Agenesis of the dorsal pancreas: a very rare entity causing diabetes mellitus.

Dorsal pancreatic agenesis is a very rare pancreatic developmental anomaly resulting in missing corpus and cauda of the pancreas. Due to improvements and more widespread use of advanced radiological techniques like CT or MRI, the possibility of finding this disorder is growing. Thus, this rare congenital condition, as well as a pancreas divisum and pseudo-agenesis secondary to chronic pancreatitis, must be considered in the differential diagnosis. Although most of the patients seem to be asymptomatic, abdominal pain and pancreatitis may develop. Moreover, this entity should be known by the treating physician, as these patients are at a high risk of developing diabetes mellitus during their lifetime. Herein, we present the case of a 65-year-old woman with complete agenesis of the dorsal pancreas. The patient was hospitalized due to weight loss, abdominal discomfort, and diabetes mellitus type 2.

Cement-augmented screws in a cervical two-level corpectomy with anterior titanium mesh cage reconstruction: a biomechanical study.

STUDY DESIGN: Biomechanical investigation. PURPOSE: Cervical two-level corpectomies with anterior-only instrumentation are associated with a high rate of implant-related complications. These procedures, therefore, often require an additional dorsal instrumentation to prevent screw loosening. Cement augmentation of the anterior screws in two-level corpectomies might stabilize the construct, so that a second dorsal procedure could be avoided. To evaluate the screw anchorage in cervical anterior-only procedures, an ex vivo evaluation of the range of motion (ROM) in two-level corpectomies (C4 and C5), with and without cement augmentation of the anterior screws, was carried out in this study. METHODS: Twelve human cervical cadaveric spines (C2-T1) were divided into two groups of six specimens each. Corpectomies were performed in C4 and C5, with grafting and anterior instrumentation with and without cement augmentation of the anterior screw-and-plate system (0.3-0.5 mL cement/screw). Flexibility tests with pure moments (1.5 Nm) were carried out before and after three cyclic loading periods of 5000 cycles with increasing eccentric forces (100, 200, and 300 N). RESULTS: After corpectomy and instrumentation, the control group and the augmented group showed a significant reduction in ROM in comparison with the native states with average ROMs of 49% (±17%) and 24% (±10%), respectively (P = 0.006). The ROM in the control group increased significantly in all motion directions in the course of cyclic loading and approached native values after the third cyclic loading period, with an overall ROM of 78% (±22%). In contrast, the augmented group maintained a significantly decreased ROM in all motion directions during cyclic loading, with a final ROM of 32% (±14%) after the third period of cyclic testing. Inter-group comparison demonstrated a significant difference between the two groups in the course of cyclic loading. The cement-augmented group outperformed the control group in all motion directions, with a significantly lower ROM after all three cyclic loading periods. CONCLUSIONS: A two-level corpectomy with cement-augmentation results in a significantly reduced ROM. In comparison with the conventional anterior screw-and-plate fixation, it represents a significantly stabilized two-level anterior construct. This might be a treatment option for patients with a two-level corpectomy associated with reduced bone mineral density, to avoid an additional dorsal instrumentation.