Ahmed Sabry Ramadan

Left tilt position for easy extracorporeal membrane oxygenation cannula insertion in late pregnancy patients.

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.

Penetrating Cardiac Injuries In Belgium: 20 years of Experience in University Hospitals in Brussels

Abstract 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.

FIVE YEARS FOLLOW-UP AFTER Y-GRAFT ARTERIAL REVASCULARIZATION: ON PUMP VERSUS OFF PUMP; PROSPECTIVE CLINICAL TRIAL

OBJECTIVES We report our comparative experience of on-pump and off-pump full arterial coronary artery bypass grafting (CABG) using both internal mammary arteries (IMAs) anastomosed as a Y-graft. METHODS A single-center clinical study was conducted prospectively between January 2003 and May 2008. It compared the short- and mid-term clinical outcomes of on- and off-pump arterial revascularization where the left internal mammary artery (LIMA) was anastomosed to the left anterior descending (LAD) artery while the free right internal mammary artery (RIMA) graft taking off from the LIMA was used to bypass different coronary targets. RESULTS One hundred and ninety-two patients were divided into 77 on-pump and 115 off-pump procedures based on the intention to treat. The mean age in both groups was 60.2+/-11.7 and 68.1+/-10.6 years, respectively (P<0.05). Mean predictive logistic EuroSCORE was 3.5+/-6.7% for the on-pump group and 7.3+/-8.6% for the off-pump group (P<0.0001). Mean number of distal anastomoses were 2.7+/-0.6 (group ON) and 2.5+/-0.6 (group OFF) (P=NS). Postoperative mortality was two patients (2.6%) in the on-pump group and four patients (3.4%) in the off-pump group (P=0.63). No major adverse cardiac event, no stroke and no late death were reported during the follow-up that averaged 36.5+/-18.6 months. Angina recurrence was three patients (2.6%) in off-pump and two patients (3.5%) in on-pump group (P=NS). CONCLUSIONS The use of a free RIMA as Y-graft from the LIMA performed off pump eradicates aortic manipulations and provides complete revascularization to high-risk patients with mortality similar to the one of a lower risk population operated on pump. The morbidity and cost was lower in the off-pump group. This advocates for the widespread usage of the technique in high-risk patients.

Application of the Canadian C-Spine rule and nexus low criteria and results of cervical spine radiography in emergency condition

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’s utility in emergency condition.

Hypoxemia after pneumothorax exsufflation: a case report

We describe a 36-year-old patient who was admitted to the emergency ward for acute dyspnea due to a spontaneous pneumothorax. He was successfully drained but shortly after presented a severe hypoxemia due to pulmonary oedema secondary to pulmonary re-expansion. The physiopathology behind this complication is still unknown. We will try to describe this complication and its predictive factors.

Cannabis body packing : a case report

Drug traffic is a major concern worldwide. We report a case of a 27-year old male who presented with a diffuse abdominal plain to the emergency department. Abdominal X-ray demonstrated multiple foreign bodies along the intestinal tract, which were found to be cannabis packets. The patient was treated conservatively with a good result.

Computer tomography imaging of an unusual cause of appendicitis: a case report

Foreign body occlusion of appendices lumen is a quite rare cause of appendicitis due to foreign body. We present a case of a 63-year-old male who presented with right lower quadrant pain since 24 hours. Computed tomography (CT) demonstrated an acute appendicitis due to a metallic foreign body which was found to be a bullet.