scholarly journals Radiation Injury After a Nuclear Detonation: Medical Consequences and the Need for Scarce Resources Allocation

2011 ◽  
Vol 5 (S1) ◽  
pp. S32-S44 ◽  
Author(s):  
Andrea L. DiCarlo ◽  
Carmen Maher ◽  
John L. Hick ◽  
Dan Hanfling ◽  
Nicholas Dainiak ◽  
...  
Keyword(s):  
Radiation Injury ◽  
Whole Body ◽  
Scarce Resources ◽  
Radiation Emergency ◽  
Central Nervous Systems ◽  
Injury Treatment ◽  
Partial Body ◽  
Clinically Significant ◽  
Management Approaches ◽  
Worse Prognosis

ABSTRACTA 10-kiloton (kT) nuclear detonation within a US city could expose hundreds of thousands of people to radiation. The Scarce Resources for a Nuclear Detonation Project was undertaken to guide community planning and response in the aftermath of a nuclear detonation, when demand will greatly exceed available resources. This article reviews the pertinent literature on radiation injuries from human exposures and animal models to provide a foundation for the triage and management approaches outlined in this special issue. Whole-body doses >2 Gy can produce clinically significant acute radiation syndrome (ARS), which classically involves the hematologic, gastrointestinal, cutaneous, and cardiovascular/central nervous systems. The severity and presentation of ARS are affected by several factors, including radiation dose and dose rate, interindividual variability in radiation response, type of radiation (eg, gamma alone, gamma plus neutrons), partial-body shielding, and possibly age, sex, and certain preexisting medical conditions. The combination of radiation with trauma, burns, or both (ie, combined injury) confers a worse prognosis than the same dose of radiation alone. Supportive care measures, including fluid support, antibiotics, and possibly myeloid cytokines (eg, granulocyte colony-stimulating factor), can improve the prognosis for some irradiated casualties. Finally, expert guidance and surge capacity for casualties with ARS are available from the Radiation Emergency Medical Management Web site and the Radiation Injury Treatment Network.(Disaster Med Public Health Preparedness. 2011;5:S32-S44)

Radiation Injury Treatment Network Medical and Nursing Workforce Radiation: Knowledge and Attitude Assessment

2020 ◽  
pp. 1-7
Author(s):  
Tener Goodwin Veenema ◽  
Timothy P. Moran ◽  
Ziad Kazzi ◽  
Sarah Schneider-Firestone ◽  
Cullen Case ◽  
...  
Keyword(s):  
Clinical Competence ◽  
Medical Management ◽  
Radiation Injury ◽  
Education And Training ◽  
Mass Casualties ◽  
Care Providers ◽  
Treatment Network ◽  
Radiation Emergency ◽  
Injury Treatment ◽  
And Training

ABSTRACT Objectives: The Radiation Injury Treatment Network (RITN) is prepared to respond to a national disaster resulting in mass casualties with marrow toxic injuries. How effective existing RITN workforce education and training is, or whether health-care providers (HCPs) at these centers possess the knowledge and skills to care for patients following a radiation emergency is unclear. HCP knowledge regarding the medical effects and medical management of radiation-exposed patients, along with clinical competence and willingness to care for patients following a radiation emergency was assessed. Methods: An online survey was conducted to assess level of knowledge regarding the medical effects of radiation, medical/nursing management of patients, self-perception of clinical competence, and willingness to respond to radiation emergencies and nuclear events. Results: Attendance at previous radiation emergency management courses and overall knowledge scores were low for all respondents. The majority indicated they were willing to respond to a radiation event, but few believed they were clinically competent to do so. Conclusions: Despite willingness to respond, HCPs at RITN centers may not possess adequate knowledge of medical management of radiation patients, and appropriate response actions during a radiation emergency. RITN should increase the awareness of the importance of radiation education and training.

scholarly journals Observational study of thrombosis and bleeding in COVID-19 VV ECMO patients

2021 ◽  
pp. 039139882198906
Author(s):  
Brianda Ripoll ◽  
Antonio Rubino ◽  
Martin Besser ◽  
Chinmay Patvardhan ◽  
William Thomas ◽  
...  
Keyword(s):  
Intensive Care ◽  
Ct Scan ◽  
Thrombotic Event ◽  
Area Under The Curve ◽  
Whole Body ◽  
Bleeding Events ◽  
Heparin Resistance ◽  
Increased Risk ◽  
Thrombotic Complications ◽  
Clinically Significant

Introduction: COVID-19 has been associated with increased risk of thrombosis, heparin resistance and coagulopathy in critically ill patients admitted to intensive care. We report the incidence of thrombotic and bleeding events in a single center cohort of 30 consecutive patients with COVID-19 supported by veno-venous extracorporeal oxygenation (ECMO) and who had a whole body Computed Tomography Scanner (CT) on admission. Methodology: All patients were initially admitted to other hospitals and later assessed and retrieved by our ECMO team. ECMO was initiated in the referral center and all patients admitted through our CT scan before settling in our intensive care unit. Clinical management was guided by our institutional ECMO guidelines, established since 2011 and applied to at least 40 patients every year. Results: We diagnosed a thrombotic event in 13 patients on the initial CT scan. Two of these 13 patients subsequently developed further thrombotic complications. Five of those 13 patients had a subsequent clinically significant major bleeding. In addition, two patients presented with isolated intracranial bleeds. Of the 11 patients who did not have baseline thrombotic events, one had a subsequent oropharyngeal hemorrhage. When analyzed by ROC analysis, the area under the curve for % time in intended anticoagulation range did not predict thrombosis or bleeding during the ECMO run (0.36 (95% CI 0.10–0.62); and 0.51 (95% CI 0.25–0.78); respectively). Conclusion: We observed a high prevalence of VTE and a significant number of hemorrhages in these severely ill patients with COVID-19 requiring veno-venous ECMO support.

scholarly journals Diagnostic performance of lung volumes in assessment of reversibility in chronic obstructive pulmonary disease

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Gamal Agmy ◽  
Manal A. Mahmoud ◽  
Azza Bahaa El-Din Ali ◽  
Mohamed Adam
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Cutoff Point ◽  
Whole Body ◽  
Significant Response ◽  
Chronic Obstructive ◽  
Lung Volumes ◽  
Obstructive Pulmonary Disease ◽  
Gold Stage ◽  
Clinically Significant

Abstract Background Reversibility measured by spirometry in chronic obstructive pulmonary disease (COPD) is defined as an increase in forced expiratory volume in first second (FEV1) that is both more than 12% and 200 mL above the pre-bronchodilator value in response to inhaled bronchodilators. FEV1 only may not fully reverberate the changes caused by reduction in air trapping or hyperinflation. To date, the studies that examined the effect of inhaled bronchodilators (BD) on residual volume (RV) and total lung capacity (TLC) are limited. This study was carried out to assess the differences between flow and volume responses after bronchodilator reversibility testing in patients with different COPD GOLD stages (GOLD stage I to stage IV). Spirometry and whole body plethysmography were done before and 15 min after inhalation of 400 μg salbutamol. Results Majority (53.3%) of cases were volume responders, 18.7% were flow responders, 20% were flow and volume responders, and 8% were non responders. Significant increase in Δ FEV1% was found in 15% of cases while 55% showed a significant increase in Δ FVC (P= < 0.001). Mean difference of Δ FVC (L) post BD was significantly increased with advancing GOLD stage (P= 0.03). A cutoff point > 20% for Δ RV% had 70% sensitivity and 60% specificity and > 12% for Δ TLC% showed 90% sensitivity and 45% specificity for prediction of clinically significant response to BD based on FEV1. A cutoff point > 18% for Δ RV% had 78% sensitivity and 29% specificity and > 14% for Δ TLC% had 50% sensitivity and 70% specificity for prediction of clinically significant response to BD based on FVC. Conclusion ΔFEV1 underestimates the true effect of bronchodilators with advancing GOLD stage. Measurement of lung volumes in addition to the standard spirometric indices is recommended when determining bronchodilator response in COPD patients.

scholarly journals Radiation Injury Treatment Network (RITN): Healthcare professionals preparing for a mass casualty radiological or nuclear incident

2011 ◽  
Vol 87 (8) ◽  
pp. 748-753 ◽  
Author(s):  
Joel R. Ross ◽  
Cullen Case ◽  
Dennis Confer ◽  
Daniel J. Weisdorf ◽  
David Weinstock ◽  
...  
Keyword(s):  
Healthcare Professionals ◽  
Radiation Injury ◽  
Mass Casualty ◽  
Treatment Network ◽  
Injury Treatment

Direct Determination of the Body Content of Radionuclides: Abstract

2003 ◽  
Vol 3 (1) ◽  
pp. 9-9
Author(s):  
R. Griffith ◽  
H. Bergmann ◽  
F. A. Fry ◽  
D. Hickman ◽  
J.-L. Genicot ◽  
...  
Keyword(s):  
Direct Measurement ◽  
Direct Determination ◽  
The Body ◽  
Whole Body ◽  
Control Measurement ◽  
In Vivo Measurement ◽  
Calibration Methods ◽  
Partial Body ◽  
And Control

Previous ICRU reports have dealt with the formulation and properties of tissue substitutes and phantoms that are used to calibrate in vivo measurement systems. This report provides guidance on the overall process of the direct measurement of radionuclides in the human body for radiation protection and medical applications. It addresses the detectors and electronics used for the measurement; methods of background reduction and control; measurement geometries for whole body, partial body or organ counting; physical and mathematical calibration methods; data analysis; and quality assurance. It is directed to readers who need practical advice on the establishment and operation of direct measurement facilities.

Phase II study of gemcitabine, oxaliplatin in combination with bevacizumab (GEMOX-B) in patients with unresectable or metastatic biliary tract and gallbladder cancers

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 4625-4625 ◽  
Author(s):  
J. W. Clark ◽  
J. A. Meyerhardt ◽  
D. V. Sahani ◽  
S. Namasivayam ◽  
T. A. Abrams ◽  
...  
Keyword(s):  
Biliary Tract ◽  
Fdg Pet ◽  
Poor Prognosis ◽  
Performance Status ◽  
Progression Free Survival ◽  
Whole Body ◽  
Eligibility Criteria ◽  
Tract Cancer ◽  
Clinically Significant ◽  
Grade 3

4625 Background: Patients (Pts) with unresectable or metastatic biliary tract cancer (BTC) and gallbladder cancer (GBC) have a poor prognosis. Vascular endothelial growth factor (VEGF) expression has been detected in BTC and GBC. Increased angiogenesis has been correlated with advanced stage of disease and poor prognosis. Given reported activity of gemcitabine (GEM) and oxaliplatin (OX) in BTC/GBC and potential benefits of targeting the VEGF pathway with bevacizumab (B), we performed a study to examine the efficacy and tolerability of GEM, OX and B (GEMOX-B) in unresectable or metastatic BTC/GBC. Methods: Eligibility criteria included unresectable or metastatic measurable BTC/GBC, 0–1 prior chemotherapy regimens, performance status = 2, and adequate organ function. No clinically significant cardiovascular disease or history of active bleeding. Pts were treated with all 3 drugs intravenously on days 1 and 15 every 28 days (one cycle): B was given first at 10 mg/kg, followed by GEM at 1000 mg/m2 as dose rate infusion at 10 mg/m2/minute, and OX at 85 mg/m2. Whole body FDG-PET scan was obtained at baseline and after cycle 2. The primary endpoint of the study was progression-free survival (PFS). Results: 19 pts (10 BTC and 9 GBC) have been enrolled since May 17, 2006: median age = 69 (25–82), M/F = 13/6, ECOG 0/1/2 = 7/10/2. Treatment has been well tolerated with no grade 4–5 toxicities seen. Treatment related grade 3 toxicities included (number of pts): hypertension (2), neutropenia (1), transient SGPT elevation (1), proteinuria (1), neuropathy (1), and fatigue (1). Of 11 pts followed for at least 4 months, 3 had confirmed partial responses (PR), 5 had stable disease (SD) of at least 4 cycles, and 3 had progressive disease (PD) per RECIST criteria. Five pts had more than 50% decrease in CA19–9 levels. Of 16 PET studies analyzed, changes in SUV values from baseline to after 2 cycles of treatment were: 11 PRs, 4 SDs, 1 PD per EORTC criteria. Conclusions: GEMOX-B can be safely administered with tolerable safety profiles in patients with advanced BTC/GBC. Early evidence of antitumor activity was seen. A decreased SUV in FDG-PET following GEMOX-B treatment was observed in the majority of patients. No significant financial relationships to disclose.

scholarly journals DIRECT AND INDIRECT EFFECTS OF X-RADIATION ON ANTIBODY-PRODUCING CELLS

1957 ◽  
Vol 105 (5) ◽  
pp. 417-424 ◽  
Author(s):  
Frank J. Dixon ◽  
James C. Roberts ◽  
William O. Weigle
Keyword(s):  
Antibody Response ◽  
Indirect Effects ◽  
Lymphoid Tissue ◽  
Radiation Injury ◽  
Inhibitory Effect ◽  
Significant Inhibition ◽  
Lymphoid Cells ◽  
Whole Body ◽  
Direct And Indirect Effects

X-radiation appears to exert its inhibitory effect on the antibody response by two mutually dependent routes: (a) direct radiation injury to the antibody-producing lymphoid tissue, and (b) indirect effects of altered homeostasis in the radiated host on antibody-producing tissues. Neither of these two effects alone produces significant inhibition of the secondary antibody response made by transferred lymphoid cells. However, 400 to 500 r administered in vitro to the transferred cells, plus 400 r whole body x-radiation of the recipient prior to transfer, completely inhibited the antibody response.

scholarly journals Parasympathetic Activity and Blood Catecholamine Responses Following a Single Partial-Body Cryostimulation and a Whole-Body Cryostimulation

PLoS ONE ◽  
2013 ◽  
Vol 8 (8) ◽  
pp. e72658 ◽  
Author(s):  
Christophe Hausswirth ◽  
Karine Schaal ◽  
Yann Le Meur ◽  
François Bieuzen ◽  
Jean-Robert Filliard ◽  
...  
Keyword(s):  
Parasympathetic Activity ◽  
Whole Body ◽  
Partial Body
Sign in / Sign up

Export Citation Format

Share Document