[Current place of cultured epithelial autografts in the management of massive burns and future prospects: Literature review]. / Place actuelle des cultures d'épidermes autologues dans la prise en charge des brûlures étendues et perspective d'avenir : revue de littérature.

Cultured Epithelial Autografts (CEAs), developed at the end of the 1970s from in vitro culture amplification of keratinocytes, have led to a therapeutic revolution in the treatment of major burns. The areas of improvement of the cultures initially involved the manufacturing processes (culture media, support matrices, etc.) and then clinical applications (use of a largely expanded allogeneic or autologous dermal bed). These advances have enabled burn centers (BC) using CEAs to obtain very satisfactory percentages of graft integration and survival of major burns patients. However, since CEAs are not without major drawbacks (fragility, high rate of infection, high cost, unstable scars), these pitfalls have restricted their use worldwide. As of 2014, CEAs produced by Genyzme Tissue Repair are no longer available in Europe, which has considerably reduced an indispensable therapeutic arsenal for severe and extensive burns. To overcome these therapeutic limitations, current research is focusing on techniques combining surgery, tissue engineering and cell therapy. The advent of regenerative medicine, based on the use of stem cells, in particular mesenchymal stem cells (MSC), can contribute to an improvement in the management of these massively burned patients (optimization of the environmental medium, attenuation of the systemic inflammatory response and the immunosuppressive effects of the burn, acceleration of tissue regeneration, etc.). Cell therapy, therefore, offers alternatives to CEAs, which must imperatively retain their place in the therapeutic arsenal, namely an effective emergency coverage technique that can be improved.

Successful management of a severe combat penetrating brain injury.

We report the case of successful management of a transcranial penetrating high-energy transfer injury in a 20-year-old soldier. The bullet traversed both cerebral hemispheres and lacerated the superior sagittal sinus rendering him unconscious. We detail the care received at all stages following injury from 'Buddy Aid' on the battlefield, resuscitation by a forward medical team through to prompt neurosurgery within 2 h of injury. Subsequent aeromedical evacuation and continuing aggressive critical care has allowed the patient to survive with acceptable neurological impairment after what is generally considered an unsurvivable injury.

[Successful treatment of life-threatening Panton-Valentine leucocidin positive Staphylococcus aureus pneumonia with antibiotics and immunoglobulins targeting the toxin production]. / Pneumopathie nécrosante à Stapholococcus aureus sécréteur de la leucocidine de Panton-Valentine: traitement avec succès par antibiotiques et immunoglobulines à visée anti-toxinique.

We report a patient who presented a severe Panton-Valentine-secreting methicillin-susceptible Staphylococcus aureus pneumonia with threatening multi-organ failure including acute respiratory distress syndrome, cardiac failure, renal failure and disseminated intravascular coagulation. Clinical and biological disease course using empiric therapy with treatment directed against toxin production (linezolid, clindamycin and intravenous immunoglobulins) was found to be quickly effective.

[Antitoxin treatments for necrotizing pneumonia due to Panton-Valentine leukocidin-secreting Staphylococcus aureus]. / Traitements antitoxiniques et pneumopathies nécrosantes àStaphylococcus aureus sécréteurs de leucocidine de Panton-Valentine.

Staphylococcus aureus is responsible for two main clinical presentations in humans: suppurative infections and toxigenic diseases. A small percentage of S. aureus strains secrete Panton-Valentine leukocidin (PVL). This toxin is implicated in skin infections, furunculosis, osteoarticular infections, and particularly, in serious pulmonary infections known as necrotizing pneumonia, which affect immunocompetent patients with no comorbidity. A clear outline of the clinical presentation was described recently. Necrotizing pneumonia caused by PVL-secreting S. aureus strains is characterized by a combination of fever, hemoptysis, multilobar alveolar infiltrations, and leukopenia. The disease usually progresses to toxic shock or refractory hypoxemia. A number of interesting therapies targeting leukocidin have been proposed over the past few years based on in vitro data. This review focuses on the physiopathological basis and on the therapeutic relevance of various drugs.

[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.

[Ethylene glycol intoxication: a case report]. / Intoxication par l'éthylène glycol : réflexion à propos d'un cas.

Ethylene glycol intoxication is one of the most serious acute poisonings due to the high toxicity that can result in death if not treated rapidly. We report the case of a patient who presented to the intensive care unit with a hypertensive crisis associated to a renal insufficiency. Laboratories investigations which revealed metabolic acidosis and elevated anion gap, highlighted an unexpected ethylene glycol intoxication. Clinical and psychiatric feature lead to suspect a chronic ingestion. Spontaneous recovery occured without specific treatment.

[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.

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.

[Is there any place for hypertonic saline for fluid resuscitation in septic shock]. / Il y a-t-il une place pour le sérum salé hypertonique dans les états septiques graves?

Fluid loading is the first step, necessary to care for severe sepsis. Two main classes of solutions are currently available: crystalloids and colloids. The concept of small volume resuscitation with hypertonic saline has emerged these last years in the care of traumatic haemorrhagic shock. The main benefits are the restoration of intravascular volume, improvement of cardiac output and improvement of regional circulations. Many experiments highlight modulation of immune and inflammatory cascades. We report the mechanisms of action of hypertonic saline based on experimental human and animal studies, which advocate its use in septic shock.

[Promotility drugs use in critical care: indications and limits?]. / Utilisation des médicaments prokinétiques en réanimation: indications et limites?

Enteral feeding is often limited by gastric and intestinal motility disturbances in critically ill patients, particularly in patients with shock. So, promotility agents are frequently used to improve tolerance to enteral nutrition. This review summaries the pathophysiology, presents the available pharmacological strategies, the clinical data, the counter-indications and the principal limits. The clinical data are poor. No study demonstrates a positive effect on clinical outcomes. Metoclopramide and erythromycin seems to be the more effective. Considering the risk of antibiotic resistance, the first line use of erythromycin should be avoided in favor of metoclopramide.