Clinical anatomy of the coronary venous system and relevance to retrograde cardioplegia and cardiac electrophysiological interventions.

Anomalies of coronary venous system, the valve of the coronary sinus (Thebesian valve) and other cardiac malformations may make interventions through the coronary sinus difficult. These variants may pose a challenge in cannulating the coronary sinus for retrograde cardioplegia and for interventions performed through the coronary sinus by cardiac electrophysiologist/interventional cardiologist. Retrograde cardioplegia is an established method of myocardial protection with advantages, indications, and complications. A good knowledge of the anatomy of the coronary sinus and its variants is important in understanding the difficulties encountered while cannulating the coronary sinus for the delivery of retrograde cardioplegia, cardiac resynchronization therapy, treatment of arrhythmias, and percutaneous mitral valve annuloplasty.

Positron emission tomography - Computed tomography for staging of mediastinal lymph nodes in patients with non-small cell lung cancer.

Background: The tumor involvement of lymph nodes (LN) in N2 station is a very important factor for the further therapy decision and the prognosis of lung cancer patients. Today, integrated positron emission tomography-computed tomography (PET-CT) is considered to be the new standard in the staging of bronchial carcinoma. The aim of this study is to investigate the correctness of the clinical staging of the mediastinal LNs in operated patients and to investigate the sensitivity and specificity of the PET-CT examination for mediastinal LNs. Subjects and Methods: In the years 2010-2014, 359 patients underwent surgery for bronchial carcinoma. The histological examination of all mediastinal and hilar LNs was used as a reference to the data from the PET-CT examinations. The correctness of the PET staging, overestimation, and underestimation for the N stage was analyzed. In addition, the "sensitivity," "specificity," and "overall accuracy" of the PET-CT examination with regard to the N2 LNs were calculated. Results: It was found that in 8.9% the staging of the mediastinal N2/N3 LN stations was rated too high by the PET and in 11.2% too low. The study showed a sensitivity of 47.37%, a specificity of 90.07%, and an accuracy of 81.01% for the mediastinal LNs. Conclusion: Our study confirms the limited ability of integrated PET-CT in staging the mediastinal LNs. We, therefore, recommend a histological examination of the LNs in patients with PET-positive N2 LNs to avoid false-positive results and to initiate correct therapy.

Résumé Contexte: L'implication tumorale des ganglions lymphatiques (LN) au stade N2 est un facteur très important pour la décision thérapeutique ultérieure et le pronostic des patients atteints de cancer du poumon. Aujourd'hui, la tomographie par émission de positons intégrée (TEP-CT) est considérée comme être la nouvelle norme dans la stadification du carcinome bronchique. Le but de cette étude est d'étudier l'exactitude de la stadification clinique des ganglions lymphatiques médiastinaux chez les patients opérés et d'étudier la sensibilité et la spécificité de l'examen TEP-TDM pour les ganglions lymphatiques médiastinaux. Sujets et méthodes: Dans les années 2010 à 2014, 359 patients ont été opérés d'un carcinome bronchique. L'examen histologique de tous les LN médiastinaux et hilaires a servi de référence aux données des examens PET-CT. La justesse de la mise en scène PET, la surestimation et la sous-estimation pour le stade N ont été analysées. De plus, la " sensibilité ", la " spécificité " et la " précision globale " de l'examen PET-CT en ce qui concerne les N2 LNs ont été calculés. Résultats: Il a été constaté que dans 8,9 % des cas, la mise en scène du médiastin N2/ Les stages N3 LN ont été jugées trop élevées par le PET et dans 11,2 % trop faibles. L'étude a montré une sensibilité de 47,37%, une spécificité de 90,07%, et une précision de 81,01 % pour les LN médiastinaux. Conclusion: Notre étude confirme la capacité limitée de la TEP-TDM intégrée dans la stadification les LN médiastinaux. Nous recommandons donc un examen histologique des ganglions lymphatiques chez les patients avec des ganglions lymphatiques N2 positifs à la TEP pour éviter résultats faussement positifs et d'initier un traitement correct Mots-clés: Cancer du poumon, tomographie par émission de positrons/tomodensitométrie, stadification.

Nurses' knowledge of care of chest drain: A survey in a Nigerian semiurban university hospital.

BACKGROUND/OBJECTIVE: Inefficient nursing care of chest drains may associated with unacceptable and sometimes life-threatening complications. This report aims to ascertain the level of knowledge of care of chest drains among nurses working in wards in a teaching hospital in Nigeria. METHODS: A cross-sectional study among nurses at teaching hospital using pretested self-administered questionnaires. RESULTS: The majority were respondents aged between 31 and 40 years (45.4%) and those who have nursing experience between 6 and 10 years. Only 37 respondents (26.2%) had a good knowledge of nursing care of chest drains. Knowledge was relatively higher among nurses who cared for chest drains daily, nurses who have a work experience of <10 years, low-rank nurses and those working in the female medical ward; however, the relationship were not statistically significant (P > 0.05). Performance was poor on the questions on position of drainage system were not statistically significant with relationship to waist level while mobilizing the patient, application of suction to chest drains, daily changing of dressing over chest drain insertion site, milking of tubes and drainage system with dependent loop. CONCLUSION: The knowledge of care of chest drains among nurses is poor, especially in the key post procedural care. There is an urgent need to train them so as to improve the nursing care of patients managed with chest drains.

Challenges in the management of iliofemoral deep vein thrombosis in a resource limited setting: a case series.

Iliofemoral deep vein thrombosis is a medical emergency associated with pulmonary embolism, severe postthrombotic morbidity and increased rates of recurrence. We present 3 cases of iliofemoral deep vein thrombosis managed in a setting of limited resources. Results of 2-D Ultrasound scan which suggested proximal DVT was confirmed by Doppler ultrasound scan. Patients were all managed by systemic anticoagulation alone. In experienced hands, it is possible to diagnose iliofemoral DVT with 2-D Ultrasound scan and treatment with systemic anticoagulation alone still has a role. However recent studies have proved clearly the superiority of thrombectomy over systemic anticoagulation alone. There is a need to improve the infrastructure and expertise of clinicians managing these conditions in underdeveloped settings to enable them offer the best to their patients.