Metastatic clear cell sarcoma of the pancreas:From diagnosis to treatment

This article presents a comprehensive case report on an uncommon instance of metastatic clear cell sarcoma(CCS)originating from the pancreas.The high mortality rate of pancreatic carcinoma underscores the importance of precise diagnosis and early detection.The authors report a novel case of CCS with pancreatic metastasis,detailing successful surgical intervention through distal pancreatectomy and splenectomy,resulting in favourable outcomes.This study highlights the standard role of surgery in treating advanced CCS and emphasizes preoperative imaging and thorough patient history assessment.This article also underscores the necessity for long-term surveillance due to the potential for recurrence or metastasis.Despite the favourable recovery postsurgery,the absence of subsequent follow-up evaluation prompts consideration of the need for extended monitoring.This article raises questions about the nature of the pancreatic lesion and suggests the possibility of a primary lesion.Further evidence is crucial to establish the correlation between the features related to the development of the patient's primary and metastatic tumours.In conclusion,this study offers valuable insights into metastatic CCS of the pancreas,highlighting the importance of regular postoperative follow-up for improved outcomes through early detection and intervention.

Application of the cortical bone trajectory technique in posterior lumbar fixation

The cortical bone trajectory(CBT) is a novel technique in lumbar fixation and fusion.The unique caudocephalad and medial-lateral screw trajectories endow it with excellent screw purchase for vertebral fixation via a minimally invasive method.The combined use of CBT screws with transforaminal or posterior lumbar interbody fusion can treat a variety of lumbar diseases,including spondylolisthesis or stenosis,and can also be used as a remedy for revision surgery when the pedicle screw fails.CBT has obvious advantages in terms of surgical trauma,postoperative recovery,prevention and treatment of adjacent vertebral disease,and the surgical treatment of obese and osteoporosis patients.However,the concept of CBT internal fixation technology appeared relatively recently;consequently,there are few relevant clinical studies,and the long-term clinical efficacy and related complications have not been reported.Therefore,large sample and prospective studies are needed to further reveal the long-term complications and fusion rate.As a supplement to the traditional pedicle trajectory fixation technique,the CBT technique is a good choice for the treatment of lumbar diseases with accurate screw placement and strict indications and is thus deserving of clinical recommendation.

Epidural gas-containing pseudocyst leading to lumbar radiculopathy:A case report

BACKGROUND Lumbar radiculopathy is a common symptom in the clinic and is often caused by lumbar disc herniation or osteophytes compressing the nerve root;however,it is rare for nerve roots to be compressed by epidural gas.Few symptomatic epidural gas-containing pseudocyst cases have been reported.Furthermore,the reported cases were due to a mix of gas and obvious osteophytes;therefore,it was hard to rigorously conclude that gas was the factor responsible for radiculopathy.We provide evidence that because no epidural gas accumulated before radiculopathy occurred and the symptoms were relieved after removal of the gas,the epidural gas-containing pseudocyst was the root cause of radiculopathy in this case.CASE SUMMARY An 87-year-old man with a 3-wk history of right radiating pain was admitted to our hospital.Computed tomography(CT)and magnetic resonance imaging(MRI)examinations showed a vacuum phenomenon and huge lesions with low signal intensity located in the same area where the pain occurred.After carefully checking the images acquired in the last 3 mo,we found an abdominal CT examination performed 40 d prior because of abdominal pain.The CT images showed no gas-containing pseudocyst in the epidural space and notably,he had no leg pain at the time.To ensure a low-intensity intervention and complete decompression of the nerve,percutaneous endoscopic lumbar nerve decompression surgery was advised.A gas-containing pseudocyst was identified under endoscopy.The symptoms were relieved after surgery,and the postoperative images showed total disappearance of the vacuum phenomenon and lesions with low signal intensity on CT and MRI.Histological examination showed that the sampled gas-containing pseudocyst tissue was fibrous connective tissue.CONCLUSION This case thoroughly illustrates that an epidural gas-containing pseudocyst can result in radiculopathic pain through a comprehensive evidence chain.Percutaneous endoscopic decompression is a minimally invasive and effective treatment method.

How to manage and avoid revision after unicompartmental knee arthroplasty?

The article by Zhao et al presents a retrospective case series on the reasons for initial revision after unicompartmental knee arthroplasty(UKA).Clarifying the reasons that may cause UKA revision can further reduce the rate of revision UKA,focusing on gasket dislocation,osteophytes,intra-articular loose bodies,and tibial prosthesis loosening.This article provides valuable insights,not only by detailing the revision status of 13 patients who underwent revision after initial UKA but also by providing a comprehensive analysis of the incidence of revision after initial UKA.By reviewing and analyzing the causes,they established references for the early detection of risk factors for revision in clinical practice and for formulating surgical strategies and rehabilitation programmes.This commentary emphasizes the need for a meticulous understanding and an analysis of the revision rate following initial UKA and related management strategies.The implant rates,regional variation,and benefits of uncemented Oxford UKA have been explored,particularly in terms of bone preservation,appropriate surgical techniques,and weight management to control complications and improve patient prognosis.