An unusual cause of spontaneous bleeding in the intensive care unit – mastocytosis: a case report

We report the case of a 39-year old male patient who presented with anaphylactoid shock and diffuse bleeding with prolonged activated partial thromboplastin time at the emergency room. The diagnosis of aggressive mastocytosis was suspected and then confirmed by raised tryptase level and mastocytic infiltration of the bone marrow. The outcome was favorable with supportive measures, antihistamine drugs, and imatinib mesylate

The pretext of foresight to debate on irrigation groundwater management: lessons from six cases studies in France

International audienceThe transcription of the 2000’s European Water Framework Directive in France has led to define maximum volumes that can be abstracted in water bodies. In many French contexts, it requires reducing more or less drastically current water consumption, especially in agriculture where farmers were granted permits by the water policy authority, regardless the real level of water availability. To do so, French water law imposes, where water bodies are structurally in water scarcity, to create irrigation associations charged to share available water between farmers. And the challenge is particularly high in the groundwater case, where farmers are not embedded in collective irrigation schemes. Sharing rules have then to be designed from the ground up.This communication presents and critics the way that innovative management instruments were explored in six cases’ studies representative of the diversity of agricultural products and hydrogeological situations. These instruments were debated during 18 foresight workshops held with institutional representatives (50) and farmers (87). Foresight workshops had the advantages to make credible institutional and resource changes, and to retrieve from current but side-debates. In five cases, researchers took the lead of these workshops, and in the last one it was directly carried by a stakeholder (an Agriculture Chamber), which allows to test the transferability of such a method in real context with a direct implementing goal.Lessons are drawn at several levels. Firstly, debating on contrasted scenarios is a robust way to facilitate discussions on something not implemented yet in France. Secondly, the context highly matters, in particular the perception of the reality of groundwater scarcitylevel. Thirdly, to debate on groundwater management tools has to be firstly embedded in a more general discussion, on the future of agriculture or at least on more broadly water challenges (like in terms of quantity and quality)