title: Initial medical management of patients severely irradiated in the Tokai-mura criticality accident.
abstract: A nuclear criticality accident occurred in Japan on September 30, 1999, which resulted in severe exposure of three victims to mixed flux of neutrons and gamma-rays. Estimated average doses for the three victims were 5.4 Gy of neutrons and 8.5 Gy of gamma-rays for Patient A, 2.9 Gy of neutrons and 4.5 Gy of gamma-rays for Patient B, and 0.81 Gy of neutrons and 1.3 Gy of gamma-rays for Patient C. They then suffered the consequences of the effects of ionizing radiation resulting in acute radiation syndrome. In Patients A and B, bone marrow failure was so severe that they received haematopoietic stem cell transplantation. The graft initially took successfully in both patients, although in Patient B it was later taken over by his own haematopoietic cells. They also suffered from severe skin lesions, later exhibited gastrointestinal bleeding and eventually died of multiple organ failure 82 and 210 days after the accident, respectively. The survival of these patients beyond the period of agranulocytosis means that bone marrow failure per se caused by exposure to ionizing radiation may now be overcome. Patient C also developed bone marrow failure and was treated with granulocyte colony-stimulating factor as well as supportive care. He recovered without major complications and is now under periodical follow-up. Remarkably, during the prodromal phase, all the patients exhibited hypoxaemia, two of whom also showed interstitial oedema of the lungs. In Patient C these manifestations improved within a week. The circumstances of the accident and the initial medical treatment of the victims are described.
authors.affiliation: Research Center for Radiation Emergency Medicine, National Institute of Radiological Sciences, Chiba, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Hirama
authors.forename: S
authors.initials: S
authors.lastname: Tanosaki
authors.forename: S
authors.initials: S
authors.lastname: Kandatsu
authors.forename: N
authors.initials: N
authors.lastname: Kuroiwa
authors.forename: T
authors.initials: T
authors.lastname: Kamada
authors.forename: H
authors.initials: H
authors.lastname: Tsuji
authors.forename: S
authors.initials: S
authors.lastname: Yamada
authors.forename: H
authors.initials: H
authors.lastname: Katoh
authors.forename: N
authors.initials: N
authors.lastname: Yamamoto
authors.forename: H
authors.initials: H
authors.lastname: Tsujii
authors.forename: G
authors.initials: G
authors.lastname: Suzuki
authors.forename: M
authors.initials: M
authors.lastname: Akashi
mesh_terms: D000328:Adult; D017809:Fatal Outcome; D005720:Gamma Rays; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009502:Neutrons; D016273:Occupational Exposure; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D018788:Radioactive Hazard Release