Acta Chir Belg
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A case of pneumomediastinum following a minor blunt thoracic trauma is presented. As no underlying organic lesion could be found, the pathophysiology must have been that of a spontaneous pneumomediastinum, i.e. alveolar rupture with subsequent dissection of air along the bronchovascular sheats to the mediastinum. ⋯ With regard to the treatment it seems most important not to be too aggressive, because spontaneous pneumomediastinum is a benign and self-limiting condition. Spontaneous regression within a week can be expected.
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An uncommon case of pneumoperitoneum without peritonitis, related to small bowel diverticulosis is presented. Pneumoperitoneum is usually a life-threatening incident, most frequently attributed to a perforated viscus and generally requiring emergency surgery. Non surgical pneumoperitoneum, however, is known to be caused by a variety of pathological and non pathological entities. ⋯ In the presence of mechanical bowel obstruction, the latter kind of pneumoperitoneum can suddenly become impressively increased. A conservative attitude is generally advocated in the presence of such a benign pneumoperitoneum. However, laparoscopic exploration may be helpful for the diagnosis.
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Surgical resection of non-small cell lung cancer (NSCLC) is the treatment of choice if complete resection is possible. There is consensus regarding a pretreatment minimal staging. For the pre-operative exploration CT scan (with contrast) and mediastinoscopy are complemental. ⋯ A reported 7.5% 5-year survival was mainly for intrapulmonary metastases, also considered as satellite nodules. Careful follow-up of patients operated for lung cancer is necessary, as the incidence of metachronous lung cancer is as high as 10% for the long survivors. Reoperation with an economic but complete resection is the treatment of choice in the absence of metastases or other contraindications.
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Benign mature teratomas account for approximately 10-15% of all ovarian neoplasms. Many patients with these dermoid cysts are asymptomatic. ⋯ In a 26-year female patient admitted for severe, acute abdominal pain, a computerized abdominal tomography in accordance with the clinical characteristics of the abdominal examination, was highly suggestive for a torsion of a teratoma. The diagnose was confirmed by a celioscopic operative approach and the teratoma with the left tubo-ovarian complex was successfully removed laparoscopically.
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A consecutive series of 105 patients with type B or type C pelvic ring lesions, which were treated operatively between 1987 and 1991, was reviewed retrospectively. 76 patients were also reviewed clinically and radiologically after a mean time of 20,7 months. The average ISS of all patients was 32,8, the peri-operative mortality was 12,4%. ⋯ The actual guidelines for primary and secondary operative management of patients with unstable pelvic ring injuries are exposed. An overview of possible concomitant intrapelvic lesions with their primary treatment is also presented.