to avoid any unnecessary misdiagnosis.

Huge retroperitoneal germinoma presenting with pathological fracture of the spine.

Primary retroperitoneal germ cell tumors are extremely rare neoplasms. The most common presenting features are abdominal pain and palpable abdominal masses. Pathological fractures of the spine presenting as bilateral lower leg weakness are exceptionally rare. We describe a 16-year-old girl who developed progressive paraplegia after a minor falling injury. Radiological study demonstrated a huge retroperitoneal tumor with invasion of the T12 vertebral body and spinal canal. A posterior surgical approach was used to perform laminectomy (T12, L1), removal of the intraspinal tumor and internal fixation with transpedical screws (T10, T11 to L2,3), and posterolateral fusion. Postoperative combination chemotherapy for six cycles with cisplatin (100 mg/m2 per day for 1 day every 3 weeks), bleomycin (15 units intravenously weekly for 18 weeks) and etoposide (100 mg/m2 per day for 3 days every 3 weeks) were given and the tumor responded dramatically. The patient had fully recovered without evidence of sequelae or recurrence at 2 years after operation. To the authors' knowledge, this is the first case in which a huge retroperitoneal germinoma presented as pathological fracture of the spine and spinal cord compression. The effectiveness of the postoperative cisplatin-based chemotherapy against this tumor made major retroperitoneal surgery to remove the main tumor mass unnecessary is also demonstrated.