Update (11/04): Status of patients from the JCO Criticality

["Tosh Ushino" <tushino@icnpharm.com>]

RADSAFERS,

Well, maybe someone in Science and Technology Agency read my complaint on the
last update that they are not posting updates regularly. All the sudden they
updated status for all three workers.  :-)

Tosh Ushino
ICN Dosimetry

==========================================================================

RBC  = Red Blood Cell   WBC = White Blood Cell   BP  = Blood Pressure
Temp = Temperature      Pulse = Pulse Rate       Resp = Respiration rate
CRP  = C-reactive protein


Mr. A: 17 Sv
------------------------------------------------------------------------------
10/29/99 17:00
BP: 132/64 mm Hg, Pulse: 100/min., Resp: 15/min., Temp: 38.2 C
Continuing with sedative and ventilation. No major change to respiratory
function. Kidney function worsening but still does not require dialysis. Damage
to skin and mucous membrane of area thought to have received highest dose has
become a major problem. In particular, condition on right forearm and left hand
is severe. Still requiring platelet transfusion, however blood production
appears to be recovering.  WBC count in small blood vessels is 9,600/mm^3. There
was total of 1,755 gram of stool in diarrhea (from midnight to 4:00 PM ). Since
we cannot rule out the possibility that this diarrhea is indication of
transplant rejection we are continuing treatment. But we also cannot determine
if this result of damage to large intestine. As before, no clear indication of
infection.
Treatment Direction: Prevention of infection of areas with radiation burn.
Treatment will continue for suspected graft-versus-host disease. Continue
ventilation management, infection prevention, nutrition management, continued
transfusion management, and detailed total body management.
Others: Continue vigilance.

10/30/99 17:00
BP: 126/72 mm Hg, Pulse: 120/min., Resp: 16/min., Temp: 37.4 C
Continuing with sedative and ventilation. No major change to respiratory
function. Kidney function improving. Damage to skin and mucous membrane of area
thought to have received highest dose has become a major problem. Affected area
expanded to back on right side. In particular, condition on right forearm and
left hand is severe. Still requiring platelet transfusion, however blood
production appears to be recovering.  WBC count in small blood vessels is
12,700/mm^3. Diarrhea continuing but the quantity decreasing (615 gram from
midnight to 4:00 PM ). Since we cannot rule out the possibility that this
diarrhea is indication of transplant rejection we are continuing treatment. But
we also cannot determine if this result of damage to large intestine. As before,
no clear indication of infection.
Treatment Direction: Prevention of infection of areas with radiation burn.
Treatment will continue for suspected graft-versus-host disease. Continue
ventilation management, infection prevention, nutrition management, continued
transfusion management, and detailed total body management.
Others: Continue vigilance.

10/31/99 17:00
BP: 148/76 mm Hg, Pulse: 118/min., Resp: 24/min., Temp: 36.7 C
Continuing with sedative and ventilation. No major change to respiratory
function. No major change to kidney function, but the highly unusual condition
resulting from radiation burn persists, and perhaps as result of medication,
nutritional uptake is not sufficient and high level of nitrogen found in blood
stream. WBC count in small blood vessels is 17,000/mm^3. Damage to skin and
mucous membrane of area thought to have received highest dose has become a major
problem. Affected area has expanded and severity changing. In particular,
condition on both hands is severe. Diarrhea continuing but the quantity
decreasing (571 gram from midnight to 4:00 PM ). As before, no clear indication
of infection.
Treatment Direction: Prevention of infection of areas with radiation burn.
Treatment will continue for suspected graft-versus-host disease. Continue
ventilation management, infection prevention, nutrition management, continued
transfusion management, and detailed total body management.
Others: Continue vigilance.

11/01/99 17:00
BP: 136/70 mm Hg, Pulse: 124/min., Resp: 20/min., Temp: 38.1 C
Continuing with sedative and ventilation. No major change to respiratory
function. No major change to kidney function, but the highly unusual condition
resulting from radiation burn persists, and perhaps as result of medication,
nutritional uptake is not sufficient and high level of nitrogen found in blood
stream. WBC count in small blood vessels is 16,200/mm^3. Damage to skin and
mucous membrane of area thought to have received highest dose has become a major
problem. Affected area has expanded and severity is changing. In particular,
condition on both hands is severe. Quantity of stool in diarrhea increased
(1,185 gram from midnight to 4:00 PM ). As before, no clear indication of
infection.
Treatment Direction: Prevention of infection of areas with radiation burn.
Treatment will continue for suspected graft-versus-host disease. Continue
ventilation management, infection prevention, nutrition management, continued
transfusion management, and detailed total body management.
Others: Continue vigilance.

11/02/99 17:00
BP: 157/85 mm Hg, Pulse: 123/min., Resp: 23/min., Temp: 37.5 C
Continuing with sedative and ventilation. No major change to respiratory
function. Kidney function recovering. Highly unusual condition resulting from
radiation burn, combined with effect of medication affecting nutritional uptake,
resulted in high level of nitrogen found in blood stream, but blood analysis
conducted this morning show slight improvement. Liver function becoming worse
and we are analyzing to determine if this is due to radiation or if it is the
result of medication. WBC count in small blood vessels is 18,900/mm^3. Damage to
skin and mucous membrane of area thought to have received highest dose has
become a major problem. Affected area has expanded and severity is changing. In
particular, condition on both hands is severe. Since the quantity of stool in
diarrhea increased yesterday, there has been no major change (1,100 gram from
midnight to 4:00 PM ). As before, no clear indication of infection.
Treatment Direction: Prevention of infection of areas with radiation burn.
Continue ventilation management, infection prevention, nutrition management,
continued transfusion management, and detailed total body management.
Others: With radiation burn present over large area, damage to function of
several organs has become major problem. Condition requires continued vigilance.

11/03/99 17:00
BP: 135/71 mm Hg, Pulse: 124/min., Resp: 26/min., Temp: 38.0 C
Continuing with sedative and ventilation. No major change to respiratory
function. Kidney function continuing to recover. Liver function trending down.
WBC count in small blood vessels is 17,000/mm^3. Damage to skin and mucous
membrane of area thought to have received highest dose is a major problem.
Affected area has expanded to back area. Myoglobin level in blood from muscle
deteriation increasing. Quantity of stool in diarrhea increased again (1,695
gram from midnight to 4:00 PM ). As before, no clear indication of infection.
Treatment Direction: Prevention of infection of areas with radiation burn.
Continue ventilation management, infection prevention, nutrition management,
continued transfusion management, and detailed total body management.
Others: With severe radiation burn present over large area, damage to function
of several organs has become major problem. Condition requires continued
vigilance.

11/04/99 17:00
BP: 140/71 mm Hg, Pulse: 114/min., Resp: 22/min., Temp: 37.7 C
Continuing with sedative and ventilation. No major change to respiratory
function. Kidney function continuing to recover. WBC count in small blood
vessels is 14,000/mm^3. Damage to skin and mucous membrane of area thought to
have received highest dose is a major problem. Affected area has expanded to
back area. Myoglobin level in blood from muscle deteriation increasing little at
a time. Large quantity of stool in diarrhea thought to be due to radiation
damage of intestine continuing (1,580 gram from midnight to 4:00 PM ). As
before, no clear indication of infection.
Treatment Direction: Prevention of infection of areas with radiation burn.
Continue ventilation management, infection prevention, nutrition management,
continued transfusion management, and detailed total body management.
Others: With severe radiation burn present over large area, damage to function
of several organs has become major problem. Condition requires continued
vigilance.


Mr. B: 10 Sv
-------------------------------------------------------------------------
10/29/99
Pain in mouth and throat nearly gone. Intense skin change on fingers and soles
of feet, blisters spreading. Worsening skin change to face. Fever and CRP still
high.
BP: 134/72          Pulse: 104/min. Temp (peak): 38.8 C
Blood oxygen level: 98%            WBC count: 7,700/mm^3
Hemoglobin conc.:  9.0 g/dl        Platelet count: 24,000/mm^3
CRP: 15.0 mg/dl

10/30/99
No significant change.
Temp (peak): 37.5 C
WBC count: 10,800/mm^3

10/31/99
No significant change. Lower temperature. Conscious, lucid.
BP: 134/72          Pulse: 88/min. Temp (peak): 37.4 C
Blood oxygen level: 98%            WBC count: 14,600/mm^3
Hemoglobin conc.:  9.0 g/dl        Platelet count: 24,000/mm^3
CRP: 5.77 mg/dl

11/01/99
No significant change. Lower temperature. Conscious, lucid.
BP: 120/65          Pulse: 89/min. Temp (peak): 37.4 C
Blood oxygen level: 99%            WBC count: 16,950/mm^3
CRP: 6.43 mg/dl

11/02/99
Lower temperature continuing. Big reduction of pain in areas of fingers and
soles of feet with skin change.
BP: 120/80          Pulse: 89/min. Temp (peak): 37.6 C
Blood oxygen level: 99%            WBC count: 16,390/mm^3
CRP: 5.64 mg/dl

11/03/99
No particular changes. No increase in skin and membrane damage observed, but no
indication of recovery either.
BP: 130/70          Pulse: 104/min. Temp (peak): 37.5 C
Blood oxygen level: 99%            WBC count: 13,300/mm^3
CRP: 1.86 mg/dl

11/04/99
No particular changes, but temperature increased. Conscious, lucid.
BP: 120/82          Pulse: 91/min. Temp (peak): 38.1 C
Blood oxygen level: 98%            WBC count: 15,150/mm^3
CRP: 2.77 mg/dl

Mr. C: 3 Sv
------------------------------------------------------------------------
10/23/99
Stable. Temp: 36.0 C, BP: 100/70 mmHg. Blood platelet transfusion.

10/24/99
Stable. Temp: 36.5 C, BP: 115/75 mmHg. Incresing trend in WBC count.

10/25/99
Stable. Temp: 36.2 C, BP: 104/69 mmHg.

10/26/99
Stable. Temp: 36.0 C, BP: 110/75 mmHg. Incresing trend in WBC and platelet
count.

10/27/99
Stable. Temp: 35.9 C, BP: 93/64 mmHg. Incresing trend in WBC and platelet count.
Sterile isolation management relaxed.

10/28/99
Stable. Temp: 36.4 C, BP: 110/80 mmHg. WBC and platelet count continuing to
increase.

10/29/99
Stable. Temp: 36.2 C, BP: 125/85 mmHg.

10/30/99
Stable. Temp: 36.2 C, BP: 120/95 mmHg.

10/31/99
Stable. Temp: 36.2 C, BP: 110/80 mmHg.

11/01/99
Stable. Temp: 36.0 C, BP: 125/80 mmHg. Discontinued sterile isolation.


-------------------------------------------------------------------------
Toshihide "Tosh" Ushino, CHP                Tel: (800) 548-5100 x2413
Product Development Manager                 Fax: (714) 668-3149
Dosimetry Div., ICN Biomedicals, Inc.       Email:  tushino@icnpharm.com
3300 Hyland Ave., Costa Mesa, CA  USA 92626         tushino@hotmail.com


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