Radial illness

Description:

Radial illness — the disease resulting from influence of different types of ionizing radiation and characterized by the symptom complex depending on a type of the striking radiation, its dose, localization of a source of radioactive materials, distribution of a dose in time and a body of the person.

Symptoms of the Radial illness:

Clinical displays of a disease depend on a total dose of radiation, and also on its distribution in time and in a body of the person. Depending on the nature of spacing of a dose distinguish the radial illness caused by uniform (general), local and uneven radiation, and on distribution of a dose in time — an acute and chronic radial illness. The course of a disease can be caused both by external radiation, and influence of the radionuclides which came to an organism.

The acute radial illness at the person develops at short-term (from several minutes to 1 — 3 days) radiation of all body in the dose exceeding 1 Gr. Can arise when finding the person in an area of coverage of radiation or radioactive fallout, the disturbance of service conditions of powerful sources of radiation leading to accident, use of general irradiation in the medical purposes.

The main manifestations of an acute radial illness decide by defeat of a hemopoiesis on development of an aplasia of marrow and the complications caused by a cytopenia — a hemorrhagic syndrome, infectious defeats of bodies, sepsis; disturbance of a physiological reproduction of an epithelium of a small bowel with an exposure of a mucous membrane, loss of protein, liquid and electrolytes; heavy intoxication owing to massive destruction of radio sensitive fabrics (marrow, a small bowel, and also skin — at extensive defeat by slabopronikayushchy external beta radiation); a direct injury of TsNS with disturbance of its functions, especially central regulation of blood circulation and breath. According to it allocate marrowy, intestinal, toxemic, neurocerebral and the forms of an acute radial illness, transitional between them, arising respectively after general irradiation in the following ranges of doses: 1 — 10, 10 — 50, 50—100 and more than 100 Gr.

The marrowy form of an acute radial illness will respond to effective treatment. In the period of its formation 4 phases clearly are allocated: a phase of priming reaction, a latent phase, a heat phase, or the expressed clinical manifestations, and a phase of early recovery. Duration of a disease makes about 2 — 3 months from the radiation moment (at more severe defeats up to 3 — 6 months)

The acute radial illness of easy (I) degree arises at impact of ionizing radiation in a dose of 1 — 2,5 Gr. Moderately expressed priming reaction (dizziness, is rare — nausea) is noted in 2 — 3 h after radiation. Changes of skin and mucous membranes, as a rule, do not come to light. The latent phase proceeds 25 — 30 days. The number of lymphocytes (in 1 мкл blood) in the first 1 — 3 day decreases to 1000 — 500 cells (1 — 0,5 • 109/l), leukocytes in the disease heat - to 3500 — 1500 (3,5 — 1,5 • 109/l), thrombocytes for the 26-28th days - to 60 000-10 000 (60-40 • 109/l); SOE moderately increases. Infectious complications arise seldom. Bleeding is not observed. Recovery is slow, but full.

The acute radial illness of average (II) degree develops at impact of ionizing radiation in a dose of 2,5 — 4 Gr. Priming reaction (a headache, nausea, sometimes vomiting) arises in 1 — 2 h. Emergence of an erythema of skin is possible. The latent phase proceeds 20 — 25 days. The number of lymphocytes in the first 7 days decreases to 500, number of granulocytes in a heat phase (20 — the 30th days) - to 500 cells in 1 мкл blood (0,5 • 109/l); SOE — 25 — 40 mm/h. Infectious complications, changes of a mucous membrane of a mouth and throat are characteristic, at number of thrombocytes less than 40 000 in 1 мкл blood (40 • 109/l) insignificant signs of bleeding — a petechia in skin come to light. Lethal outcomes are possible, especially at overdue and inadequate treatment.

The acute radial illness of heavy (III) degree is observed at. impact of ionizing radiation in a dose of 4 — 10 Gr. Priming reaction arises in 30 — 60 min. and is sharply expressed (repeated vomiting, fervescence, a headache, a skin erythema). The number of lymphocytes in the first days makes 300 — 100, leukocytes with 9 — the 17th day — less than 500, thrombocytes — less than 20 000 in 1 мкл blood. Duration of the hidden phase does not exceed 10 — 15 days. In the heat of a disease damages of a mucous membrane of a mouth and a nasopharynx, infectious complications of various etiology (bacterial, virus, fungal) and localizations (lungs, intestines, etc.), moderate bleeding are noted the expressed fever. Frequency of lethal outcomes increases (in the first 4 — 6 weeks).

The acute radial illness of extremely heavy (IV) degree arises at impact of ionizing radiation in a dose more than 10 Gr. The symptomatology is caused by the deep defeat of a hemopoiesis which is characterized by an early resistant lymphopenia — less than 100 cells in 1 мкл blood (0,1 • 109/l), an agranulocytosis, since 8th days thrombocytopenia — less than 20 000 in 1 мкл blood (20 • 109/l), and then anemia. With increase in a dose all manifestations are made heavier, duration of the hidden phase is reduced, gain paramount value of defeat of other bodies (intestines, skin, a brain) and the general intoxication. Lethal outcomes are almost inevitable.

With increase of severity of an acute radial illness at the persons who endured the period of its formation completeness of the subsequent recovery decreases, the residual phenomena of defeat of a hemopoiesis (thrombocytopenia and a neutropenia) are more expressed, the cataract develops, dystrophic changes of skin progress, adynamy signs are shown.

Reasons of the Radial illness:

At the person the radial illness can be caused by external radiation and internal — at hit of radioactive materials in an organism with the inhaled air, through digestive tract or through skin and mucous membranes, and also as a result of an injection.

The general clinical manifestations of a radial illness depend, mainly, on the received total dose of radiation. Doses to 1 Gr (100 I am glad) cause rather easy changes which can be considered as a condition of a predisease. Doses over 1 Gr cause marrowy or intestinal forms of a radial illness of varying severity which depend mainly on defeat of bodies of a hemopoiesis. Doses of single exposition over 10 Gr are considered as absolutely deadly.

Treatment of the Radial illness:

Treatment consists in providing the aseptic mode (in the special or adapted chambers), prevention of infectious complications and purpose of symptomatic means. At development of an agranulocytosis and fever, even without identification of the centers of an infection, apply antibiotics of a broad spectrum of activity and according to indications (herpes infection) antiviral drugs. For increase in efficiency of anti-infectious therapy appoint drugs of hyperimmune plasma and gamma-globulin.

Substitution of deficit of thrombocytes (less than 20 000 cells in 1 мкл blood) make by introduction of the trombotsitny weight received whenever possible from one donor (300 • 109/l cells on one infusion), after its preliminary radiation in a dose of 15 Gr. According to indications (anemia — less than 2 500 000 erythrocytes in 1 мкл blood) transfusions of the washed fresh erythrocytes make.

At general irradiation in the range of doses of 8 — 12 of Gr, lack of contraindications and presence of the donor bone marrow transplantation taking into account histocompatibility is proved.

Focal lesions of mucous membranes demand systematic special leaving and processing of a mouth, a nose, a throat bactericidal and mucolytic drugs. To treatment and anesthesia of damages of skin apply the aerosols and collagenic films moistening bandages with the tanning and antiseptic agents, and later salve dressings with hydrocortisone derivatives on the basis of wax and propolis. Not healing wound and cankers exsect with the subsequent plastics. Correction of water and electrolytic and other metabolic disturbances is carried out by the general rules of an intensive care.

In cases of mass defeats the acute radial illness is often combined with influences of thermal, chemical or mechanical factors. In these cases it is necessary to simplify several treatment methods in connection with difficulties of their implementation in full (purpose of drugs of the prolonged action inside, treatment of burns and wounds under a bandage, observance of the elementary mode of an asepsis, etc.).

Fixed assets of prevention are the measures limiting levels of radiation of all body and its separate parts: shielding, restriction of time of stay in fields of intensive radiation, reception of special prophylactics.