Temporary vascular shunt for damage control of extremity vascular injury: A toolbox for trauma surgeons.

In an emergency, a general surgeon may be faced with the need to treat arterial trauma of the extremities when specialized vascular surgery is not available in their hospital setting, either because an arterial lesion was not diagnosed during pre-admission triage, or because of iatrogenic arterial injury. The need for urgent control of hemorrhage and limb ischemia may contra-indicate immediate transfer to a hospital with a specialized vascular surgery service. For a non-specialized surgeon, hemostasis and revascularization rely largely on damage control techniques and the use of temporary vascular shunts (TVS). Insertion of a TVS is indicated for vascular injuries involving the proximal portion of extremity vessels, while hemorrhage from distal arterial injuries can be treated with simple arterial ligature. Proximal and distal control of the injured vessel must be obtained, followed by proximal and distal Fogarty catheter thrombectomy and lavage with heparinized saline. The diameter of the TVS should be closely approximated to that of the artery; use of an oversized TVS may result in intimal tears. Systematic performance of decompressive fasciotomy is recommended in order to prevent compartment syndrome. In the immediate postoperative period, the need for systematic use of anticoagulant or anti-aggregant medications has not been demonstrated. The patient should be transferred to a specialized center for vascular surgery as soon as possible. The interval before definitive revascularization depends on the overall condition of the patient. The long-term limb conservation results after placement of a TVS are identical to those obtained when initial revascularization is performed.

[Mediastinal localization of a growing teratoma syndrome: a case report]. / Localisation thoracique d'un growing teratoma syndrome : à propos d'un cas.

The development of testicular germ cell tumors may be marked by a rare phenomenon: the growing teratoma syndrome. It consists of residual masses, usually retroperitoneal and, more rarely, thoracic, that appear during or after chemotherapy, although the tumor markers are normalized. We report a case of posterior mediastinal localization. This mediastinal localization is very rare, and because of the proximity to intercostal arteries, induces a risk of postoperative paraplegia.

[Intrathoracic giant peripheral nerve sheath tumor during Von Recklinghausen disease]. / Tumeur nerveuse géante du thorax au cours de la maladie de Von Recklinghausen.

We report the case of a patient aged 23, admitted for bilateral intrathoracic tumor, including a giant right. Surgery was performed by right sternothoracotomy. After 7 days, she presented an irreversible cardiac arrest. The malignant peripheral nerve sheath tumors are rare and aggressive. Their incidence is 0.001% in the general population and 0.16% in patients with neurofibromatosis type 1. These tumors are characterized by their risk of recurrence and poor prognosis. The treatment is the surgical resection. We analyze incidence, diagnosis and prognosis of these tumors.

[Catamenial pneumothorax with diaphragmatic lacerations]. / Brèches diaphragmatiques majeures au cours d'un pneumothorax cataménial.

The authors describe a case of catamenial pneumothorax with diaphragmatic lacerations and partial liver herniation. It's a rare presentation of catamenial pneunmothorax. We analyse the diagnostic and surgical therapeutic.

[Role of self-expanding stent in the treatment of obstructing colorectal cancer]. / L'endoprothèse dans l'occlusion colique tumorale.

BACKGROUND: Obstruction due to colorectal cancer is a common occurrence. It often arises in patients in poor general condition with malnutrition and advanced tumor stage. Prognosis can be improved by prompt resolution of obstruction through a mininimally invasive approach. GOAL: To analyze the management of cases of acute colorectal obstruction and evaluate the efficacity and morbidity/mortality associated with the use of endocolic stent prostheses. MATERIAL AND METHODS: This retrospective study at a single center evaluated patients presenting with acute colorectal obstruction between January 2003 and May 2008, assessing the patient sample, cancer characteristics, treatment, and morbidity/mortality. RESULTS: The mean age of the 26 patients was 75 years; ASA Class was greater than III in 63% of cases, The colorectal cancer was located in the sigmoid in 65% of cases and was a Stage IV tumor in 73% of cases. Placement of an endocolic stent was the primary intervention in 94% of patients. Morbidity was 12% and mortality was 4%. CONCLUSION: Colonic stenting is an effective therapeutic option in the elderly with painful symptoms of obstruction and should be the initial approach.