Catastrophes Liées À Une Explosion De Camionciterne Entre 2000 Et 2020. Deux Groupes Distincts.

Incidents involving tanker trucks regularly appear in the media. The one in Morogoro (Tanzania) on August 10th 2019 (killing at least 89) attracted our attention. We reviewed medical literature (sparse) and media reports to identify and analyse these incidents. In high income countries isolated accidents may be responsible for a few deaths. In low income countries "double" accidents can occur. A commonplace incident occurs which frequently has no victim. When the incident involves a petrol leak, people gather to scoop up the fuel. A spark ignites the petrol and the ensuing engulfing fire is in itself deadly. Frequently, it triggers a tanker BLEVE, which is responsible for a disaster. Preventing these casualties should include avoiding the initial incident, and also (and above all) discouraging the locals from scooping up fuel they can use or possibly sell in order to survive.

[Hospitalisations Related To Burns In France. Analyses Of 2019's National Data Base]. / Hospitalisations Pour Brûlure En France. Données 2019 Extraites De La Base PMSI Nationale.

Thanks to the Medical Information Service of our institution, we obtained the data on burns during 2019, saved in the national database. We found 10,913 reports, among them 10,347 metropolitan and 566 overseas. When compared to the French population on January 1st 2020, the incidences were 16 (global population); 15.7 (metropolitan) and 27.1 (overseas)/100,000 inhabitants respectively. The majority (62.95%) of the patients were taken care of in Burn Centres (BCs). However, 4,043 patients were never seen by a burn specialist. Nevertheless 88.54% of skin grafts were performed in BCs and 71.86% of the burns with high seriousness (levels 3 and 4) were in BCs. One hundred and seventy-nine patients (1.64%) died. For the first time, we obtained the intensive care activity, through the scoring actions. Intensive care was held for 958 patients (8.96%), 90.81% of them in a BC. Only 28.57% were associated with major (>30% BSA) burns, but these major burns accounted for 63.78% of the organ failure treatments.

Catastrophes et brûlologie.

Traumatology is an old specialty, and most knowledge about it was developed during wars. On the other hand, burn care is much more recent and knowledge has been acquired in particular from civilian disaster casualties. This paper aims to describe some of the disasters that led to progress in burn care.

Digital antimicrobial susceptibility testing using the MilliDrop technology.

We present the MilliDrop Analyzer (MDA), a droplet-based millifluidic system for digital antimicrobial susceptibility testing (D-AST), which enables us to determine minimum inhibitory concentrations (MICs) precisely and accurately. The MilliDrop technology was validated by using resazurin for fluorescence readout, for comparison with standard methodology, and for conducting reproducibility studies. In this first assessment, the susceptibility of a reference Gram-negative strain Escherichia coli ATCC 25922 to gentamicin, chloramphenicol, and nalidixic acid were tested by the MDA, VITEK®2, and broth microdilution as a reference standard. We measured the susceptibility of clinically relevant Gram-positive strains of Staphylococcus aureus to vancomycin, including vancomycin-intermediate S. aureus (VISA), heterogeneous vancomycin-intermediate S. aureus (hVISA), and vancomycin-susceptible S. aureus (VSSA) strains. The MDA provided results which were much more accurate than those of VITEK®2 and standard broth microdilution. The enhanced accuracy enabled us to reliably discriminate between VSSA and hVISA strains.

Operative care and surveillance in severe trauma patients. Interference between resuscitation treatments and anaesthesiology, and consequence on immunity.

Major trauma remains a worldwide cause of morbi-mortality. Early mortality is the consequence of hemorrhagic shock and traumatic brain injury. During early resuscitation, anaesthesia is often mandatory to perform surgery. It is mandatory to master the hemodynamic effects of hypnotic drugs in order to anticipate their potential deleterious effects in the setting of hemorrhagic shock. After early resuscitation, trauma patients present a high prevalence of nosocomial pneumonia, which sustains major morbidity. Nosocomial pneumonia are the consequence of an overwhelming systemic inflammatory response syndrome (SIRS) as well as a trauma-related immunosuppression. The administration of hemisuccinate of hydrocortisone modulates the SIRS and reduces the risk of nosocomial pneumonia as well as the length of mechanical ventilation. Finally in the operating theatre, fighting against hypothermia and un-anatomical positions, which can aggravate rhabdomyolysis, are both mandatory.

High-flow priapism in children: immediate treatment by selective embolization.

We present a case of a high-flow priapism related to a posttraumatic aneurysm in a ten-year-old boy treated by selective embolization. Patient history and thorough physical examination often lead to the diagnosis of high-flow priapism. Colour-coded duplex ultrasonography confirms the diagnosis, and treatment consists of angiographic embolization.

[Correlation of genitourinary abnormalities, spermiogram and CFTR genotype in patients with bilateral agenesis of the vas deferens]. / Corrélation entre anomalies génito-urinaires, spermogramme et génotype CFTR chez les patients atteints d'une agénésie bilatérale des canaux déférents.

OBJECTIVES: To evaluate the frequency of urogenital ultrasound and spermatic abnormalities in patients with bilateral vas deferens agenesis according to the presence or absence of CFTR gene mutation. METHODS: In 41 patients with bilateral vas deferens agenesis confirmed by surgical exploration between 1988 and 1997, renal and seminal vesicle anomalies were investigated by ultrasonography. Spermatic parameters (pH, fructose and ejaculate volume) were also studied, together with sweat chloride assay and PCR of mutations on exons 3, 4, 7, 9, 10, 11, 13, 14b, 17b, 19, 20 and 21 of the CFTR gene. RESULTS: None of the 8 patients with a renal anomaly presented a CFTR gene mutation, versus 23 out of 33 patients without a renal anomaly (p < 0.02). Seminal vesical anomalies were not more frequent in patients with or without mutations (11/20 versus 13/19, p = NS), except for composite heterozygous patients (with 2 mutations: 8/13 versus 4/11, p = NS). Spermatic parameters (pH < 7.2, fructose < 1 g/l and volume < 2 ml) could not distinguish between patients with or without renal or seminal vesical anomalies or mutation, except for patients with pH < 7.2, who presented fewer renal anomalies (2/25 versus 6/16, p < 0.05) and a higher incidence of gene mutation (19/25 versus 5/12, p < 0.01). CONCLUSION: Renal agenesis is considered to be pathognomonic of a developmental anomaly. Unlike a seminal vesical anomaly, a semen volume < 2 ml or fructose < 1 g/l, pH less than 7.2 is a nonspecific parameter, but more frequently present in patients with CFTR mutation.

Correlation between genito-urinary anomalies, semen analysis and CFTR genotype in patients with congenital bilateral absence of the vas deferens.

OBJECTIVE: To evaluate the incidence of renal and seminal vesicle (SV) abnormalities, and the presence or absence of CFTR gene mutations, in a cohort of patients referred for congenital bilateral absence of the vas deferens (CBAVD). PATIENTS AND METHOD: Forty-one patients with CBAVD, confirmed by surgical exploration, were evaluated by ultrasonography for renal and SV anomalies. Semen variables (pH, fructose level and ejaculate volume), sweat chloride levels and mutations of the 3, 4, 7, 9, 10, 11, 13, 14b, 17b, 19, 20 and 21 exons of the CFTR gene were determined. RESULT: In eight patients with renal anomalies there were no detectable mutations of CFTR, compared with 23 in the 33 patients with no renal anomalies (P < 0.02). SV anomalies were not related to the presence or absence of mutations (11 of 23 vs 11 of 18), or in compound heterozygote patients carrying two mutations (eight of 13 vs three of 10). Semen variables (pH < 7.2, fructose < 1 g/L and ejaculate volume < 2 mL) did not differentiate patients with or without anomalies of the kidney, SV or with mutations, except in patients with a pH < 7.2 for which renal anomalies were less frequent (two of 25 vs six of 16, P < 0.05) and mutations more frequent (19 of 25 vs five of 12, P < 0.01). CONCLUSION: Renal anomalies associated with CBAVD should be considered as supporting maldevelopment as a cause, but analysis of CFTR mutations in these cases should not be omitted. Unlike anomalies of the SV, a low ejaculate volume or low fructose level, a semen pH of < 7.2 is the only nonspecific variable in patients with CFTR mutations.