RADIAL ILLNESS — the disease developing as a result of action of ionizing radiation in the doses exceeding admissible. Depending on the nature of influence (single massive or long repeated in rather small doses) distinguish respectively acute and hron, forms L. varying severity with dominance of the local general changes of a pla.
For the first time beam damages (see) with the general and local manifestations are described at the patients who were affected by ionizing radiation with to lay down. the purpose, and also at radiologists and radiologists. Further cases of disturbance of health at the persons producing radium preparations and working with sources of ionizing radiation in the industry became known. Use of the USA in 1945 of nuclear weapon led to mass radiation injuries. Acute beam damages to result of accidents, hl are described. obr. at gross violation of rules of the address with various sources of ionizing radiation.
L. — the final stage in a chain of the processes developing as a result of impact of ionizing radiation on fabrics, cells and fluid mediums of a complete organism (see. Ionizing radiation, biological effect ). At molecular level and formation of reactive connections in fabrics and fluid mediums leads changes to emergence in blood of products patol, exchange (see. Nitrogen metabolism , Water salt metabolism , Lipometabolism , Carbohydrate metabolism ), what at radiation in high doses is a basis beam toxaemia (see).
Changes of function of nervous, endocrine systems and disturbance of regulation of activity of other systems of an organism together with cellular and fabric defeats create a wedge, manifestations of L.
The damaging action of ionizing radiation especially affects stem cells of the hemopoietic fabric, an epithelium of testicles, a small intestine and terminate; it depends on level and distribution of a dose of radiation in time and body capacity. First of all the systems which are in a radiation time in a condition of an active organogenesis and a differentiation are surprised (see. Critical body ). At radiation, especially in small doses, individual reactivity and funkts, a condition of nervous and endocrine systems matters.
Acute radial illness
The majority of publications represents descriptions of a pathoanatomical picture acute L. at various experimental animals and only separate of them concern the people who died at explosion of an atomic bomb in Japan and in case of accidents. The pathological anatomy of a so-called marrowy form acute is fullestly studied by L. with preferential defeat of the hemopoietic fabric (see. Hemopoiesis ), developing at impact of ionizing radiation in doses till 1000 I am glad. Characteristic of this form acute L. morfol, changes are shown in stage of latency and become expressed in the period of a heat of a disease. At the same time symptoms of hemorrhagic diathesis macroscopically are found: hemorrhages in skin, serous and mucous membranes, in parenchymatous bodies. Degree of manifestation of hemorrhagic diathesis fluctuates over a wide range depending on weight of defeat; additional injuries strengthen the phenomena of bleeding. Plentiful hemorrhages in a stomach and intestines, in lungs, in adrenal glands with their destruction, the extensive hemorrhages in a myocardium taking the carrying-out system of heart can have crucial importance in the outcome of a disease (tsvetn. fig. 2 — 4). Active marrow loses a usual consistence and becomes liquid, its color is defined by impurity of blood; limf, nodes look increased due to hemorrhagic treatment of fabric. Deep disturbances in the hemopoietic system define tendency to bleedings and frequency of development inf. complications which, as a rule, are found in the period of a heat of a disease. Ulcer and necrotic ulites, necrotic quinsies belong to their number (tsvetn. fig. 1), pneumonia, inflammatory changes of a small and large intestine. In other bodies signs of disturbance of blood circulation and dystrophic changes are found. Skin defeats (a hair loss, beam burns) can be shown clearly at considerable radiation; at the victims of atomic explosion they were combined, as a rule, with thermal burns.
At microscopic examination changes of bodies of a hemopoiesis which initial signs of defeat are found in stage of latency long before bright a wedge, manifestations acute L are most characteristic. In limf, nodes during the first hours after radiation it is possible to see disintegration of lymphocytes, especially in the central part of follicles, i.e. in a zone of an arrangement of V-lymphocytes; a bit later changes in a paracortical layer (a zone of T lymphocytes) come to light. In the period of a heat of a disease against the background of a sharp hyperemia elements of a stroma limf, a node and plasmocytes are distinguishable generally. Similar changes are observed in almonds, a spleen, group follicles (peyerovy plaques) and solitary follicles went. - kish. path. In marrow the aplasia quickly develops: to third day in it remains, according to some authors, only apprx. 10% of cellular structure that is explained by the strengthened emission in a peripheral bed of mature forms, the termination of division and disintegration of cells (interfazny death); in the subsequent mitotic activity on a nek-swarm time renews, but the sharing cells die in process of a mitosis. Bystry and considerable cellular devastation is followed as if by a vicarious plethora of vessels of marrow with ruptures of vascular walls and formation of fields of hemorrhages. In the period of a heat acute L. in marrow there is almost no usual hemopoietic fabric left, elements of a stroma and plasmocytes (fig.) are visible preferential. Defeat of an adenoid tissue and marrow leads to decrease immunobiol, reactivity of an organism and creates favorable conditions for development of various complications, to hl. obr. autoinfektsionny character.
At recovery the phenomena of regeneration of the hemopoietic cells are found, but even later a long time against the background of decrease in total number of cells of marrow the delay of a differentiation and maturing of cells, as a rule, is found; in gematol, drugs younger cellular elements prevail. Regeneration of an adenoid tissue occurs later, than recovery of marrow: in limf, nodes the bast layer with a diffusion arrangement of cellular elements forms, then follicles are formed there occurs recovery of a paracortical layer (a zone of T lymphocytes) later.
At L. typical changes of gonads, especially men's develop. In stage of latency the termination of mitotic division and disintegration of an epithelium of testicles, emergence of separate ugly large and colossal cells are found; in the period of a heat of a disease in tubules of testicles there is no germinative epithelium, only separate spermatogones and Sertoli's cells remain. In ovaries dystrophic and necrobiotic changes which originally occur in more mature follicles are observed and consist in death of ova, and a bit later — cells of the inner layer of a granular cover.
It is highly sensitive to ionizing radiation the mucous membrane of a small intestine, early changes a cut are shown by destruction and suppression of mitotic activity of cells of an epithelium of crypts with emergence patol, forms of a mitosis. By the time of development expressed a wedge, symptoms of a disease these changes, as a rule, disappear. Terminal changes are connected with frustration krovo-and lymphokineses, autoinfektsionny processes: the mucous membrane is edematous, there are sites of ulcerations and a necrosis on which surface the melted mass of fibrin, slime and colonies of microorganisms is visible; almost completely there are no leukocytic infiltration, proliferation of local connective tissue and epithelial cells. Large digestive glands belong to the category of bodies, insensitive to ionizing radiation, however at microscopic examination, napr, in a liver, disturbances of blood circulation and symptoms of dystrophy, and by the time of death — considerable destructive changes with signs of a microbic and virus invasion are found (see. Hepatitis, beam ).
In cardiovascular system at acute L. profound changes are localized by hl. obr. in small vessels that matters in a pathogeny of hemorrhagic diathesis. Morfol, signs of the increasing permeability of vessels in the form of hypostasis of a wall, nek-ry swelling and amotio of an endothelium, the accruing perivascular hypostasis and a razvolokneniye of vascular walls are found even before developing of hemorrhages. In the period of a heat of L. diapedetic hemorrhages, diffusion treatment of walls of vessels erythrocytes and the phenomena of a plasmorrhagia are visible. In heart there are dystrophic changes of muscle fibers, hemorrhages under an endocardium, in a myocardium and especially under an epicardium.
In lungs at acute L. the changes connected with disturbance of blood circulation and inf are found. complications among which the special attention is deserved by the so-called agranulocytic pneumonia which is followed by loss of serous and fibrinous and hemorrhagic exudate, formation of the centers of a necrosis with colonies of microorganisms without perifocal inflammatory reaction.
In kidneys at acute L. hl are observed. obr. disturbance of blood circulation and high-permeability of vessels: in their fabric hemorrhages are visible, in gleams of capsules of balls proteinaceous liquid with impurity of erythrocytes collects, dystrophic changes of an epithelium of gyrose tubules are noted.
For acute L. deep disturbance of activity of hemadens is characteristic, a cut it is originally estimated as manifestation of the strengthened function; further there occurs relative normalization, and in the period of a heat of a disease signs funkts, exhaustions of glands come to light. After beam influence in lethal doses in a hypophysis there occurs degranulation of chromophilic cells; in a thyroid gland the sizes of follicles decrease, the follicular epithelium hypertrophies, vacuolation and a rassasyvaniye of a colloid is noted. In bark of adrenal glands there is a redistribution of fatty inclusions, in a medulla reduction of quantity and sometimes full escaping of cells of chromaffin inclusions is observed.
In friable connecting fabric — dystrophic changes, disintegration of cells, sharp reduction of quantity and shift of a ratio of cellular forms in favor of mature, destruction of fibers and interstitial substance. In a bone tissue — the phenomena of a resorption of bone substance.
Changes in a nervous system at acute L. in the form of the reactive phenomena or destruction develop in parallel with vascular frustration, have focal character and are localized in nervous cells, fibers and the terminations.
At exposure doses 1000 — 2000 I am glad beam injuries of a small intestine dominate (an intestinal form acute L.): the mucous membrane is thinned, covered with not numerous, roughly changed epithelial cells, the submucosa of a wall of a gut is bared by places. These changes are caused by death and the termination fiziol, updates of an intestinal epithelium in the conditions of the continuing exfoliating of cells from a surface vorsin a mucous membrane according to a life cycle of fabric. Similar changes of a wall of a gut can also develop at local radiation of area of a stomach or even separate loops of intestines.
At an exposure dose from 2000 to 5000 I am glad, especially at uneven influence, the expressed disturbances of a hemodynamics, hl prevail. obr. in intestines and a liver, with sharp overflow by blood of capillaries, venous vessels and emergence of hemorrhages. The mucous membrane of a small intestine looks moderately bulked up, in a liver micronecroses and a diskompleksation of a parenchyma are noted.
So-called nervous form acute L. develops at radiation in doses St. 5000 I am glad. At the same time in a brain disturbances of blood circulation and a likvoroobrashcheniye with edematization of a brain prevail.
A clinical picture
In a wedge, a current acute L. (hl. obr. a marrowy form) distinguish four periods: initial, or period of priming general reaction; hidden, or latent, the period seen a wedge, wellbeing; the period of a heat, or expressed a wedge, manifestations; period of recovery.
The period of priming general reaction proceeds of several hours to 1 — 2 days, the hl is characterized by dominance of neuroregulatory shifts. obr. reflex (dispeptic syndrome); redistribution shifts as a part of blood (the neutrophylic leukocytosis is more often); disturbances of activity of analizatorny systems. Symptoms of the direct damaging action of ionizing radiation on an adenoid tissue and marrow are found: reduction of number of lymphocytes, death of young cellular elements, emergence of aberation chromosomes in cells of marrow and lymphocytes. A characteristic wedge, symptoms in an initial stage — nausea, vomiting, a headache, temperature increase, the general weakness, an erythema. During priming general reaction against the background of the developing general weakness and vazovegetativny shifts there are an increased drowsiness, the block alternating with a condition of euphoric excitement. At acute L. heavy and extremely heavy degree there are Meningeal and all-brain symptoms with the accruing stupefaction (from a hypersomnia to a sopor and a coma) that during recovery can affect structure of the forming psychoneurological syndrome.
Stage of latency proceeds depending on an exposure dose of 10 — 15 days to 4 — 5 weeks and is characterized by gradual increase patol, changes in the most struck bodies (the proceeding devastation of marrow, suppression of a spermatogenesis, development of changes in a small intestine and skin) at nek-rum subsiding of the general neuroregulatory disturbances and, as a rule, satisfactory health of patients.
Transition to the period expressed a wedge, manifestations comes in various terms for separate fabric elements that is connected with duration of a cellular cycle, and also their unequal adaptation to action of ionizing radiation. The leading pathogenetic mechanisms are: deep defeat of system of blood and tissue of intestines, oppression of immunity (see. Immunology radiation ), development of infectious complications and hemorrhagic manifestations, intoxication. Duration of the period expressed a wedge, manifestations does not exceed 2 — 3 weeks. By the end of this term against the background of even the expressed cytopenia there are first signs of regeneration of marrow. In this period acute L., caused by ionizing radiation in the dose exceeding 250 I am glad, without carrying out to lay down. actions death is possible, to-rogo the marrowy syndrome with hemorrhagic manifestations inherent in it and inf is the proximate reasons. complications.
In the period of recovery the general condition of patients considerably improves, temperature decreases to normal figures, hemorrhagic manifestations disappear, there is sloughing and healing of superficial erosion on skin and mucous membranes; with 2 — the 5th month function of sweat and sebaceous glands of skin is normalized, growth of hair is resumed. In general the period of recovery covers 3 — month and is characterized, especially at severe forms of L., the fact that along with regeneration in the damaged bodies the long time remains the raised exhaustion and funkts, insufficiency of regulatory processes, especially in cardiovascular and nervous systems. Full completion of recovery processes depending on weight of L. can drag on for 1 — 3 years.
Decisive influence on a current of L. render conditions of beam influence and the size of an absorbed dose. So, at the prolonged radiation of several hours to 3 — 4 days priming reaction in the form of nausea, vomiting, weakness arises later, than at short-term (impulsive) influence in the same dose though other distinctions during and disease severity does not come to light. At the prolonged fractional irradiation lasting more than 10 days accurate recurrence in formation of a disease disappears, priming reaction can be absent, the period of a heat extends; in a slowed-up way the period of recovery proceeds. At patients the marrowy form L develops. with the subacute course of varying severity; the general disease severity at the same time is lower, than at single-step radiation in that yaga to a dose. At uneven radiation the general weight of defeats decreases, the main patterns of a course of a disease (recurrence, oppression of a hemopoiesis) come to light less clearly, into the forefront symptoms of defeat of the most irradiated bodies and fabrics act. At L., resulting from radiation with dominance of a neutron component, a little big intensity of priming reaction and early emergence of local beam injuries of skin, hypodermic cellulose, a mucous membrane of an oral cavity is possible; more frequent and early emergence is characteristic went. - kish. frustration. At combined gamma and beta exposure the wedge, a picture of defeat consists of symptoms acute L., the skin which is combined with beta defeat of open sites and a beta epithelitis of intestines. The general priming reaction at the same time is followed by the phenomena of irritation of a conjunctiva and upper respiratory tracts; dispeptic frustration are more expressed. Damages of skin are less deep, than at gamma irradiation, and differ in rather favorable current. Typical remote effects acute L. are beam cataracts (see), at severe forms there can be leykotsitopeniya, thrombocytopenia, moderate general astenisation and vegetative dysfunction, focal nevrol, symptoms. In certain cases disturbances from endocrine system meet — hypofunction of gonads and a thyroid gland. 6 — 10 years later after single exposition, especially in the doses exceeding 100 I am glad, some authors noted growth of number of cases of a myeloleukemia (see. Leukoses ).
Depending on the size of absorbed doses of radiation acute L. on weight subdivide into four degrees: The I degree — easy (a dose 100 — 200 I am glad); The II degree — average (a dose 200 — 400 I am glad); The III degree — heavy (a dose 400 — 600 I am glad); The IV degree — extremely heavy (a dose more than 600 I am glad). At acute L. easy degree some patients can have no signs of priming reaction, but at the majority in several hours after radiation nausea is noted, single vomiting is possible. At acute L. moderate severity the expressed priming reaction which is shown hl is noted. obr. vomiting, edges comes in 1 — 3 hour and stops in 5 — 6 hours after influence. At acute L. heavy degree vomiting arises in 30 min. — 1 hour after radiation and stops in 6 — 12 hours; priming reaction in 6 — 12 hour comes to an end. At extremely heavy degree of L. priming reaction begins early: vomiting arises in 30 min. after radiation, has painful, unrestrained character. The IV degree — extremely heavy degree acute L. — depending on the level of doses the wedge, forms is shown in several: transitional, intestinal, toxic and nervous.
Transitional (between marrowy and intestinal) a form (600 — 1000 I am glad): the depression of a hemopoiesis, however in a wedge is the cornerstone of its pathogeny, to a picture the essential place is taken by signs of damage of intestines; priming reaction lasts 3 — 4 days (possibly development of an erythema, a liquid chair), with 6 — the 8th day the coloenteritis, enteritis, fever can come to light. The general course of a disease heavy, recovery is possible only at timely treatment.
An intestinal form (1000 — 2000 I am glad): priming reaction heavy and long, is observed development of an erythema, a liquid chair; in 1 week there are expressed changes of a mucous membrane of an oral cavity and a throat, temperature subfebrile, the chair is normalized; the sharp aggravation of symptoms comes on 6 — the 8th day of a disease — fever (to t ° 40 °), heavy enteritis, dehydration, bleeding, inf. complications.
A toxemic form (2000 — 5000 I am glad): priming reaction, as at an intestinal form; directly after influence perhaps short-term kollaptoidny state without loss of consciousness; on 3 — 4 days develop heavy intoxication, hemodynamic disturbances (weakness, arterial hypotonia, tachycardia, an oliguria, an azotemia), with 3 — the 5th days — all-brain and Meningeal symptoms (wet brain).
A nervous form (at radiation in a dose St. 5000 I am glad): directly after radiation the collapse with a loss of consciousness, after recovery of consciousness (in the absence of a collapse is possible — the first minutes after influence) there is an exhausting vomiting and a diarrhea with tenesmus; further consciousness is broken, there are signs of wet brain, arterial hypotonia, an anury progresses; death comes on 1 — 3 days at the phenomena of wet brain.
Heavy and extremely heavy forms L. are complicated by local beam damages (see) which are possible also at acute L. smaller weight with selective reradiation of separate body parts. Local beam damages have staging of a current similar to the general, however stage of latency them is rather shorter and expressed a wedge. manifestations are observed in the first 7 — 14 days, i.e. in terms when the general signs of L. are expressed poorly.
the First action after obtaining information on radiation and its possible dose is a conclusion of the impact of ionizing radiation struck from a zone; at radiocontamination — a dignity. processing, deactivation of integuments and visible mucous membranes, plentiful gastric lavage. For stopping of priming reaction use antiemetics (difenidol, etaperazin, atropine, aminazine, Aeronum); at long pernicious vomiting and the related hypochloraemia enter intravenously 10% solution of sodium chloride, and at threat of a collapse and decrease in the ABP — reopoliglyukin or glucose in combination with a phenylephine hydrochloride or noradrenaline; at the phenomena of vascular and heart failure appoint Korglykonum, strophanthin, Cordiaminum.
In stage of latency of L. regime of the patient — sparing. Apply sedatives, tranquilizers. At acute L. transplantation of the allogenic or singenny marrow compatible on the AB0 system, a Rh-factor and the MLC test typed on HLA antigens under control is shown to extremely heavy degree (see. Transplantation of marrow )] the quantity of marrowy cells in a transplant shall make not less than 10 — 15 billion. Transplantation of marrow can be effective in the range of doses of general irradiation 600 — 1000 is glad.
At acute L. II \The III degree already in stage of latency needs to aim at creation of the aseptic mode — dispersal of patients, their placement to the isolated boxed chambers supplied with germicidal lamps or sterile cabinets (see. Chamber sterile ). At an entrance to chamber the personnel put on gauze respirators, an additional dressing gown and the footwear which is on the rug moistened with 1% solution of chloroamine. The air and objects which are in chamber are exposed systematic bacterial, to control.
Prevention inf. complications begin on 8 — the 15th day depending on the predicted weight acute L. and in any terms at decrease in quantity of leukocytes of blood till 1000 in 1 mkl blood. With the preventive purpose use bactericidal antibiotics of a broad spectrum of activity (Oxacillinum, ampicillin) on 0,5 g in four times a day; ampicillin can be replaced with Kanamycinum which is entered intramusculary by two times a day on 0,5 g into 3 — 4 ml of 0,25 — 0,5% of solution of novocaine or in isotonic solution of sodium chloride. Use of other antibacterial drugs, napr, streptocides of the prolonged action which are less reasonable in the preventive purposes during the forecasting of a deep cytopenia is possible (less than 1000 leukocytes and less than 100 — 500 granulocytes in 1 mkl blood). The important actions warning inf. complications at patients acute L., careful care of an oral cavity and a gigabyte are. processing of an integument solutions of antiseptic agents. The intravenous way by means of the constant catheter established in a subclavial vein is preferable to administration of any drugs. The means reducing patol, afferentation) from the struck bodies and fabrics are shown, especially at development of local damages — intravenous administration of solution of novocaine, and also its use in the form of regional blockade. Apply the bandages moistened by solutions of Rivanolum, Furacilin affected areas of skin. Affected areas cool with available means; bubbles on skin keep, reducing their tension by a puncture.
In the period of a heat acute L. the bed rest with the maximum isolation of the patient is necessary for prevention of exogenous infection. In cases with the expressed beam injury of a mucous membrane of a mouth and throat it is reasonable to appoint food via the nasal probe full on structure, specially processed food. Emergence of signs of infectious complications is the indication to use of the maximum therapeutic doses of bactericidal antibiotics which appoint empirically even before identification of species of the activator. The effect is estimated on decrease in temperature, a wedge, to signs of regression of the center of an inflammation and improvement of the general condition of the patient during the closest 48 hours; at positive effect continue to administer the drugs in a full dose before normalization of a picture of blood. In the absence of obvious improvement the specified antibiotics replace tseporiny (Cefaloridinum) in a dose of 3 — 6 g a day and sulfate of gentamycin on 120 — 180 mg a day. According to urgent indications replacement is made without data by bacterial, researches, at the same time one more bactericidal antibiotic can be added. Antibiotics for treatment inf. complications enter bucketed, not exceeding the 6th hour. In 7 — 8 days at preservation of symptoms of an agranulocytosis or emergence of the new center of an inflammation change drugs. For prevention of a fungal infection by the patient appoint nystatin. Carry out systematic bacterial, researches with identification of microflora, definition of its sensitivity to antibiotics.
Than the level of leukocytes in blood is higher, that justified use of bacteriostatic antibiotics and streptocides to a large extent, and their parenteral administration can be replaced with intake. Cancellation of antibiotics is possible at a wedge, signs of elimination of the centers of an infection and achievement of level of granulocytes higher than 2000 in 1 mkl blood. At crushing staphylococcal damages of a mucous membrane of a mouth and throat, at pneumonia and a septicaemia use of anti-staphylococcal plasma or anti-staphylococcal gamma-globulin is shown.
Apply the means filling shortage of thrombocytes to fight against a hemorrhagic syndrome: native or svezhezagotovlenny blood, trombotsitny weight (see), and also the means increasing the coagulating properties of blood (aminocaproic to - that, Ambenum, dry plasma) influencing permeability of a vascular wall (Ascorutinum). At bleedings from a nose and wound surfaces appoint drugs of local action: an absorbable gelatin sponge, a fibrinny film (see. Fibrinnaya sponge, film ), dry thrombin, etc.
At development of anemia carry out transfusion, including and direct, odnogruppny a Rhesus factor - compatible blood (see. Hemotransfusion ), eritrotsitny weight (see), suspensions of the frozen and washed erythrocytes. For fight against a toxaemia use intravenous drop administration of isotonic solution of sodium chloride, glucose, Haemodesum, reopoliglyukin and other liquids, sometimes in combination with diuretics — during the forecasting and edematization of a brain. At expressed went. - kish. a syndrome special food (the wiped niche, the enveloping means), spasmolysants is necessary; at severe damages of intestines it is shown parenteral food (see) with use of proteinaceous hydrolyzates (see).
Hypostasis and the accruing pains in the sites which underwent considerable reradiation are the indication to use of anti-fermental drugs: Contrykal (Trasylolum) with the subsequent injection of Haemodesum, reopoliglyukin, Neocompensanum and diuretics. At the same time the favorable analgesic effect occurs directly at the time of introduction, antiedematous — later a nek-swarm time. Besides, apply the means improving microcirculation) and exchange processes: anginin (Parmidinum), Glyvenolum (Tribenozidum), solkoserit. At a necrosis of fabrics and especially emergence of the symptoms of heavy intoxication and sepsis supported by local infectious and necrotic process it is shown necretomy (see). It is desirable to carry out amputation on 5 — the 6th week, i.e. at improvement of indicators of blood, and the volume of operation shall be most reduced. The subsequent reconstructive plastic surgeries are performed depending on a wedge, indications and the forecast in several stages at the end of the period of recovery.
In the period of recovery at L. for the purpose of stabilization of a hemopoiesis and function of c. N of page apply small doses of anabolic steroids — methandrostenolone (Nerobolum), retabolil, vitamins, hl. obr. groups B; the diet enriched with proteinaceous products and iron is recommended. The motive mode under control of overall health and reaction of cardiovascular system gradually extends. The rational psychotherapy and the correct orientation of the patient in the labor and vital forecast is extremely important. Terms of an extract from a hospital in the absence of focal lesions, as a rule, do not exceed 2 — 3 months from the moment of radiation, return to work at acute L. II \The III degrees it is possible in 4 — 6 months. After hospitalization stay in somatic sanatorium and the subsequent dispensary observation is shown.
At use of nuclear weapon perhaps large number struck with gamma and neutron emission. At the same time depending on degree of security of people radiation can be uniform and uneven. Acute L. can result also from radiation of the people who are on the area contaminated by the products of nuclear explosion (PNE) where weight of radiation defeat in the basic defines external gamma irradiation, a cut during radioactive fallout it can be combined with pollution of skin, mucous membranes and clothes of PYaV, and in some cases with their penetration in an organism (see. Incorporation of radioactive materials ).
First aid (see) in the center of nuclear explosion, and also on the area contaminated by PYaV (including in the conditions of GO), it is directed to removal of dispeptic symptoms of priming reaction on radiation by means of an antiemetic from the individual first-aid kit (see. First-aid kits ). Actions of the pre-medical help on the IFV also come down to it.
During the rendering first medical assistance (see) in PMP and OPM PYaV of skin and clothes struck with pollution above tolerance level are subject to partial to cleansing (see). Here medical sorting is carried out (see. Sorting medical ), based on early diagnosis and forecasting of weight of radiation defeat, including according to individual dosimetry (see. Dosimetry of ionizing radiation ), and also by assessment of time of emergence and expressiveness of a dispeptic syndrome of priming reaction on radiation. At easy priming reaction are limited to giving in an antiemetic, at expressed — antiemetics enter parenterally (2,5% solution of aminazine on 1 ml intramusculary, 0,1% solution of atropine of 1 ml subcutaneously). Struck from PMP evacuate in MSB (or OMO), and in the conditions of GO — in-tsy hospital base (see).
During the rendering the qualified medical care (see) in MSB (or OMO) consider weight of L., to-ruyu it is possible to specify with the help gematol, indicators. In the conditions of MSB (or OMO) it is not always possible, especially at mass receipt struck. Primary signs of radiation injury allow to predict approximately disease severity and to carry out sorting of the following groups which were injured with allocation: easily struck who are directed in hospital for lightly wounded (see); struck with L. average and heavy degree which need in the next few hours and days acute medical aid due to the need of stopping of the phenomena of priming reaction. Diagnosis and forecasting of weight of radiation defeat become complicated at the uneven and prolonged radiation, and also at reception radioprotectors (see). For stopping of a dispeptic syndrome use antiemetics, at pernicious vomiting and symptoms of dehydration of an organism enter isotonic solution of sodium chloride, apply cardiotonic means to fight against heavy cardiovascular insufficiency, at bleeding administer the antihemorrhagic drugs, for fight against a toxaemia use isotonic solution of sodium chloride, glucose, Haemodesum.
During the rendering specialized medical care (see) in specialized hospitals hospital base (see) and in MSGO the great value would get definition of weight of L. with the help gematol. indicators. So, the level of lymphocytes more than 20% (St. 1000 cells in 1 mkl blood) in 2 — 3 days is observed at acute by L. I degrees; 6 — 20% of lymphocytes (apprx. 500 — 1000 cells in 1 mkl blood) — at acute L. II degrees; 2 — 5% of lymphocytes (100 — 400 cells in 1 mkl blood) — at acute L. III degrees; 0,5 — 1% of lymphocytes (to 100 cells in 1 mkl blood) — at acute L. extremely heavy degree. Weight of L. it is possible to specify on the level of leukocytes in blood, at the same time proceed from their minimum contents in 1 mkl blood in one of three analyses on 7 — the 10th days. In this span at acute L. The I degrees total number of leukocytes makes 4000 — 3000 in 1 mkl blood, at acute L. The II degrees — 3000 — 2000 in 1 mkl blood, at acute L. The III degrees — 2000 — 1000 in 1 mkl blood, at acute L. The IV degrees — less than 1000 in 1 mkl blood.
In complex therapy of a radial illness the haemo stimulating, anti-infective, antihemorrhagic, desensibilizing agents find application. Vitamin therapy is of great importance, and in necessary cases apply symptomatic means.
A chronic radial illness
In a morphological picture at chronic L. in the beginning the combination of at the same time proceeding processes of destruction and regeneration is noted; in the hemopoietic fabric the accruing focal hypoplasia is combined with an insular hyperplasia. In the conditions of the prolonged external beam influence there is a revival of processes of regeneration; the continuing radiation on such background leads to disturbance and a perversion of regeneration, to a delay of a differentiation and maturing of cells that can be shown by a cytopenia.
In the remote terms after radiative effects distinguish age changes and the organ pathology which is found hl. obr. in those bodies where energy of ionizing radiation preferential is implemented. At the same time in cases of rough damage there is substitution connecting fabric of a parenchyma of body. So, e.g., the pneumosclerosis at local radiation of lungs in high doses develops (see. Pneumosclerosis, beam ), the cirrhosis at incorporation of cerium-144 sclerosing a nephrosis at defeat by polonium-210. Essential disturbances come to light in hemadens, in the central and peripheral nervous system. In other bodies signs of an atrophy, a perversion of processes of regeneration and morfol, the manifestations inherent to natural aging come to light. Age changes under the influence of ionizing radiation occur and are shown in earlier terms.
Idiosyncrasy of impact of ionizing radiation is high oncogenous performance, edges is caused by mutagen action and the general suppression immunol, reactivity of an organism. In an experiment of a tumor it is possible to receive at radiation of any fabric, at the same time their distinctive feature is primary plurality of emergence and a multitsentrichnost of development. Under the influence of ionizing radiation also the range of spontaneous new growths can significantly change.
Hron. L. — the disease with diverse a wedge, syndromes — develops at long action of ionizing radiation in rather small, but exceeding tolerance levels doses. Characteristic features hron. L. defeat of various bodies and systems, duration and waviness of a current, a combination of symptoms of damage of critical bodies to recovery and adaptive reactions of adaptive and regulatory systems are. Allocate hron. L., developing owing to the general long irradiation from external sources, and also as a result of receipt in an organism evenly and unevenly distributed radioactive nuclides.
Originality hron. L. at uneven radiation (receipt of nuclides of radium, iodine, phosphorus, etc.) the combination of the progressing profound local changes to poorly expressed and late shown signs of the general reaction of an organism is. In these cases there are erased displays of a disease found only at a special research (a preclinical stage). At the general long irradiation relatively early there are diverse disturbances of neurovisceral, and first of all neurovascular, regulation, signs funkts, insufficiency, and then and structural defeat of the most radio sensitive bodies and systems are observed (see. Radiochuvstvitelnost ). Initial instability of indicators of blood is replaced by reduction of number of leukocytes (neutrophils) and thrombocytes owing to disturbance fiziol, regenerations of cells of white and megakariotsitarny ranks of marrow. Anemia is caused by deep suppression of a red sprout of marrow seldom (only at intensive radiation) and demonstrates heavy beam damage and the adverse forecast. At reduction of a dose or the termination of radiation in the hemopoietic system recovery processes which tension conceals in itself danger of transition to patol, regenerations are, as a rule, well-marked.
Neuroregulatory disturbances of blood circulation and cordial activity are replaced further by more expressed insufficiency of a regional hemodynamics: a little the ABP decreases, the moderate expansion of borders of heart, muting of cordial tones, change of an ECG indicating development of unsharp diffusion changes of a myocardium comes to light later.
Early unstable shifts of enzymatic activity and sekretornomotorny function went. - kish. a path in process of increase of a total exposure dose are replaced by permanent natural oppression of secretion. Recovery processes in an epithelium of a mucous membrane are observed even at rather high exposure doses, is possible patol. regeneration with development of tumors went. - kish. path. In a nervous system at long impact of ionizing radiation regulatory shifts, before everything affecting in the field of a vegetovascular innervation — a syndrome gradually develop neurocirculatory dystonia (see), is more often than hypotonic type. Later arises clear funkts, insufficiency, forms asthenic syndrome (see), the microstructural changes found at morfol, a research are possible. In cases when the total dose at long general irradiation exceeds 200 — 300 I am glad, emergence of the symptoms indicating easy micronecrotic and dystrophic changes in c is possible. N of page. For hron. L. the adynamy is characteristic. Development of an adynamy happens gradually, to fluctuations in intensity and noticeable weighting in process of continuation of impact of ionizing radiation. The feeling of fatigue, weakness, disturbance "a dream, affective fieriness with the increased vulnerability and a hyperpathia to external irritants increase; headaches gain more resistant character, sometimes being followed by unsharp optiko-vestibular frustration and vazovegetativny crises as diencephalic. Psychoses in the true sense, out of a condition of the upset consciousness, are observed seldom; in their formation the role of accessory factors is essential.
At action of the radioactive nuclides which are selectively collecting in separate bodies, changes depend on the level of doses and anatomo-funkts. features of fabric of bodies. Defeats of bone structures (necroses, tumors) are described at influence of nuclides of strontium and radium; anemia — at severe defeats by nuclides of thorium; a pneumosclerosis and cancer of a lung — from the combined pyleradiatsionny influence at workers of uranium mines. At high levels of doses relatively early there are dystrophic and necrobiotic processes (an osteonecrosis, hypoplastic anemia, a pneumosclerosis); at smaller doses in the remote terms development of tumors and leukoses is observed.
At big groups of people (the population of the cities of Hiroshima and Nagasaki) which transferred L. or radiation in the doses exceeding 100 I am glad on all body or reaching 1000 I am glad on critical bodies, shifts in structure of the general incidence and mortality come to light.
Treatment and prevention
In some cases arises need for hospitalization, at Krom to lay down. actions depend on the leader a wedge, a syndrome. The general recommendations — the dosed exercise stress, correctly organized mode of rest and food, rational work in the conditions excluding reradiation that creates optimal conditions for adaptation to dysfunction of vascular regulation, to the raised muscular and mental exhaustion, the broken interaction of various analizatorny systems and stimulates recovery processes.
For the purpose of removal from an organism of radionuclides use mechanical removal by a gastric lavage, cleansing enemas using sorbents, diuretic and diaphoretics, receiving selectively strong compounds of radionuclides with so-called kompleksobrazovatel. At defeat by polonium-210 as a kompleksobrazovatel use 5% solution of oxathiol. For acceleration of removal of nuclides of plutonium and rare earth elements Pentacinum which is entered intravenously in the form of 5% of solution on 5 ml, on a course of treatment of 10 — 20 injections or inhalations of the same solution under control of the radiometric analysis of urine and a calla is effective. At receipt of radioactive nuclides of radium and strontium appointment in finely divided fixed white (25 — 50 g) is shown. For prevention of defeat by a radioiodine use stable iodine or potassium iodide — 100 — 300 mg are single-step. Main warning facility hron. L. — the rational organization of work and strict observance of accepted standards of radiation safety (see. Doses of ionizing radiation , Marginal doses of radiation ). Regular purposeful medical inspection allows to reveal initial signs of L. or to distinguish a disease, at Krom further work with sources of ionizing radiation is contraindicated. Reduction or the termination of contact with ionizing radiation, i.e. rational employment, is the first and most important action preventing development hron. L. Timely taken measures can provide the favorable course of recovery processes and a wedge, recovery at the persons who transferred hron. L.
See also Antiactinic protection .
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A. K. Guskova; H. A. Krayevsky, B. I. Lebedev (stalemate. An.), E. V. Gembitsky (soldier.), R. G. Golodets (psikhiat.).