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.

Using Clinical Signs and Symptoms for Medical Management of Radiation Casualties - 2015 NATO Exercise.

The utility of early-phase (≤5 days) radiation-induced clinical signs and symptoms (e.g., vomiting, diarrhea, erythema and changes in blood cell counts) was examined for the prediction of later occurring acute radiation syndrome (ARS) severity and the development of medical management strategies. Medical treatment protocols for radiation accident victims (METREPOL) was used to grade ARS severities, which were assigned response categories (RCs). Data on individuals (n = 191) with mild (RC1, n = 45), moderate (RC2, n = 19), severe (RC3, n = 20) and fatal (RC4, n = 18) ARS, as well as nonexposed individuals (RC0, n = 89) were generated using either METREPOL (n = 167) or the system for evaluation and archiving of radiation accidents based on case histories (SEARCH) database (n = 24), the latter comprised of real-case descriptions. These data were converted into tables reflecting clinical signs and symptoms, and submitted to eight teams representing five participating countries. The teams were comprised of medical doctors, biologists and pharmacists with subject matter expertise. The tables comprised cumulated clinical data from day 1-3 and day 1-5 postirradiation. While it would have reflected a more realistic scenario to provide the data to the teams over the course of a 3- or 5-day period, the logistics of doing so proved too challenging. In addition, the team members participating in this exercise chose to receive the cumulated reports of day 1-3 and 1-5. The teams were tasked with predicting ARS incidence, ARS severity and the requirement for hospitalization for multiple cases, as well as providing the certainty of their diagnosis. Five of the teams also performed dose estimates. The teams did not employ harmonized methodologies, and the expertise among the members varied, as did the tools used and the means of analyzing the clinical data. The earliest report time was 3 h after the tables were sent to the team members. The majority of cases developing ARS (89.6% ± 3.3 SD) and requiring hospitalization (88.8% ± 4.6 SD) were correctly identified by all teams. Determination of ARS severity was particularly challenging for RC2-3, which was systematically overestimated. However, RC4 was correctly predicted at 94-100% by all teams. RC0 and RC1 ARS severities were more difficult to discriminate. When reported RCs (0-1 and 3-4) were merged, on average 89.6% (±3.3 SD) of all cases could be correctly classified. Comparisons on frequency distributions revealed no statistically significant differences among the following: 1. reported ARS from different teams (P > 0.2); 2. cases generated based on METREPOL or SEARCH (P > 0.5); or 3. results reported at day 3 and 5 postirradiation (P > 0.1). Dose estimates of all teams increased significantly along with ARS severity (P < 0.0001) as well as with dose estimates generated from dicentric chromosomal-aberration measurements available for SEARCH cases (P < 0.0001). In summary, early-phase radiation-induced clinical signs and symptoms proved to be useful for rapid and accurate assessment, with minor limitations, toward predicting life-threatening ARS severity and developing treatment management strategies.

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.

A simple technique to remove well-fixed, all-polyethylene cemented acetabular component in revision hip arthroplasty.

Well-fixed, all-polyethylene acetabular components may have to be removed in cases of recurrent dislocations, infection, or fracture of ceramic femoral heads. We describe a simple technique using acetabular reamers that allow cup thinning. Through this technique, the polyethylene rigidity is diminished considerably, allowing its easy removal without any risk of fracture, particularly of the acetabulum walls.

[A case of ureteral stenosis and ureterorectal fistula secondary to sigmoid diverticulitis]. / Su di un caso di stenosi ureterale e fistola uretero-rettale secondarie a diverticolite del sigma.

The paper reports a case of ureteral [correction of urethral] stenosis with ureterorectal [correction of urethro-rectal] fistula due to diverticulitis of the sigmoid [correction of sigma] which resolved following reconstruction of the urinary tract by ureterocystostomy [correction of urethrocystotomy] using a modified version of Boari's technique, with satisfactory renal functional recovery. On the basis of an analysis of the literature, the authors comment on ureteral [correction of urethral] stenosis and its etiological diagnosis.

[Constipation: drug or surgical treatment?]. / La stipsi: terapia medica o chirurgica?

Constipation is a very frequent symptom. It affects 7-10% of people. Otherwise a severe constipation exists which is rare, but extremely serious with evacuations every 15 days to 2 months. We expose the classification of constipation in its types: colonic, rectal and anal. We analyse the diagnostic trial which has to be started with a careful anamnesis and well directed physical examination. Laboratory tests and instrumental investigations will be essential means to define exactly the type of constipation and its pathogenetic mechanism. We go deep into physical involvement of constipation and into the problem of constipation in the elderly: except for particular groups (women suffering from colonic hypokinetic constipation) the age of patient is usually old. Medical treatment is described especially regarding the type of constipation. At last we review the surgical techniques proposed for every form of constipation, with exposure and interpretation of their results.

The surgical treatment of post-traumatic vertebral deformities.

The authors report their experience in the treatment of malunited fractures of the spine. After eliminating reducible lesions, the methods of treatment used for fixed irreducible lesions are described. In the cervical spine, the approach is anterior, and includes corporectomy to decompress the medullary canal. It is often impossible to restore cervical lordosis but this is not essential. In the dorsal, dorsolumbar and lumbar spines, experience has demonstrated the inadequacy of isolated anterior and posterior surgical approaches, so a combined approach is proposed aimed at achieving good results, both neurological and mechanical. Reconstruction of the vertebral body is carried out by anterior grafting using bank bone from femoral heads, while fixation is achieved posteriorly by the use of Roy-Camille plates. Indications are carefully considered, taking into account that progression is always a possibility in patients with no neurological deficit. The results are analysed in 14 cervical lesions and 10 dorsolumbar lesions. This operative treatment frequently produced stabilisation as well as the regression of pyramidal signs, but recovery of medullary lesions was never observed. The relief of pain, however, was a constant finding.

[Chronic external instability of the ankle. Surgical treatment by a periosteum ligamentoplasty]. / Les laxités externes chroniques de cheville. Cure chirurgicale par une ligamentoplastie au périoste.

The authors have used an original technique of repair for lateral instability of the ankle. The method utilises the fibro-periosteal covering of the lateral malleolus as a strip which is inserted either into the talus only, or into the talus and the calcaneum in cases with severe talar tilt. The advantages of this technique are to preserve the peroneus brevis tendon and to leave sub-talar joint mobility unimpaired. Twenty-three patients have been operated on and reviewed with an average follow-up of 27 months. The results were encouraging.

Transverse fracture of the upper sacrum. Suicidal jumper's fracture.

Thirteen patients with transverse fractures of the upper sacrum were studied to determine fracture anatomy, clinical presentation, and therapeutic approaches. The injury results from falls from a height and is usually associated with suicidal attempts by jumping. The position of the lumbar spine in lordosis or kyphosis at the time of impact determines which of three types of morbid anatomy will result. Because of associated polytrauma, fracture of the upper sacrum is often not recognized in the acute stage, and awareness of the possibility of such injury, especially in the presence of perineal neurologic deficit should result in securing good quality radiographic study, including tomograms. Surgical treatment is often required.

[Primary lymphoma of the breast]. / Il linfoma primitivo della mammella.

Analysis of 5 cases of primary breast lymphoma highlights the marked rarity of the lesion and the extreme difficulty of pre-operative diagnosis. It is also shown that the disease generally runs a rapid course and that prognosis is usually unfavourable. The most effective treatment appears to be a combination of surgery and radiation therapy, while chemotherapy--although widely used--still requires further confirmation.