[Not Available]. / Transport aérien longue distance des brûlés graves: revue de la littérature et application pratique.

The best treatment for victims of severe burns is provided in highly specialised burn centres. Due to the paucity of these centres, long distance aeromedical evacuation is often required. However, published data regarding such transfers are scarce. In this review, in order to help optimize patient management when air transportation is decided or even only considered, we propose simple principles derived from this limited literature and backed by the practical experience of the French military. We first describe how specific flight conditions may impact transportation of severe burn patients aboard aircraft. We then focus on the planning and organisation of these transfers discussing the risks associated with air transportation of such patients and their implications on indication, timing and modality of transport. Finally, provide an end-to-end view of the process from pre-flight equipment preparation, pre-boarding patient assessment and conditioning, to in-flight care.

Epidemiology of filamentous fungal infections in burned patients: A French retrospective study.

INTRODUCTION: Filamentous fungal infections (FFI) seem to become more frequent in burn patients, in whom they are usually accepted to cause severe. However published data regarding their incidence and consequences in that context remain scarce. The aim of this study was to evaluate the incidence of mould infections in our burn centre, and to review characteristics and outcomes of patients with such infections. METHODS: This retrospective single-centre study reviews all patients admitted in our centre with acute burns (2000-2011) and positive culture for moulds. Wound infections were defined as follows: fungal wound colonisations (FWC) for positive mycological cultures without signs of wound infection; fungal wound infections (FWI) for positive mycological cultures with local signs of wound infection; disseminated infection (DI) for FWI with a positive blood culture or a positive galactomannan (for aspergillosis) or severe sepsis or secondary organ localisation(s). RESULTS: Among 1849 patients, 31 patients presented a FFI. For 29 patients (93%), positive fungal samples were cutaneous: 20 Aspergillosis ASP (5 FWC, 8 FWI and 7 DI), 9 mucormycosis MMC (3 FWC and 6 FWI) and 3 fusariosis FUS (3 FWI). Two patients presented a catheter colonisation or a pulmonary colonisation (Aspergillus fumigatus). Incidence of FFI was 1.7%. Total body surface area burned, full-thickness burn surface area, Unit Burn Standard, Tobiasen score and SAPS2 (respectively 55% [40-73], 45% [30-63], 180 [129-259], 11 [8-12] and 50 [40-62]) were markedly higher than in burned patients without FFI hospitalised during the same time period. 30% of the patients with burn wound ASP (6/22) died. Mean length of stay was 111±67 days. CONCLUSION: FFI are essentially cutaneous, infrequent and occur in the most severe burned patients. ASP seems to be more serious than other FFI.

Sigmoid diverticulitis perforation in burns: case reports and review of the literature.

Burned patients are prone to develop severe intestinal complications because of decreased splanchnic circulation. We report three cases of sigmoid perforation in burn patients appearing late during hospitalization. The common aetiological factor was a state of septic shock treated with infusion of vasopressors. Two patients also received corticosteroids as treatment for acute respiratory distress syndrome. These cases underline the necessity to maintain adequate organ perfusion and to prevent intestinal ischaemia in severe burns.

[Epidemiology of war injuries, about two conflicts: Iraq and Afghanistan]. / Type et épidémiologie des blessures de guerre, à propos de deux conflits actuels : Irak et Afghanistan.

Since March 2003, military operations in Iraq "Operation Iraqi Freedom" (OIF) and in Afghanistan "Operation Enduring Freedom" (OEF), have made many wounded and killed in action (KIA). This article proposes to highlight the specific epidemiology of combat casualties, met in these both non-conventional and asymmetric conflicts. Personal protective equipments, Kevlar helmet and body armor, proved their efficiency in changing features of war injuries. Health Force Services organized trauma care system in different levels, with three main objectives: immediate basic medical care in battalion aid station, forward surgery and early aeromedical evacuation. The Joint Theater Trauma Registry (JTTR), a war injury registry, provides medical data, analyzed from the combat theater to the military hospital in United States. This analysis concluded that during modern conflicts, most injuries are caused by explosive devices; injuries are more severe and interestingly more specifically the head region and extremities than the trunk. Hemorrhage is the first cause of death, leading to the concept of avoidable death. Specific databases focused on mechanisms and severity of injuries, diagnostic and treatment difficulties, outcomes can guide research programs to improve war injuries prevention and treatment.

[Cardiac complications following hip fracture surgery]. / Complications cardiovasculaires après chirurgie du col fémoral.

Hip fracture is a major health burden due to both its frequency and its deep impact on patient's outcome. The key issue of this poor outcome seems to be cardiac complications. The onset of these cardiac complications seems to appear early in the clinical course in the form of perioperative myocardial ischemia that are both preventable and treatable. Their clinical and electrocardiographic pattern is very poor and they can be thoroughly detected by only either a systematic electrocardiographic 12 lead monitoring or troponin dosage.

[Burns care following a nuclear incident]. / Soins Aux Brules Apres Un Accident Nucleaire.

Radiation injuries are usually caused by radioactive isotopes in industry. Detonations of nuclear reactors, the use of military nuclear weapons, and terrorist attacks represent a risk of mass burn casualties. Ionizing radiation creates thermal burns, acute radiation syndrome with pancytopenia, and a delayed cutaneous syndrome. After a latency period, skin symptoms appear and the depth of tissue damages increase with dose exposure. The usual burn resuscitation protocols have to be applied. Care of these victims also requires assessment of the level of radiation, plus decontamination by an experienced team. In nuclear disasters, the priority is to optimize the available resources and reserve treatment to patients with the highest probability of survival. After localized nuclear injury, assessment of burn depth and surgical techniques of skin coverage are the main difficulties in a burn centre. Training in medical facilities and burn centres is necessary in the preparation for management of the different types of burn injuries.

[Risk analysis of postoperative anemia through biological databases querying]. / Méthode d'analyse du risque d'exposition à l'anémie postopératoire par interrogation des bases de données de biologie.

INTRODUCTION: The assessment of postoperative care relies mainly on spontaneous reporting of major adverse events (MAE). We propose an alternative approach that we have tested on the measurement of the risk of postoperative anemia which is frequentely associated with anaesthethic related deaths. METHODS: The procedure consisted in extracting the electronic sheet generated by the biological analyser and merging it with the anesthesia data base with a filter based on patient's location in the hospital. The orthopedic surgery ward was chosen because of the frequency of full blood count (FBC) associated with the prescription of low weight molecular heparin in this setting. All FBC of the year 2005 were analysed. A risk stratification was achieved according to the conbination of age and depth of anemia. Medical charts of patients exposed to the greatest risk were reviewed. RESULTS: FBC of 691 orthopaedic surgery patients were analysed. Haemoglobin levels (Hb) less than 8g/dl were observed in 41 (5.9%) patients. Two consecutive Hb less than 8g/dl were founded in 18 patients (2.6%), eight (1.2%) charts of patients exposed to the highest risk were reviewed and six cases of no-transfusion or delayed transfusion were identified. CONCLUSION: A global approach to the risk of postoperative anemia but also of MAE related to postoperative haemorrage can be obtained by monitoring electronic databases.

Effects of food processing on the thermodynamic and nutritive value of foods: literature and database survey.

One of the goals of our society is to provide adequate nourishment for the general population of humans. In the strictness sense, the foodstuffs which we ingest are bundles of thermodynamic energy. In our post-industrial society, food producers provide society with the bioenergetic content of foods, while stabilizing the food in a non-perishable form that enables the consumer to access foods that are convenient and nutritious. As our modern society developed, the processing of foodstuffs increased to allow consumers flexibility in their choice in which foods to eat (based on nutritional content and amount of post-harvest processing). The thermodynamic energy content of foodstuffs is well documented in the literature by the use of bomb calorimetry measurements. Here, we determine the effects of processing (in most cases by the application of heat) on the thermodynamic energy content of foods in order to investigate the role of processing in daily nutritional needs. We also examine which processing procedures affect the nutritive quality (vitamin and mineral content) and critically assess the rational, advantages and disadvantages of additives to food. Finally, we discuss the role of endogenous enzymes in foods not only on the nutritive quality of the food but also on the freshness and flavor of the food. Our results show that a significant decrease in thermodynamic energy content occurs in fruits, vegetables, and meat products upon processing that is independent of water content. No significant change in energy content was observed in cereals, sugars, grains, fats and oils, and nuts. The vitamin content of most foods was most dramatically decreased by canning while smaller effects were observed upon blanching and freezing. We found that most food additives had very little effect on thermodynamic energy content due to their presence in minute quantities and that most were added to preserve the foodstuff or supplement its vitamin content. The endogenous food enzymes while aiding in digestibility of some foods (yogurt or grains) also helped some foods have a more palatable taste. Our conclusions are there is some scientific merit to the idea that enzymes in food can act synergistically with those in the human body to facilitate maximum nutritive value of foods.

Substrate specificity of human glycinamide ribonucleotide transformylase.

The nucleotide substrate specificity of human glycinamide ribonucleotide transformylase, a chemotherapeutic target, has been examined. The enzyme accepts the sarcosyl analog of glycinamide ribonucleotide, carbocyclic glycinamide ribonucleotide, and two phosphonate derivatives of carbocyclic glycinamide ribonucleotide with V/K values, relative to that obtained for beta-glycinamide ribonucleotide, of 1, 27, 1.4, and 2.9%, respectively. Several other analogs of carbocyclic glycinamide ribonucleotide, namely a truncated phosphonate and 2',3'-dideoxy- and 2',3'-dideoxy-2',3'-didehydro-carbocyclic glycinamide ribonucleotide, were inhibitors of the enzyme, competitive against glycinamide ribonucleotide, with Ki values approximately 100 times higher than the Km for -glycinamide ribonucleotide. Although the results of the present study parallel those obtained previously with the avian enzyme (V. D. Antle, D. Liu, B. R. McKellar, C. A. Caperelli, M. Hua, and R. Vince (1996) J. Biol. Chem. 271, 6045-6049), quantitative differences between the two enzyme species have been uncovered.

[Desensitization for 4 successive years using calcium phosphate-adsorbed pollen extracts: study of sera with RAST and PRIST immunoimprints]. / Désensibilisation par des extraits de pollen adsorbés sur phosphate de calcium pendant 4 années consécutives: étude des sérums par immunoempreintes, RAST et PRIST.

The clinical study for four years running of desensitization treatment to adsorbed pollen calcium phosphate, prepared "at request" by Institut Pasteur, shows that these preparations produced particularly good results. The population of allergic subjects is divided into two categories as from first year of treatment: good responders and non responders. A study on the serums of these patients, in view of a different "immuno-imprint" in these two groups, has not yet been conclusive, whereas we were expecting much from this prognosis test, which would have given us better treatment information.

Grass pollen hyposensitization versus placebo therapy. I. Clinical effectiveness and methodological aspects of a pre-seasonal course of desensitization with a four-grass pollen extract.

The present work reports the results of a double-blind clinical trial, comparing the effects of hyposensitization treatment versus placebo in 33 patients with allergic rhinitis, sensitive to a crude extract of the pollen of four different grasses (Dactylis glomerata, Lolium perenne, Secale cereale, and Phleum pratense). The distribution of these patients in the two groups was done randomly and gave two comparable groups, as far as clinical and biological features are concerned. The treatment course included five low doses of the aqueous extract followed by 12 injections of Al(OH)3-adsorbed aliquots of the same extract. Evaluation of the clinical scores was based on diary cards on which symptoms and medications were recorded. A reevaluation of the significance of the symptom and medication scores is presented and the link between both scores is studied. Particular attention is given to the methodological and statistical problems raised during this study. The non-parametric tests reveal a significant difference (P less or equal to than 0.03) in the total clinical score between the treated and the placebo groups for the second half of the observation period, when the pathology was most intense.