[Burn: An inflammatory process]. / La brûlure : une pathologie inflammatoire.

Thermal injury induce a two-phase inflammatory response: first, a pro-inflammatory status, resulting in a systemic inflammatory response syndrome, then an anti-inflammatory phase characterized by a profound defect in cellular-mediated immunity. This inflammatory reaction proceeds from complex phenomenons in whom many cellular elements are involved (macrophage is the central one) and very complex molecular products interact (especially cytokines). These phenomenons promote significant physiopathologic consequences, especially on cardiovascular homeostasis and endothelial permeability, that lower the prognosis. The inflammatory reaction can be modified, enhanced or maintained by adverse events (i.e. infection) resulting in degradation of clinical situation. Despite a better comprehension of the phenomenons underlying this inflammatory process, diagnosis or therapeutic applications are at that time disappointing.

Prise en charge des brûlés par télé-expertise.

At the end of 2013, we proposed the possibility of obtaining specialized burn advice 24/7 via pictures transmitted through a dedicated email address, to healthcare professionals. This simple tool is now a success, and we received one request for advice per day in 2015, resulting in an exchange of numerous emails. This simple process offers a number of benefits: it allows burn centres to regulate patient flows all year long, gives healthcare professionals access to a burn care specialist when and as quickly as they need, ensures each patient receives dedicated care, and allows national authorities to provide the best public health service and gain financial profits. However, a tool that uses email is much too simple and insufficiently secure, therefore it can only represent the first step towards a much more "professional" solution.

[The diagnostic value of non-fiber-optic broncho-alveolar lavage in pneumopathies and mechanical ventilation]. / Intérêt diagnostique du lavage broncho-alvéolaire non fibroscopique dans les pneumopathies en ventilation mécanique.

73 patients on artificial ventilation and presenting with localised or diffuse consolidation had broncho-alveolar lavage (LBA), in search for a causative organism, in a prospective fashion. LBA was done using a supple balloon catheter (LBA-c) which was placed blind down the intubation tube, until a distal bronchus was blocked (under radiographic control). The mean number of organisms found was 1.56 +/- 1.2. LBA-c alone provided a diagnosis in 31 cases (42%) and in association with blood cultures in 14 cases (19%). In 11 cases (15%) the consolidation was not caused by infection. In 14 cases (19%) the diagnosis was made by serology or blood cultures alone. Finally in 8 cases (11%) no diagnosis could be made. Thus LBA-c achieved an etiological diagnosis for the pneumonia in 45 cases (54.8%) and remained negative in non-infectious cases. The good tolerance of the technique as regards blood gases, its simplicity of operation (without a fibrescope) and its diagnostic reproducibility make LBA-c an option in the diagnosis of pneumonias on artificial ventilation.