Minimally Invasive Stabilization with Percutaneous Screws Fixation of APC-3 Pelvic Ring Injury

Pelvic fractures are associated with life-threatening injuries and high rates of morbidity and mortality. Management of internal blood loss associated with unstable pelvic ring injuries is paramount during the initial period. The reconstruction of the pelvic ring is of importance because it is a major contributor to the stability of the pelvic ring. We report the case of a 25-year-old man who had an unstable pelvic ring fracture combined with rupture of an obturator artery and had a successful and satisfactory treatment using minimally invasive surgery with percutaneous antegrade screw fixation.

Non-Operatively Treated Thoracolumbar Burst Fracture with Posterior Ligamentous Complex Injury: Case Report and Consideration on the Limitation of Thoracolumbar Injury Classification and Severity (TLICS) Score

Fractures at the thoracolumbar region are commonly followed after major traumatic injuries, and up to 20% of these fractures are known to be burst fractures. Making surgical decisions for these patients are of great interest however there is no golden standard so far. Since the introduction of Thoracolumbar Injury Classification and Severity (TLICS) score in 2007, it has been widely used as a referential guideline for making surgical decisions in thoracolumbar fractures. However, there is still limitations in this system. In this clinical case report, we introduce a L1 burst fracture after motor vehicle injury, who was successfully treated conservatively even while she was graded as a TLICS 5 injury. A case report is presented as well as discussion on the limitations of this grading system.

Analysis of the Importance of Sacroiliac Joint Fractures as a Prognostic Factor of the Patients with Pelvic Fractures

PURPOSE@#The diagnosis of pelvic fractures pattern has become to be essential in the decision making of treatment modality and reducing morbidity and mortality in multiple trauma patients. Sacroiliac joint (SIJ) disruption can cause life-threatening massive arterial bleeding. This study aimed to determine a method of predicting the prognosis and treatment direction with pelvis X-ray alone in the emergency room. We investigated whether SIJ disruption can be used alone as a poor prognostic factor.@*METHODS@#We analyzed the medical records and radiologic examination results of 167 patients with pelvic fractures from January 1, 2015 to December 31, 2016 retrospectively. Patients with pathologic fractures, thoraco-abdominal bleeding, and acetabulum fractures and pediatric patients (n=63) were excluded. Factors related to the clinical manifestations and treatments, such as transfusion and surgery, were statistically compared.@*RESULTS@#The cross-sectional analysis showed that there was no correlation between SIJ injury and sex; there were statistically significant relationships between occurrences of shock, conjoined fractures, transfusion, and surgeries. The hospitalization period and partial thromboplastin time and prothrombin time values increased. The logistic regression analysis showed that when an SIJ injury occurred, blood transfusion and hypotension possibilities increased.@*CONCLUSION@#When pelvic fractures occur near the SIJ, blood transfusion and shock possibilities increase. Physicians must be aware of the high severity and poor prognosis of such fractures when these are diagnosed in the emergency room. And furthermore, the physician has to predict and prepare the intensive care and multidisciplinary approaches.

Primary Gastric Malignant Melanoma Mimicking Adenocarcinoma

We report a case of primary gastric malignant melanoma that was diagnosed after curative resection but initially misdiagnosed as adenocarcinoma. A 68-year-old woman was referred to our department for surgery for gastric adenocarcinoma presenting as a polypoid lesion with central ulceration located in the upper body of the stomach. The preoperative diagnosis was confirmed by endoscopic biopsy. We performed laparoscopic total gastrectomy, and the final pathologic evaluation led to the diagnosis of primary gastric malignant melanoma without a primary lesion detected in the body. To the best of our knowledge, primary gastric malignant melanoma is extremely rare, and this is the first case reported in our country. According to the literature, it has aggressive biologic activity compared with adenocarcinoma, and curative resection is the only promising treatment strategy. In our case, the patient received an early diagnosis and underwent curative gastrectomy with radical lymphadenectomy, and no recurrence was noted for about two years.

Results of Surgical Treatment for Primary Gastric Adenocarcinoma: Single Institute Experience for 14 Years

PURPOSE: The aim of this study was to evaluate the clinicopathologic features, treatment outcomes, and prognostic factors of gastric cancer based on 14 years' experience in a single medical center, and to compare treatment outcomes with a previous study. MATERIALS AND METHODS: We retrospectively studied 2,327 patients who were operated on for gastric cancer between 1993 and 2006 at Korea University Hospital. RESULTS: The resection rate was 92.8% and curative resection was achieved for 1,960 (90.8%) patients. The 5-year survival rate was 70.0% for all patients undergoing resection and 79.2% for patients undergoing curative resection. The 5-year survival rate was 1.5% for unresected cases. Age, tumor size, location of the tumor, gross tumor type, depth of tumor invasion, lymph node involvement, distant metastasis, tumor stage, combined resection, complications, histology, and type of operation each had prognostic significance on univariate analysis. On multivariate analysis, lymph node involvement, depth of invasion, venous invasion, and age were independent prognostic factors. CONCLUSION: The 5-year survival rate for patients who underwent curative resection was 79.2%. Depth of invasion, lymph node involvement, venous invasion, and age were independent prognostic factors. The fact that tumor stage is the most important prognostic factor after curative resection, increases the importance of early detection.