Peer reviewed article authored by (Ngatchou W, Lemogoum D, Ndobo P, Yagnigni E, Tiogou E, Nga E, Kouanfack C, van de Borne P, Hermans MP). Read article or submit your manuscript for publishing.

The aim was to describe how to avoid technical difficulties during venous femoral cannula insertion for extracorporeal membrane oxygenation (ECMO) in a woman in late pregnancy. A 28-year old pregnant woman presented at 32 weeks of gestation after developing an acute respiratory distress syndrome (ARDS) of an unknown origin that required venovenous ECMO insertion via the femoral vein. A cannula insertion by the Seldinger visual control technique was impossible in the supine position. A left lateral tilt between 15° and 30° was performed by placing a wedge-shaped cushion under the right hip permitting the cannula insertion. We proposed a systematic 15°–30° left lateral tilt position during the ECMO femoral cannula insertion in late pregnancy cases needing ECMO. This precaution should avoid an injury to the vessels due to multiple insertion attempts.

Background : Cardiac wounds remain as highly lethal lesions in which their prognosis depends on the emergency management. Objectives : The aim of this study is to analyse experiences of cardiac surgeons in different hospitals in Brussels and compare it with the findings in the literature. Methods : From 1st January 1990 till 1st December 2010, all penetrating cardiac wounds in three Brussels hospitals were retrospectively reviewed. Data recorded included clinical parameters, surgical constatation and outcome. Results : A total of fourteen (12 male/2 female) patients sustained penetrating cardiac injuries. There were thirteen patients (93%) with stabs wounds and, one patient (7%) with gunshot wound. Wound locations are as follows: ten patients (71%) right ventricle, three patients (22%) the pericardium, and one patient (7%) the left ventricle. The hemodynamic status was unstable in nine patients (64%), in-extremis in two patients (14%) and stable in three patients (22%). The mean Abbreviate Injury Score was 4.6 and the mean New Injury Severity Score was 31. Thirteen patients (93%) had operations (11 sternotomie, 2 thoracotomies). Two patients required cardiopulmonary bypass. Three patients (22%) died. Conclusion : Penetrating cardiac wounds are relatively rare in Belgium, which is mainly due to stabs and with consequent mortality. The implementation of clear guidelines is necessary to improve survival.

Background HIV infection increases cardiovascular risk and highly active antiretroviral therapy may further augment it. We hypothesized that an increase in large artery stiffness may be a mechanism of enhanced cardiovascular risk in treated HIV-infected (HIV-T) patients. Materials and methods Pulse wave velocity (PWV) and augmentation index (AI) were measured in 108 Cameroonian untreated HIV-infected (HIV-UT) patients and in 130 HIV-T patients. Results Brachial and aortic systolic blood pressure (BP), diastolic BP, and pulse pressure were higher in HIV-T patients than in HIV-UT patients (all, P<0.01). PWV was comparable in HIV-T and HIV-UT patients (7.2±1.5 vs. 7.46±2.2 m/s, respectively, P=0.3), whereas AI was higher in HIV-T patients than in HIV-UT patients (7.9±5 vs. 5.76±4%, respectively, P=0.003). AI was associated independently with age, brachial systolic BP, brachial diastolic BP, and height in HIV patients (R2=0.75, P<0.01). Conclusion This study shows that pulse pressure and AI were increased in HIV-T patients, compared with matched HIV-UT patients, suggesting that highly active antiretroviral therapy could increase cardiovascular risk. However, PWV was not accelerated in HIV-T patients.

INTRODUCTION: The Canadian C Spine Rule (CCR) and the National Emergency X-Radiography Utilization Study (Nexus) low criteria are well accepted as guide to help physician in case of cervical blunt trauma. METHODS: we aimed to evaluate retrospectively the application of these recommendations in our emergency department. Secondly we analyzed the quality of cervical spine radiography (CSR) in an emergency setting. RESULTS: 281 patients with cervical blunt trauma were analyzed retrospectively. The CCR and the NEXUS rules were respected in 91.2% and 96.8% of cases respectively. No lesions were found in 96.4% of patient. A lesion was present in 1.1% of patient and suspected in 2.5% of patient. The quality of CSR was adequate in only 37.7% of patient. The poor quality of CSR was due either to the lack of C7 vertebrae visualization in 64.6% or other lower vertebrae in 28%. Other causes included the absence of open mouth view (8%), the absence C1 vertebrae visualization (3.4%), artifact in 2.3% and the absence of lateral view in 0.6% of patient. CONCLUSION: CCR and NEXUS are widely used in our emergency department. The high rate of inadequate CSR reinforces the debate about it