ABSTRACT
BACKGROUND: Unstable pelvic fractures, especially vertical shear fractures, require surgery for correct reduction, rigid fixation, and improved postoperative outcomes. Herein, we assess the effectiveness of our minimally invasive procedure for the management of unstable pelvic fractures. HYPOTHESIS: We hypothesized that this procedure would be useful for the management of unstable pelvic fractures. PATIENTS AND METHODS: This study included 28 patients with unstable pelvic fractures (vertical shear injuries; AO types C1-3) treated using minimally invasive surgery for spinopelvic fixation (MIS-SP) between 2014 and 2020 (mean follow-up time, 15 months). The MIS-SP requires four percutaneous pedicle screws and four iliac screw insertions. Subsequently, reduction and fixation are performed. RESULTS: The mean preoperative displacement of the posterior pelvic elements in craniocaudal correction was 17.6 (range, 9.0-32.2) mm. The mean length of the craniocaudal reduction was 16.5 (8.1-30.1) mm, with a mean reduction rate of 93.5% (78%-100%). The mean length of the mediolateral reduction was 11.3 (3.9-19.6) mm, with a mean reduction rate of 87.3% (76%-100%). DISCUSSION: Our novel reduction and fixation procedure is a powerful, minimally invasive option for the treatment of unstable pelvic ring fractures. LEVEL OF EVIDENCE: III.
Subject(s)
Fractures, Bone , Pedicle Screws , Pelvic Bones , Humans , Retrospective Studies , Fracture Fixation, Internal/methods , Fractures, Bone/diagnostic imaging , Fractures, Bone/surgery , Pelvic Bones/surgery , Pelvic Bones/injuries , Minimally Invasive Surgical Procedures/methodsABSTRACT
A 79-year-old man experiencing sudden abdominal pain was admitted to our hospital. Upper gastrointestinal endoscopy and computed tomography images revealed an 8-cm lesion, suggestive of submucosal tumor in the gastric antrum and a type 0-IIc early gastric cancer in the gastric body. The tumor ruptured during preoperative examinations, which necessitated emergency D1+ distal gastrectomy. Pathological findings confirmed the penetration of the gastric cancer into the submucosa. The cancer comprised well-differentiated tubular carcinoma cells with a low papillary structure. At the submucosa, small clusters of carcinoma cells were surrounded by clear spaces. These clusters displayed a characteristic "inside out pattern" on immunohistochemical examination, suggesting that the clusters were probably incipient lesions of invasive micropapillary carcinoma. The ruptured tumor was identified as a lymph node metastasis from the gastric cancer. We herein report this extremely rare case in which lymph node metastasis from early gastric cancer enlarged and ruptured. The findings of this study suggest that the characteristic pathological type identified in this report, which signified high-grade malignancy, was associated with the rupture.
Subject(s)
Adenocarcinoma/diagnosis , Lymph Nodes/pathology , Lymphatic Metastasis/diagnosis , Stomach Neoplasms/diagnosis , Aged , Endoscopy , Gastrectomy , Humans , Male , Stomach Neoplasms/pathologyABSTRACT
A 65-year-old male was referred to our hospital 2 years ago for a multilocular cyst accompanied with a protein plug in the pancreas tail. He was diagnosed as having branch duct-type intraductal papillary mucinous neoplasm and was followed-up. Two years later, endoscopic ultrasonography revealed a hypoechoic lesion, 10mm in diameter, near the cyst-like lesion. Finally, he was diagnosed with small pancreatic adenocarcinoma concomitant with intraductal papillary mucinous neoplasm and underwent radical distal pancreatectomy with splenectomy. Resected specimen revealed that the protein plug in the main pancreatic duct had caused distal pancreatic duct dilatation, resembling a multilocular cyst and pancreatic duct stenosis with inflammatory changes and fibrosis around the pancreatic parenchyma. Here, we report a rare case of protein plugs in the pancreatic duct mimicking pancreatic cancer concomitant with branch-type intraductal papillary mucinous neoplasm.
