[The organization of therapeutic care in radiation lesions].
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Biomedical subjects
Publications and source records attributed to A V Barabanova.
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The paper is concerned with analysis of correlation of the time of appearance of vomit in a person and a mean dose rate of prolonged gamma-radiation in the persons affected at the Chernobyl accident. The data were approximated by power function. For irradiation with a constant dose rate (P) such correlation looks like Tp = 2.48p-0.5, where Tp is the time of the beginning of vomit, hours after the beginning of irradiation. A semiempirical model combining different conditions of irradiation was formed. Prognosis of a severity of lesion with relation to the time of vomit was given for different conditions of irradiation.
A high activity of combutec 2, prepared on the basis of soluble collagen, was demonstrated in patients with radiation injuries of the skin after the accident at Chernobyl. Combutec 2 can be recommended for local therapy of patients with skin radiation injuries in all periods of development of these changes.
Out of 115 victims to the breakdown, 56 persons had radiation burns, 17 the intestinal syndrome, 80 the oropharyngeal syndrome, and 7 interstitial radiation pneumonitis. In the lethal outcome, of crucial importance were radiation burns (over 40% of the body surface) (19 persons) and radiation pneumonitis (7 persons). The grave intestinal and oropharyngeal syndromes were accompanied by other fatal manifestations of radiation injuries. Hemoperfusion, plasmapheresis, continuous heparinization and administration of freshly frozen plasma did not bring about any improvement. The local use of different remedies under aseptic conditions was the leading method of the treatment of radiation burns in the acute period. Parenteral feeding turned out to produce a beneficial effect in the treatment of the intestinal and oropharyngeal syndromes.
A follow-up of 115 patients with acute radiation disease resulting from external gamma-beta-radiation confirmed a high value of the previously proposed principles of predicting a degree of severity on the basis of the clinical manifestations of a primary reaction of disease and some syndromes using methods of hematological and cytogenetic analysis. Early isolation of patients with ARD of II-IV degree, selective intestinal decontamination, administration of antibiotics of a broad spectrum of action, antimycotic and antiviral drugs, and gamma-globulin can practically eliminate the risk of development of fatal infectious complications in medullary and transient types of radiation disease. The efficient use of thrombomass transfusion completely prevents development of the thrombocytopenic hemorrhagic syndrome. Experience in bone marrow transplantation requires a review of therapeutic indications.
Observation made over 115 patients with acute radiation sickness due to exposure to external gamma- and beta-rays confirmed high efficiency of the earlier proposed principles of prognostication of the degree of severity by clinical manifestations of the primary disease response and those of separate syndromes, using the methods of hematological and cytogenetic analyses. Out of 115 victims, 56 persons had radiation burns (RB), 17--intestinal syndrome (IS), 80--oropharyngeal syndrome (ORS), 7--interstitial radiation pneumonitis (IRP). In thanatogenesis, of prime importance were: RB (more than 40% of the body surface)--19 persons and IRP--7 persons. A severe course of intestinal and oropharyngeal syndromes was combined with other fatal manifestations of radiation injury. Early isolation of patients (II-IV stages), selective decontamination of the intestine, prescription of a wide spectrum antibiotics, antimycotic and antiviral drugs, as well as gamma-globulin could practically remove the risk of the development of fatal infectious complications during a medullary and transitory forms of radiation sickness.
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The function of the respiratory organs using the results of ventilation, gas exchange and roentgenopneumopolygraphy, was analysed in 98 Hodgkin's disease patients in a state of a prolonged remission (5-12 yrs.) after radiation therapy of the mediastinum. Pulmonary ventilation disorders were revealed in 43.9% of the patients. The degree of ventilation disorders depended on the degree of expression of radiation fibrosis in the paramediastinal regions of the lungs. Usually there were no clinical signs of the revealed changes.
The cardiovascular system was analysed in 157 patients with Hodgkin's disease in a prolonged remission after radiation therapy including irradiation of the mediastinum. The revealed myocardial changes were equally often noted in different irradiation volumes of the heart within the range of 31 to 45 Gy. The number of changes was growing with time. Functional disorders of the pulmonary, hepatic and capillary vessels were also revealed.
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