Medical Management of Radiation Accidents provides a complete reference for those concerned with radiation accidents nationally as well as abroad. Substantially different from the first edition, which dealt predominantly with radiation accident experiences in the United States, this updated and revised Second Edition represents an international cooperative effort that reflects current international approaches and experiences related to the medical management of radiation accidents. It is organized into areas that include:the fundamental aspects, medical characteristics, and classification of radiation accidentsaspects of radiation on the entire body and specific tissuesthe history of accidents throughout the worlda general overview of certain types of accidents with specific examples a follow-up of persons accidentally exposed to radiation with considerations related to epidemiological studies and a few selected examplesradiation protection and dosimetry issues, psychological considerations, and accidental exposure of pregnant females.
Show more. Show less. Although radiation accidents are rare and often complex in nature, they are of great concern not only to the patient and involved medical staff, but to the media and public as well. No customer reviews. Discover the best of shopping and entertainment with Amazon Prime.
The pleiotropic FL acts at very early stages of hematopoietic and lymphoid development and appears essential in the development of a murine stem cell subset toward lymphoid-restricted progenitors in vivo and in vitro. Either cocktail significantly increased survival from 8. These data suggest that early administration of anti-apoptotic cytokines provide an anti-apoptotic survival effect on irradiated hematopoietic stem and progenitor cells assuring short-term reconstitution but limited long-term reconstitution. The authors suggested that supplemental treatment with selected cytokines or prolonged administration of the cytokine cocktail may be required for long-term hematopoietic reconstitution.
However, the utility of this treatment protocol in the radiation accident scenario is marginalized due to the apparent requirement for 2, very early 2-hour and hour injections of cytokines postirradiation. The early administration of survival promoting CSFs is worth consideration but also raises questions regarding the induced survival of genomically-damaged stem cells by diminishing the induction of the apoptotic pathway.
Activation of P53 gives rise to cell cycle arrest and apoptosis. The P53 gene is highly expressed in radiation-sensitive tissues such as the hematopoietic system. Wlodarski et al 47 demonstrated the role of P53 in hematopoietic recovery after chemotherapy using P53 knockout and wild-type mice. These results suggest that P53 suppression facilitates hematopoietic recovery by delaying exhaustion of the HSC pool, decreasing HSC sensitivity to apoptosis and enhancing the proliferative response to in situ CSFs. Previous investigations showed a single TPO administration within 2 hours or immediately after lethal exposure to mice significantly improved survival.
This effect coincided with the downregulation of Bax and Mdm2 protein levels. The invocation of the PMdm2 autoregulatory loop acts to keep P53 in tight check and possibly terminate the apoptotic signal. Thus, in the case of antiapoptotic cytokines, the radiation-damaged HSCs, stimulated by appropriate cytokines, avoid apoptotic signals remain viable, repair genomic damage and remain available for renewal and differentiation.
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Currently, there is only one treatment protocol for radiation-induced neutropenia in the accident scenario. There are two components. The first is aggressive supportive care.
Preclinical studies in canines and nonhuman primates have documented the effect of supportive care consisting of antibiotics, platelets or whole blood transfusions and fluids on survival after lethal and supralethal doses of radiation. There is a substantial preclinical database showing the effect of these CSFs in stimulating granulopoiesis and survival after lethal doses of radiation.
The available preclinical data with regard to IL-7, KGF, and FL suggests their utility in enhancing recovery of the immune system in severely irradiated personnel.
It is reasonable to consider combination cytokine regimens given the lineage dominance of the CSFs available Table 9. Estimated threshold absorbed doses for deterministic effects after acute exposure. Grading system for response of neurovascular, gastrointestinal and cutaneous systems. Treatment consensus guidance based on a threshold whole-body or significant partial body radiation exposure.
Threshold thyroid radioactive exposures and recommended doses of KI for different risk groups. Fatality from nuclear weapons occurs by different mechanisms, depending on the distance from the hypocenter. Fatality rates for a single type of injury are graphed. Fatality is increased by the interaction of multiple types of injuries. Frequency of chromosome aberrations dicentrics and rings at low doses dashed line and at higher doses solid line. The probability of an exchange aberration is proportional to dose D and the square of the dose D 2 , respectively. At low doses, a secondary electron resulting from absorption of an x-ray photon induces breaks in each of the chromosomes.
At high doses, secondary electrons from multiple atoms induce these chromosome breaks. The net effect of a break is interchange of chromosomal material, resulting in the formation of a dicentric and an acentric fragment. Reprinted with permission from Hall EJ. Radiobiology for the Radiologist.
Medical Management of Radiation Accidents, Second Edition
Following an initial small shoulder, a single exponential curve is evident between doses of 0. This is followed by greater than expected survival at 4. The results are consistent with a multiphasic, concave model. Reprinted from Experimental Hematology, Vol.
Survival of spleen colony-forming units CFU-S of irradiated bone marrow cells in mice: evidence for the existence of a radioresistant subfraction, p. A numerical degree of severity is assigned for the cutaneous, gastrointestinal, neurovascular, and hematopoietic systems, as defined in Tables 4 and 5. Supportive therapy alone is indicated fluids, blood components,antibiotics, pain Rx, counseling. Modified from N. Leukocyte counts based on exposure dose in patients exposed to radiation in Chernobyl. The onset of neutropenia may not occur for weeks especially with lower exposures and the duration of neutropenia may be weeks.
Reprinted with permission from Vorobiev A. Acute radiation disease and biological dosimetry. Stem Cells. AlphaMed Press Sign In or Create an Account. User Tools. Sign In.
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