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Purpose We assessed the security and efficiency of intravenously injected agitated saline in conjunction with transthoracic echocardiography to identify recirculation in patients supported with a venovenous extracorporeal membrane oxygenation (VV ECMO) device. Materials and Methods We injected agitated saline 4 consecutive times separated by an interval of 5 minutes in 2 patients supported by VV ECMO. In both patients, the drainage cannula was placed in the left femoral vein, and the return cannula was placed in the right internal jugular vein. Echocardiography was performed during the injection and until the bubbles disappeared. The security of the method was assessed by evaluating the mechanical function of the ECMO and the efficiency of the oxygenator. The value of this method was assessed by visualizing the increase of inferior vena cava's echogenicity as well as by measuring the time required for this change to occur after the injection of agitated saline at different ECMO output levels. Results We did not observe any change in ECMO, oxygenation function, or the hemodynamic status of patients after the 4 injections of agitated saline. The echogenicity of the inferior vena cava increased more rapidly as the ECMO's output increased. The recirculation phenomenon was noted even with low levels of ECMO output ( Conclusions Transthoracic echocardiography in conjunction with agitated saline administration may be a safe and easily applicable method to evaluate a recirculation phenomenon in patients supported with VV ECMO.

We describe the case of a 46-year-old man admitted for upper gastrointestinal bleeding in the context of cirrhosis. A deep bleeding duodenal ulcer was treated by sclerotherapy. Abdominal pain and fever lead us to perform an abdominal computed tomography, which demonstrated emphysematous cholecystitis. An emergency cholecystectomy was performed and antimicrobial therapy initiated. The patient recovered uneventfully. Links between ulcers and emphysematous cholecystitis are discussed., Case Reports, Journal Article, SCOPUS: ar.j, info:eu-repo/semantics/published

An 81-year-old woman with a previous history of hyperthyroidism treated with 10 mg/day thiamazole presented with episodes of syncope. On admission, her ECG showed ectopic ventricular beats and a prolonged QT interval (QTc 520 ms). Torsades de pointes was recorded while she was having another syncope attack. A thyroid function test showed a thyroid-stimulating hormone (TSH) level of 72.7 AU/ml (range 0.3–4.0 AU/ml), free triiodothyronine (T3) 1.6 pg/ml (2.1–5.3 pg/ml) and free thyroxin (T4) 0.3 ng/dl (0.8–2.0 ng/dl), pointing to secondary hypothyroidism. We thought that this was the cause of her torsades de pointes and so we initially treated her intravenously with liothyronine 25 Ag/day and levothyroxine 50 Ag/day and subsequently orally with thyroxin 50 Ag/day, later increased to 75 Ag/day [1–5]. Our diagnosis was sustained by the absence of a long QT interval on a previous ECG while a thyroid test was slightly abnormal, with a shortened QT interval and the absence of recurrent tachyarrhythmias after thyroid replacement therapy. The arrhythmia never recurred and the patient’s QT interval returned to normal. We would