Case Report: Medical Treatment and 4 Years Follow-up of Five Exposed Persons with 192Ir Radiation Accident
|Keywords||192Ir Excess radiation Radiation-induced skin damage Medical treatment Medical follow-up|
The purpose of technical preparations for nuclear accident emergency medical treatment provided through together 192Ir radiation accident in five cases according to the medical treatment and the system medical follow-up period of 4 years, to accumulate data for the study of the after-effects of ionizing radiation far. Method 1. Clinical observation: including history taking and physical examination. Focus on observation radiosensitive tissues of the hematopoietic system, skin, eye lens, thyroid, gonads. Dose estimates: the use of peripheral blood lymphocyte chromosome aberration analysis estimating biological dose; estimate the physical dose is calculated through the field of simulation and physical. Radiation Genetics indicators of follow-up: including peripheral blood lymphocytes analysis of chromosomal aberrations in conventional G-banding analysis and micronucleus. 4. Immune function tests: measured by radioimmunoassay immunoglobulin (IgA, IgG, IgM) and complement levels evaluate humoral immune function; measured by flow cytometry total T cells (CD3), T auxiliary cells (CD4) The suppressor T cells (CD8), the proportion of B cells and natural killer cells (NK) to evaluate the cellular immune function. 5 endocrine indicators Determination: RIA technology determination of serum triiodo thyronine (T3) and thyroxine (T4), thyroid-stimulating hormone (TSH), testosterone (Tes), follicle-stimulating hormone (FSH) and corpus luteum generate hormone (LH) and other hormone levels. 6. Detection of radicals indicators: use of superoxide dismutase (SOD) detection kit plasma SOD inhibition rate, the evaluation of the activity of SOD. Detection of gene expression levels: application of real-time fluorescence reverse transcriptase polymerase chain reaction (RT-PCR) and quantitative analysis of the accident in exposed peripheral blood lymphocytes of nm23-H1 the GADD45 gene mRNA expression, compared with normal control . Psychological assessment: the Minnesota Multiphasic Personality quiz, and Eysenck emotional stability QUIZ evaluation according psychological characteristics. Results 1. Physical dose estimates: the ZXW systemic 0.19 to 0.26 Gy, his right hand that 5.1 ~ 7.7 Gy, the right hand hypothenar of 5 ~~ 7.5 Gy, the left hand hypothenar of 5 ~~ 7.5 Gy, left fingers 40 to 60 mGy; CJ systemic 0.18 ~ 0.25 Gy, his right hand that 2.5 ~ 5.1 Gy, left hand 0.9 ~~ 1.7 Gy; LEJ body 0.18 to 0.25 Gy, the right-hand finger of 2.6 ~~ ??5.2 Gy, left fingers 40 to 60 mGy; ZJT body 0.12 ~~ 0.34 mGy; ZSQ: due source skin distance longer, according to a short time, the radiation dose is very low, not physical dose estimates. Biological dose estimates the results: ZXW systemic 0.25 (0.083 to 0.37) Gy; CJ systemic 0.29 (0.11 ~ 0.42) Gy; LEJ body 0.20 (0.033 ~~ 0.32) Gy; ZSQ systemic 0.17 (0.045 ~~ 0.28) Gy; ZJT: lymphocyte chromosome aberration analysis and micronucleus assay were normal, and can not estimate the biological dose. Exposed combination of the subject according to history, clinical manifestations and dose estimates results in systemic radioactive damage, 4 the ZXW, CJ, LEJ, ZSQ diagnosis for 192Ir overdose outside irradiation; localized radioactive damage, diagnosis for acute radiation skin damage Ⅲ degrees of: ZXW right thumb and right index finger III degree, the right hand Hypothenar Ⅲ degree, left hand hypothenar Ⅲ degree facial I; LEJ degrees of right index finger II, the right thumb III degrees; CJ left hand palm Ⅱ degree, right-handed full palm Ⅱ degree. The initial processing of Medicine, of the ZXW, CJ, LEJ 3 patients take the hand skin the topical Vitamin B12 solution and protection measures, the the blisters scope of the ZXW right index finger distal, high tension, acupressure reaction () to blisters puncture for pumping liquid; systemic adopt comprehensive regulation of the immune TCM treatment measures. ZJT work unit changes after the accident, ZSQ retired, lost to the initial visit. The four-year follow-up, found the ZXW CJ lower limbs, numbness. The ZXW right index finger and hypothenar acute radiation-induced skin damage Ⅲ degree persistent chronic radiation skin damage Ⅱ degree, the right thumb acute radiation-induced skin loss Ⅲ degree and facial loss loss I degree of acute radiation-induced skin injury fully restored; LEJ right index finger of acute radiation-induced skin injury Ⅱ degree of development of chronic radiation skin damage Ⅰ degree right thumb Ⅲ degree of acute radiation skin loss injuries fully recover, after three years found that both legs below the knee 5cm × 3cm pigmentation exposed; CJ left hand and right hand palm acute radiation-induced skin injury Ⅱ degree fully restored. 5. Radiation genetics indicators: early, ZXW, CJ, LEJ 3 exposed peripheral blood lymphocyte chromosome aberration rate increased micronucleus rate is normal, after 2 years of exposure chromosome aberration rate returned to normal. Four years after the exposed peripheral blood lymphocyte chromosome G-banding karyotype analysis were normal. Immune function, endocrine hormone levels and plasma SOD activity: exposed ZXW, ZSQ 2 proportion of lymphocyte subsets disorders, four years after the exposed mildly abnormal cellular immune function ZXW, CJ, LEJ 3; 4 not found during exposed by serum immunoglobulin and thyroid dysfunction; 4 years after the accident ZXW, CJ, LEJ 3 with the control group no significant difference in plasma SOD activity. 7 real-time quantitative RT-PCR method determination of the ZXW four years, CJ, LEJ people exposed peripheral blood lymphocytes GADD45 and nm23-H1 gene mRNA compared to healthy people, the relative expression levels of difference not statistically significant (p gt; 0.05). After the accident 5 per capita certain degree of tension, anxiety, improved significantly after psychological counseling. 4 years ZXW, CJ, LEJ 3 exposed were the Minnesota Multiphasic Personality Test, and Eysenck emotional stability tests, suggesting that CJ still anxiety, tension, ZXW, LEJ psychological in good condition. Conclusion Victim of five cases with 192Ir radiation accident medical treatment, and three cases of exposed individuals 4 years of medical follow-up observation; need to be further evaluated for late effects longer medical follow-up.