Postdeployment reintegration attitude of injured Dutch service members: a longitudinal study.

OBJECTIVE: After deployment, service members can experience difficulties reintegrating. Sustaining injuries on the battlefield can disrupt the reintegration period. The first aim was to follow-up the reintegration attitude towards family, work and on a personal level after deployment in Dutch battlefield casualties (BCs). The second was to compare their postdeployment reintegration attitude with that of healthy controls. METHODS: A questionnaire concerning reintegration attitude, the Postdeployment Reintegration Scale (PDRS), was provided to all service members who received rehabilitation after sustaining injuries in Op TASK FORCE URUZGAN. The questionnaire was administered in 27 BCs at a median of 2 years post incident and 5.5 years post incident. At 5.5 years post incident, the PDRS of the BCs was compared with a control group consisting of service members from the same combat units. RESULTS: A significant difference was found for the BCs with an increased negative personal attitude (p=0.02) and a decreased negative attitude towards work (p=0.02) at 5.5 years compared with 2 years post incident. No differences in postdeployment reintegration attitude was observed between the BCs and controls at 5.5 years post incident. CONCLUSIONS: The results showed that for the BCs the personal attitude becomes more negative in time. However, the negative attitude towards work decreases in time after deployment. Particular attention should be paid to traumatic stress and aftercare.

Long-term participation of Dutch service members with combat-related injury.

BACKGROUND: After deployment service members need to adapt to civilian life and return to participation in family, vocational and community life. AIMS: To assess the level of activity and participation of service members with combat-related injury after their rehabilitation intervention and to measure the effect of injury severity, adaptive coping, number of deployments and traumatic stress. METHODS: The physical functioning scale of the 36-Item Short Form Health Survey (SF-36 PF), the Assessment of Life Habits short version (LIFE-H), the Impact of Event Scale (IES-R) and the Cognitive Emotion Regulation Questionnaire (CERQ) were administered to service members who sustained combat-related injury. The Injury Severity Score (ISS) was calculated, and the number of deployments was noted. Correlations were calculated between the LIFE-H and ISS, IES-R, number of deployments and adaptive coping and between the SF-PF and ISS, IES-R, number of deployments and adaptive coping. RESULTS: The response rate was 55% (32 service members). A moderate correlation was found between LIFE-H and IES (r = -0.49) and a very weak correlation was found between LIFE-H and injury severity (r = 0.31). No correlation was found between SF-36 PF and ISS, IES, number of deployments or CERQ and between LIFE-H and number of deployments or CERQ. CONCLUSIONS: A moderate correlation was found between level of participation and traumatic stress in service members with combat-related injury in a 5-year follow-up. Therefore, it is advisable to screen for traumatic stress symptoms and monitor these symptoms during the rehabilitation intervention.

Imaging of cervical artery dissection.

Cervical artery dissection (CAD) may affect the internal carotid and/or the vertebral arteries. CAD is the leading cause of ischemic stroke in patients younger than 45 years. Specific treatment (aspirin or anticoagulants) can be implemented once the diagnosis of CAD has been confirmed. This diagnosis is based on detection of a mural haematoma on ultrasound or on MRI. The diagnosis can be suspected on contrast-enhanced MRA (magnetic resonance angiography) or CT angiography, in case of long stenosis, sparing the internal carotid bulb, or suspended, at the junction of V2 and V3 segments of the vertebral artery, in patients with no signs of atheroma of the cervical arteries. MRI is recommended as the first line imaging screening tool, including a fat suppressed T1 weighted sequence, acquired in the axial or oblique plane at 1.5T, or 3D at 3T. Complete resolution of the lumen abnormality occurred in 80% of cases, and CAD recurrence is rare, encountered in less than 5% of cases. Interventional neuroradiology (angioplasty and/or stenting of the dissected vessel) may be envisaged in rare cases of haemodynamic effects with recurring clinical infarctions in the short-term.

Genetic and non-genetic parameters related to embryo production in superovulated Large White (LW) gilts.

The aim of this study was to identify genetic and non genetic factors which might affect results of embryo production of Large White (LW) cyclic gilts from data collected in one herd during 6 years. Donors (n=1060) were synchronized with a progestogen treatment and luteolysis was induced 13-15 days later by 2 injections of cloprostenol. To stimulate follicular development 800IU eCG was then injected 24h later, followed by 500IU hCG 48h later. Donors were inseminated twice; depending on the onset of oestrus, the interval between hCG treatment and first insemination (hCGAI1) was either 24 or 41 h. Embryos were collected at 5-6 days after the 1st AI by flushing uterine horns. Traits of interest were the number of corpora lutea (CL), the number of flushed embryos (FE), the number of transferable embryos (TE) and the number of unfertilized embryos (UE). The average number of TE was 18.8 ± 9.0. The main sources of variation for CL, FE and TE were the season (P≤0.002) and hCGAI1 (P≤0.001) effects. For the interval of 24h of hCGIA1 the number of TE was increased by 4 compared with the TE obtained for the 41 h interval of hCGIA1. Maternal and paternal genetic effects were estimated using restricted maximum likelihood methodology applied to the univariate animal model, whereas genetic covariance components were estimated in bivariate models. Estimates of maternal heritability were 0.45 for CL, 0.32 for FE, 0.29 for TE and 0.05 for UE whereas for the paternal effect, heritabilities were very low (<0.06). Genetic correlation between CL, FE and TE variables were very high (>0.89) for the maternal effect. A breeding scheme based on CL selection in response to superovulation could thus improve the number of transferable embryos.

A systematic review of job-specific workers' health surveillance activities for fire-fighting, ambulance, police and military personnel.

PURPOSE: Some occupations have tasks and activities that require monitoring safety and health aspects of the job; examples of such occupations are emergency services personnel and military personnel. The two objectives of this systematic review were to describe (1) the existing job-specific workers' health surveillance (WHS) activities and (2) the effectiveness of job-specific WHS interventions with respect to work functioning, for selected jobs. METHODS: The search strategy systematically searched the PubMed, PsycINFO and OSH-update databases. The search strategy consisted of several synonyms of the job titles of interest, combined with synonyms for workers' health surveillance. The methodological quality was checked. RESULTS: At least one study was found for each of the following occupations fire fighters, ambulance personnel, police personnel and military personnel. For the first objective, 24 studies described several job-specific WHS activities aimed at aspects of psychological, 'physical' (energetic, biomechanical and balance), sense-related, environmental exposure or cardiovascular requirements. The seven studies found for the second objective measured different outcomes related to work functioning. The methodological quality of the interventions varied, but with the exception of one study, all scored over 55% of the maximum score. Six studies showed effectiveness on at least some of the defined outcomes. The studies described several job-specific interventions: a trauma resilience training, healthy lifestyle promotion, physical readiness training, respiratory muscle training, endurance and resistance training, a physical exercise programme and comparing vaccines. CONCLUSIONS: Several examples of job-specific WHS activities were found for the four occupations. Compared to studies focusing on physical tasks, a few studies were found that focus on psychological tasks. Effectiveness studies for job-specific WHS interventions were scarce, although their results were promising. We recommend studying job-specific WHS in effectiveness studies.

[Cryopreservation and transfer of pig in vivo embryos: State of the art]. / Cryopréservation et transfert des embryons porcins produits in vivo: état des lieux.

The present review article describes the development of porcine cryopreservation and transfer of embryos and the sanitary regulations related to these technologies. Rapid progress has been made during the last decade in cryopreservation by using vitrification which involves a very rapid cooling rate. Currently, this technology is suitable for morulae and blastocysts and to date, more than 300 piglets are born after surgical transfers of vitrified embryos. Moreover, farrowings are obtained after non-surgical transfers of fresh or vitrified embryos. However, further improvements are required to permit the dissemination of these technologies in the near future. According to the recommendations of the International Embryo Transfer Society (IETS) regarding international transportation, embryos must be washed and cryopreserved with an intact zona pellucida. Transmission by embryo transfer of virus or bacteria to swine has been studied and rather converging results are now published. The risk of disease transmission by the embryo transfer is reduced. The major advantage of these technologies is the possibility to transport and store genetic material whilst reducing the risks of pathogen transmission.

[Efficacy of rituximab in lymphomatoid granulomatosis]. / Efficacité du Rituximab au cours d'une granulomatose lymphomatoïde.

INTRODUCTION: Lymphomatoid Granulomatosis is a rare and serious disease, now considered to be a B-cell lymphoma, which is frequently associated with Epstein-Barr virus infection. There is no consensus on treatment, which is usually based on steroid therapy, either alone or combined with cyclophosphamide and combination chemotherapy. CASE REPORT: We report the case of an asymptomatic patient diagnosed after the incidental discovery of bilateral nodular opacities on their chest x-ray. Physical examination and bronchoscopy were normal. The diagnosis of Lymphomatoid Granulomatosis was made on the basis of surgical lung biopsy. Immunohistochemical studies confirmed the B phenotype of the lymphoma with the identification of atypical large CD 20 positive cells. In situ hybridisation confirmed the presence of EBV. In this case the course of the disease was slow. Treatment with anti CD 20 monoclonal antibodies (rituximab) led initially to a reduction in parenchymal abnormalities and mediastinal adenopathy. CONCLUSION: This treatment, recently used in Lymphomatoid Granulomatosis with pulmonary involvement, has shown promising results. Rituximab can be used in combination chemotherapy as standard treatment for aggressive B-cell lymphoma.

Characterization of the fertility of Kit haplodeficient male mice.

The role of the proto-oncogene Kit expression during gonadal development, then in differentiated spermatogonia has been thoroughly established. The present study was designed to investigate the consequences of a partial defect in Kit gene expression on sperm fertilizing ability, using Kit haplodeficient mice (kitW-lacZ/+). Same inbred mice (kit+/+) were used as controls. Epididymal sperm characteristics and in vivo fertility were assessed, then in vitro-fertilization experiments were carried out for mice of both genotypes. Epididymal sperm count was drastically reduced, and sperm motility was also decreased in kitW-lacZ/+ compared with kit+/+ males. Both in vivo or in vitro fertility were greatly reduced in kitW-lacZ/+ compared with kit+/+ males. By contrast, the fertility of kitW-lacZ/+ females was apparently unaffected. Additionally, a higher number of spermatozoa with undetected acrosomal contents was revealed by fluorescein isothiocyanate-labelled Pisum sativum agglutinin acrosomal staining after epididymal sperm retrieval in kitW-lacZ/+ mice, whereas no difference was observed after induction of acrosomal reaction in mice of either genotype. Ultra-structural data confirmed the higher frequency of abnormal acrosome in spermatozoa of kitW-lacZ/+ mice. Thus, sperm production is impaired in Kit haplodeficient mice both on a quantitative and a qualitative basis. Finally, we show that one single copy of Kit gene is not sufficient to maintain genuine fertility in male mice.

[Pulmonary malacoplakia caused by Rhodococcus equi in AIDS: a case report]. / Malacoplasie pulmonaire à Rhodococcus equi au cours du SIDA: à propos d'un cas.

We describe the observation of a right upper lobe consolidation with cavitation produced by Rhodococcus equi in a patient suffering from AIDS. The inefficacy of a prolonged antimicrobial therapy adapted against R. equi led to a right upper lobectomy. The histopathology showed a pseudotumoral mass, with dense infiltration of macrophages containing Michaelis-Gutmann bodies, which was positive for the culture of R. equi. Pulmonary malacoplakia with Rhodococcus equi was diagnosed. This pathology should be evoked when a R. equi pneumonia persists despite a right management of treatment for several months. The features of pneumonia with Rhodococcus equi and of pulmonary malacoplakia are taken from a literature review.

6-Fluoro-serotonin as a substrate for the neuronal serotonin transporter.

6-Fluoro-serotonin (6F-5-HT) was previously identified in the rat brain after peripheral administration of 6-fluoro-DL-tryptophan, a serotonin (5-HT) synthesis inhibitor. These present studies, performed with rat brain synaptosomes show that: i-neuronal 6F-5-HT uptake partly involved the 5-HT transporter since it was inhibited by clomipramine, a 5-HT uptake inhibitor, ii-6F-5-HT blocked the synaptosomal uptake of 3H-5-HT, with an IC50 value of 98 +/- 13 nM, and iii- 6F-5-HT induced 3H-5-HT release from preloaded synaptosomes, with an EC50 value of 95 +/- 6 nM; this release was decreased in the presence of clomipramine, suggesting the involvement of the 5-HT transporter. This release was also reduced when using synaptosomes from reserpinized rats, suggesting that the vesicular pool also participates to the 3H-5-HT release induced by 6F-5-HT. So, 6F-5-HT behaved as a substrate for the 5-HT neuronal transporter.

Monoclonal antibodies to bis-indole alkaloids of Catharanthus roseus and their use in enzyme-linked immuno-sorbent-assays.

High affinity monoclonal antibodies directed against bis-indole alkaloids from Catharanthus roseus were produced. Once characterized, they were used to develop sensitive enzyme-linked-immuno-sorbent-assays, enabling us to determine minute quantities of alkaloids related to vinblastine in plant material.

[Abdominal ultrasound diagnosis of malignant lymphomas]. / Abdominale Ultraschalldiagnostik bei malignen Lymphomen.

The abdominal clinical staging in malignant lymphomas should be started from sonography. The size of detectable lymph nodes and focal lesions in liver and spleen (to 0.5 cm on favourable conditions of examination) reflects a comparable position of ultrasound, computed tomography and magnetic resonance imaging. The last called method seems to be advantageous only in the pelvic region. Involved lymph nodes in malignant lymphomas on the contrary to metastatic infiltration in carcinomas appear for the most part hypoechoic. The sonographic findings in liver, spleen, pancreas and kidneys infiltrated by lymphomas and other malignant diseases do not differ significantly. The involvement of gastrointestinal tract can be associated with the so called "bull's eye"-, "target"- or "pseudokidney"-sign. The endoscopic sonography could improve the preoperative staging by measuring thickened gastrointestinal wall structures and by detecting infiltrated neighbouring organs. Ultrasound-assisted needle biopsies are useful. However the favourable results reported (sensitivity, positive correlation, concordance-100%) seems to be connected with low number of cases involved. Remarkable proportion of false negative results should be expected. Laparotomy with splenectomy remains the most accurate staging method in Hodgkin's disease and non-Hodgkin's lymphomas.

[The unusually favorable prognosis of multiple primary bronchial carcinoma--the consequence of natural killer cell elevation and increased interleukin 2 receptor expression?]. / Ungewöhnlich günstige Prognose eines multiplen primären Bronchialkarzinoms--Folge von Natural-Killer-Zell-Elevation und vermehrter Interleukin-2-Rezeptor-Expression?

It is reported on a 65-years-old man with the metachronous type of multiple primary bronchogenic carcinoma: initial peripheral adenocarcinoma (RUL) was observed; after 7 years developed left central squamous cell carcinoma; within 5 following years no evidence for relapse. The only remaining sign of malignant disease seems to be the increase of copper-level measured in the patients serum. The elevated quantity of natural-killer-cells (CD 16) and the high-grade Interleukin-2-receptor-expression (CD 25) obtained in our patient are discussed as indicators of pathophysiological processes which could possibly lead to the favourable prognosis of this case.

Non-Hodgkin's lymphomas--prognostic analysis and therapeutic recommendations.

The total non-Hodgkin's lymphoma-population between 1960 and 1985 treated by means of radiotherapy or combined radio-chemotherapy in the Medical Academy Dresden was analysed prognostically. 247 patients were classified according to previous scheme, 79 were subdivided on the basis of the recommendations of the Kiel-classification. The remission rates and survival curves achieved bear comparison with international literature (remission rates for the low-malignancy group = 85.3% and for the high-malignancy group = 80.0%; 5-year survival rates for the low-malignancy group = 61.9% and for the high-malignancy group = 41.7%). The influence of histology, clinical stage and involvement of organs is discussed according to our results and information from appropriate reference sources. Our analysis confirms the high importance of a common radiologic-internal outpatient department for coordination of the diagnostic and therapeutic programme. Principles of treatment are presented with special respect to polychemotherapy.

[Disorders in the contact phase system of blood coagulation as a cause of increased partial thromboplastin time]. / Störungen im Kontaktphasensystem der Blutgerinnung als Ursache einer verlängerten partiellen Thromboplastinzeit.

Deficiency conditions in the contact phase system of the blood coagulation belong to the rare hereditary defects. Clinically, there is as a rule no inclination to haemorrhage but an increased risk of thrombosis. Therefore, the diagnosis is frequently made on the basis of incidental findings within the framework of routine examinations. Indicating sign is a greatly prolonged partial thromboplastin time (PTT) without clinical signs of haemorrhage. 3 patients with factor XII deficiency are presented and the diagnostic method in prolonged PTT is explained.

[Primary extranodular non-Hodgkin's lymphomas--observations on etiopathogenesis, histology and prognosis]. / Primär extranoduläre Non-Hodgkin-Lymphome--Betrachtungen zur Atiopathogenese, Histologie und Prognose.

The total non-Hodgkin's lymphoma-population treated between 1978 and 1986 by means of radiotherapy or combined chemo/radiotherapy was analysed as to primary extranodular manifestation. 39 cases, 16 women and 23 men, were observed (stage IE 12, stage IIE 22 and stage IIIE 5). Immunoblastic (10), lymphoblastic (9) and centroblastic (6) lymphomas are the most frequent with respect to histology. Gastroenteron (16) and otorhinolaryngological region (13) are in the lead with regard to localisation. 5-year-survival-rates are determined in dependence on clinical stage: IE 65.8%, IIE 39.2% (low, connected with the proportion of high-malignant histology) and IIIE 25.0%. The 5-year-survival-rate of primary gastrointestinal manifestation amounted to 51.5%. With respect to aetiopathogenesis of primary extranodular lymphomas gut-, mucosa- and bronchial-associated lymphoid tissue, aberrant lymph-nodes and the influence of viral- and immunologic factors seem to be important.