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Update (11/19): Status of patients from the JCO Criticality
RADSAFERS,
Update at STA's web page for Mr. A only. No updates for Mr. B and C.
In the 11/13 update for Mr. B, I indicated that Mr. B had some sort of viral
infection. Apparently the virus is cytomegalovirus (CMV). CMV infection is a
disease that attacks the salivary glands, liver, spleen, and lungs. It causes
pneumonia and severe blood disorder which leads to hemorrhage in the tissue and
death. Typically found in newborn babies and immunosuppressed patients.
Information on cytomegalovirus was supplied to me by Dr. Atsushi Funahashi of
Mazda Affiliated Occupational Health Center in Hiroshima City, Japan
[introduced to me by my wife's niece who works there part-time.]
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: 18 Sv
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11/13/99 17:00
BP: 142/78 mm Hg, Pulse: 130/min., Resp: 20/min., Temp: 39.2 C
Continuing with sedative and ventilation. No major change to respiratory, renal
and liver functions. WBC count in small blood vessels is 12,000/mm^3. Increase
in volume of fluid seeping from the areas of injuries due to radiation burn.
Radiation damage to intestine and skin is extremely critical problem at this
time (Volume of stool in diarrhea was 1,400 gram from midnight to 4:00 PM ). 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.
11/14/99 17:00
BP: 120/64 mm Hg, Pulse: 128/min., Resp: 26/min., Temp: 38.6 C
Continuing with sedative and ventilation. No major change to respiratory, renal
and liver functions. WBC count in small blood vessels is 13,400/mm^3. Fluid
continuing to seep out from the areas of injuries due to radiation burn.
Radiation damage to intestine and skin is extremely critical problem at this
time (Volume of stool in diarrhea has decreased to 800 gram from midnight to
4:00 PM ).
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.
11/15/99 17:00
BP: 155/95 mm Hg, Pulse: 130/min., Resp: 21/min., Temp: 38.6 C
Continuing with sedative and ventilation. Fluid in lungs and stomach has
increased and oxygen intake has decreased. Renal function has decreased again.
WBC count in small blood vessels is 12,000/mm^3. Increase in volume of fluid
seeping out from the areas of injuries due to radiation burn (3,238 gm over a
day). Problem with radiation damage to intestine continues (Volume of stool in
diarrhea was 1,350 gram from midnight to 4:00 PM ). 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: Overall condition is critical, requiring continued vigilance.
11/16/99 17:00
BP: 126/78 mm Hg, Pulse: 134/min., Resp: 22/min., Temp: 39.4 C
Continuing with sedative and ventilation. Respiratory, renal and liver functions
are trending down. WBC count in small blood vessels is 12,000/mm^3. Continuing
problem with volume of fluid seeping out from the areas of injuries due to
radiation burn, and diarrhea continues. Radiation damage to intestine and skin
is extremely critical problem. Because of this, the patient requires massive
amount of fluid and transfusion of blood products daily.
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: Overall condition is very critical, requiring continued vigilance.
11/17/99 17:00
BP: 129/82 mm Hg, Pulse: 126/min., Resp: 19/min., Temp: 38.0 C
Continuing with sedative and ventilation. Respiratory, renal and liver functions
trending down. WBC count in small blood vessels is 11,000/mm^3. Continuing
problem with volume of fluid seeping out from the areas of injuries due to
radiation burn, and diarrhea continues. Radiation damage to intestine and skin
is extremely critical problem. Because of this, the patient requires massive
amount of fluid and transfusion of blood products daily.
Treatment Direction: Since graft versus host disease cannot be completely ruled
out, appropriate treatment will be initiated. Prevention of infection of areas
with radiation burn. Continue ventilation management, infection prevention,
nutrition management, continued transfusion management, and detailed total body
management.
Others: Overall condition is very critical, requiring continued vigilance.
11/18/99 17:00
BP: 136/88 mm Hg, Pulse: 120/min., Resp: 22/min., Temp: 38.0 C
Continuing with sedative and ventilation. Respiratory, renal and liver functions
continue to trend down. WBC count in small blood vessels is 12,400/mm^3.
Radiation damage to intestine and skin is extremely critical problem. Because of
this, the patient requires massive amount of fluid and blood products
transfusion daily. Continuing problem with volume of fluid seeping out from the
areas of injuries due to radiation burn. We have transplanted artificially
cultured human skin tissue to a small burn area. Bleeding in stool began. Upon
visual inspection using endoscope inside large intestine, it is thought that
bleeding is through festering wound in small and large intestines.
Treatment Direction: Treatment of bleeding. Prevention of infection of areas
with radiation burn. Continue ventilation management, infection prevention,
nutrition management, continued transfusion management, and detailed total body
management.
Others: Currently, blood pressure, pulse rate and other vital signs remain
comparatively stable, but the overall condition is very critical, requiring
continued vigilance.
11/19/99 17:00
BP: 138/81 mm Hg, Pulse: 120/min., Resp: 19/min., Temp: 38.6 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
9,300/mm^3. Radiation damage to intestine and skin is extremely critical
problem. Because of this, the patient requires massive amount of fluid and blood
products transfusion daily. Continuing problem with volume of fluid seeping out
from the areas of injuries due to radiation burn. To reduce fluid loss, today,
we have again transplanted artificially cultured human skin tissue to a small
burn area. Volume of blood in stool decreased, and the volume of stool in
diarrhea decreased dramatically.
Treatment Direction: Covering small areas of radiation burn area at a time with
cultured human skin . Prevention of infection of areas with radiation burn.
Continue ventilation management, infection prevention, nutrition management,
continued transfusion management, and detailed total body management.
Others: Currently, blood pressure, pulse rate and other vital signs remain
somewhat stable, but the overall condition is very critical, requiring continued
vigilance.
Mr. B 10 Sv
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11/13/99
No major change to overall condition, skin change, and examination result.
Anti-viral drug being provided for cytomegalovirus (CMV) infection.
(There is some sort of viral infection and they are providing anti-viral drug.)
BP: 135/88 Temp: 38.0 C WBC count: 20,700/mm^3
11/14/99
No major change to overall condition, skin change, and examination result.
Conscious, lucid.
BP: 140/90 Temp: 38.1 C WBC count: 23,000/mm^3
11/15/99
No major change to overall condition and examination result, but skin change
(damage) spreading. Conscious, lucid. Area of skin peeling is large, and is
covered with topical dressing. Patient experiences extreme pain while dressing
is changed. Since this is a slow process that takes long time, the patient's
agony is great.
BP: 140/82 Temp: 38.3 C WBC count: 21,200/mm^3
Since the patient's condition has become relatively unchanging, unless there is
major change, we will henceforth update the patient condition three times a week
on Monday, Wednesday and Friday.
11/17/99
No major change to overall condition, skin change, and examination result.
Conscious, lucid.
BP: 122/88 Temp: 38.3 C WBC count: 22,500/mm^3
Mr. C: 2.5 Sv
------------------------------------------------------------------------
11/13/99: Stable. Temp: 36.0 C, BP: 125/85 mm Hg
11/14/99: Stable. Temp: 36.0 C, BP: 130/65 mm Hg
11/15/99: Stable. Temp: 36.0 C, BP: 118/80 mm Hg
-------------------------------------------------------------------------
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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