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Update (12/06): Status of patients from the JCO Criticality
RADSAFERS,
More updates.....
Again, I had to ask Dr. Atsushi Funahashi of Mazda Affiliated Occupational
Health Center in Hiroshima City, Japan, for help in translation of Mr. A's
condition.
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: 9.06 Sv
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11/30/99 17:00
BP: 136/74 mm Hg, Pulse: 118/min., Resp: 25/min., Temp: 36.4 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
12,700/mm^3. On continuous hemodialysis due to the state of hypouresis. Liver
function has deteriorated to the point where there is essentially no liver
function. Radiation damage to intestine and skin remain 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. Bleeding from
upper digestive tract increased (1,285 gm from midnight to 4:00 PM).
Treatment Direction: Continue massive volume of transfusion and continue with
dialysis. Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: With medication, blood pressure, pulse and other vital signs remain
relatively stable, but due to inadequate liver function, increase in bleeding
observed, becoming even more critical to maintain vigilance.
12/01/99 17:00
BP: 131/69 mm Hg, Pulse: 119/min., Resp: 29/min., Temp: 37.2 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
7,700/mm^3. On continuous hemodialysis due to the state of hypouresis. Slight
improvement in liver function. Radiation damage to intestine and skin
continues. Continuing problem with large volume of fluid seeping out from the
areas of injuries due to radiation burn. Because of this, the patient requires
massive amount of fluid and blood products transfusion daily. Bleeding from
digestive tract decreased and the severity decreased (176 gm in bowel, 435 gm
through tube through nostril, from midnight to 4:00 PM).
Treatment Direction: Continue massive volume of transfusion and continue with
dialysis. Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: With medication, blood pressure, pulse and other vital signs remain
relatively stable, but the condition continue to require vigilance.
12/02/99 17:00
BP: 132/55 mm Hg (w/ blood pressure controlling medication), Pulse: 122/min.,
Resp: 30/min., Temp: 37.4 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
6,800/mm^3. On continuous hemodialysis due to the state of hypouresis. Slight
improvement in liver function. Radiation damage to intestine and skin
continues. Continuing problem with large volume of fluid seeping out from the
areas of injuries due to radiation burn. Because of this, the patient requires
massive amount of fluid and blood products transfusion daily. Bleeding from
digestive tract worsened again, patient on continuos transfusion.
Treatment Direction: Continue massive volume of transfusion and continue with
hemodialysis. Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: With medication, blood pressure, pulse and other vital signs remain
relatively stable, but the condition continue to require vigilance.
12/03/99 17:00
BP: 165/70 mm Hg (w/ blood pressure controlling medication), Pulse: 120/min.,
Resp: 24/min., Temp: 37.4 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
5,400/mm^3. On continuous hemodialysis due to the state of hypouresis. Despite
the transfusion, the rate of RBC increase is low. Hemophagocytic syndrome (HS)
was diagnosed, and plasma was exchanged today. The cause of HS is suspected to
be viral infection and fat dysbolism (sp?) due to inadequate liver function,
etc. Currently investigating the cause. (HS is condition in which RBC, etc., are
engulfed by macrophage.) There is slight improvement trend in liver function.
Radiation damage to intestine and skin continues. Continuing problem with large
volume of fluid seeping out from the areas of injuries due to radiation burn.
Because of this, the patient requires massive amount of fluid and blood products
transfusion daily.
Treatment Direction: Continue massive volume of transfusion and continue with
hemodialysis. Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: With medication, blood pressure, pulse and other vital signs remain
relatively stable, but the condition continue to require vigilance.
12/04/99 17:00
BP: 121/62 mm Hg (w/ blood pressure controlling medication), Pulse: 127/min.,
Resp: 30/min., Temp: 38.6 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
5,200/mm^3. On continuous hemodialysis due to the state of hypouresis. Plasma
was exchanged again today to counter hemophagocytic syndrome (HS). The cause of
HS is suspected to be viral infection and fat dysbolism due to inadequate liver
function, etc. There is slight improvement trend in liver function. Radiation
damage to intestine and skin continues. Continuing problem with large volume of
fluid seeping out from the areas of injuries due to radiation burn. Bleeding
from digestive tract continues, the patient requires massive amount of fluid and
blood products transfusion daily.
Treatment Direction: Continue massive volume of transfusion and continue with
hemodialysis. Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: With medication, blood pressure, pulse and other vital signs remain
relatively stable, but the condition continue to require vigilance.
12/05/99 17:00
BP: 150/73 mm Hg (w/ blood pressure controlling medication), Pulse: 112/min.,
Resp: 30/min., Temp: 36.5 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
4,200/mm^3. On continuous hemodialysis due to the state of hypouresis. Plasma
was exchanged again today to counter hemophagocytic syndrome (HS). There is
slight improvement trend in liver function. Radiation damage to intestine and
skin continues. Continuing problem with large volume of fluid seeping out from
the areas of injuries due to radiation burn. Due to bleeding from digestive
tract and hemophagocytic syndrome, the patient is on continuous transfusion.
Treatment Direction: Continue massive volume of transfusion and continue with
hemodialysis. Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: With medication, blood pressure, pulse and other vital signs remain
relatively stable, but the condition continue to require vigilance.
12/06/99 17:00
BP: 142/63 mm Hg (w/ blood pressure controlling medication), Pulse: 114/min.,
Resp: 30/min., Temp: 38.6 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
3,300/mm^3. On continuous hemodialysis due to the state of hypouresis. Plasma
was exchanged again today to counter hemophagocytic syndrome (HS). There is
slight improvement trend in liver function. Radiation damage to intestine and
skin continues. Continuing problem with large volume of fluid seeping out from
the areas of injuries due to radiation burn. Due to bleeding from digestive
tract and hemophagocytic syndrome, the patient is on continuous transfusion.
Treatment Direction: Continue massive volume of transfusion and continue with
hemodialysis. Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: With medication, blood pressure, pulse and other vital signs remain
relatively stable, but the condition continue to require vigilance.
Mr. B 4.96 Sv
-------------------------------------------------------------------------
12/01/99
Conscious, lucid, with good spirits, and no major change to examination result.
BP: 140/82 Pulse: 120/min, Temp (peak): 38.3 C WBC count:
12,040/mm^3 Hemoglobin: 7.3 g/dl
Bilirubin: 3.4 mg/dl
12/03/99
Conscious, lucid, with good spirits, and no major change to examination result.
RBC transfusion given because of anemia.
BP: 144/62 Pulse: 100/min, Temp (peak): 37.7 C WBC count:
11,980/mm^3 Hemoglobin: 7.9 g/dl
Platelet: 49,000/mm^3
12/06/99
Conscious, lucid, in good spirits as usual. There was a bowel movement. No major
change to examination result. Continuing fever and inflammation. Examination
reveals epidermis recovering but tend to bleed easily.
BP: 132/70 Pulse: 120/min, Temp (peak): 39.0 C WBC count:
8,930/mm^3
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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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