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Update (12/08): Status of patients from the JCO Criticality
Ladies and Gentlemen of RADSAFE,
With an apology to those people who may be offended by it or find it
inappropriate, I have decided to continue with the updates. I based my decision
on the following: 1) I read every email I have received on the updates, and
considered each opinion provided; 2) At last count, there has been almost 150
RADSAFE postings and private emails sent to me since the issue of ethics of
medical update was raised, and only 4 were opposed to the updates; 3) I was
advised that it would be difficult to manage so many email addresses on a
private distribution list; and 4) I consulted a number of friends who I can
count on to provide me with a swift "reality check" kick, and they were
unanimous in their support for continuation of the updates.
I will keep the subject line consistent so that anyone not wishing to read it
can identify it and delete it.
I would like express my thanks to each and every person who sent me an email. It
was an interesting exercise, to say the least. Several people asked me direct
questions on related ethics issues. I do not wish tro use the updates as a forum
for my personal views. I will leave that to others who are more eloquent.
The Science and Technology Agency web page has more updates. Mr. A's condition
is critical. My prayers are with him. I would like thank Dr. Atsushi Funahashi
of the Mazda Affiliated Occupational Health Center in Hiroshima City, Japan, for
his prompt assistance on the (12/07) update. I will revise the (12/08) update
when I receive Dr. Funahashi's translation.
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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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. The patient is on continuous
transfusion due to bleeding from upper digestive tract and hemophagocytic
syndrome.
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.
12/07/99 17:00
The patient's circulatory function has become unstable and blood pressure is
fluctuating. Sepsis is suspected to be the cause.
BP: 167/68 mm Hg (w/ blood pressure controlling medication), Pulse: 137/min.,
Resp: 30/min., Temp: 38.6 C
Continuing with sedative and ventilation. WBC count in small blood vessels is
2,200/mm^3. On continuous hemodialysis due to the state of hypouresis. Plasma
was not exchanged today due to unstable circulatory 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. The patient is on
continuous transfusion due to bleeding from upper digestive tract and
hemophagocytic syndrome.
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 have
recovered, but the condition has become critical, requiring even more vigilance.
12/08/99 17:00
BP: 141/43 mm Hg (w/ blood pressure controlling medication), Pulse: 123/min.,
Resp: 30/min., Temp: 37.0 C
(?? Something ??) is causing blood to become acidified. The patient's blood
pressure has been fluctuating even more, and from the characteristics of
circulatory function, progression of toxic shock (sepsis?) is suspected.
Continuing with sedative and ventilation. WBC count in small blood vessels is
1,100/mm^3. On continuous hemodialysis due to the state of hypouresis.
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.
The patient is on continuous transfusion due to bleeding from upper digestive
tract and hemophagocytic syndrome.
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 are
maintained, but the condition has become critical, requiring more vigilance.
Mr. B 4.96 Sv
-------------------------------------------------------------------------
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
12/08/99
Conscious, lucid, in good spirits as usual. There was a bowel movement today. No
major change to examination result. Continuing fever in 39 deg C range.
BP: 138/80 Temp (peak): 39.2 C WBC count: 8,930/mm^3
-------------------------------------------------------------------------
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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