Update (11/07): Status of patients from the JCO Criticality

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

More updates....

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
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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
deterioration 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 deterioration 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.

11/05/99 17:00
BP: 168/88 mm Hg, Pulse: 108/min., Resp: 18/min., Temp: 37.5 C
Continuing with sedative and ventilation. No major change to respiratory and
renal functions. WBC count in small blood vessels is 13,600/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 deterioration increasing little at a time. Compared to the previous day,
the quantity of stool in diarrhea decreased (480 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, requiring continued vigilance.

11/06/99 17:00
BP: 167/77 mm Hg, Pulse: 112/min., Resp: 20/min., Temp: 38.5 C
Continuing with sedative and ventilation. No major change to respiratory and
renal functions. WBC count in small blood vessels is 15,800/mm^3. Injuries due
to radiation burn appears to have settled down. The quantity of stool in
diarrhea decreased substantially due as result of tissue regeneration hormone
(17 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, requiring continued vigilance.

11/07/99 17:00
BP: 160/75 mm Hg, Pulse: 120/min., Resp: 22/min., Temp: 38.2 C
Continuing with sedative and ventilation. No major change to respiratory
function. Some renal function recovery. WBC count in small blood vessels is
15,200/mm^3. Injuries due to radiation burn appears to have settled down.
Radiation damage to internal organs still is a major problem. The quantity of
stool in diarrhea increased (17 gram from midnight to 4:00 PM ), and (???fluid
from stomach though a tube inserted through nose???) also increased. No apparent
blockage of intestine. 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: Continue vigilance.



Mr. B: 10 Sv
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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

11/05/99
As reported at the 3:00 PM press conference today, blood forming functions (RBC,
WBC, and platelet) is on way to recovery. The recovery is thought to be the
result of transplanted stem cells from umbilical cord blood cells and powerful
tissue regeneration hormone. Result is chimera consisting of transplanted stem
cells and recovery of patient's own stem cells. There is substantial damage to
skin of hands, feet, face, and back of neck, and lately there peeling of skin on
localized spots on face. Sharp pain to hands and feet continuing.
No clear indication of infection. Conscious, lucid. Strong sharp pain.
BP: 120/80          Pulse: 108/min. Temp (peak): 37.9 C
Blood oxygen level: 99%            WBC count: 15,250/mm^3
Hemoglobin level: 9.4 g/dl,        Platelet count: 80,000/mm^3
CRP: 3.59 mg/dl

11/06/99
No major change to overall condition, skin damage, and examination. Conscious,
lucid.
BP: 132/82          Temp (peak): 37.7 C    WBC count: 15,150/mm^3

11/07/99
No major change to overall condition, skin damage, and examination. Conscious,
lucid, but drowsy.

BP: 128/68          Temp (peak): 38.0 C    WBC count: 12,500/mm^3


Mr. C: 3 Sv
------------------------------------------------------------------------
11/02/99: Stable. Temp: 36.0 C, BP: 94/65 mm Hg

11/03/99: Stable. Temp: 36.2 C, BP: 120/60 mm Hg

11/04/99: Stable. Temp: 36.2 C, BP: 110/80 mm Hg

11/05/99: Stable. Temp: 35.6 C, BP: 110/70 mm Hg

11/06/99: Stable. Temp: 36.5 C, BP: 108/80 mm Hg

11/07/99: Stable. Temp: 36.0 C, BP: 111/66 mm Hg

11/08/99: Stable. Temp: 36.2 C, BP: 125/90 mm Hg

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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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