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Delacour H.,Federation de Biologie Clinique | Dorandeu F.,Institute Of Recherche Biomedicale Des Armees
Reanimation | Year: 2014

Chemical warfare agents represent an ever-lasting threat, not only for military forces but also for civilian populations as illustrated by the recent events in Syria. Nerve agents such as those used by Iraq during the Iran/Iraq war or by the Aum Shinri Kyo sect in Japan are among the deadliest of those non-conventional weapons. Their effects are mainly due to their ability to inhibit cholinesterases throughout the body. After a short review of the main characteristics of nerve agents and of the pathophysiology and clinical presentation of acute nerve agent poisoning, the general principles of clinical management will be reviewed. © 2014 Société de réanimation de langue française (SRLF) and Springer-Verlag France.

Martinaud C.,Federation de Biologie Clinique | Ausset S.,Hopital dinstruction des armees Percy | Deshayes A.V.,Sanguine | Cauet A.,Hopital dinstruction des armees Percy | And 2 more authors.
Journal of Trauma - Injury, Infection and Critical Care | Year: 2011

Background: Modern warfare causes severe injuries, and despite rapid transportation to theater regional trauma centers, casualties frequently arrive coagulopathic and in shock. Massive hemorrhage management includes transfusion of red blood cells and plasma in a 1:1 ratio. Fresh frozen plasma requires thawing and badly fits the emergency criteria. Since 1994, the French Military Blood Bank has been producing freeze-dried plasma (FDP) and providing it for overseas operation. The aim of our study was to evaluate the use of FDP in war settings and to assess its clinical efficiency and safety. PATIENTS: We performed a prospective study of the FDP delivered at the International Security Assistance Force Role 3 Military Medical Treatment Facility in the Kabul Afghanistan International Airport between February 2010 and February 2011. We included every patient who received at least one unit of FDP. Basic clinical data were recorded at admission. Transfusion requirements were monitored. Biological testing were performed before and after administration of FDP including hemoglobin concentration, platelets count, fibrinogen level, prothrombin time (PT), and thromboelastography. Result: Eighty-seven casualties received FDP during 93 episodes of transfusion. On average, 3.5 FDP units were transfused per episodes of transfusion. Of the 87 patients studied, 7 died because of nonsurvivable injuries and outcomes were unavailable for 11. The other 59 patients survived. PT significantly declined by an average of 3.3 seconds after FDP transfusion. This moderate decrease in PT reflects continued bleeding and resuscitation. It nevertheless suggests improvement in hemostasis before surgical control of bleeding. All FDP users reported ease of use, clinically observed efficacy equivalent to fresh frozen plasma and the absence of adverse effects associated with FDP. CONCLUSION: Our results provide evidence of the effectiveness of FDP for the prevention or correction of coagulopathy and hemorrhage in combat casualties.Copyright © 2011 by Lippincott Williams & Wilkins.

Mayet A.,Center Depidemiologie Et Of Sante Publique Des Armees | Haus-Cheymol R.,Center Depidemiologie Et Of Sante Publique Des Armees | Bouaiti E.A.,Center Depidemiologie Et Of Sante Publique Des Armees | Decam C.,Institute Of Medecine Tropicale | And 6 more authors.
Eurosurveillance | Year: 2012

French military personnel are subject to a compulsory vaccination schedule. The aim of this study was to describe vaccine adverse events (VAE) reported from 2002 to 2010 in armed forces. VAE are routinely surveyed by the military Centre for epidemiology and public health. For each case, military practitioners fill a notification form, providing patient characteristics, clinical information and vaccines administered. For this study, VAE following influenza A(H1N1)pdm09 vaccination were excluded. Among the 473 cases retained, 442 (93%) corresponded to non-severe VAE, including local, regional and systemic events, while 31 corresponded to severe VAE, with two leading to significant disability. The global VAE reporting rate (RR) was 14.0 per 100,000 injections. While stationary from 2002 to 2008, the RR increased from 2009. The most important observations were a marked increase of VAE attributed to Bacillus Calmette-Guérin (BCG) vaccine from 2005 to 2008, a high RR observed with the inactivated diphtheria-tetanus (toxoids)-poliovirus vaccine combined with acellular pertussis vaccine (dTap-IPV) from 2008 and an increase in RR for seasonal influenza vaccine VAE in 2009. Our RR for severe VAE (1.1 VAE per 100,000) appears comparable with rates observed among United States civilians and military personnel. The increase observed from 2009 could be partly explained by the influenza A(H1N1)pdm09 pandemic which increased practitioner awareness towards VAE. In conclusion, the tolerance of the vaccines used in French armed forces appears acceptable.

Martinaud C.,Federation de Biologie Clinique | Chastagnet N.,Sanguine | Sailliol A.,Sanguine | De Jaureguiberry J.-P.,Service DOncologie Hematologie | Aguilon P.,Sanguine
Transfusion Clinique et Biologique | Year: 2012

Purpose of the study: Platelet transfusion follows the national guidelines published in 2003 by the AFSSAPS, determining, for instance, indications, transfusion threshold and platelets dose. We wanted to assess how these guidelines are routinely used in our hospital, with a special focus on transfusion threshold and delivered dose. Material and methods: We conducted a prospective study during 11 months on every platelet transfusion. Our establishment is a medium size structure, devoted to emergency and oncology, without bone marrow transplantation. During this period, 235 products were delivered to 105 patients. Half (52%) were delivered to oncological units, a third to emergency units and the remaining to medical and surgical units. Results: The average dose was 4.3±0.8×10 11 platelets (2.0 to 7.6×10 11 platelets), corresponding to 0.45×10 11 platelets per 7kg. During prophylactic transfusions, the average platelet count was 9.4±5.5G/L ; during curative transfusions (43%), it was 39.0±47.8G/L and finally when platelets were infused during surgery (21%), the average platelet count was 57.8±61.4G/L. Conclusion: Globally, with regard to transfusion threshold, guidelines were followed in 71%, and 93% in oncological units. Transfusion efficacy, attested by post-transfusion platelet efficiency was above 20% in 59% of the cases. These data highlight a good respect of the transfusion thresholds in the usual platelets-consuming units, but raise the question of the dose, often under those proposed by the guidelines. © 2011 Elsevier Masson SAS.

Flateau C.,Service des Maladies Infectieuses et Tropicales | Asfalou I.,Service de cardiologie | Deman A.-L.,Service de cardiologie | Ficko C.,Service des Maladies Infectieuses et Tropicales | And 5 more authors.
Infection | Year: 2013

We report the case of a patient who presented with a thrombus of the aortic arch complicated with splenic, renal and peroneal artery embolisms, associated with transient lupus anticoagulant, during a Mycoplasma pneumoniae infection. The outcome was good under antibiotic and anticoagulant treatment. We also review the medical literature on M. pneumoniae-related thromboses. © 2013 Springer-Verlag Berlin Heidelberg.

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