Radiation ulcer. Treatment of local radiation injuries
Radiation damage to the skin, often referred to as radiation burn, can have a variety of clinical manifestations (Fig. 5-10).
Rice. 5-10. Radiation damage to the skin (development of radiation burns). Rice. 5. Erythema. Rice. 6 - 8. Development of bubbles. Wet radioepidermitis. Rice. 9. Erosion. Rice. ten. ; dyschromia, telangiectasias and a border of hyperpigmentation are visible.
Wet radioepidermitis is accompanied by a sharp redness and swelling of the skin, the appearance of blisters filled with a transparent yellowish liquid, which quickly open, and the basal layer of the epidermis is exposed. After 1-2 days, epithelialization begins.
Wet epidermatitis ends with persistent atrophy of hair follicles, sebaceous and, significant thinning of the skin, loss of its elasticity, depigmentation (dyschromia), the appearance of telangiectasia. Later, hyperkeratosis (excessive keratinization) and sclerosis of the underlying subcutaneous fatty tissue may be detected. After irradiation with hard X-ray or after 6-9 months. and later, slowly progressive atrophy of muscle tissue and osteoporosis of the bones are detected. The most severe degree of muscle atrophy and retardation of bone growth are observed in children.
In the treatment of malignant tumors, wet radioepidermitis is permissible only on small irradiation fields.
radiation ulcer can develop acutely in the coming days and weeks after intense single exposure, subacutely after 6-10 weeks, and also several years after exposure. The acute course is characterized by intense reddening of the skin shortly after irradiation, accompanied by a sharp edema, severe pain, and a violation of the general condition. On edematous, with congestive hyperemia, large blisters often appear with hemorrhagic cloudy contents. Upon rejection of the epidermis, a necrotic surface is exposed, covered with a non-removable plaque, in the center of which an ulcer is formed. Over a long period of time, rejection of necrotic tissue occurs, the formation of sluggish and unstable granulations and ulcer epithelialization. Often, healing does not occur. A subacute developing radiation ulcer is often the outcome of a long-term wet epidermatitis. In the tissues surrounding the ulcer within the irradiated field, pronounced radiation atrophy develops over the next few months.
Late radiation ulcer usually develops against the background of sharply atrophied tissues at the site of irradiation. The formation of an ulcer occurs according to the type of acute radiation necrosis of tissues in the area of \u200b\u200beverything, which captures not only the skin, but also the underlying tissues, subcutaneous tissue, muscles, bones. In some cases, a superficial excoriation (abrasion) appears on atrophied skin, which gradually deepens and increases in size, turning into a deep ulcer.
Radiation atrophy of the skin and radiation ulcer often end in the development of radiation cancer.
The result of radiation exposure to the skin and subcutaneous adipose tissue is often indurated tissue edema.
Indurated edema develops as a result of damage not only to blood vessels, but also to lymphatic vessels, which leads to impaired lymph outflow, edema and sclerosis of the skin and subcutaneous tissue. The skin and subcutaneous tissue of the irradiated field gradually become dense, rise above the level of normal skin, and when pressed, a fossa remains. The skin is hyperpigmented, covered with telangiectasias or acquires a reddish-bluish hue, becomes painful. Under the influence of trauma or for no apparent reason, skin necrosis may occur in the area of indurative edema, leading to the formation of deep radiation ulcers.
With radiation sickness, the level of ionizing radiation is at a level of 1 to 10 Gray or more. A person can get sick with such an ailment due to the ingress of radioactive substances through the air, toxic food, mucous membranes, and also through injections. The type of clinical manifestations depends on the level of exposure. So, for example, when hit by ionization up to one Gray, the body experiences slight changes, which is called the state of pre-illness. Irradiation doses greater than ten Gy have a negative effect on the activity of the stomach, intestines, and blood-forming organs are affected. The condition when irradiated in a volume of more than ten Grays is considered fatal to the human body. Let's try to understand the symptoms and treatment of radiation sickness.
The reasons
Radiation sickness is provoked by radiation that penetrates the human body and provokes destructive changes in the organs and systems of the human body.
Basic prerequisites:
Radiation can enter through:
- dermis;
- mucous membranes of the eyes, mouth, nose;
- lungs during normal inhalation of air;
- blood when injecting drugs;
- lungs during inhalation procedures, etc.
Classification
In modern medical practice, there are several stages of the disease:
- acute;
- subacute;
- chronic stage.
There are several types of radiation that provoke radiation sickness:
- A-radiation - an increased ionization density, reduced penetrating power are relevant for it;
- B-radiation - here there is a weak ionization and penetrating ability;
- Y-study - characterized by deep tissue damage in the area of its action;
- neutron radiation - characterized by uneven damage to tissue linings and organs.
Phases:
- phase number 1 - the skin turns red, swelling appears, the temperature rises;
- phase No. 2 - occurs 4-5 days after irradiation, there is a decrease in blood pressure, an unstable pulse, a violation of the structure of the skin, hair loss, reflex sensitivity decreases, problems with motor skills, movement are observed;
- phase No. 3 - characterized by vivid manifestations of symptoms of radiation sickness, the hematopoietic and circulatory systems are affected, bleeding is observed, the temperature rises, the mucous membrane of the stomach and other internal organs is affected;
- phase No. 4 - the patient's condition gradually improves, but for a long time the so-called asthenovegetative syndrome can be observed, the level of hemoglobin in the blood drops sharply.
Depending on the level of damage to the body by radiation, 4 degrees of radiation sickness are distinguished:
- mild degree, in which the level of exposure is in the range from one to two Grays;
- stage medium, when the level of exposure is in the range from two to four Grays;
- severe degree - the level of radiation is fixed in the range from four to six Gy;
- fatal when the exposure level is more than six Gy.
Symptoms of radiation sickness
Symptoms depend on the main stages, its course and the characteristics of the human body.
Phase I is characterized by such signs of radiation sickness:
- slight malaise;
- frequent vomiting;
- constant feeling of nausea;
- drowsiness;
- recurrent headaches;
- low blood pressure;
- increased body temperature;
- sudden loss of consciousness;
- reddening of the skin, up to the manifestation of a cyanotic hue;
- increased heart rate;
- finger trembling;
- decreased muscle tone;
- general malaise.
In phase II (imaginary recovery), the following symptoms of radiation sickness are observed:
- gradual disappearance of signs of phase I;
- damage to the skin;
- hair loss;
- violation of gait, hand motility;
- muscle aches;
- "The effect of shifty eyes";
- subsidence of reflexes.
In the III phase are diagnosed:
- general weakness of the body;
- hemorrhagic syndrome (abundant bleeding);
- lack of appetite;
- the skin acquires a light color;
- ulcers appear;
- swelling and increased bleeding of the gums;
- frequent urination;
- rapid pulse;
- damage to the circulatory and hematopoietic systems;
- problems with digestion of food, etc.
Symptoms of radiation sickness are non-specific and require careful study by the doctor. The help of a therapist, a hematologist, possibly an oncologist is required.
Diagnostics
To refute or confirm the diagnosis It is necessary to undergo diagnostics, which includes the following types of studies:
Radiation sickness treatment
- emergency assistance in case of infection (remove clothing, wash the body, cleanse the stomach, etc.);
- taking sedative complexes;
- antishock therapy;
- body detoxification;
- taking complexes that block problems of the stomach and intestines;
- isolation of the patient;
- taking antibacterial agents;
- physical exercise;
- taking antibiotics (especially in the first two days);
- bone marrow transplant surgery.
The path of treatment of the disease should be chosen by the therapist, hematologist. You may need an additional consultation with an oncologist, gynecologist, gastroenterologist, proctologist, etc.
- avoid the radio emission zone;
- use various types of protection (respirators, bandages, suits);
- take drugs of the radioprotective group (an hour before the expected stay);
- take vitamins P, B6, C;
- use anabolic-type hormonal drugs;
- drink plenty of water.
Currently, there is no ideal means of protection against radiation exposure. Therefore, it is necessary to use devices to measure the level of radiation and, if a threat arises, use protective equipment.
Forecast
Contact with people who have been exposed to radiation cannot lead to exposure to radiation. Patients diagnosed with radiation sickness are allowed to contact without protective equipment. This disease is most dangerous for children and adolescents. Ionization affects cells during their growth. It also poses a serious threat to pregnant women, since cells are most vulnerable at the stage of intrauterine development, and exposure can adversely affect the development of the fetus. For those who have been exposed to radiation, the following consequences are dangerous: damage to the circulatory and hematopoietic systems, endocrine, central nervous, digestive, reproductive systems, individual organs. There is also a high risk of developing oncological processes in the body. Assistance in the treatment of this disease should be provided by a professional therapist. Under his control, therapy should also be carried out. Expert advice may be needed.
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Radiation damage to the skin, often referred to as radiation burns, can have a variety of clinical manifestations.
Radiation damage to the skin (development of radiation burns). Rice. 5. Erythema. Rice. 6 - 8. The development of bubbles. Wet radioepidermitis. Rice. 9. Erosion. Rice. 10. Scar; dyschromia, telangiectasias and a border of hyperpigmentation are visible.
Erythema - temporary reddening of the skin at the site of exposure; develops on the 13-14th day after a single and 2-6 weeks after fractional irradiation.
Permanent hair removal develops with a single or fractional irradiation of the scalp. Dry epidermitis develops 7-10 days after a single or 2-3 weeks after fractional irradiation. Clinically manifested by erythema, swelling of the skin, followed by lamellar peeling. Recovery of irradiated skin is incomplete. The skin remains atrophied, dry, epilated. Later, telangiectasias and uneven pigmentation appear.
Wet radioepidermitis is accompanied by a sharp redness and swelling of the skin, the appearance of blisters filled with a transparent yellowish liquid, which quickly open, and the basal layer of the epidermis is exposed. After 1-2 days, epithelialization begins.
Wet epidermatitis ends with persistent atrophy of hair follicles, sebaceous and sweat glands, significant thinning of the skin, loss of its elasticity, depigmentation (dyschromia), the appearance of telangiectasia. Later, hyperkeratosis (excessive keratinization) and sclerosis of the underlying subcutaneous fatty tissue may be detected. After irradiation with hard x-ray or amma radiation after 6-9 months. and later, slowly progressive atrophy of muscle tissue and osteoporosis of the bones are detected. The most severe degree of muscle atrophy and retardation of bone growth are observed in children.
In the treatment of malignant tumors, wet radioepidermitis is permissible only on small irradiation fields.
radiation ulcer can develop acutely in the coming days and weeks after intense single irradiation, subacutely after 6-10 weeks, and also several years after irradiation. The acute course is characterized by intense reddening of the skin shortly after irradiation, accompanied by a sharp edema, severe pain, and a violation of the general condition. On edematous, with congestive hyperemia, large blisters often appear with hemorrhagic cloudy contents. Upon rejection of the epidermis, a necrotic surface is exposed, covered with a non-removable plaque, in the center of which an ulcer is formed. Over a long period of time, rejection of necrotic tissue occurs, the formation of sluggish and unstable granulations and ulcer epithelialization. Often, healing does not occur. A subacute developing radiation ulcer is often the outcome of a long-term wet epidermatitis. In the tissues surrounding the ulcer within the irradiated field, pronounced radiation atrophy develops over the next few months.
Late radiation ulcer usually develops against the background of sharply atrophied tissues at the site of irradiation. The formation of an ulcer occurs according to the type of acute radiation necrosis of tissues in the area of the entire irradiation field, which captures not only the skin, but also the underlying tissues, subcutaneous tissue, muscles, and bones. In some cases, a superficial excoriation (abrasion) appears on atrophied skin, which gradually deepens and increases in size, turning into a deep ulcer.
Radiation atrophy of the skin and radiation ulcer often end in the development of radiation cancer.
The result of radiation exposure to the skin and subcutaneous adipose tissue is often indurated tissue edema.
Indurated edema develops as a result of damage not only to blood vessels, but also to lymphatic vessels, which leads to impaired lymph outflow, edema and sclerosis of the skin and subcutaneous tissue. The skin and subcutaneous tissue of the irradiated field gradually become dense, rise above the level of normal skin, and when pressed, a fossa remains. The skin is hyperpigmented, covered with telangiectasias or acquires a reddish-bluish hue, becomes painful. Under the influence of trauma or for no apparent reason, skin necrosis may occur in the area of indurative edema, leading to the formation of deep radiation ulcers.
Erythema does not require special treatment; only protection from any kind of skin irritation is needed: solar insolation, thermal, chemical and mechanical effects, washing, especially with soap. All of these stimuli contribute to an increase in the degree of damage.
Lubrication of redness of the skin surface with indifferent fat, oils, prednisolone ointment is allowed.
Wet epidermatitis treated in an open way, without a bandage. The weeping surface is treated daily or every other day with an alcohol solution of gentian violet. If necessary, dressings are applied with aloe liniment, tezan emulsion, sea buckthorn oil, fish oil. Epithelialization ends in 1-2 weeks.
Radiation ulcer treatment consists in radical surgical removal of the ulcer and surrounding tissues changed by radiation exposure. Non-radical intervention, i.e., leaving part of the irradiated tissues, leads to the divergence of the sutures and the formation of an initially non-healing defect, which later turns into an ulcer again. After excision of small ulcers, suturing is possible without additional plastic surgery. With large ulcers, the operation ends with plastic flaps from the surrounding tissues or flaps according to Filatov.
Before the operation, a long preparation is necessary, consisting in the fight against infection, for which antibiotics are used; to cleanse the ulcer from necrotic tissues, a 5-10% solution of dibunol in linetol, peloidin, vinylin (Shostakovsky's balm) is used; to stimulate the formation of granulations, metacil ointment, fish oil, linol, aloe liniment are used. To improve the blood supply to the tissues surrounding the ulcer and increase its mobility in relation to the underlying tissues, as well as to improve the nervous trophism, circular-novocaine blockade is used with a 0.25% solution.
Radiation sickness is the body's reaction to the effects of radioactive radiation. Under its influence, unnatural processes are launched in the body, which lead to failures in many body systems.
The disease is considered very dangerous because it provokes irreversible processes. Modern medicine can only stop their destructive development in the body.
The degree of radiation damage depends on the area of the irradiated surface of the body, the time of exposure, the way the radiation penetrates, and also on the body's immune response.
There are several forms of the disease: those that are formed as a result of uniform exposure, as well as with a narrowly localized effect of radiation on a specific part of the body or organ. In addition, there are transitional and combined forms of the disease, in acute and chronic course.
Penetrating radiation provokes oxidative reactions in cells. At the same time, the antioxidant defense system is depleted, and the cells die. This leads to a gross violation of the metabolic processes.
Given the degree of damage by radiation, it is possible to determine the main systems that are most susceptible to pathological effects. First of all, the gastrointestinal tract, the circulatory and central nervous systems, and the spinal cord suffer. By affecting these organs and systems, radiation causes serious dysfunction. The latter may appear as single complications or in combination with others. With complex symptoms, they usually talk about third-degree radiation damage. Such pathologies usually end in death.
Radiation sickness can occur in acute and chronic forms, depending on the absolute value of the radiation load and the duration of its exposure. A peculiar mechanism for the development of acute and chronic forms of the disease excludes the possibility of transition from one form of the disease to another.
The conditional boundary that separates the acute form from the chronic one is the accumulation for a limited period (1 hour - 3 days) of the total tissue dose of radiation, which is equivalent to the effect of 1 Gy of external penetrating radiation.
An important role in the development of radiation sickness is played by the type of radiation. Each of them is characterized by features of damage to various organs and systems. Let's take a closer look:
- alpha radiation. It is characterized by high ionization density, low penetrating power. Therefore, sources emitting a-waves have a damaging effect limited in space.
- beta radiation. It has a weak penetrating and ionizing ability. It can affect tissues directly in areas of the body that are tightly adjacent to the source of radiation.
- Gamma radiation and X-ray. Causes deep damage to all tissues in the area of action of the radiation source.
- neutron radiation. It has a different penetrating ability, therefore it affects organs heterogeneously.
When irradiated with a dosage of 10-50 Gy, the symptoms of damage to the digestive organs come to the fore. In this case, the mucous membrane of the small intestine is rejected, and death occurs within 14 days.
At lower doses of radiation (1-10 Gy), first of all, hematological syndromes, bleeding, complications of infectious genesis are observed.
The main causes of radiation sickness
The development of the disease can be due to external and internal radiation. Radiation can enter the body with inhaled air, through the skin, gastrointestinal tract, mucous membranes, and also as a result of injections.
Small doses of ionizing radiation from various sources (natural and man-made) affect a person constantly. But at the same time, the development of radiation sickness does not occur. It occurs in humans under the influence of radioactive radiation received at a dosage of 1-10 Gy and above. At lower radiation doses (0.1-1 Gy), preclinical manifestations of the disease may occur.
There are two main causes of radiation sickness:
- Single (short-term) high-level irradiation during various man-made disasters in nuclear energy, experiments, the use of nuclear weapons, the treatment of oncological and hematological diseases.
- Long-term training with small doses of radiation. It is usually noted in medical workers in the departments of radiation therapy and diagnostics (radiology, radiology), as well as patients who need regular radionuclide and radiological examinations.
Symptoms of radiation sickness
The symptomatology of the disease depends primarily on the dose of radiation received, as well as on the severity of the disease. There are several main phases of radiation sickness, which are characterized by certain symptoms:
- The first phase is the primary general reaction. It is observed in all people who have received radiation doses above 2 Gy. The period of manifestation depends on the dose of radiation and, as a rule, is calculated in minutes and hours. Characteristic signs: nausea, vomiting, feeling of bitterness and dryness in the mouth, weakness, fatigue, headache, drowsiness. Often there is a state of shock, which is accompanied by a drop in blood pressure, loss of consciousness, fever, diarrhea. Such symptoms of radiation sickness usually appear when exposed to a dose of more than 10 Gy. Sometimes there is reddening of the skin with a bluish tinge in areas of the body that have been irradiated with a dose of 6-10 Gy. Patients may experience variability in pulse, pressure with a tendency to decrease, overall muscle tone, tendon reflexes decrease, fingers tremble. There is also a developed inhibition of the cerebral cortex. During the first day, the number of lymphocytes in the blood decreases in patients. This process is associated with cell death.
- The second phase is latent or latent, in which clinical well-being is noted. It usually occurs after the disappearance of the symptoms of the primary reaction 3-4 days after exposure to radiation. Can last up to 32 days. The state of health of patients improves significantly, only some lability of the pulse rate and pressure level can be maintained. If the dose of received radiation was more than 10 Gy, then this phase may be absent and the first one flows into the third one. On days 12-16, patients who received more than three Grays of radiation begin to lose their hair. Also during this period, various skin lesions may occur. Their prognosis is unfavorable and indicates a high dose of radiation. In the second phase, neurological symptoms may become distinct: movements are disturbed, eyeballs tremble, reflexes decrease, mild pyramidal insufficiency. By the end of the second phase, blood clotting slows down, and the stability of the vascular wall decreases.
- The third phase - pronounced symptoms. The timing of the onset and intensity of symptoms depend on the dose of ionizing radiation received. The duration of the period fluctuates around 7-20 days. Damage to the circulatory system, immunosuppression, hemorrhagic syndrome, the development of infections, and autointoxication come to the fore. By the beginning of this phase, the patient's condition worsens: weakness increases, there is a frequent pulse, fever, and blood pressure decreases. The gums begin to bleed, swelling appears. The mucous membranes of the oral cavity and digestive organs are also affected, necrotic ulcers appear. With a small dose of radiation, the mucous membrane is restored almost completely over time. With a large dose of radiation, inflammation of the small intestine occurs. It is characterized by diarrhea, bloating, pain in the iliac region. In the second month of radiation sickness, inflammation of the esophagus and stomach often joins. Infections, as a rule, manifest themselves in the form of erosive and ulcerative tonsillitis, pneumonia. Hematopoiesis is inhibited, and the immunobiological reactivity of the body is suppressed. Hemorrhagic syndrome manifests itself in the form of numerous hemorrhages that appear in various places, such as the skin, heart muscle, digestive organs, central nervous system, respiratory mucosa, urinary tract. There is usually extensive bleeding. Symptoms of a neurological nature are manifested in the form of general weakness, adynamia, decreased muscle tone, darkening of consciousness, increased tendon reflexes, and meningeal manifestations. Often reveal signs of increasing swelling of the brain and membranes.
- The fourth phase is the period of restoration of structure and functions. The condition of patients improves, hemorrhagic manifestations disappear, damaged areas of the skin, mucous membranes begin to heal, new hair grows. The recovery period lasts, as a rule, about six months. At high doses of radiation, recovery can take up to two years. After the end of the fourth phase, we can talk about a complete recovery. True, in most cases, after exposure and radiation sickness, residual manifestations remain. The recovery process is accompanied by heart rhythm failures, jumps in blood pressure.
Classification of radiation sickness
The classification of the disease is based on the criteria for the duration of the lesion and the dosage of ionizing radiation. With a single massive exposure to radiation, acute radiation sickness develops. With prolonged exposure, repeated in relatively small doses, it is a chronic ailment.
The degree of radiation sickness, the clinical form of the lesion is determined by the dosage of the radiation received:
- radiation injury. May occur with short-term, simultaneous exposure to radiation with a dosage of less than 1 Gy. Pathological disorders are reversible.
- Bone marrow form (typical). It develops with short-term single-stage exposure to 1-6 Gy. The mortality rate is 50%. It can have four degrees: mild (1-2 Gy), medium (2-4 Gy), severe (4-6 Gy), extremely severe (6-10 Gy).
- Gastrointestinal form. The result of a one-time short-term exposure to radiation of 10-20 Gy. It is characterized by severe enteritis, hemorrhagic syndrome, fever, infectious and septic complications.
- Vascular (toxemic) form. The result of single-stage irradiation with a dose of 20-80 Gy. Hemodynamic disorders and severe intoxication are noted.
- cerebral form. It develops as a result of exposure to a dose of more than 80 Gy. Death occurs on the first or third day. The cause of death is cerebral edema.
The outcome of chronic radiation sickness can be recovery, partial recovery, stabilization of favorable changes or their progression.
Features of the treatment of radiation sickness
When exposed to radiation with a dose above 2.5 Gy, lethal outcomes are possible. A dose of 4 Gy is considered an average lethal dose for humans. Clinical recovery is possible with correct and timely treatment of radiation sickness with irradiation of 5-10 Gy. However, in the vast majority of cases, exposure to a dose of 6 Gy leads to death.
Treatment of the disease consists in providing an aseptic regimen in specially equipped wards, preventing infectious complications and relieving symptoms. With an increase in fever and agranulocytosis, antibiotics and antiviral drugs are used.
For the relief of nausea and vomiting, Aeron, Aminazine, Atropine are prescribed. When dehydrated, saline is infused.
In severe irradiation, detoxification therapy with Cordiamin, Mezaton, Norepinephrine, kinin inhibitors is carried out during the first day.
To increase anti-infective therapy, hyperimmune plasma agents and gamma globulin are prescribed. The system of measures aimed at the prevention of internal and external infections uses different types of isolators with sterile air supply, sterile materials, and food. Skin and mucous membranes should be treated with antiseptics. To suppress the activity of the intestinal flora, nonabsorbable antibiotics are used - Gentamicin, Kanamycin, Neomycin, Ristomycin.
Replacement of platelet deficiency is carried out by introducing a platelet mass obtained from one donor after irradiation with a dose of 15 Gy. According to the indications, transfusions of washed fresh erythrocytes may be prescribed.
To combat bleeding, hemostatic drugs of general and local action are used. Means are also prescribed that strengthen the vascular wall - Dicinon, Rutin, ascorbic acid, steroid hormones, and also increase blood clotting - Fibrinogen.
Local lesions of the mucous membrane require special care and treatment with bactericidal mucolytic drugs. To eliminate skin lesions, aerosols and collagen films, moisturizing dressings with antiseptics and tannins, as well as ointment dressings with hydrocortisone and its derivatives are used. Non-healing wounds and ulcers are excised with further plasty.
With the development of necrotic enteropathy, Biseptol, antibiotics that sterilize the gastrointestinal tract are used. Complete fasting is also indicated. Allowed the use of boiled water and drugs against diarrhea. In especially severe cases, parenteral nutrition is used.
With high doses of radiation, no contraindications and the presence of a suitable donor, bone marrow transplantation is recommended. Usually the indication is an irreversible depression of hematopoiesis, a deep suppression of immunological reactivity.
Consequences and complications of radiation sickness
The prognosis of the disease is associated with the massive dose of radiation and the duration of exposure. Patients who survive the critical period of 12 weeks after irradiation have a chance of a favorable outcome.
However, even after non-lethal radiation injury, the victims can often subsequently develop various complications - hemoblastoses, malignant tumors of different localization. Often there is a loss of reproductive function, and various genetic abnormalities can be detected in the offspring.
Latent chronic infectious diseases, blood pathologies can also become aggravated. Deviations also occur in the field of ophthalmology - the lens and vitreous body become cloudy. There are various dystrophic processes in the body.
It is possible to protect yourself from the consequences of radiation sickness as much as possible only with a timely visit to a specialized clinic.
How to treat radiation sickness - look at the video:
Radiation sickness is a serious illness that manifests itself with a whole “bouquet” of symptoms. At the moment, there is no effective treatment for the disease, and therapy is reduced only to the suppression of symptoms. Therefore, it is important to take precautions near sources of radiation and try to protect yourself from ionizing radiation as much as possible.
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Radiation sickness
What is radiation sickness
Radiation sickness is formed under the influence of radioactive radiation in the dose range of 1-10 Gy and more. Some changes observed with irradiation at doses of 0.1-1 Gy are regarded as preclinical stages of the disease. There are two main forms of radiation sickness, which are formed after a general relatively uniform exposure, as well as with a very narrowly localized exposure of a certain segment of the body or organ. Combined and transitional forms are also noted.
Pathogenesis (what happens?) during radiation sickness:
Radiation sickness is subdivided into acute (subacute) and chronic forms, depending on the time distribution and the absolute value of radiation exposure, which determine the dynamics of developing changes. The peculiarity of the mechanism of development of acute and chronic radiation sickness excludes the transition of one form to another. The conditional boundary, delimiting acute or chronic forms, is the accumulation over a short period (from 1 hour to 1-3 days) of a total tissue dose equivalent to that from exposure to 1 Gy of external penetrating radiation.
The development of the leading clinical syndromes of acute radiation sickness depends on the doses of external radiation, which determine the variety of observed lesions. In addition, the type of radiation also plays an important role, each of which has certain features that are associated with differences in their damaging effect on organs and systems. So, a-radiation is characterized by a high ionization density and low penetrating power, in connection with which these sources cause a damaging effect limited in space.
Beta radiation, which has a weak penetrating and ionizing ability, causes tissue damage directly on the body parts adjacent to the radioactive source. On the contrary, y-radiation and X-rays cause deep damage to all tissues in the zone of their action. Neutron radiation causes significant inhomogeneity in damage to organs and tissues, since their penetrating ability, as well as linear energy losses along the neutron beam in tissues, are different.
In the case of irradiation with a dosage of 50-100 Gy, CNS damage determines the leading role in the mechanism of the development of the disease. With this form of the disease, death is usually noted on the 4-8th day after exposure to radiation.
When irradiated in doses from 10 to 50 Gy, symptoms of damage to the gastrointestinal tract with rejection of the small intestinal mucosa leading to death within 2 weeks come to the fore in the mechanism of development of the main manifestations of the radiation clinical picture of the disease.
Under the influence of a lower dose of radiation (from 1 to 10 Gy), symptoms typical of acute radiation sickness are clearly seen, the main manifestation of which is the hematological syndrome, accompanied by bleeding and all kinds of complications of an infectious nature.
Damage to the organs of the gastrointestinal tract, various structures of both the brain and spinal cord, as well as the organs of hematopoiesis, is characteristic of exposure to the above radiation doses. The severity of such changes and the speed of development of disorders depend on the quantitative parameters of exposure.
Radiation sickness symptoms:
In the formation and development of the disease, the following phases are clearly distinguished: Phase I - the primary general reaction; Phase II - apparent clinical well-being (s-ytaya, or latent, phase); Phase III - pronounced symptoms of the disease; IV phase is the period of restoration of structure and function.
In the event that acute radiation sickness proceeds in a typical form, four degrees of severity can be distinguished in its clinical picture. The symptoms characteristic of each of the degrees of acute radiation sickness are due to the dose of radioactive exposure that fell on this patient:
1) a mild degree occurs when exposed to a dose of 1 to 2 Gy;
2) moderate severity - the radiation dose is from 2 to 4 Gy;
3) severe - the dose of radiation ranges from 4 to 6 Gy;
4) an extremely severe degree occurs when irradiated at a dose exceeding 6 Gy.
If the patient received a dose of radioactive irradiation at a dose of less than 1 Gy, then we have to talk about the so-called radiation injury, which occurs without any obvious symptoms of the disease.
A severe degree of the disease is accompanied by recovery processes that take a long time for 1-2 years. In cases where there are any changes that acquire a persistent character, in the future one should talk about the consequences of acute radiation sickness, and not about the transition of the acute form of the disease to the chronic one.
Phase I of the primary general reaction is observed in all individuals when exposed to doses exceeding 2 Gy. The time of its appearance depends on the dose of penetrating radiation and is calculated in minutes and hours. The characteristic signs of the reaction are nausea, vomiting, a feeling of bitterness or dryness in the mouth, weakness, fatigue, drowsiness, headache.
Perhaps the development of shock-like conditions, accompanied by a decrease in blood pressure, loss of consciousness, possibly fever, and diarrhea. These symptoms usually occur at exposure doses exceeding 10 Gy. Transient reddening of the skin with a somewhat bluish tint is detected only in areas of the body that have been irradiated at a dose exceeding 6-10 Gy.
In patients, there is some variability in pulse and blood pressure with a downward trend, a uniform general decrease in muscle tone, trembling of the fingers, and a decrease in tendon reflexes are characteristic. Changes
electroencephalograms indicate moderate diffuse inhibition of the cerebral cortex.
During the first day after irradiation, neutrophilic leukocytosis is observed in the peripheral blood with no noticeable rejuvenation in the formula. In the future, over the next 3 days, the level of lymphocytes in the blood decreases in patients, this is due to the death of these cells. The number of lymphocytes after 48-72 hours after irradiation corresponds to the received dose of radiation. The number of platelets, erythrocytes and hemoglobin in these periods after irradiation does not change against the background of myelokaryocytopenia.
In the myelogram, a day later, the almost complete absence of such young forms as myeloblasts, erythroblasts, a decrease in the content of pronormoblasts, basophilic normoblasts, promyelocytes, and myelocytes is revealed.
In the first phase of the disease, at radiation doses exceeding 3 Gy, some biochemical changes are detected: a decrease in the content of serum albumins, an increase in the level of blood glucose with a change in the sugar curve. In more severe cases, moderate transient bilirubinemia is detected, thereby indicating metabolic disorders in the liver, in particular, a decrease in the absorption of amino acids and increased protein breakdown.
Phase II - the phase of imaginary clinical well-being, the so-called latent, or latent, phase, is observed after the disappearance of signs of the primary reaction 3-4 days after exposure and lasts for 14-32 days. The state of health of patients in this period improves, only some lability of the pulse rate and blood pressure remains. If the radiation dose exceeds 10 Gy, the first phase of acute radiation sickness passes directly into the third.
From the 12-17th day, in patients exposed to radiation at a dose exceeding 3 Gy, baldness is detected and progresses. During these periods, other skin lesions also occur, sometimes being prognostically unfavorable and indicating a high dose of radiation.
In phase II, neurological symptoms become more pronounced (impaired movement, coordination, involuntary trembling of the eyeballs, organic motility, symptoms of mild pyramidal insufficiency, decreased reflexes). The EEG shows the appearance of slow waves and their synchronization in the rhythm of the pulse.
In the peripheral blood, by the 2-4th day of the disease, the number of leukocytes decreases to 4 H 109/l due to a decrease in the number of neutrophils (the first decrease). The lymphocytopenia persists and progresses somewhat. Thrombocytopenia and reticulocytopenia are added to the 8-15th day. The number of red blood cells does not decrease significantly. By the end of phase II, a slowdown in blood clotting is detected, as well as a decrease in the stability of the vascular wall.
The myelogram shows a decrease in the number of more immature and mature cells. Moreover, the content of the latter decreases in proportion to the time elapsed after irradiation. By the end of phase II, only mature neutrophils and single polychromatophilic normoblasts are found in the bone marrow.
The results of biochemical blood tests indicate a slight decrease in the albumin fraction of serum proteins, normalization of blood sugar levels and serum bilirubin.
In phase III, which proceeds with severe clinical symptoms, the timing of onset and the degree of intensity of individual clinical syndromes depend on the dose of ionizing radiation; the duration of the phase ranges from 7 to 20 days.
Dominant in this phase of the disease is the defeat of the blood system. Along with this, immune suppression, hemorrhagic syndrome, the development of infections and autointoxication take place.
By the end of the latent phase of the disease, the condition of the patients worsens, resembling a septic condition with characteristic symptoms: increasing general weakness, rapid pulse, fever, lowering blood pressure. Swelling and bleeding of the gums. In addition, the mucous membranes of the oral cavity and the gastrointestinal tract are affected, which is manifested in the appearance of a large number of necrotic ulcers. Ulcerative stomatitis occurs when irradiated in doses of more than 1 Gy to the oral mucosa and lasts about 1-1.5 months. The mucous membrane almost always recovers completely. At high doses of radiation, severe inflammation of the small intestine develops, characterized by diarrhea, fever, bloating, and tenderness in the iliac region. At the beginning of the 2nd month of illness, radiation inflammation of the stomach and esophagus may be added. Infections are most often manifested in the form of ulcerative erosive tonsillitis and pneumonia. The leading role in their development is played by autoinfection, which acquires pathogenic significance against the background of a pronounced inhibition of hematopoiesis and suppression of the immunobiological reactivity of the organism.
The hemorrhagic syndrome manifests itself in the form of hemorrhages, which can be localized in completely different places: the heart muscle, skin, mucous membrane of the respiratory and urinary tract, gastrointestinal tract, central nervous system, etc. The patient has heavy bleeding.
Neurological symptoms are the result of general intoxication, infection, anemia. Increasing general lethargy, weakness, blackout of consciousness, meningeal symptoms, increased tendon reflexes, and decreased muscle tone are noted. Usually there are signs of increasing swelling of the brain and its membranes. Slow pathological waves appear on the EEG.
Diagnosis of radiation sickness:
The hemogram shows a second sharp decrease in the number of leukocytes due to neutrophils (preserved neutrophils with pathological granularity), lymphocytosis, plasmatization, thrombocytopenia, anemia, reticulocytopenia, a significant increase in ESR.
The beginning of regeneration confirms an increase in the number of leukocytes, the appearance of reticulocytes in the hemogram, as well as a sharp shift in the leukocyte formula to the left.
The picture of the bone marrow at lethal doses of radiation remains devastated throughout the III phase of the disease. At lower doses, after a 7-12-day period of aplasia, blast elements appear in the myelogram, and then the number of cells of all generations increases. With a moderate severity of the course of the process in the bone marrow from the first days of phase III, against the background of a sharp decrease in the total number of myelokaryocytes, signs of hematopoietic repair are found.
Biochemical studies reveal hypoproteinemia, hypoalbuminemia, a slight increase in the level of residual nitrogen, and a decrease in the amount of blood chlorides.
Phase IV - the phase of immediate recovery - begins with normalization
temperature, improvement of the general condition of patients.
In the event that there was a severe course of acute radiation sickness, the pastosity of the face and limbs persists for a long time in patients. The remaining hair fades, becomes dry and brittle, the growth of new hair at the site of baldness resumes on the 3-4th month after irradiation.
Pulse and blood pressure normalize, sometimes moderate hypotension remains for a long time.
For some time, hand trembling, static incoordination, a tendency to increase tendon and periosteal reflexes, and some unstable focal neurological symptoms have been noted. The latter are regarded as the result of functional disorders of cerebral circulation, as well as the exhaustion of neurons against the background of general asthenia.
There is a gradual recovery of peripheral blood parameters. The number of leukocytes and platelets increases and by the end of the 2nd month reaches the lower limit of the norm. In the leukocyte formula, there is a sharp shift to the left to promyelocytes and myeloblasts, the content of stab forms reaches 15-25%. The number of monocytes is normalized. By the end of the 2-3rd month of the disease, reticulocytosis is detected.
Until the 5-6th week of the disease, anemia continues to increase with the phenomena of anisocytosis of erythrocytes due to macroforms.
The myelogram reveals signs of a pronounced recovery of hematopoietic cells: an increase in the total number of myelokaryocytes, the predominance of immature erythropoiesis and leukopoiesis cells over mature ones, the appearance of megakaryocytes, and an increase in the number of cells in the mitotic phase. Biochemical indicators are normalized.
Typical long-term consequences of severe acute radiation sickness are the development of cataracts, moderate leuko-, neutro- and thrombocytopenia, persistent focal neurological symptoms, and sometimes endocrine changes.
V persons exposed to radiation, in the long term, leukemia develops 5-7 times
more often.
The mechanism of development of the observed changes in hematopoiesis at various stages of the course of acute radiation sickness is associated with different radiosensitivity of individual cellular elements. Thus, blast forms and lymphocytes of all generations are highly radiosensitive. Promyelocytes, basophilic erythroblasts, and immature monocytoid cells are relatively radiosensitive. Mature cells are highly radioresistant.
On the first day after total irradiation at a dose exceeding 1 Gy, there is a massive death of lymphoid and blast cells, and with an increase in the irradiation dose, more mature cellular elements of hematopoiesis.
At the same time, the mass death of immature cells does not affect the number of granulocytes and erythrocytes in peripheral blood. The only exceptions are lymphocytes, which themselves are highly radiosensitive. The neutrophilic leukocytosis that occurs is mainly of a redistributive nature.
Simultaneously with interphase death, the mitotic activity of hematopoietic cells is suppressed while maintaining their ability to mature and enter the peripheral blood. As a result, myelokaryocytopenia develops.
Severe neutropenia in the III phase of the disease is a reflection of the devastation of the bone marrow and the almost complete absence of all granulocytic elements in it.
Approximately at the same time, there is a maximum decrease in the number of platelets in the peripheral blood.
The number of red blood cells decreases even more slowly, since their lifespan is about 120 days. Even with a complete cessation of the entry of erythrocytes into the blood, their number will decrease daily by about 0.85%. Therefore, a decrease in the number of erythrocytes and the content of Hb is usually detected only in phase IV - the recovery phase, when the natural loss of erythrocytes is already significant and is not yet compensated by newly formed ones.
Radiation sickness treatment:
In the case of irradiation at a dose of 2.5 Gy and above, fatal outcomes are possible. A dose of 4 ± 1 Gy is tentatively considered average lethal for humans, although in cases of irradiation at a dose of 5-10 Gy, clinical recovery with proper and timely treatment is still possible. When irradiated at a dose of more than 6 Gy, the number of survivors is practically reduced to zero.
To determine the correct tactics for managing patients, as well as predicting acute radiation sickness, dosimetric measurements are carried out for exposed patients, which indirectly indicate the quantitative parameters of radioactive effects on tissues.
The dose of ionizing radiation absorbed by the patient can be determined on the basis of a chromosomal analysis of hematopoietic cells, and is determined in the first 2 days after exposure. During this period, per 100 peripheral blood lymphocytes, chromosomal abnormalities amount to 22-45 fragments in the first degree of severity, 45-90 fragments in the second degree, 90-135 fragments in the third, and more than 135 fragments in the fourth, extremely severe degree of the disease.
In the first phase of the disease, Aeron is used to relieve nausea and prevent vomiting; in cases of repeated and indomitable vomiting, chlorpromazine and atropine are prescribed. In case of dehydration, saline infusions are necessary.
In severe acute radiation sickness, during the first 2-3 days after exposure, the doctor conducts detoxification therapy (for example, polyglucin). To combat collapse, well-known agents are used - cardiamine, mezaton, norepinephrine, as well as kinin inhibitors: trasilol or contrical.
Prevention and treatment of infectious complications
In the system of measures aimed at the prevention of external and internal infections, various types of isolators with sterile air supply, sterile medical materials, care items and food are used. The skin and visible mucous membranes are treated with antiseptics, non-absorbable antibiotics (gentamicin, kanamycin, neomycin, polymyxin-M, ristomycin) are used to suppress the activity of the intestinal flora. At the same time, large doses of nystatin (5 million units or more) are administered orally. In cases of a decrease in the level of leukocytes below 1000 in 1 mm3, it is advisable to use prophylactic antibiotics.
In the treatment of infectious complications, large doses of intravenously administered broad-spectrum antibacterial drugs (gentamicin, tseporin, kanamycin, carbenicillin, oxacillin, methicillin, lincomycin) are prescribed. When joining a generalized fungal infection, amphotericin B is used.
It is advisable to strengthen antibacterial therapy with biological preparations of directed action (antistaphylococcal plasma and y-globulin, antipseudomonal plasma, hyperimmune plasma against Escherichia coli).
If within 2 days there is no positive effect, the doctor changes antibiotics and then prescribes them, taking into account the results of bacteriological cultures of blood, urine, feces, sputum, smears from the oral mucosa, as well as external local infectious foci, which are produced on the day of admission and beyond -in one day. In cases of accession of a viral infection with an effect, acyclovir can be used.
The fight against bleeding includes the use of hemostatic agents of general and local action. In many cases, agents that strengthen the vascular wall (dicinone, steroid hormones, ascorbic acid, rutin) and increase blood clotting (E-ACC, fibrinogen) are recommended.
In the vast majority of cases, thrombocytopenic bleeding can be stopped by transfusing an adequate amount of freshly prepared donor platelets obtained by thrombocytopenia. Platelet transfusions are indicated in cases of deep thrombocytopenia (less than 20 109 / l), occurring with hemorrhages on the skin of the face, upper half of the body, in the fundus, with local visceral bleeding.
Anemic syndrome in acute radiation sickness rarely develops. Red blood cell transfusions are prescribed only when the hemoglobin level drops below 80 g / l.
Transfusions of freshly prepared erythrocyte mass, washed or thawed erythrocytes are used. In rare cases, it may be necessary to individually select not only the AB0 system and the Rh factor, but also other erythrocyte antigens (Kell, Duffy, Kidd).
Treatment of ulcerative-necrotic lesions of the mucous membranes of the gastrointestinal tract.
In the prevention of ulcerative necrotic stomatitis, rinsing the mouth after meals (with a 2% soda solution or 0.5% novocaine solution), as well as antiseptic agents (1% hydrogen peroxide, 1% solution 1: 5000 furacilin; 0.1% gramicidin, 10% water-alcohol emulsion of propolis, lysozyme). In cases of development of candidiasis, nystatin, levorin are used.
One of the severe complications of agranulocytosis and direct exposure to radiation is necrotic enteropathy. The use of biseptol or antibiotics sterilizing the gastrointestinal tract helps to reduce clinical manifestations or even prevent its development. With the manifestation of necrotic enteropathy, the patient is prescribed complete fasting. In this case, only the intake of boiled water and means that stop diarrhea (dermatol, bismuth, chalk) is allowed. In severe cases of diarrhea, parenteral nutrition is used.
Bone marrow transplant
Transplantation of allogeneic histocompatible bone marrow is indicated only in cases characterized by irreversible depression of hematopoiesis and profound suppression of immunological reactivity.
Consequently, this method has limited possibilities, since there are still no sufficiently effective measures to overcome tissue incompatibility reactions.
The selection of a bone marrow donor is made necessarily taking into account the transplantation antigens of the HLA system. In this case, the principles established for allomyelotransplantation with preliminary immunosuppression of the recipient (use of methotrexate, irradiation of blood transfusion media) must be observed.
Special attention should be paid to the general uniform irradiation used as a pre-transplantation immunosuppressive and antitumor agent in a total dose of 8-10 Gy. The observed changes differ in a certain pattern; in different patients, the severity of individual symptoms is not the same.
The primary reaction that occurs after radiation exposure at a dose of more than 6 Gy is the appearance of nausea (vomiting), chills against the background of elevated temperature, a tendency to hypotension, sensations of dryness of the mucous membranes of the nose and lips, a bluish color of the face, especially lips and neck. The general irradiation procedure is carried out in a specially equipped irradiator under constant visual observation of the patient with the help of television cameras in a two-way voice communication. If necessary, the number of breaks can be increased.
Of the other symptoms that naturally arise as a result of "therapeutic" total irradiation, it should be noted inflammation of the parotid gland in the first hours after irradiation, reddening of the skin, dryness and swelling of the nasal mucosa, sensations of pain in the eyeballs, conjunctivitis.
The most formidable complication is the hematological syndrome. As a rule, this syndrome develops in the first 8 days after the patient receives a dose of radiation.
Which doctors should you contact if you have Radiation Sickness:
Hematologist
Therapist
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Other diseases from the group Diseases of the blood, hematopoietic organs and individual disorders involving the immune mechanism:
| B12 deficiency anemia |
| Anemia due to impaired synthesis by utilization of porphyrins |
| Anemia due to a violation of the structure of globin chains |
| Anemia characterized by the carriage of pathologically unstable hemoglobins |
| Anemia Fanconi |
| Anemia associated with lead poisoning |
| aplastic anemia |
| Autoimmune hemolytic anemia |
| Autoimmune hemolytic anemia |
| Autoimmune hemolytic anemia with incomplete heat agglutinins |
| Autoimmune hemolytic anemia with complete cold agglutinins |
| Autoimmune hemolytic anemia with warm hemolysins |
| Heavy chain diseases |
| Werlhof's disease |
| von Willebrand disease |
| Di Guglielmo's disease |
| Christmas disease |
| Marchiafava-Micheli disease |
| Rendu-Osler disease |
| Alpha heavy chain disease |
| gamma heavy chain disease |
| Shenlein-Henoch disease |
| Extramedullary lesions |
| Hairy cell leukemia |
| Hemoblastoses |
| Hemolytic uremic syndrome |
| Hemolytic uremic syndrome |
| Hemolytic anemia associated with vitamin E deficiency |
| Hemolytic anemia associated with deficiency of glucose-6-phosphate dehydrogenase (G-6-PDH) |
| Hemolytic disease of the fetus and newborn |
| Hemolytic anemia associated with mechanical damage to red blood cells |
| Hemorrhagic disease of the newborn |
| Histiocytosis malignant |
| Histological classification of Hodgkin's disease |
| DIC |
| Deficiency of K-vitamin-dependent factors |
| Factor I deficiency |
| Factor II deficiency |
| Factor V deficiency |
| Factor VII deficiency |
| Factor XI deficiency |
| Factor XII deficiency |
| Factor XIII deficiency |
| Iron-deficiency anemia |
| Patterns of tumor progression |
| Immune hemolytic anemias |
| Bedbug origin of hemoblastoses |
| Leukopenia and agranulocytosis |
| Lymphosarcomas |
| Lymphocytoma of the skin (Caesari disease) |
| Lymph node lymphocytoma |
| Lymphocytoma of the spleen |
| Marching hemoglobinuria |
| Mastocytosis (mast cell leukemia) |
| Megakaryoblastic leukemia |
| The mechanism of inhibition of normal hematopoiesis in hemoblastoses |
| Mechanical jaundice |
| Myeloid sarcoma (chloroma, granulocytic sarcoma) |
| multiple myeloma |
| Myelofibrosis |
