The combined pathology of intra-mural haematoma (IMH) and penetrating aortic ulcer (PAU) represents disease progression of the PAU with high risk for further progression to either rupture or pseudo-aneurysm formation, and hence surgical intervention should be offered once diagnosis is made regardless of the presentation. We present a 70-year-old fit lady with chronic type A IMH associated with multiple PAUs, diagnosed incidentally, the patient underwent urgent surgical repair with good outcome.

Spinal arachnoid cysts are mostly intradural. Spinal extradural arachnoid cyst (SEAC) is very rare condition accounting for only 1% cases of spinal tumors. [1,2,3] SEAC is mostly found in males in their second to fifth decades. Most common location of SEAC is thoracic spine

Background: Since receiving unexplained pneumonia patients at the Jinyintan Hospital in Wuhan, China in December 2019, the new coronavirus (COVID-19) has rapidly spread in Wuhan, China and spread to the entire China and some neighboring countries. We establish the dynamics model of infectious diseases and time series model to predict the trend and short-term prediction of the transmission of COVID-19, which will be conducive to the intervention and prevention of COVID-19 by departments at all levels in mainland China and buy more time for clinical trials. Methods: Based on the transmission mechanism of COVID-19 in the population and the implemented prevention and control measures, we establish the dynamic models of the six chambers, and establish the time series models based on different mathematical formulas according to the variation law of the original data. Findings: The results based on time series analysis and kinetic model analysis show that the cumulative diagnosis of pneumonia of COVID-19 in mainland China can reach 36,343 after one week (February 8, 2020), and the number of basic regenerations can reach 4.01. The cumulative number of confirmed diagnoses will reach a peak of 87,701 on March 15, 2020; the number of basic regenerations in Wuhan will reach 4.3, and the cumulative number of confirmed cases in Wuhan will reach peak at 76,982 on March 20. Whether in Mainland China or Wuhan, both the infection rate and the basic regeneration number of COVID-19 continue to decline, and the results of the sensitivity analysis show that the time it takes for a suspected population to be diagnosed as a confirmed population can have a significant impact on the peak size and duration of the cumulative number of diagnoses. Increased mortality leads to additional cases of pneumonia, while increased cure rates are not sensitive to the cumulative number of confirmed cases. Interpretation: Chinese governments at various levels have intervened in many ways to control the epidemic. According to the results of the model analysis, we believe that the emergency intervention measures adopted in the early stage of the epidemic, such as blocking Wuhan, restricting the flow of people in Hubei province, and increasing the support to Wuhan, had a crucial restraining effect on the original spread of the epidemic. It is a very effective prevention and treatment method to continue to increase investment in various medical resources to ensure that suspected patients can be diagnosed and treated in a timely manner. Based on the results of the sensitivity analysis, we believe that enhanced treatment of the bodies of deceased patients can be effective in ensuring that the bodies themselves and the process do not result in additional viral infections, and once the pneumonia patients with the COVID-19 are cured, the antibodies left in their bodies may prevent them from reinfection COVID-19 for a longer period of time.

Obesity is associated with an increased risk of cancer development in the upper gastrointestinal tract. One own case of a female patient with gastric carcinoma after sleeve gastrectomy was the reason to review the literature about the frequency and the genesis of gastric carcinoma after bariatric surgery. Additional to our case 3 further patients with gastric carcinoma after sleeve gastrectomy and 33 patients with carcinomas of the upper gastrointestinal tract after other bariatric operations are reported in the literature. Due to a lack of registry studies the incidence of gastric cancer after bariatric surgery cannot be calculated. Early diagnostics should be performed in symptomatic patients and in patients with unspecific symptoms after bariatric surgery to avoid a delay of the diagnosis of potential carcinomas of the upper gastrointestinal tract.

This is a case of a 46 years old male presented with acute cholangitis 2 years after laparoscopic cholecystectomy for cholecystolithiasis. He underwent biliary drainage and common bile duct (CBD) exploration for multiple stones at 2017. A year later, he presented with a recurrent acute cholangitis associated with choledocholithiasis and dilatation of left hepatic bile duct. Cholangiogram revealed that there is contract flowing to the stomach from the CBD, showing a choledochogastric fistula. Exploratory laparotomy was performed with CBD exploration with extraction of multiple stones, choledochoscopy and hepatojejunostomy. Insertion of PTC drain over a guidewire passed through a fistulous opening into the stomach. We decided on conservative management for fistula tract to heal.