[The role of the pulmonologist in an armed conflict]. / Place du pneumologue en situation de conflit armé.

INTRODUCTION: Recent news points to the eventuality of an armed conflict on the national territory. STATE OF THE ART: In this situation, pulmonologists will in all likelihood have a major role to assume in caring for the injured, especially insofar as chest damage is a major cause of patient death. PERSPECTIVES: The main injuries that pulmonologists may be called upon to treat stem not only from explosions, but also from chemical, biological and nuclear hazards. In this article, relevant organizational and pedagogical aspects are addressed. Since exhaustiveness on this subject is unattainable, we are proposing training on specific subjects for interested practitioners. CONCLUSION: The resilience of the French health system in a situation of armed conflict depends on the active participation of all concerned parties. With this in mind, it is of prime importance that the pneumological community be sensitized to the potential predictable severity of war-related injuries.

SEED: An Operational Numerical Tool for Dosimetric Reconstruction in Case of External Radiological Overexposure.

ABSTRACT: In the event of a radiological accident involving external exposure of one or more victims and potential high doses, it is essential to know the dose distribution within the body in order to sort the victims according to the severity of the irradiation and then to take them to the most suitable medical facilities. However, there are currently few techniques that can be rapidly deployed on field and capable of characterizing an irradiation. Therefore, a numerical simulation tool has been designed. It can be implemented by a doctor/physicist pairing, projected within a limited time as close as possible to the irradiation accident and emergency response teams. Called SEED (Simulation of External Exposures & Dosimetry), this tool (dedicated to dose reconstruction in case of external exposure) allows a rapid modeling of the irradiation scene and a visual exchange with the victims and witnesses of the event. The user can navigate in three dimensions in the accident scene thanks to a graphical user interface including a "first person" camera. To validate the performance of the SEED tool, two dosimetric benchmarking exercises were performed. The first consisted in comparing the dose value provided by SEED to that given by a reference calculation code: MCNPX. The purpose of the second validation was to perform an experiment irradiating a physical dummy equipped with dosimeters and to reconstruct this irradiation using SEED. These two validation protocols have shown satisfactory results with mean difference less than 2% and 12% for the first and second exercises, respectively. They confirm that this new tool is able to provide useful information to medical teams in charge of dosimetric triage in case of a major external exposure event.

Deployment of the DosiKit System Under Operational Conditions: Experience From a French Defense National Nuclear Exercise.

Estimation of the dose received by accidentally irradiated victims is based on a tripod: clinical, biological, and physical dosimetry. The DosiKit system is an operational and mobile biodosimetry device allowing the measurement of external irradiation directly on the site of a radiological accident. This tool is based on capillary blood sample and hair follicle collection. The aim is to obtain a whole-body and local-surface dose assessment. This paper is about the technical evaluation of the DosiKit; the analytical process and scientific validation are briefly described. The Toulon exercise scenario was based on a major accident involving the reactor of a nuclear attack submarine. The design of the scenario made it impossible for several players (firefighters, medical team) to leave the area for a long time, and they were potentially exposed to high dose rates. The DosiKit system was fully integrated into a deployable radiological emergency laboratory, and the response to operational needs was very satisfactory.

Complex upper arm reconstruction using an antero-lateral thigh free flap after an extravasation of Yttrium-90-ibritumomab Tiuxetan: A case report and literature review.

Yttrium-90-Ibritumomab Tiuxetan (Zevalin®) is used in the treatment of non- Hodgkin's lymphoma. Extravasation is an iatrogenic complication that is fortunately rare. However, the treatment of this complication is often complex due to the risk of extensive skin necrosis and unpredictable evolution of localized irradiation. This vesicant drug requires emergency management when extravasation occured. Radiations burns have specificities. Therefore, wound coverage involves specific plastic surgical techniques. Here, we report the case of a man presenting a chronic and extensive skin necrosis of upper arm treated with an antero-lateral thigh free flap. Moreover, we compare our experience of Zevalin® extravasation management to other past publications and propose recommendations to prevent this unacceptable complication.

Missions of the French Defense Radiation Protection Service Concerning The Medical Management of Radio-contaminated Patients.

The French Defense Radiation Protection Service (SPRA) is an institution of the French Armed Forces (SSA) that provides technical support in radiation protection matters for French military units. It provides services for the armed forces and when necessary for the national public health system. The aim of this note is to describe the variety of services provided by the SPRA in France and abroad, not only in a military context but also in the broader field of radiation protection.

MRI assessment of local acute radiation syndrome.

OBJECTIVES: To describe local acute radiation syndrome and its radiological imaging characteristics. METHODS: We performed a retrospective study of patients who had suffered skin and deeper radiation damage who were investigated by magnetic resonance imaging (MRI). We compared the clinical findings, C-reactive protein (CRP) levels and MRI results. RESULTS: A total of 22 MRI examinations were performed between 2005 and 2010 in 7 patients; 6 patients had increased CRP levels and MRI abnormalities. They were treated by surgery and local cellular therapy. One patient had no CRP or MRI abnormalities, and had a spontaneous good outcome. Eighteen abnormal MR examinations demonstrated high STIR signal and/or abnormal enhancement in the dermis and muscle tissues. Three MRI examinations demonstrated skeletal abnormalities, consistent with radionecrosis. The four normal MRI examinations were associated only with minor clinical manifestations such as pain and pigmentation disorders. CONCLUSION: MRI seems to be a useful and promising imaging investigation in radiation burns management i.e. initial lesion evaluation, treatment evaluation and complication diagnosis. MRI findings correlated perfectly with clinical stage and no false negative examinations were obtained. In particular, the association between normal MRI and low CRP level seems to be related to good outcome without specific treatment. KEY POINTS: Local acute radiation syndrome (radioepidermitis) mainly affects the skin and superficial tissues. MRI findings correspond with clinical stage (with a strong negative predictive value). MRI outperformed X-ray examination for the diagnosis of bone radionecrosis. Diffusion-weighted imaging shows low ADC in bone and soft tissue necrosis. Perfusion sequence allows assessment of tissue microcirculation impairment.

[Radiation burn "innovating therapeutic approach"]. / Brûlure par irradiation « approche thérapeutique innovante ¼.

Radiation burn is a determinist effect of localized irradiation. The lesion is in good correlation with absorbed dose. Radiation burn is different from thermal burn. The evolution is spatiotemporal unpredictable with successive inflammatory waves and recurrence of necrosis. The conventional surgical treatment is rarely efficient because each surgical operative act seems to stimulate the inflammatory waves and fibro-necrosis process. The lesion can escape to this conventional surgical treatment. The new therapeutic approach combines surgery and cellular therapy with local administration of autologous mesenchymal stem cells. From 5 years, cell therapy have been an adjuvant treatment of surgery. This association is a therapeutic innovation, it's now the recommendation for conservative surgery of this very serious radiation burn.

Diagnosis of internal radionuclide contamination by mobile laboratories.

To support patient management of possible radiation casualties in case of a radiological or a nuclear event, the Defence Radiation Protection Service (SPRA) is able, 24 h a day, to supply intervention means in France and overseas if requested by military authorities or civilian institutions. SPRA has developed mobile laboratories for the diagnosis of internal radionuclide contamination. The mission of this mobile unit is to study health and environment risks linked to radiological hazards for exposed people: workers, soldiers and also civilians. The mobile laboratories are able to be deployed in all types of nuclear or radiological events, and give the results of analysis to physicians and authorities in a short time. The vehicles are fully equipped to detect and to survey exposure to alpha, beta and gamma emitters for the supervision of people exposed to ionising radiation, by whole body counting or analysis of biological samples. Environmental survey by analysis of wipes, soil, water, vegetation or air filters can also be achieved.