La Revue du praticien
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Osteosarcoma is the most frequent malignant tumor of bones. The peak incidence is in the second decade and the metaphyseal part of long bones is the site of predilection. This tumor is spontaneously rapidly fatal but recent progresses in chemotherapy and surgery have improved its prognosis (for example initial chemotherapy with high dose methotrexate and postoperative chemotherapy adapted to the histological response of the resected tumor to preoperative treatment).
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In 1992, appendicitis is still common among children. Mortality due to a belated or erroneous diagnosis is far from being nil. ⋯ No significant advance has been made on this subject, and clinical findings remain of paramount importance. Hospitalization for observation at the slightest doubt and emergency surgery when the diagnosis is probable are the best means of improving the management of appendicitis in children.
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Lumbar radiculalgia may be due, beside the disc-nerve root conflict, to stenosis of osteoarticular canals, wide dural sac, epidural lipomatosis, segmental arachnoiditis, malignant or benign tumours and meningoradiculitis. Extraspinal truncular or radicular sciatica is usually due to compression by an expansive process. Some types of pain referred from articular structures may mimic sciatica.
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Pain along the sciatic nerve can be due to many causes. Sciatica of radicular origin caused by compression of L5 or S1 root is usually separated from truncular or peripheral sciatica. Radicular sciatica is divided into mechanical sciatica and the so-called inflammatory sciatica. ⋯ Posterior intervertebral osteoarthritis and lumbar canal stenosis also are frequent causes of sciatic pain. Truncular sciatica is much less frequent and should incite clinicians to investigate for pelvic tumoral infiltration. Peripheral sciatica is usually caused by suffering of the external popliteal nerve around the neck of the fibula, but it may also be caused by compression of a ramus from the internal popliteal nerve, resulting in tarsal tunnel syndrome or in Morton's syndrome.