Prévenir le feu : la communication et la sensibilisation vers le grand public.

Nous ne le répéterons jamais assez, la mémoire est courte en matière d'incendie de forêt. Même des personnes touchées par les incendies "oublient" de débroussailler leur propriété quelques années après ! De nombreux PV pour usage dangereux du feu ont été dressés en 2003 dans le Var. Cela montre une imprudence notoire de la part de la population inconsciente du risque, et donc l'importance de communiquer de manière permanente sur la question. L'expression "Vivre avec le feu" ne doit pas être synonyme de fatalisme, mais d'une prise de conscience collective du risque feux de forêt

Communiquer après le feu.

International audienc

Comparative pharmacodynamic and pharmacokinetic characteristics of subcutaneous insulin glulisine and insulin aspart prior to a standard meal in obese subjects with type 2 diabetes

Aims: A multinational, randomized, double-blind, two-way crossover trial to compare the pharmacokinetic and pharmacodynamic properties of bolus, subcutaneously administered insulin glulisine (glulisine) and insulin aspart (aspart) in insulin-naÏve, obese subjects with type 2 diabetes

A year in review in Minerva Anestesiologica 2019. Anesthesia, analgesia, and perioperative medicine

Innovations in anesthesia and perioperative pain management have animated the debate the last year

Acute mesenteric ischaemia in refractory shock on veno-arterial extracorporeal membrane oxygenation

Background: Acute mesenteric ischaemia is a severe complication in critically ill patients, but has never been evaluated in patients on veno-arterial extracorporeal membrane oxygenation (V-A ECMO). This study was designed to determine the prevalence of mesenteric ischaemia in patients supported by V-A ECMO and to evaluate its risk factors, as well as to appreciate therapeutic modalities and outcome. Methods: In a retrospective single centre study (January 2013 to January 2017), all consecutive adult patients who underwent V-A ECMO were included, with exclusion of those dying in the first 24 hours. Diagnosis of mesenteric ischaemia was performed using digestive endoscopy, computed tomography scan or first-line laparotomy. Results: One hundred and fifty V-A ECMOs were implanted (65 for post-cardiotomy shock, 85 for acute cardiogenic shock, including 39 patients after refractory cardiac arrest). Overall, median age was 58 (48-69) years and mortality 56%. Acute mesenteric ischaemia was suspected in 38 patients, with a delay of four (2-7) days after ECMO implantation, and confirmed in 14 patients, that is, a prevalence of 9%. Exploratory laparotomy was performed in six out of 14 patients, the others being too unstable to undergo surgery. All patients with mesenteric ischaemia died. Independent risk factors for developing mesenteric ischaemia were renal replacement therapy (odds ratio (OR) 4.5, 95% confidence interval (CI) 1.3-15.7, p=0.02) and onset of a second shock within the first five days (OR 7.8, 95% CI 1.5-41.3, p=0.02). Conversely, early initiation of enteral nutrition was negatively associated with mesenteric ischaemia (OR 0.15, 95% CI 0.03-0.69, p=0.02). Conclusions: Acute mesenteric ischaemia is a relatively frequent but dramatic complication among patients on V-A ECMO

A year in review in Minerva Anestesiologica 2014

Year in revie

Predictors of mortality following emergency open colectomy for ischemic colitis: A single-center experience

Background: Ischemic colitis (IC) is a severe emergency in gastrointestinal surgery. The aim of the present study was to identify the predictors of postoperative mortality after emergent open colectomy for IC treatment. Additionally, we compared postoperative outcomes of patients undergoing emergent colectomy due to aortic surgery-related IC (AS-IC group) vs. other IC etiologies (Other-IC group). Methods: We analyzed records of consecutive patients who underwent emergency open colectomy for IC between 2008 and 2019. Logistic regression analysis was performed to identify clinical and operative parameters associated with postoperative mortality. The AS-IC and Other-IC groups were compared for mortality, morbidity, ICU stay, hospital stay, and survival. Results: During the study period, 94 patients (mean age, 67.4 ± 13.7 years) underwent emergent open colectomy for IC. In the majority of cases, IC involved the entire colon (53.2%) and vasopressor agents were required preoperatively (63.8%) and/or intraoperatively (78.8%). Thirty-four patients underwent surgery due to AS-IC, whereas 60 due to Other-IC causes. In the AS-IC group, 9 patients had undergone endovascular aortic repair and 25 open aortic surgery; 61.8% of patients needed aortic surgery for ruptured abdominal aortic aneurism (AAA). Overall, 66 patients (70.2%) died within 90 days from surgery. The AS-IC and Other-IC groups showed similar operative outcomes and postoperative complication rates. However, the duration of the ICU stay (19 days vs. 11 days; p = 0.003) and of the total hospital stay (22 days vs. 16 days; p = 0.016) was significantly longer for the AS-IC group than for the Other-IC group. The rate of intestinal continuity restoration at 1 year after surgery was higher for the Other-IC group than for the AS-IC group (58.8% vs. 22.2%; p = 0.05). In the multivariate model, preoperative increased lactate levels, a delay between signs/symptoms' onset and surgery > 12 h, and the occurrence of postoperative acute kidney injury were statistically associated with postoperative mortality. Neither IC etiology (aortic surgery vs. other etiology) nor ruptured AAA was associated with postoperative mortality. Conclusion: Emergency open colectomy for IC is associated with high postoperative mortality, which appears to be unrelated to the IC etiology. Preoperative lactate levels, > 12-h delay to surgery, and postoperative acute kidney injury are independent predictors of postoperative mortality

Influence of commercial formulation on leaching of four pesticides through soil

Studies with small soil columns (2 cm i.d. x 5.4 cm depth) compared leaching of four pesticides added either as technical material or as commercial formulations. Pesticides were selected to give a gradient of solubility in water between 7 and 93 mg L-1, comprising azoxystrobin (emulsifiable concentrate, EC, and suspension concentrate, SC), cyproconazole (SC), propyzamide (SC) and triadimenol (EC). Columns of sandy loam soil were leached with 6 pore volumes of 0.01M CaCl2 either 1 or 7 days after treatment. Separate experiments evaluated leaching of triadimenol to full breakthrough following addition of 18 pore volumes of 0.01M CaCl2. The mass of pesticide leached from columns treated with commercial formulation was significantly larger than that from columns treated with technical material for all compounds studied and for both leaching intervals (two-sided t-tests, p<0.001). This difference was conserved when triadimenol was leached to full breakthrough with 79 ± 1.2 and 61 ± 3.1% of applied triadimenol leached from columns treated with formulated and technical material, respectively. There were highly significant effects of formulation for all pesticides (two-way ANOVA, p<0.001), whereas leaching interval was only significant for azoxystrobin EC formulation and cyproconazole (p <0.001 and 0.021, respectively) with greater leaching when irrigation commenced 1 day after treatment. Leaching of azoxystrobin increased in the order technical material (6.0% of applied pesticide) < SC formulation (8.5-9.1% of applied) < EC formulation (15.8-21.0% of applied). The relative difference between leaching of formulated and technical pesticide increased with pesticide solubility in water, increasing from a factor of 1.4 for the SC formulation of azoystrobin to 4.3 for the SC formulation of triadimenol. Experimental systems differ markedly from field conditions (small columns with intense irrigation). Nevertheless, results indicate the need to consider further the influence of co-formulants in pesticide formulations on behaviour of the active ingredient in soil