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Update (11/21): Status of patients from the JCO Criticality
More updates.....
Tosh Ushino
ICN Dosimetry
tushino@icnpharm.com
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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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11/15/99 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 from bowel 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 bowel 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.
11/20/99 17:00
BP: 155/96 mm Hg, Pulse: 125/min., Resp: 18/min., Temp: 38.7 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
6,600/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 large volume of fluid
seeping out from the areas of injuries due to radiation burn. Volume of blood in
bowel is undetermined, but the volume of stool in diarrhea has increased again
(838 gm by 4:00 PM).
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.
11/21/99 17:00
BP: 142/88 mm Hg, Pulse: 124/min., Resp: 22/min., Temp: 37.7 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
7,200/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 large volume of fluid
seeping out from the areas of injuries due to radiation burn. To reduce fluid
loss, we have again transplanted cultured human skin tissue. The volume of stool
in diarrhea has decreased, but the level (degree?) of diarrhea has worsened. We
are trying to determine the amount of blood in bowel. Fluid in stomach of
unknown origin observed.
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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11/15/99
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
11/19/99
Fever and inflammation reaction continuing. Parts of areas of hands, feet, face
and neck with skin peeling has new layer of skin but it cannot be said that the
area is recovering. Skin of stomach area also is observed to be weakened. Blood
production capability has decreased again since the previous week. We have
reinstated blood production enhancing hormone. Hemoglobin level, platelet
concentration decreased, we are transfusing RBC and platelets. Conscious, lucid.
BP: 150/80 Temp (peak): 38.9 C WBC count: 12,070/mm^3 Hemoglobin:
8.4 g/dl
Mr. C: 2.5 Sv
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No updates.
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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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