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Introduction. With increasing herd sizes and decreasing workforce availability, precision livestock farming (PLF) is being developed in the dairy sector to facilitate herd monitoring. A desire to reduce the drudgery of repetitive tasks is another factor contributing to the adoption of PLF. This study, based on a review of the scientific literature, focuses on the impact of PLF on the profession and work organization of dairy farmers. Literature. Time savings are observed because robots and sensors take on recurrent physical tasks (milking, feeding) while simplifying the monitoring of animals (heat, health problems, etc.). Farmers appreciate the additional flexibility in organizing their work. The information provided can reduce the mental workload due to the anticipation of events (insemination, health problems). However, the mental workload can sometimes be increased due to the complexity of the information involved in managing the multiple alarms or alerts and equipment failures. The relationship between farmers and their animals is also modified. Conclusions. Precision livestock farming can have a positive impact on dairy farmers' work and can be attractive for young people. However, if the tools are not adapted to farmers' needs and skills, PLF can also lead to negative impacts on farmers and animals. It is therefore critical to consider the different dimensions of farmers' work to facilitate their adoption of these new technologies.

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Human toxocarosis is a helminthozoonosis due to the migration of toxocara species larvae throughout the human body. Lung manifestations vary and range from asymptomatic infection to severe disease. Dry cough and chest discomfort are the most common respiratory symptoms. Clinical manifestations include a transient form of Loeffler's syndrome or an eosinophilic pneumonia. We report a case of bilateral pneumonia in an 80 year old caucasian man who developed very rapidly an acute respiratory distress syndrome, with a PaO2/FiO2 ratio of 55, requiring mechanical ventilation and adrenergic support. There was an increased eosinophilia in both blood and bronchoalveolar lavage fluid. Positive toxocara serology and the clinical picture confirmed the diagnosis of the "visceral larva migrans" syndrome. Intravenous corticosteroid therapy produced a rapid rise in PaO2/FiO2 before the administration of specific treatment. A few cases of acute pneumonia requiring mechanical ventilation due to toxocara have been published but this is, to our knowledge, is the first reported case of ARDS with multi-organ failure., (Copyright 2010 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Nosocomial pneumonia occurs in 0.5 to 1.5% of all hospitalized patients and in 10 to 30% of those under artificial ventilation. The main causal agents are Staphylococcus aureus and resistant Gram-negative bacilli, particularly Pseudomonas aeruginosa. In case of early onset (before the fifth day), Haemophilus influenzae, Streptococcus pneumoniae and susceptible enterobacteria predominate. These infections are associated with overmortality, particularly in patients with P. aeruginosa pneumonia, severe respiratory failure, shock syndrome or given a poorly adapted antibiotic regimen. Management of patients with nosocomial pneumonia depends on the clinical presentation and prior bacteriology data often leading to empiric antibiotic prescription. Published guidelines, for example those recommended by the American Thoracic Society, can also be used to adapt the antibiotic therapy as a function of the severity of the clinical situation, the patient's comorbidities, and the date of onset. This type of strategy remains to be evaluated. It would be advisable to base therapeutic management on reliable microbiological data allowing selection of patients requiring antibiotics and treatment based on culture results. Currently a two-drug regimen is recommended for nosocomial pneumonia due to P. aeruginosa or particularly resistant strains.

AN UNRESOLVED ISSUE: Inappropriate duration of antibiotic treatment is one of the factors explaining the high mortality of nosocomial pneumonia. There are however few data on the ideal duration of treatment. An improvement in the radiological image is not a good criterion. The right duration would be one that is necessary and sufficient to achieve cure and avoid recurrence and relapse and also one that avoids the drawbacks of prolonged treatment. LIMITATIONS OF CLINICAL CRITERIA: High-grade fever, an alveolar image on the chest x-ray, and a high white cell count are synonymous with bacterial pneumonia in only 40 to 60% of the cases. PRIMARY AND SECONDARY INFECTION: Using reliable microbiological methodology is has been possible to demonstrate that the causal germs of primary infections disappear by day 3 of an adapted treatment but that early secondary infection occurs in 14% of the cases. PROSPECTS FOR PROGRESS: An open multicentric randomized study is being conducted in France to compare 7 day versus 14 day treatment against identified germs (irrespective of the strain isolated) using reliable microbial sampling techniques.

Nosocomial pneumonia remains a serious complication which occurs in patients who are artificially ventilated; as neither frequency nor important sequelae have altered recently inspite of the progress which has been achieved both with diagnosis and treatment. Preventative measures ought to be developed and realistically assessed before their introduction. Today it is indispensable to measure the impact of these measures, whether they have been previously or recently proposed by therapeutic trials. The current techniques proposed to prevent the appearance of nosocomial pneumonia are integrated in the usual conventional group of measures in the struggle against nosocomial infection which rests predominantly on standard approaches to hospital hygiene. These may be more specifically directed at good practical measures for the care of the ventilated patient. Regular toilet to the digestive and respiratory pathway, care of the ventilator material, absence of the changing of ventilation tubing during the stay. A certain number of measures are specifically suggested to prevent pneumonias: they have been imperfectly evaluated in clinical practice and remain controversial. Thus selective decontamination of the digestive system has not been dealt with her but also the sitting position, the utilisation of turning or oscillating beds, the continuous aspiration of oropharyngeal secretions or the use of Sucralfate as a means of prevention stress ulcers. Today, and until a complete evaluation of different techniques, the prevention of acquired pneumopathy during artificial ventilation rests above all on extremely simple measures; these cost little and are essentially meticulous care of the upper respiratory and digestive apparatus, to tracheal aspiration and physiotherapy which assure effective drainage and secretions, the use of the semi-sitting position, a well positioned gastric tube, in other words, basic care of the ventilated patient of a very good quality.

Nosocomial pneumonia is associated with substantial morbidity and mortality. Patients treated with mechanical ventilation have the highest risk for developing this intensive care unit acquired infection. Gram-negative bacilli are the predominant organisms responsible for pneumonia in this setting. However, Staphylococcus aureus has recently emerged as a significant isolate. Nosocomial pneumonia is difficult to diagnose clinically in ventilated patients because fever, lung infiltrate on chest X-ray, leukocytosis are frequent in severely ill patients under mechanical ventilation whatever lung infection is present or not and because lower respiratory tract of such patients is colonized by potentially pathogenic bacteria independently of the presence of true lung infection; thus, different diagnostic strategies are proposed. Our personal bias is that using bronchoscopic techniques to obtain bronchoalveolar lavage and protected-brush specimens permits us to devise a therapeutic strategy that is superior to one based only on clinical evaluation. Measures for prevention of nosocomial infection are essential to decrease the incidence of nosocomial pneumonia and the emergence of multiresistant pathogens.

The role of the great arteries is to distribute and stock blood. Pulsatile discontinuous flow is transformed to a continuous flow system. The elastic properties of the aorta play a major role in these functions. It is generally agreed that changes in these elastic properties may lead to the development of left ventricular hypertrophy. The evaluation of the aorta has, until recently, depended on invasive hemodynamic and angiographic techniques. In addition, the measurement of pulse wave velocity, though useful, is a global and only an approximate method. Transoesophageal echocardiography (TEE) enables accurate measurement of the aortic diameter and its systolo-diastolic variations. The accuracy of these measurements has been validated in vitro and the reproducibility is much better than with previously used techniques. Previous studies have shown an improvement of the elastic properties of the great arteries with nitrate derivatives. In recent studies using TEE, isosorbide dinitrate caused dilatation of the descending thoracic aorta and thereby improved its elastic properties. The development of tonometry techniques in our department has resulted in the finding of excellent correlations between carotid and aortic pulse pressures measured non-invasively. The association of TEE and tonometry thereby provides a direct approach to the evaluation of aortic compliance. It has then become possible to study the effects of nitrate derivatives on the aortic compliance of elderly patients in whom it is the most reduced.