Chirurgie; mémoires de l'Académie de chirurgie
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Case Reports
[Anatomoclinical forms of fractures of the sternum. Role and methods of osteosynthesis of unstable fractures].
In general, fractures of the sternum are of little interest. This is unfair since unstable fractures may be the cause of paradoxical respiration and hence respiratory distress. Fractures often result from automobile accidents and occur in passengers wearing seat belts. ⋯ With reference to several cases this variety of injury is studied from the anatomo-pathological, clinical and therapeutic viewpoints. Osteosynthesis using a plate and screws limited to the sternum or including neighbouring rib fractures would appear to be the method of choice. Surgical fixation of the fracture site, the methods of which are discussed, is of value for both isolated lesions of the thoracic cage, and also in the context of single stage surgery in certain patients with multiple trauma.
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Benign in more than 90% cases, dumbbell neurogenic tumors are rare. It was 3 thoracic schwannome and 1 thoracic ganglioneuroma and 1 lumbar schwannoma are reported. In 2 cases complete removal was performed by thoracotomy, in another case thoracic removal was incomplete with leateag of spinal fluid, laminectomy was necessary 3 months later and in a third case laminectomy was performed first because of paraplagia and thoracotomy one month later. ⋯ In thoracic localization a one stage combined resection gives the lowest morbidity. In lumbo-sacral localization tumoral large size requires a combined approach, which can be performed in a single stage. Recklinghausen's association in neurofibroma (4 to 16%) exposes to malign evolution risk (12 to 13%).
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Surgery is mandatory in severe caustic burns of the upper digestive tract, either as an emergency, or later because of secondary complications. Then, the patients who develop oesophageal stenosis require oesophagoplasty or oesophagopharyngoplasty. The first clinical survey must be performed in a surgery department with an intensive case unit. ⋯ The authors describe their experience over the 18 years up to now. Over 700 patients were admitted in the same department. The different surgical procedures are given, as well as guidelines for management.