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Update (11/25): Status of patients from the JCO Criticality
More updates....
Tosh Ushino
ICN Dosimetry
tushino@icnpharm.com
==========================================================================
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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11/19/99 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.
11/22/99 17:00
BP: 140/97 mm Hg, Pulse: 122/min., Resp: 16/min., Temp: 37.6 C
Continuing with sedative and ventilation. Some recovery of renal function, and
increase of (???something*) value in blood also stopped. WBC count in small
blood vessels is 5,100/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 blood in bowel has worsened. The
source of blood is thought to be the festering areas of injuries in small and
large intestines due to radiation burn. Volume of fluid in stomach of unknown
origin increased.
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.
(* English(?) word phonetically written as "bi-ri-ru-bin")
11/23/99 17:00
BP: 143/82 mm Hg, Pulse: 127/min., Resp: 18/min., Temp: 38.0 C
Continuing with sedative and ventilation. Further recovery of renal function.
WBC count in small blood vessels is 4,800/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. No large change to volume of blood in bowel (505 gm from midnight
to 4:00 PM). The source of blood is thought to be festering injuries due to
radiation burn. Volume of fluid in stomach of unknown origin is increasing.
Treatment Direction: Attempting to stem blood loss through intestine. Covering
small areas of radiation burn area at a time with cultured human skin . 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.
11/24/99 17:00
BP: 155/98 mm Hg, Pulse: 120/min., Resp: 20/min., Temp: 38.6 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
4,400/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 large volume of fluid
seeping out from the areas of injuries due to radiation burn. Increase in volume
of blood in bowel (2,720 gm from midnight to 4:00 PM). The source of blood is
thought to be festering areas of injuries due to radiation burn. Volume of fluid
in stomach of unknown origin is increasing.
Treatment Direction: Attempting to stem blood loss through intestine. Covering
small areas of radiation burn area at a time with cultured human skin . 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.
11/25/99 17:00
BP: 141/88 mm Hg, Pulse: 114/min., Resp: 20/min., Temp: 38.9 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
5,200/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. We have again
transplanted cultured human skin tissue. The volume of blood in bowel decreased
(655 gm from midnight to 4:00 PM). The source of blood is thought to be the
festering injuries due to radiation burn. Volume of fluid in stomach of unknown
origin is increasing.
Treatment Direction: Attempting to stem blood loss through intestine. Covering
small areas of radiation burn area at a time with cultured human skin . 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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11/19/99
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
11/22/99
Fever and inflammation reaction continuing. Exhausted and drowsy. No major
change to skin condition and evaluation data.
BP: 124/74 Pulse: 130/min Temp (peak): 38.6 C WBC count:
12,580/mm^3 Hemoglobin: 8.4 g/dl
11/24/99
No major change.
BP: 148/88 Temp (peak): 38.0 C WBC count: 14,150/mm^3
11/25/99
BP: 141/88 mm Hg Pulse: 114/min Resp.: 20/min Temp: 38.9 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
5,200/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.
Mr. C: 2.5 Sv
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11/19/99: Stable Temp: 36.2 C, BP: 138/70
11/20/99: Stable Temp: 36.0 C, BP: 108/73
11/21/99: Stable Temp: 36.3 C
11/22/99: Stable Temp: 36.0 C
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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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