[Internal jugular venous cannulation: what is the best approach?]. / Cathétérisme veineux jugulaire interne : quelle est la meilleure voie d'abord ?

OBJECTIVES: The aim of this study was to compare two approaches used for internal jugular venous cannulation: the anterior way, described by English et al. and the posterior way, described by Jernigan et al. The primary endpoint was the rate of success. The secondary endpoints were the related adverse events and the difficulty factors. STUDY DESIGN: Prospective, randomized open clinical trial. PATIENTS AND METHODS: The study took place in the vital emergency room, the operating room and the emergency intensive care unit of Ibn Sina University hospital (Rabat, Morocco), between June and September 2010. Hundred and one patients needing a central venous catheter were randomized to undergo one of the two techniques. We compared: demographics, success rates, number of attempts, difficulty factors and adverse events. RESULTS: The success rate was significantly higher in the posterior group (96% versus 68%, P < 0.001), with fewer attempts (1.3 ± 0.7 versus 2.1 ± 1.3; P < 0.001). There were less pneumothorax, (0 versus 6%) and more accidental arterial punctures (34 versus 25.5%) in the posterior group, but the difference wasn't significant. Finally, none of the difficulty factors were correlated to the failure rate. CONCLUSION: This study shows that the posterior approach in internal jugular venous cannulation is more efficient than and as safe as the anterior approach.

[Severe tetanus complicated with rhabdomyolysis and acute renal failure: a pediatric case report]. / Tétanos grave compliqué de rhabdomyolyse et d'insuffisance rénale : à propos d'une observation pédiatrique.

Renal failure is a rare complication of tetanus in children. It occurs following poorly controlled muscle spasms and rigidity. We describe a severe case of tetanus complicated with rhabdomyolysis and acute renal failure in a child.

[Traumatic asphyxia or Perthe's syndrome. About two paediatric cases]. / Syndrome d'asphyxie traumatique ou syndrome de Perthes: à propos de deux observations pédiatriques.

The traumatic asphyxia or Perthes' syndrome is a condition characterized by a classic triad involving head and neck cyanosis, subconjonctival bleeding, and petechiae. The pathophysiology of traumatic asphyxia is different in children compared to adults, because of the greater elasticity of the thorax in children. The purpose of this paper is to describe through two cases of traumatic asphyxia in young children the characteristics of this disease in children.