Hemostasis disorders are one of the major clinical conditions of snakebites and are because of mechanisms which may disrupt vessels, platelets, clotting factors and fibrinolysis. Thromboelastography (TEG) could help to understand these effects in the clinical practice. A retrospective study reports a series of patients presenting a snakebite-related coagulopathy, treated with antivenom and monitored with conventional tests and TEG in a French military treatment facility (Republic of Djibouti, East Africa) between August 2011 and September 2013. Conventional coagulation assays (platelets, prothrombin time, activated partial thromboplastin time, fibrinogen) and TEG measurements were taken on arrival and at various times during the first 72 h of hospitalization, at the discretion of the physician. The study included 14 patients (median age 28 years). Bleedings were present in five patients. All patients received antivenom. A coagulopathy was present in all patients and was detected by both conventional assays and TEG. None exhibited thrombocytopenia. Prothrombin time and fibrinogen remained abnormal for most of patients during the first 72 h. The TEG profiles of 11 patients (79%) showed incoagulability at admission (R-time > 60 min). TEG distinguished 10 patients with a generalized clotting factor deficiency and 4 patients with an isolated fibrinogen deficiency after an initial profile of incoagulability. Hyperfibrinolysis was evident for 12 patients (86%) after Hour 6. Snake envenomations in Djibouti involve a consumption coagulopathy in conjunction with delayed hyperfibrinolysis. TEG could improve medical management of the condition and assessment of additional therapeutics associated with the antivenom. Copyright (C) 2018 Wolters Kluwer Health, Inc. All rights reserved.

BACKGROUND:Management of critically ill patients in austere environments is a logistic challenge. Availability of oxygen cylinders for the mechanically ventilated patient may be difficult in such a context. One solution is to use a ventilator able to function with an oxygen concentrator (OC).METHODS:We tested two Elisée™ 350 ventilators paired with SeQual Integra 10-OM oxygen concentrators (OC) (Chart Industries, http://www .chartindustries.com) and evaluated the delivered fraction of inspired oxygen (Fio2). Ventilators were connected to a test lung and Fio2 was measured and indicated by the ventilator. Continuous oxygen was generated by the OC from 0.5L/min to 10L/min, and administered by the specific inlet port of the ventilator. Several combinations of ventilator settings were evaluated to determine the factors affecting the delivered Fio2.RESULTS:The Elisée 350 turbine ventilator is able to deliver a high Fio2 when functioning with an OC. However, modifications of the ventilator settings such as an increase in minute ventilation, inspiratory-to-expiratory ratio, and positive end-expiratory pressure affect delivered Fio2 despite steady-state oxygen flow from the concentrator.CONCLUSION:OCs provide an alternative to oxygen cylinders for delivering high Fio2 with a turbine ventilator. Nevertheless, Fio2 must be monitored continuously, since it decreases when minute ventilation is increased.

Aim: Over-triage rates related to the use of Vittel criteria are unknown. We compared severe stable trauma patients with and without significant visceral injuries.Study design: A single-centre retrospective analysis of a single-centre prospective cohort.Patients and methods: Trauma patients with at least one positive Vittel criterion from June 2010 to January 2012 in a level-1 trauma centre. Initial management included a systematic whole-body scanner. All significant lesions in stable trauma patients were recorded.Results: A total of 252 trauma patients were admitted. One hundred and twenty were stable. In this group without vital distress, 72 (60%) had at least one occult lesion, 21 (17.5%) had an isolated orthopaedic injury and 27 (22.5%) had no injury. Thoracic injuries accounted for 44% of visceral injuries, abdominal for 17%, spinal for 16% and cerebral for 15%. Overall, the over-triage rate was 19%. Surgery for significant visceral injury was performed in 13 patients (18%) and arteriography in 4 patients (5.5%). Admission in an intensive care unit was required for 13 patients with occult injuries and for one patient without such a lesion (18% versus 2%, P = 0.008). Hospital stays were longer in the group with visceral injuries (4 +/- 7 versus 9 +/- 8 days; P = 0.006).Conclusion: Vittel criteria use in trauma patients induces an acceptable over-triage rate. A large proportion of stable trauma patients have occult lesions. These visceral injuries frequently require special care. These data highlight the imperative need to transport major trauma patients immediately to a dedicated trauma centre and supports whole-body scanner use. (C) 2015 Societe francaise d'anesthesie et de reanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

OBJECTIVE Blunt cerebrovascular injuries (BCVIs) affect approximately 1% of patients with blunt trauma. An antithrombotic or anticoagulation therapy is recommended to prevent the occurrence or recurrence of neurovascular events. This treatment has to be carefully considered after severe traumatic brain injury (TBI), due to the risk of intracranial hemorrhage expansion. Thus, the physician in charge of the patient is confronted with a hemorrhagic and ischemic risk. The main objective of this study was to determine the incidence of BCVI after severe TBI.METHODS The authors conducted a prospective, observational, single-center study including all patients with severe TBI admitted in the trauma center. Diagnosis of BCVI was performed using a 64-channel multidetector CT. Characteristics of the patients, CT scan results, and outcomes were collected. A multivariate logistic regression model was developed to determine the risk factors of BCVI. Patients in whom BCVI was diagnosed were treated with systemic anticoagulation.RESULTS In total, 228 patients with severe TBI who were treated over a period of 7 years were included. The incidence of BCVI was 9.2%. The main risk factors were as follows: motorcycle crash (OR 8.2, 95% CI 1.9-34.8), fracture involving the carotid canal (OR 11.7, 95% CI 1.7-80.9), cervical spine injury (OR 13.5, 95% CI 3.1-59.4), thoracic trauma (OR 7.3, 95% CI 1.1-51.2), and hepatic lesion (OR 13.3, 95% CI 2.1-84.5). Among survivors, 82% of patients with BCVI received systemic anticoagulation therapy, beginning at a median of Day 1.5. The overall stroke rate was 19%. One patient had an intracranial hemorrhagic complication.CONCLUSIONS Blunt cerebrovascular injuries are frequent after severe TBI (incidence 9.2%). The main risk factors are high-velocity lesions and injuries near cervical arteries.

Study Objective: To assess the effects of noninvasive ventilation (NW) during spontaneous breathing anesthesia on functional residual capacity and ventilation distribution.Design: Prospective and observational study.Setting: Operating room, military teaching hospital.Patients: Eighteen adult patients submitted to digestive endoscopic procedures under spontaneous breathing anesthesia.Interventions: Anesthetic management was standardized. Patients were submitted to combined digestive endoscopic procedures (gastric fibroscopy and colonoscopy) under spontaneous breathing anesthesia in lateral decubitus position. Anesthesia was induced with propofol intravenous 1 mg/kg. Repeated boluses of propofol were administered according to the patients' clinical needs during endoscopic procedures. Ventilation distribution and functional residual capacity were assessed by electrical impedance tomography.Measurements: Ventilation distribution was assessed by electrical impedance changes in left and right lung, and functional residual capacity changes were evaluated by measurement of end-expiratory lung impedance changes. Measures were performed before anesthesia induction, 5 minutes after anesthesia induction during gastric fibroscopy, at the end of gastric fibroscopy, 5 minutes after NIV application during colonoscopy, and at the end of colonoscopy.Main Results: In awake patients, tidal volume was primarily distributed to the dependent lung (57.5% vs 43.1%; P = .009). After anesthesia induction, we observed a shift of ventilation to the nondependent lung (43.1% before anesthesia, 58.9% after anesthesia; P = .002) and marked decrease in end-expiratory lung impedancemetry of -1.68UI (4.47). Noninvasive ventilation application resulted in a significant increase of end-expiratory lung impedancemetry of 1.33 (6.49) (P = .005) but did not impact ventilation distribution.Conclusions: This study showed that NIV application in pressure support mode during spontaneous breathing anesthesia increased functional residual capacity. Other studies are needed to evaluate the clinical impact of this technique during anesthesia, especially in patients with poor respiratory conditions. (C) 2016 Elsevier Inc. All rights reserved.

INTRODUCTION: the assessment of anesthetic risks is an essential component of preoperative evaluation. In developing world, preanesthesia evaluation may be challenging because patient's medical history and records are scare, and language barrier limits physical examination. Our objective was to evaluate the impact of routine preoperative testing in a low-resources setting. METHODS: prospective observational study performed in a French forward surgical unit in Abidjan, Ivory Coast. 201 patients who were scheduled for non urgent surgery were screened with routine laboratory exams during preoperative evaluation. Changes in surgery were assessed (delayed or scheduled). RESULTS: abnormal hemoglobin findings were reported in 35% of patients, abnormal WBC count in 11,1% of patients, abnormal platelets in 15,3% of patients. Positive HIV results were found in 8,3% of cases. Routine tests represented 43,6% of changes causes. CONCLUSION: our study showed that in a developing country, routine preoperative tests showed abnormal results up to 35% of cases, and represented 43,5% of delayed surgery causes. The rate of tests leading to management changes varied widely, from 0% to 8,3%. These results suggested that selected tests would be useful to diagnose diseases that required treatment before non urgent surgery. However, larger studies are needeed to evaluate the cost/benefit ratio and the clinical impact of such a strategy.

La réanimation ne peut se concevoir sans oxygène (2). L’approvisionnement, le transport et le stockage de l’O2 demandent des ressources importantes, rendant la disponibilité de celui-ci aléatoire dans les pays en voie de développement [1] et sur les théâtres d’opérations extérieures. Une alternative à l’O2 pressurisé ou liquide est l’extraction de l’O2 de l’air par un extracteur d’oxygène (EO). Le couple EO/ventilateur dont nous disposons permet de délivrer [2], [3], une FiO2 de 80 %. Le but de cette étude est d’évaluer les situations nécessitant le recours a l’O2 mural dans une réanimation ou la principale source d’O2 sont les EO. L’EO en dotation est le CO Integra 10™ (10 L/min à FiO2 92 %), les ventilateurs en dotation sont les LTV 1000 et 1200 (Pulmonetic system). Sont inclus tous les patients admis en réanimation nécessitant une oxygénothérapie (ventilation spontanée au masque, ventilation non invasive en pression positive, ventilation mécanique invasive). Le suivi débute à l’admission du patient en réanimation et est réalisé quotidiennement jusqu’à sa sortie. Tous les patients inclus sont oxygénés par EO par défauts. L’échec d’oxygénation par EO est défini par la nécessité de recours à l’O2 mural : – impossibilité technique de délivrer de l’O2 par le CO ; – un rapport PaO2/FiO2 < 100 malgré optimisation de la PEEP et manœuvres posturales. Vingt patients ont été inclus du 12/07/2014 au 17/10/2014. 65 % de femme et 35 % d’hommes âgés en moyenne de 38,9 ans (13–70 ans). Les motifs d’admission étaient médicaux dans 50 % des cas, traumatologique dans 30 % des cas et chirurgicaux pour les 20 % restants. Les scores APACHE II étaient de 14,45 en moyenne (0–35) et IGS2 de 31,8 (0–74). La durée de séjour moyenne était de 4,45 jour en moyenne (1–9). Le taux de patient traité pour une infection est de 66,9 %. Quatre patients (20 %) sont décédés dont 3 après limitation et/ou arrêt des thérapeutiques actives. Le nombre de jours d’oxygénothérapie sous EO était au total de 112 (38 jours de ventilation invasive, 74 jours de VS ou VNI), avec 6 jours de recours a l’O2 mural (5,3 %). Les causes de recours a l’oxygène mural/bouteille étaient : – SDRA sévère avec PaO2/FiO2 < 100 malgré une thérapeutique approprié ; – les patients traumatises ou chirurgicaux de retour du bloc ou en partance pour le bloc ; – défaillance respiratoire aiguë nécessitant une intubation en extrême urgence. La FiO2 moyenne délivrée était de 44,6 % (25–75) pour des débit d’O2 moyen de 4,1 L/min (1–10) pour une ventilation minute de 8,3 L/min (5,2–12,1). Les EO permettent une économie d’O2 au sein d’une réanimation, l’utilisation d’O2 hyperbare est indispensable dans des situation urgente (arrêt respiratoire, intubation en urgence), pour les patients nécessitant des FiO2 > 80 % ou le transports des patients. Il paraît donc raisonnable d’utiliser les EO comme source principale d’O2 en réanimation dans les pays ou un accès fiable a l’oxygène est difficile, mais ceux ci ne permettent pas de s’affranchir de l’utilisation épisodique d’une source d’O2 hyperbare.

BACKGROUND:Extraperitoneal laparoscopy has become a common technique for many surgical procedures, especially for inguinal hernia surgery. Investigations of physiological changes occurring during extraperitoneal carbon dioxide (CO2) insufflation mostly focused on blood gas changes. To date, the impact of extraperitoneal CO2 insufflation on respiratory mechanics remains unknown, whereas changes in respiratory mechanics have been extensively studied in intraperitoneal insufflation.OBJECTIVES:The aim of this study was to investigate the effects of extraperitoneal CO2 insufflation on respiratory mechanics.PATIENTS AND METHODS:A prospective and observational study was performed on nine patients undergoing laparoscopic inguinal hernia repair. Anesthetic management and intraoperative care were standardized. All patients were mechanically ventilated with a tidal volume of 8 mL/kg using an Engström Carestation ventilator (GE Healthcare). Ventilation distribution was assessed by electrical impedance tomography (EIT). End-expiratory lung volume (EELV) was measured by a nitrogen wash-out/wash-in method. Ventilation distribution, EELV, ventilator pressures and hemodynamic parameters were assessed before extraperitoneal insufflation, and during insufflation with a PEEP of 0 cmH2O, 5 cmH20 and of 10 cmH20.RESULTS:EELV and thoracopulmonary compliance were significantly decreased after extraperitoneal insufflation. Ventilation distribution was significantly higher in ventral lung regions during general anesthesia and was not modified after insufflation. A 10 cmH20 PEEP application resulted in a significant increase in EELV, and a shift of ventilation toward the dorsal lung regions.CONCLUSIONS:Extraperitoneal insufflation decreased EELV and thoracopulmonary compliance. Application of a 10 cmH20 PEEP increased EELV and homogenized ventilation distribution. This preliminary clinical study showed that extraperitoneal insufflation worsened respiratory mechanics, which may justify further investigations to evaluate the clinical impact.

An ocean general circulation model (OGCM) is used to identify a Southern Ocean southeast Pacific intrinsic mode of low frequency variability. Using CORE data a comprehensive suite of experiments were carried out to elucidate excitation and amplification responses of this intrinsic mode to low frequency forcing (ENSO, SAM) and stochastic forcing due to high frequency winds. Subsurface anomalies were found to teleconnect the Pacific and Atlantic regions of the Antarctic Circumpolar Current (ACC) thermocline. The Pacific region of the ACC is characterised by intrinsic baroclinic disturbances that respond to both SAM and ENSO, while the Atlantic sector of the ACC is sensitive to higher frequency winds that act to amplify thermocline anomalies propagating downstream from the Pacific. Non-stationary cluster analysis was used to identify the system’s dynamical regimes and characterise meta-stability, persistence and transitions between the respective states. This analysis reveals significant trends, indicating fundamental changes to the meta-stability of the ocean dynamics in response to changes in atmospheric forcing. Intrinsic variability in sea-ice concentration was found to be coupled to thermocline processes. Sea-ice variability localised in the Atlantic was most closely associated with high frequency weather forcing. The SAM was associated with a circumpolar sea-ice response whereas ENSO was found to be a major driver of sea-ice variability only in the Pacific. This simulation study identifies plausible mechanisms that determine the predictability of the Southern Ocean climate on multi-decadal timescales.

Analyzing anaesthesia adverse events reports over a 50 months period. Monocentric retrospective study. We evaluated number of reports, patients characteristics, the place and moment of the adverse event, and its consequences. Numerical data were compared with a Mann and Whitney test or a Chi2 test. A P-value < 0.05 was considered as statistically significant. Two hundred and sixty-eight adverse events were reported over the study period. It represented 1.1% of anaesthesia activity. Median patient age was 61 years old, and median ASA score was 2. Most of the statements were made by anaesthesiologists. Adverse events occurred mainly between 8 am and 2 pm, and in operating room. They were due to general dysfunctions in 29.1% of cases. They were considered severe in 7.8% of cases. Severe adverse events were associated with a higher ASA score. Adverse events occurred mainly in working hours and in operating room. They are mostly non severe. The role of the experience feedback committee is to analyze adverse effects to learn regarding the causation of the incident prevent it from recurring. As a result, an efficient reporting system is needed. An informatics based reporting system may be a useful tool because it may facilitate the reporting.

Introduction: Ebola Virus Disease (EVD) causes severe diarrhoea and vomiting, leading to dehydration and electrolyte abnormalities. Treatment remains supportive and often requires intravenous (IV) access. IV catheters are difficult to insert and maintain in this context. Our primary objective was to compare peripheral venous catheters (PVCs) and central venous catheters (CVCs) for volume resuscitation in patients with EVD.Material and methods: We performed a prospective observational study between January and March 2015 at the Conakry Healthcare Workers Ebola Treatment Unit (ETU). The primary judgement criterion was the ratio of the daily infused volume of fluids to the prescribed volume (DIV/PV).Results: Fourteen patients were admitted. Twenty-eight PVCs and 8 CVCs were inserted. CVCs had a longer survival time (96 +/- 34 hours versus 33.5 +/- 21 hours, P < 0.001). The mean DIV/PV was higher for the CVCs (0.95 +/- 0.08 versus 0.7 +/- 0.27, P < 0.001), as well as the number of days with full administration of prescribed IV fluids (71.2% versus 34.1%, P = 0.002).Discussion: Inserting CVCs is a safe and reliable way of obtaining IV access in ETUs, provided adequately trained personnel are available. CVCs optimize fluid infusion compared to PVCs. Further studies comparing fluid management strategies in EVD are necessary. (C) 2015 Societe francaise d'anesthesie et de reanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Décrire les caractéristiques des évènements indésirables de novembre 2009 à décembre 2013 déclarés par système informatique, et en discuter l’apport pour la mise en place des comités de retour d’expérience. Étude rétrospective monocentrique. L’analyse des évènements indésirables a porté sur les caractéristiques du patient, l’heure, le lieu de survenue, la nature et les conséquences de l’évènement. Sur la période de l’étude, 268 évènements étaient déclarés. Le taux d’évènements indésirables déclarés était de 1,1 %. L’âge médian des patients était de 61ans, le score ASA médian était de 2. Les déclarations étaient faites dans 53,3 % des cas par les médecins, et le plus souvent entre 8h et 14h (57,4 %). Les évènements déclarés survenaient le plus souvent en salle d’intervention (70 % des cas), et étaient liés à un défaut d’organisation dans 29,1 % des cas. Ils étaient considérés graves dans 7,8 % des cas. Le score ASA des patients chez lesquels un évènement indésirable grave survenait était significativement plus élevé. Les évènements indésirables déclarés sont le plus souvent des évènements porteurs de risque qui surviennent en heure ouvrable. La mise en place des comités de retour d’expérience s’inscrit dans une politique de sécurité des soins dont l’objectif est d’analyser ces évènements puis d’en faire le retour d’expérience au profit de l’équipe. Leur travail repose sur un signalement efficace et exhaustif de ces évènements. Le recueil informatisé des EI peut être une aide pour ces comités en favorisant le processus de déclaration.

Background: Management of critically ill patients in austere environments is a logistic challenge. Availability of oxygen cylinders for the mechanically ventilated patient may be difficult in such a context. A solution is to use a ventilator able to function with an oxygen concentrator. Objectives: We tested the SeQual Integra (TM) (SeQual, San Diego, CA) 10-OM oxygen concentrator paired with the Pulmonetic System (R) LTV 1000 ventilator (Pulmonetic Systems, Minneapolis, MN) and evaluated the delivered fraction of inspired oxygen (FiO(2)) across a range of minute volumes and combinations of ventilator settings. Methods: Two LTV 1000 ventilators were tested. The ventilators were attached to a test lung and FiO(2) was measured by a gas analyzer. Continuous-flow oxygen was generated by the OC from 0.5 L/min to 10 L/min and injected into the oxygen inlet port of the LTV 1000. Several combinations of ventilator settings were evaluated to determine the factors affecting the delivered FiO(2). Results: The LTV 1000 ventilator is a turbine ventilator that is able to deliver high FiO(2) when functioning with an oxygen concentrator. However, modifications of the ventilator settings such as increase in minute ventilation affect delivered FiO(2) even if oxygen flow is constant on the oxygen concentrator. Conclusions: The ability of an oxygen concentrator to deliver high FiO(2) when used with a turbine ventilator makes this method of oxygen delivery a viable alternative to cylinders in austere environments when used with a turbine ventilator. However, FiO(2) has to be monitored continuously because delivered FiO(2) decreases when minute ventilation is increased. (C) 2014 Elsevier Inc.

BACKGROUND AND OBJECTIVE:Almost 50% of military trauma patients who need transfusions develop a coagulopathy. Immediately treating this coagulopathy improves the patient?s prognosis. Field military hospitals often lack laboratory devices needed to diagnose a clinically significant coagulopathy and have limited blood product resources such as plasma. Point-of-care (POC) devices for the measurement of prothrombin time (PT) are available and have been tested in a variety of situations, including hemorrhagic surgery. The authors compared a POC device, the Coaguchek XS Pro (F. Hoffmann-La Roche Ltd., Basel, Switzerland), with laboratory measures for determining the PT in military trauma patients in a field hospital.METHODS:This single-center prospective study was designed to compare POC coagulation monitoring with traditional laboratory testing. It was conducted at the French military hospital located at Kabul International Airport. All patients with trauma injuries resulting from war operations were included. A blood sample was drawn immediately on admission. PT was determined both in the laboratory and with use of the Coaguchek XS pro.RESULTS:Forty patients with war trauma were enrolled during a 3-month period. The authors recorded 69 measurements. The two methods were correlated with a correlation coefficient of 0.78 (p < .001). The Bland-Altman plot showed a mean difference of 5.8% (95% confidence interval ?14.9% to 26.6%). Using a PT cutoff of 60%, POC had a sensitivity of 77.1% and a specificity of 94.1%. RESULTS from POC PT measurement were available within a mean of 25.8 minutes before laboratory measures.CONCLUSIONS:The Coaguchek XS Pro device can be used successfully in an austere environment without compromising its performance.

Introduction: Few data are available about pediatric cardiovascular disease (CVD) in the Horn of Africa. The objective of this study was to describe the spectrum of CVD in children in Djibouti. Methods: Clinical features and management of Djiboutian children between 1 month-old and 15 year-old with CVD were prospectively recorded over a two-year period in Bouffard Military Hospital in Djibouti (January 2009-December 2010). Results: Clinical examination and echocardiography were performed on 156 patients: 32 of them (20 %) had CVD. Three (10%) of them had Down's syndrome. The median age was 5 years (male 53%). Congenital heart disease was observed in 27 (84%) patients and dilated cardiomyopathy (DCM) in 5 (16%) patients including 2 patients with rheumatic valvular disease. Ventricular septal defect was frequent (28%). Other abnormalities were atrial septal defect (13%), Tetralogy of Fallot (9%), pulmonary stenosis (6%) and 3 other patients had multiple congenital anomalies condition. Surgical management was required in 22 (69%) patients and was performed on 15 (47%) cases. During follow up (mean 11.3 +/- 6.8 months), 5 (16%) patients died. Absence of surgery was associated with significant mortality (p > 0.05) but age, sex and mean follow up were not. Conclusion: Pediatric CVD is at least as common in this Djiboutian community as in other African cohorts. The absence of surgery was a major mortality risk factor. DCM was frequent in this study. Much work remains to be done to discover the size and nature of genetic and environmental contributions to these various forms of heart diseases in the Horn of Africa.

Background: Hypothermia remains one of the major factors limiting surgery in extensively burned patients. We evaluated the effectiveness of an intravascular rewarming technique using CoolGard 3000 (TM) system and Icy (TM) catheter to maintain normothermia during surgeries of severe burned patients and compared these findings to a historical control group.Methods: This was a controlled non-randomised trial conducted between March 2008 and August 2009. Patients with burns greater than or equal to 40% of the total body surface area were included. Before the first burn excision, the Icy (TM) catheter was placed in the inferior vena cava via the femoral vein. Warming was then initiated and maintained until the bladder temperature reached over 37.5 degrees C. The bladder temperature was recorded every 30 min during surgery and for the first hour post-operatively and compared to a historical control group.Results: We enrolled 4 patients and 11 surgeries in the CoolGard (TM) group and compared them to 3 patients and 10 surgeries in the historical cohort. All intraoperative bladder temperatures from T = 30 were statistically different in the two groups. In the CoolGard (TM) group, no patient became hypothermic and no surgery was aborted because the patient's temperature had rapidly fallen below the threshold temperature (35.5 degrees C). No device-related complication was reported.Conclusion: The use of an intravenous warming catheter is a novel approach to maintain normothermia during surgery in burn victims and may be more effective than traditional methods. (C) 2010 Elsevier Ltd. All rights reserved.

Right heart failure remains poorly investigated and understood, whereas left heart failure has been extensively studied ( 1 Voelkel N.F. Quaife R.A. Leinwand L.A. et al. Right ventricular function and failure: report of a National Heart, Lung, and Blood Institute working group on cellular and molecular mechanisms of right heart failure. Circulation. 2006; 114: 1883-1891 Crossref PubMed Scopus (917) Google Scholar ). Mechanisms of right heart failure are mainly classified as pulmonary hypertension, valvular disease, ischemia, and endotoxemia ( 2 Markel T.A. Wairiuko G.M. Lahm T. et al. The right heart and its distinct mechanisms of development, function, and failure. J Surg Res. 2008; 146: 304-313 Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar ). We report here a rare case of fatal right heart failure in a 33-year-old woman due to undiagnosed end-stage breast cancer, and discuss the possible causes.

SummaryWe describe a case of tracheobronchial inhalation of a bead by a five-year-old girl in Djibouti. The bead was extracted using a Fogarty balloon catheter passed through the rigid bronchoscope without complication. This kind of accident is not exceptional and we discuss the management of such cases with limited diagnostic tools and therapeutic environments.