[Bullet fragment in the interventricular septum : Is surgery always obligatory ?] / Fragments de balle dans le septum interventriculaire : faut-il opérer à tout prix ?

INTRODUCTION: Cardiac gunshot injuries are fatal and very challenging to manage for surgeons. Unfortunately, there is no consensus regarding the management of these patients. CASE PRESENTATION: We report an unusual case of a cardiac injury after an indirect gunshot to the heart. The 59 years-old male was hemodynamically stable which allowed us to do further investigations revealing a bullets fragment in the interventricular septum without other complication. Conservative management was decided with a careful regular follow-up. CONCLUSION: Cardiac gunshot injuries must be managed aggressively in hemodynamically unstable patients. In stable patients, further investigations can be done to allow decision-making.

Nail gun may cause heart injury: a young adult's misadventure.

Penetrating cardiac and great vessels trauma is life threatening and a surgical challenge. We relate an unusual case of pulmonary artery injury secondary to an accidental trauma by a nail gun. Surgical repair was late but successful.

[Assessment of the interest of using confirmatory test in ELISA with use of high concentration of heparin-induced thrombocytopenia]. / Évaluation de l'intérêt du test de confirmation avec une forte concentration d'héparine en Elisa dans la thrombopénie induite par l'héparine.

Heparin-induced thrombocytopenia (HIT) is a severe complication of heparin therapy caused by an antibody against heparin/Platelet Factor 4 (PF4) complex. It complicates the treatment with unfractionated heparin (UFH). The aim of the study was to assess the interest of using confirmatory test in ELISA with use of high concentration of heparin (100 UI/mL) in patients (n=15) with discordance between platelet activation test and ELISA test. We obtained a rate inhibition higher than 50% in 86% of patients was observed. We conclude that inclusion of the high heparin confirmatory procedure in ELISA demonstrate the dependent heparin character of the antibodies but does not improve diagnostic specificity. In addiction a 2-fold increase in final test cost is observed.

Severe acute pancreatitis after surgical treatment of a ruptured abdominal aortic aneurysm.

Acute pancreatitis (AP) is a rare complication of surgery for abdominal aortic aneurysms, which is often diagnosed late. It is secondary to ischemia and to peroperative pancreatic trauma. We report a case of severe AP after surgical treatment of a ruptured abdominal aorta aneurysm and discuss its etiopathogenic mechanisms.

[Intra-aortic balloon counterpulsation, which complications may result from?]. / Le ballon de contre-pulsion intra-aortique, à quelles complications s'attendre ?

Bilateral renal infarction is a complication of intra-aortic balloon counterpulsation, ever described in the literature. We illustrate this complication by a clinical observation and underline the interest of taking a prevention action.