Acta Chir Belg
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Bronchopleural fistula with empyema is an uncommon but tragic complication after pulmonary resection. The possible therapeutic procedures are discussed. The patient often requires multiple surgical interventions and prolonged hospitalisation. According to the literature, open window thoracostomy (OWT) and even mutilating interventions such as myoplasty or thoracoplasty have to be performed when simple chest-tube drainage and antibiotic therapy do not suffice as illustrated by the present case.
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The authors describe a patient who was admitted with total necrosis of the oesophageal and gastric mucosa after ingestion of concentrated sodium hydroxide solution. An emergency total gastrectomy and blunt, thoracic oesophageal stripping was performed. Three months later, the continuity of the digestive tract was restored by a retrosternal colon interposition. ⋯ I. tract is mandatory. If a third degree oesogastric mucosal burn is diagnosed urgent laparatomy should be performed to assess transmural wall necrosis. If present an oesophageal gastrectomy should be performed as a life saving intervention.
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Surgery for humeral shaft fractures. A series of 78 operative treated humeral shaft fractures was studied retrospectively. Sixteen times we found a radial nerve palsy, preoperatively. ⋯ Because we found nearly always a macroscopically lesion of the nerve in this type of fracture, we recommend an early exploration in spiroid fractures at that junction. For the same reason we advise an early exploration in cases of secondary radial nerve palsy. If no other indication to operate occurs, we accept a conservative treatment of the humeral fracture with radial palsy.
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Although perioperative myocardial infarction has a relative low incidence, its occurrence is associated with a high morbidity and mortality. Although many single risk factors for developing a perioperative myocardial infarction have been described, it soon became apparent that surgical risk could hardly be determined by one single factor. ⋯ Further investigation, however, indicated that the risk of developing a perioperative myocardial infarction was not only determined by preoperative risk factors and a number of peroperative risk factors were also identified. Since identification of those patients, particularly at risk for developing a perioperative myocardial infarction, is a matter of prime importance in the choice of the treatment and the monitoring, a thorough understanding and knowledge of the different pre- and peroperative risk factors is a must for every surgeon and anesthetist.
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Data about the number and treatment of trauma-patients are, certainly in our country, very rare. In this study we showed that such a registration with grading of the severity of the injuries following the ISS-Score is feasible and useful. Further and more extensive registration seems necessary in order to obtain a better insight in epidemiology and treatment of trauma patients in our country.