Initial medical management of patients severely irradiated in the Tokai-mura criticality accident

Abstract

A nuclear criticality accident occurred in Japan on September 30, 1999, which resulted in severe exposure of three victims to mixed flux of neutrons and gamma-rays. Estimated average doses for the three victims were 5.4 Gy of neutrons and 8.5 Gy of gamma-rays for Patient A, 2.9 Gy of neutrons and 4.5 Gy of gamma-rays for Patient B, and 0.81 Gy of neutrons and 1.3 Gy of gamma-rays for Patient C. They then suffered the consequences of the effects of ionizing radiation resulting in acute radiation syndrome. In Patients A and B, bone marrow failure was so severe that they received haematopoietic stem cell transplantation. The graft initially took successfully in both patients, although in Patient B it was later taken over by his own haematopoietic cells. They also suffered from severe skin lesions, later exhibited gastrointestinal bleeding and eventually died of multiple organ failure 82 and 210 days after the accident, respectively. The survival of these patients beyond the period of agranulocytosis means that bone marrow failure per se caused by exposure to ionizing radiation may now be overcome. Patient C also developed bone marrow failure and was treated with granulocyte colony-stimulating factor as well as supportive care. He recovered without major complications and is now under periodical follow-up. Remarkably, during the prodromal phase, all the patients exhibited hypoxaemia, two of whom also showed interstitial oedema of the lungs. In Patient C these manifestations improved within a week. The circumstances of the accident and the initial medical treatment of the victims are described.

Ghrelin as a Novel Therapy for Radiation Combined Injury

“…Nonetheless, those people who were dying shortly after the attack had injuries to nearly every organ system, which included brain, cardiovascular, gastrointestinal tract, respiratory and renal-as well as hematologic/infectious complications (1). In addition to the nuclear attacks at Hiroshima and Nagasaki, a number of critical accidents, including the accident at Chernobyl in April 1986, have provided important information on the severity of injury caused by ionizing radiation (3,(7)(8)(9)(10)(11)(12)(13). Although limited, these observations highlight the need to understand and to develop therapeutic measures to treat radiation-induced injuries.…”

Protection against Radiation-Induced Bone Marrow and Intestinal Injuries by Cordyceps sinensis, a Chinese Herbal Medicine

“…Naturally, the interaction between antimicrobial therapy and radiation has been studied in some depth. It has been shown to be beneficial for rodents receiving sublethal irradiation (169), dogs (see earlier), and even humans who received lethal doses in the Tokai-mura accident (170). In keeping with this concept, probiotic bacteria have been shown to decrease the incidence of radiation therapy-induced diarrhea in humans (171).…”

Multiplacenta derived stem cell/cytokine treatment increases survival time in a mouse model with radiation-induced bone marrow damage

“…However, there is currently a lack of therapeutic agents that are safe, effective, and approved for patient care (Augustine et al 2005;Coleman et al 2003). Hematopoietic stem cells and hematopoietic growth factors have been shown to be effective treatments for radiation-induced bone marrow damage Audet et al 2002;Waselenko et al 2004;Hirama et al 2003;Vávrová et al 2002). However, problems of donor deficiency, high mortality for conditioning, and complications resulting from transplantation are still associated with these treatments (Hu et al 2010).…”