Compte rendu de la table ronde du 36ème Congrès de la SFB à Cassis (1-3 Juin 2016), première partie: brûlures chimiques, brûlures électriques.

The 2016 SFB congress focused on 'non-thermal burns', and this session lasted the whole day of Thursday 2nd June. While the reports on radiation-induced burns are currently being prepared by the presenters themselves, this paper on chemical and electrical burns was put together by the above-mentioned authors using notes taken during the session and video of the presentations. Any reader desiring further information on a topic can contact the author of the relevant presentation directly.

Optimization of combined microwave-hot air roasting of malt based on energy consumption and neo-formed contaminants content.

UNLABELLED: To produce specialty malt, malts were roasted by combined microwave-hot air at various specific microwave powers (SP = 2.5 to 3 W/g), microwave heating times (t(mw) = 3.3 to 3.5 min), oven temperatures (T(oven) = 180 to 220 degrees C), and oven heating times (t(oven) = 60 to 150 min). The response variables, color, energy consumption by microwave (E(mw)) and oven (E(oven)), total energy consumption (E(tot)), quantity of neo-formed contaminants (NFCs), which include hydroxymethylfurfural, furfural, furan, and acrylamide were determined. Response surface methodology (RSM) was performed to analyze and predict the optimum conditions for the specialty malt. Production using combined microwave-hot air roasting process based on minimum energy consumption and level of NFCs. At 95% confident level, SP, T(oven), and t(oven) were the most influencing effects with regard to E(tot), whereas t(mw) did not affect E(tot). T(oven) and t(oven) significantly affected malt color. Only T(oven) significantly influenced the NFCs content. The optimum parameters were: SP = 2.68 W/g for 3.44 min, T(oven) = 206 degrees C for 136 min for coffee malt, SP = 2.5 W/g for 3.48 min, T(oven) = 214 degrees C for 136 min for chocolate malt, and SP = 2.5 W/g for 3.48 min, T(oven) = 211 degrees C for 150 min for black malt. Comparing with conventional process, combined microwave-hot air reduced E(tot) by approximately 40%, 26%, and 26% for coffee, chocolate, and black malts, respectively, and reduced HMF, furfural, furan, and acrylamide contents by 40%, 18%, 23%, and 95%, respectively, for black malt. PRACTICAL APPLICATION: An important goal for research institutions and the brewery industry is to produce colored malt by combining microwave and hot air roasting, while saving energy, getting desirable color, and avoiding the formation of carcinogenic and toxic neo-formed contaminants (NFCs). Therefore, one objective of this study was to compare energy consumption and content of NFCs during roasting of malt by hot air-only and combined microwave-hot air processes as well as to determine the effect of specific power, microwave processing time, oven temperature, and oven processing time during combined microwave-hot air roasting. Another objective was to predict the optimum conditions for the production of coffee, chocolate, and black malts.

[Metabolic problems and nutrition in burns]. / Troubles métaboliques et nutrition du brûlé.

Metabolic changes with burns patients are enormous. The loss of skin substance and the necessity of its reconstruction are at the origin of this exceptional situation. In this context of major aggression with important metabolic alteration the nutritional needs are considerable. To assure a tissue reconstruction, nutrition is as important as the fight against infection. The authors make the point on the quantity needs and the quality needs. They raise up the perspectives concerning immunonutriments and note the importance of enteral administration. As a conclusion, they insist on the fundamental role of the clinical aspect, in the survey of nutritional state.

Differences between burns in rural and in urban areas: implications for prevention.

This study aimed to identify typical features of burns in rural areas and to improve their prevention by comparing the characteristics of burnt patients and their burns in rural and urban areas. A cross-sectional survey was conducted in 19 of the 23 French burns units over one year, using a structured questionnaire. We analysed the resulting database. Of the 1422 patients, excluding 188 burnt in unclassified areas, 420 (34%) were burnt in rural areas. Burns were more frequent in rural than in urban areas. Occupational burns were more frequent in rural than in urban areas. The characteristics of patients and burns did not differ between the areas. Patients burnt during everyday activities were older and more frequently had predisposing factors in rural than in urban areas. Burns occurred outdoors more often in rural than in urban areas and were frequently due to flames or explosions or to the use of barbecues or open fires. The hands and perineum were burnt more frequently in rural than in urban areas. Rural burns were more severe than urban burns: they were deeper, involved a larger body surface area and caused more deaths. Preventive measures in rural areas should take into account occupation and everyday activities. They should be specifically adapted to the profiles of burnt patients.

[Continuous administration of vancomycin in patients with severe burns]. / Vancomycine en administration continue chez le grand brûlé.

OBJECTIVES: In the severely burned patient, a marked, rapid fall in serum concentrations is often observed after intermittent infusion of vancomycin at the usual dose of 30 mg/kg. This specific "jagged" pharmokinetic course with inadequate residual concentrations raises the problem of the efficacy of this time-dependent antibiotic. Studies in patients in general resuscitation units have shown the interest of vancomycin administration in continuous infusion. METHODS: We analyzed variations in serum concentrations of vancomycin during continuous infusion in 18 patients with burns involving a mean of 40% total body surface and reported the doses necessary to maintain serum vancomycin at therapeutic levels; the possible correlations between serum vancomycin concentrations, burn parameters, age and renal function; and clinical and biological tolerance. RESULTS: Higher initial doses were required in burn patients (40 mg/kg in patients aged under 60) than in other patients. Impairment of renal function is a contra-indication of continuous infusion. CONCLUSION: This mode of administration has the advantage of ensuring greater efficacy by preventing fluctuations in serum concentrations.

Aortic valve replacement in elderly patients.

The results for 62 consecutive patients aged 70 or more given aortic valve replacement (A.V.R.) between 1970 and 1982 are reported. All the patients were in the New York Heart Association (N.Y.H.A.) functional class III (29%) or IV (71%); 54.8% had angina and 30.6% had experienced syncope. Forty patients had aortic stenosis (A.S.), 10 had aortic regurgitation and 12 had mixed aortic valve disease. The operative myocardial infarction rate was 6.4%. Tilting disk valves were used. Eighty percent of the patients were anticoagulated with Warfarin whilst twenty percent received only antiplatelet drugs. All the patients were followed up for a mean period of 26 months; late mortality was 22.6% with 4.8% cardiac deaths. The thromboembolic rate was 1.6% and the disinsertion rate was 3.2%. Cerebral stroke was fatal in 3 cases in anticoagulated patients but the mechanism of the accident was not known. At the termination of the study 93% of surviving patients were in N.Y.H.A. class I or II. No patient was in class IV. The probability of five year survival is 71% for the entire group.

[Accidents of fulguration]. / Les accidents de la fulguration

Fulguration, first electric accident in which the man was a victim, is to day better known. A clap of thunder is decomposed in two elements: lightning, and thunder. Lightning is caused by an electrical discharge, either within a cloud, or between two clouds, or, above all, between a cloud and the surface of the ground. Experimental equipments owned by the French Electricity Company and by the Atomic Energy Commission, have allowed to photograph lightnings and to measure certain physical characteristics (Intensity variable between 25 to 100 kA, voltage variable between 20 to 1 000 kV). The frequency of storms was learned: the isokeraunic level, in France, is about 20, meaning that thunder is heard twenty days during one year. Man may be stricken by thunder by direct hit, by sudden bursting, by earth current, or through various conductors. The electric charge which reached him may go to the earth directly by contact with the ground or may dissipate in the air through a bony promontory (elbow). The total number of victims, "wounded" or deceased, is not now known by statistics. Death comes by insulation breakdown of one of several anatomic cephalic formations: skull, meninx, brain. Many various lesions may happen in survivors: loss of consciousness, more or less long, sensorial or motion deficiencies. All these signs are momentary and generally reversible. Besides one may observe much more intense lesions on the skin: burns and, over all, characteristic aborescence (skin effect by high frequency current). The heart is protected, contrarily to what happens with industrial electrocution. The curative treatment is merely symptomatic : reanimation, surgery for burns or associated traumatic lesions. A prevention is researched to help the lonely man, in the country or in the mountains in the houses (lightning conductor, Faraday cage), in vehicles (aircraft, cars, ships). The mysterious and unforseeable character of lightning still stays, leaving a door opened for numerous investigations.