[Telemedicine and social Media in the management of ECMOs in the era of COVID-19: The Tunisian experience]. / La télémédecine et les réseaux sociaux dans la gestion des ECMO à l'ère de COVID-19 : l'expérience Tunisienne.

INTRODUCTION: In Tunisia, as elsewhere in the world, severe forms of acute respiratory distress syndrome (ARDS) related to SARS-Covid19 have been observed. When the usual means of resuscitation were no longer sufficient, the implementation of the Extracorporeal membrane oxygenation or ECMO was needed. AIM: The whole problem of the management of these patients in this pandemic period has been to manage the operation of the ECMO machine, usually reserved for expert and specialized centers in the field. METHODS: The cardio-vascular surgery department of La Rabta teaching hospital of Tunis has tried the experience of management of ECMO implanted in the different reanimations of Tunis, remotely, using telemedicine and social networks. Thus, a Facebook-Messenger discussion group was created and enabled the management of patients under ECMO via video conferencing in real time involving all stakeholders. RESULTS: A call was made whenever the physician needed it. The video provided an opportunity to discuss with surgeons and perfusionists in real time the complications or problems of these patients. Their clinical status was continuously shared on the focus group. Following the instructions of the expert surgeons and the exchanges made on the group, the reanimator could then intervene on this or that parameter. CONCLUSION: Social media have invaded everyone's daily lives and health professionals are not exception to this trend. The Covid-19 pandemic has only strengthened this digital alternative with the goal of efficiency and patient interest. While their use in a professional setting offers many advantages, it must nevertheless be done in compliance with the rules of ethics and bring real added value.

Tuberculosis lymphadenopathy: A rare etiology of the superior vena cava syndrome.

Superior vena cava syndrome is the clinical expression of the obstruction of the superior vena cava reducing the blood flow. Malignant etiologies are the most common. Its management is multidisciplinary and despite the progress of endovascular procedures, conventional surgery retains its place in certain indications. Mediastinal fibrosis secondary to tuberculosis lymphadenopathy may be associated with superior vena cava syndrome. In the presence of symptomatic SVCS associated with extensive mediastinal fibrosis compressing the superior vena cava with sub occlusive thrombosis, conventional surgery remains a treatment option, with cavo-venous derivation by prosthetic bypass.

[Revascularization delay and complications in acute upper limb ischemia]. / Délai de revascularisation et complications dans l'ischémie aiguë du membre supérieur.

INTRODUCTION: Acute upper limb ischemia is a medical and surgical emergency. Studies that have reported revascularization results in acute upper limb ischemia are rare. For this reason, the revascularization delay has remained poorly defined. The purpose of this study was to evaluate surgery results of acute upper limb ischemia related to revascularization delay. METHODS: We report a retrospective study of patients operated for acute upper limb ischemia between 2008 and 2016. Patients with thrombotic, traumatic or iatrogenic ischemia were excluded from this study. Patients were divided into two groups (those operated before 12hours and those operated after 12hours). A statistical analysis was performed to compare surgery results between the two groups in terms of limb salvage rate and neurological sequelae rate. RESULTS: Our population consisted of 138 patients. The average age was 69 [31,92]. There were 90 women and 48 men. The mean revascularization delay was 20hours [2,240]. Seventy-six patients were operated on before 12hours and 62 patients after 12hours. At one month, the mortality was 1.4% and the morbidity was 5.7%. The overall limb salvage rate was 86.9% and the overall neurologic sequelae rate was 31.8%. Statistical analysis showed that there was no significant difference between patients operated before or after 12hours in terms of limb salvage (86.8% versus 87%, P=0.258). However, there was a statistically significant difference in terms of neurological sequelae in favor of patients operated after 12hours (15.7% versus 51.6%, P=0.012). CONCLUSION: Revascularization of acute embolic upper limb ischemia is often associated with good results even if performed late. Beyond 12hours of ischemia, amputation rate is not significantly higher, however, the rate of neurological sequelae can be high.

[A rare localization of angio-Behçet revealed by a false aneurism of a gluteal artery treated surgically]. / Une localisation rare de l'angio-Behçet révélée par un faux anévrisme d'une artère glutéale traité chirurgicalement.

Behçet's disease is a rare chronic systemic inflammatory disease. It is more common in Turkey, North Africa and Japan. The incidence of vascular involvement (angio-Behçet) is 7 to 38%. The gluteal localization of angio-Behçet is rarely reported and could be revealed late. Aside from aneurysmal rupture, nerve compression with pain and lower limb impotence could be the main clinical signs. Because of the deep location of the lesion, management of this disease can be difficult. The classic surgical treatment remains the gold-standard especially in case of extreme urgency, non-feasibility of endovascular treatment and especially in case of associated nerve compression. We report the case of a 45-year-old man with a history of pulmonary angio-Behcet, who underwent emergency surgery for a huge false aneurism of a collateral of the hypogastric artery treated via a double anterior and posterior approach with good outcome.