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LA PIEL Y LA GUERRA
THE SKIN AND THE WAR
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***** DERMAGIC-EXPRESS No 25 ********* 
****** 20 DICIEMBRE 1.998 ******* 
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1.) EDITORIAL ESPAÑOL
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Hola amigos DERMAGICOS, ayer finalizo el operativo denominado "ZORRO DEL DESIERTO", cayeron infinidad de BOMBAS en alguna parte de nuestra tierra y mundo. Pudimos ver en televisión comodamente sentados o acostados el espectaculo. Me motivo el incidente, y me fui de viaje al Cyber, a buscar información sobre guerras, accidentes nucleares, capa de ozono, radiación, cancer, etc. Viaje que resulto asombroso por lo que encontre, yo diria espeluznante. 

Aqui les dejo estas 43 REFERENCIAS bibliograficas, que dibujan algo las locuras cometidas por el hombre y sus armas en este siglo, referencias que tambien deberian leerlas nuestros lideres del mundo, esos que vemos por los periódicos y television, hablando de conservacion del ambiente y preservacion de la raza humana, cuando realmente lo que estan es pensando en su interes personal, territorial o en una guerra para probar los nuevos armamentos. 

Estas miles de bombas que cayeron en Bagdad, tambien cayeron sobre nosotros y nuestros hijos, pues dentro de poco tiempo, los efectos atmosfericos comenzaran a verse: disminucion de la capa de ozono, cancer de piel, contaminación, huracanes, alteraciones del clima, mas efectos del "niño", y muchos mas. 

Sin ningun contenido politico y mas bien acongojado por lo acontecido en estos dias les envio este DERMAGIC, que deberia ya lo dije, publicarse en la mente de los que dicen llamarse nuestros lideres, para que tomen conciencia de que somos nosotros mismos los que nos estamos matando lentamente, por el daño que le estamos haciendo a nuestro bello planeta y la gente que vive en el.

Saludos a todos,,, 

1.) EDITORIAL ENGLISH
=====================
Hello DERMAGIC'S friends , yesterday conclude the operative denominated "FOX OF THE DESERT". Fell down infinity of BOMBS in some part of our earth and world. We could see in comfortably seated, through television the show. I motivate myself the incident, and I went on a trip to the Cyber, to look for information about wars, nuclear accidents, layer of ozone, cancer, radiation, etc. Travels that I am astonishing for what I found, I would say thrilling.

Here I leave these 43 bibliographical REFERENCES that draw something the madness made by the man and their weapons in this century, references that should also read them our leaders of the world, those that we see on newspaper and television, speaking of conservation of the atmosphere and preservation of the human race, when what they are is really thinking of their personal, territorial interest or in a war to prove the new armaments. 

These thousands of bombs that fell in Bagdad, also fell on us and our children, because in little time, the atmospheric effects will began to show: decrease of the layer of ozone, skin cancer, contamination, hurricanes, alterations of the climate, more "baby"
effects, etc.

Without any political content and but very heartbroken for what happened in these days i send this DERMAGIC, that should, I already said it, to be published in the mind of those that say to call themselves our leaders, so that they take conscience that we are ourselves those that are killing slowly, for the damage that we are making to our beautiful planet and the people who live in them. 

Greetings to all,,, 
Dr. José Lapenta
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DERMAGIC/EXPRESS(25)
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LA PIEL Y LA GUERRA // THE SKIN AND THE WAR 
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INCIDENTES EN NAGASAKI E HIROSHIMA, CHERNOBYL, GOIANIA, VIETNAM, EL GOLFO PERSICO, Y OTROS... 
INCIDENT AT NAGASAKI AND HIROSHIMA, CHERNOBYL, GOIANIA, VIETNAM, THE PERSIAN GULF, AND OTHERS...
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1.) Thyroid diseases among atomic bomb survivors in Nagasaki [published erratum appears in JAMA 1995 Jan 25; 273(4):288]
2.) Primary liver carcinoma and liver cirrhosis in atomic bomb survivors, Hiroshima and Nagasaki, 1961-75, with special reference to hepatitis B surface antigen.
3.) Multiple myeloma among atomic bomb survivors in Hiroshima and Nagasaki, 1950-76: relationship to radiation dose absorbed by marrow.
4.) Cancer of the head and neck in atomic bomb survivors: Hiroshima and Nagasaki, 1957-1976.
5.) Cancer risk among atomic bomb survivors. The RERF Life Span Study. Radiation 
6.) Perinatal loss and neurological abnormalities among children of the atomic bomb. Nagasaki and Hiroshima revisited, 1949 to 1989 [see comments]
7.) Malignant and benign ovarian neoplasms among atomic bomb survivors, Hiroshima and Nagasaki, 1950-80.
8.) Sequelae of radiation facial epilation (North American Hiroshima maiden syndrome).
9.) Studies of cancer and radiation dose among atomic bomb survivors. The example of breast cancer [see comments]
10.) Chronic cutaneous damage after accidental exposure to ionizing radiation: the Chernobyl experience.
11.) Immediate medical consequences of nuclear accidents. Lessons from Chernobyl.
12.) Caring for survivors of the Chernobyl disaster. What the clinician should know.
13.) Significant increase in trisomy 21 in Berlin nine months after the Chernobyl reactor accident: temporal correlation or causal relation? [see comments]
14.) The global impact of the Chernobyl reactor accident.
15.) Pediatric thyroid cancer after the Chernobyl disaster. Pathomorphologic study of 84 cases (1991-1992) from the Republic of Belarus.
16.) Orofacial manifestations from accidental exposure to caesium 137 in Goiania, Brazil.
17.) Soft tissue sarcoma and military service in Vietnam: a case-control study [published erratum appears in J Natl Cancer Inst 1987 Nov; 79(5):1173]
18.) Postservice mortality among Vietnam veterans. The Centers for Disease Control Vietnam Experience Study.
19.) Dermatology in a war zone: a Persian Gulf experience.
20.) Psychiatric implications of missile attacks on a civilian population. Israeli lessons from the Persian Gulf War.
21.) Q fever meningoencephalitis in a soldier returning from the Persian Gulf War.
22.) Effect of the Gulf War on infant and child mortality in Iraq [published erratum appears in N Engl J Med 1992 Dec 10; 327(24):1768] [see comments]
23.) Atropine poisoning in children during the Persian Gulf crisis. A national survey in Israel [see comments]
24.) Iraqi missile attacks on Israel. The association of mortality with a life-threatening stressor [see comments]
25.) Effect of Iraqi missile war on incidence of acute myocardial infarction and sudden death in Israeli civilians [see comments]
26.) Veterans worry that unexplained medical problems a legacy of service during Gulf War.
27.) The McConnell missile accident. Clinical spectrum of nitrogen dioxide exposure.
28.) Verification of exposure to sulfur mustard in two casualties of the Iran-Iraq 
conflict.
29.) Skin manifestations of mustard gas in a group of 14 children and teenagers: a clinical study.
30.) A serious skin sulfur mustard burn from an artillery shell.
31.) Tear gas--harassing agent or toxic chemical weapon?
32.) Use of phenytoin in healing of war and non-war wounds. A pilot study of 25 cases.
33.) Missile injuries to the temporal bone.
34.) Tympanic membrane perforation in survivors of a SCUD missile explosion.
35.) The relationship between skin cancers, solar radiation and ozone depletion.
36.) Annual exposures to carcinogenic radiation from the sun at different latitudes and amplification factors related to ozone depletion. The use of different geometrical representations of the skin surface receiving the ultraviolet radiation.
37.) Direct estimates of cancer mortality due to low doses of ionising radiation: an 
international study. IARC Study Group on Cancer Risk among Nuclear Industry Workers [see comments]
38.) A summary of mortality and incidence of cancer in men from the United Kingdom who participated in the United Kingdom's atmospheric nuclear weapon tests and experimental programmes.
39.) Sulfur mustard induces apoptosis and necrosis in endothelial cells.
40.) Radiation accidents and nuclear energy: medical consequences and therapy [clinical conference]
41.) Mortality of employees of the Atomic Weapons Establishment, 1951-82.
42.) Medical responsibility and thermonuclear war.
43.) The medical profession and nuclear war. A social history.
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1.) Thyroid diseases among atomic bomb survivors in Nagasaki [published erratum appears in JAMA 1995 Jan 25; 273(4):288]
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SO - JAMA 1994 Aug 3;272(5):364-70
AU - Nagataki S; Shibata Y; Inoue S; Yokoyama N; Izumi M; Shimaoka K
AD - Radiation Effects Research Foundation, Nagasaki, Japan.
MT - Female; Human; Male; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.
PT - JOURNAL ARTICLE
AB - OBJECTIVE--To elucidate the current thyroid disease status for the Nagasaki Adult Health Study cohort of the Radiation Effects Research Foundation. DESIGN--Survey study. SETTING--Nagasaki, Japan. PARTICIPANTS--Cohort members of the Nagasaki Adult Health Study who received biennial health examinations from October 1984 to April 1987 (n = 2856). A total of 2587 subjects remained after exclusion of persons exposed in Hiroshima or in utero and those who were not in Nagasaki at the time of the bombing. Thyroid radiation dose by the dosimetry system established in 1986 was available for 1978 of the 2587 subjects. MAIN OUTCOME MEASURES--Thyroid diseases were diagnosed using uniform procedures including ultrasonic scanning. The relationship of the prevalence of each thyroid disease with thyroid radiation dose, sex, and age was analyzed using logistic models. RESULTS--A significant dose-response relationship was observed for solid nodules, which include cancer, adenoma, adenomatous goiter, and nodules without histological diagnosis, and for antibody-positive spontaneous hypothyroidism (autoimmune hypothyroidism) but not for other diseases. The prevalence of solid nodules showed a monotonic dose-response relationship, yet that of autoimmune hypothyroidism displayed a concave dose-response relationship reaching a maximum (+/- SE) level of 0.7 +/- 0.2 Sv. CONCLUSIONS--The present study confirmed the results of previous studies by showing a significant increase in solid nodules with dose to the thyroid and demonstrated for the first time a significant increase in autoimmune disease among atomic bomb survivors. A concave dose-response relationship indicates the necessity for further studies on the effects of relatively low doses of radiation on thyroid disease.

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2.) Primary liver carcinoma and liver cirrhosis in atomic bomb survivors, Hiroshima and Nagasaki, 1961-75, with special reference to hepatitis B surface antigen.
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SO - J Natl Cancer Inst 1982 Dec;69(6):1221-7
AU - Asano M; Kato H; Yoshimoto K; Seyama S; Itakura H; Hamada T; Iijima S
MT - Female; Human; Male
PT - JOURNAL ARTICLE
AB - During 1961-75, 128 cases of primary liver carcinoma (PLC) in the Radiation Effects Research Foundation life-span study extended sample and 301 cases of liver cirrhosis in the pathology study sample were observed. The presence of hepatitis B surface antigen (HBsAg) was assessed in all of the cases with the use of orcein and aldehyde fuchsin stains and was confirmed by the immunofluorescence technique. The incidence of PLC was two times higher in Nagasaki than in Hiroshima, which was statistically significant, but little difference was noted in the prevalence of cirrhosis in the two cities. Findings that might possibly explain the higher PLC incidence in Nagasaki were 1) the 2.3 times higher presence in Nagasaki than in Hiroshima of HBsAg in the livers of subjects without liver disease and 2) the two times higher prevalence in Nagasaki than in Hiroshima of cirrhosis with PLC. We believe that the higher incidence of PLC in Nagasaki is attributable to hepatitis B virus infection, although other factors (e.g., immunologic competence affected by radiation) cannot be excluded. In both cities, a suggestive relationship of radiation dose to cirrhosis prevalence, but not to PCL prevalence, was noted. To clarify possible radiation effects on cirrhosis prevalence, further follow-up of the populations of these two cities is necessary.
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3.) Multiple myeloma among atomic bomb survivors in Hiroshima and Nagasaki, 1950-76: relationship to radiation dose absorbed by marrow.
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SO - J Natl Cancer Inst 1982 Aug;69(2):323-8
AU - Ichimaru M; Ishimaru T; Mikami M; Matsunaga M
MT - Female; Human; Male; Support, Non-U.S. Gov't
PT - JOURNAL ARTICLE
AB - The relationship between atomic bomb exposure and the incidence of multiple myeloma has been examined in a fixed cohort of atomic bomb survivors and controls in the life-span study sample for Hiroshima and Nagasaki. From October 1950 to December 1976, 29 cases of multiple myeloma were confirmed in this sample. Our analysis shows that the standardized relative risk (RR) adjusted for city, sex, and age at the time of bombings (ATB) increased with marrow-absorbed radiation dose. The increased RR does not appear to differ between cities or sexes and is demonstrable only for those survivors whose age ATB was between 20 and 59 years. The estimated risk in these individuals is approximately 0.48 cases/million person-years/rad for bone marrow total dose. This excess risk did not become apparent in individuals receiving 50 rad or more in marrow total dose until 20 years or more after exposure.

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4.) Cancer of the head and neck in atomic bomb survivors: Hiroshima and Nagasaki, 1957-1976.
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SO - Cancer 1981 Nov 15;48(10):2172-8
AU - Pinkston JA; Wakabayashi T; Yamamoto T; Asano M; Harada Y; Kumagami H; Takeuchi M
MJ - Carcinoma, Squamous Cell [epidemiology]; Head and Neck Neoplasms [epidemiology]; Neoplasms, Radiation-Induced [epidemiology]
MN - Carcinoma, Squamous Cell [etiology] [pathology]; Head and Neck Neoplasms [etiology] [pathology]; Japan; Nuclear Warfare; Probability; Radiation Dosage; Sex Factors; Time Factors
MT - Female; Human; Male; Support, U.S. Gov't, Non-P.H.S.
PT - JOURNAL ARTICLE
AB - A search was conducted in Hiroshima and Nagasaki for all cases of cancer of the lip, nose and nasal cavity, accessory sinuses, larynx, and the oral cavity and pharynx with their subdivisions occurring during the period 1957-1976 among a large, fixed cohort of atomic bomb survivors. A total of 232 cases were identified, of which 154 (66.4%) were histologically confirmed (definite cases). Among definite cases, cancer of the epiglottis and larynx predominated (31.2%), followed by accessory sinus (24.7%) and tongue (18.8%). Of the 154 definite cases, 141 (91.6%) were squamous-cell carcinomas. Only two sarcomas were identified, neither of which was attributable to radiation exposure. Analysis of both total and definite cases, by both total group and major anatomic site, failed to reveal definite evidence of a radiation relationship. Although a suggestive relationship to radiation dose was found for accessory sinus cancers (P = 0.06) among the definite cases, inconsistencies in the data do not permit the conclusion that the incidence of tumors in this group increased as a result of atomic bomb radiation exposure. The medical literature concerning post-irradiation head and neck tumors is briefly reviewed.

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5.) Cancer risk among atomic bomb survivors. The RERF Life Span Study. Radiation =======================================================================
Effects Research Foundation [see comments]
CM - Comment in: JAMA 1990 Aug; 264(5):622-3
SO - JAMA 1990 Aug 1;264(5):601-4
AU - Shimizu Y; Schull WJ; Kato H
AD - Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan.
MT - Human
PT - JOURNAL ARTICLE
AB - This article summarizes the risk of cancer among the survivors of the atomic bombing of Hiroshima and Nagasaki. We focus primarily on the risk of death from cancer among individuals in the Life Span Study sample of the Radiation Effects Research Foundation from 1950 through 1985 based on recently revised dosimetry procedures. We report the risk of cancer other than leukemia among the atomic bomb survivors. We note that the number of excess deaths of radiation-induced malignant tumors other than leukemia increases with age. Survivors who were exposed in the first or second decade of life have just entered the cancer-prone age and have so far exhibited a high relative risk in association with radiation dose. Whether the elevated risk will continue or will fall with time is not yet clear, although some evidence suggests that the risk may be declining. It is important to continue long-term follow-up of this cohort to document the changes with time since exposure and to provide direct rather than projected risks over the lifetime of an exposed individual.

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6.) Perinatal loss and neurological abnormalities among children of the atomic bomb. Nagasaki and Hiroshima revisited, 1949 to 1989 [see comments]
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CM - Comment in: JAMA 1990 Aug 1; 264(5):622-3
SO - JAMA 1990 Aug 1;264(5):605-9
AU - Yamazaki JN; Schull WJ
AD - Department of Pediatrics, University of California, Los Angeles School of Medicine.
MT - Female; Human
PT - JOURNAL ARTICLE
AB - Studies of the survivors of the atomic bombing of Hiroshima and Nagasaki who were exposed to ionizing radiation in utero have demonstrated a significant increase in perinatal loss and the vulnerability of the developing fetal brain to injury. These studies have also helped to define the stages in the development of the human brain that are particularly susceptible to radiation-related damage. Exposure at critical junctures in development increases the risk of mental retardation, small head size, subsequent seizures, and poor performance on conventional tests of intelligence and in school. The most critical period, 8 through 15 weeks after fertilization, corresponds to that time in development when neuronal production increases and migration of immature neurons to their cortical sites of function occurs. The epidemiologic data are, however, too sparse to settle unequivocally the nature of the dose-response function and, in particular, whether there is or is not a threshold to damage. If a threshold does exist, it appears to be in the 0.10- to 0.20-Gy fetal-dose range in this vulnerable gestational period.

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7.) Malignant and benign ovarian neoplasms among atomic bomb survivors, Hiroshima and Nagasaki, 1950-80.
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SO - J Natl Cancer Inst 1987 Jul;79(1):47-57
AU - Tokuoka S; Kawai K; Shimizu Y; Inai K; Ohe K; Fujikura T; Kato H
MT - Comparative Study; Female; Human; Support, Non-U.S. Gov't
PT - JOURNAL ARTICLE
AB - For 1950-80, 194 ovarian cancer cases were ascertained among the 70,030 females of the Radiation Effects Research Foundation's Life-Span Study E-85 sample, and 106 autopsied cases with benign ovarian neoplasms were ascertained among all 3,046 autopsies performed in the same sample. On the basis of microscopic review, 66% of the cancer and 84% of the benign tumor cases were classified by histologic type. The age-adjusted ovarian cancer incidence rates showed a statistically significant increase with increased exposure dose, both in the entire exposed group (P less than .01) and in the microscopically reviewed subset (P less than .01). This dose response was only significant (P less than .01) in the latter half of the study period, 1965-80. The radiation effect was higher in the younger age group at the time of the bomb (ATB) for the specific attained age or was adjusted for attained age. In general, relative risk (greater than or equal to 100 rad vs. 0 rad) did not differ by attained age, except for the youngest age group, less than 20 years old ATB, where the relative risk tended to decrease with increased attained age, although cases were few in number and follow-up study was necessary. Estimated minimum latent period for radiation-induced ovarian cancer seemed to be 15-20 years. The proportion of autopsied cases with benign ovarian tumor increased with increasing exposure dose, both in the entire series of cases (P less than .05) and in the microscopically reviewed subset. Statistical significance, however, was not achieved in the latter group (P greater than .10). The distribution of histologic types of both cancer and benign tumor of the ovary did not vary significantly with radiation dose. The data are consistent with the hypothesis that radiation injury of the ovaries and secondary excess of gonadotropic hormones are important causative factors in the development of ovarian neoplasms.

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8.) Sequelae of radiation facial epilation (North American Hiroshima maiden syndrome).
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SO - Surgery 1989 Dec;106(6):946-50
AU - Rosen IB; Walfish PG
AD - Department of Surgery, Mount Sinai Hospital, University of Toronto School of Medicine, Ontario, Canada.
MT - Female; Human
PT - JOURNAL ARTICLE
AB - Radiation for benign problems of the head and neck area has been uniformly recognized as unacceptable practice. This includes epilation for facial hirsutism. Twelve such patients, recently encountered, have characteristic radiodermatitis facies and have demonstrated multisite neoplastic involvement--including skin, thyroid, parathyroid, salivary gland, oral cavity, facial skeleton, and breast--and have also undergone extensive dermatologic treatment of complications of radiodermatitis. There was one cancer death, and three patients are alive with cancer. Such patients have a superficial resemblance to the Hiroshima maiden group of young women who survived atomic bombing and experienced severe facial burns, necessitating extensive plastic surgery. As atomic survivors they are at increased risk for cancer of thyroid, salivary gland, lung, breast, bone marrow, and gastrointestinal tract. The North American Hiroshima maiden should warrant easy clinical recognition and require lifetime scrutiny for multisite neoplastic disease.

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9.) Studies of cancer and radiation dose among atomic bomb survivors. The example of breast cancer [see comments]
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CM - Comment in: JAMA 1995 Aug 2; 274(5):427-8
SO - JAMA 1995 Aug 2;274(5):402-7
AU - Land CE
AD - Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-7362, USA.
MT - Female; Human
PT - JOURNAL ARTICLE
AB - A comprehensive program of medical follow-up of survivors of the atomic bombings of Hiroshima and Nagasaki, Japan, by the Radiation Effects Research Foundation (RERF) has produced quantitative estimates of cancer risk from exposure to ionizing radiation. For breast cancer in women, in particular, the strength of the radiation dose response and the generally low level of population risk in the absence of radiation exposure have led to a clear description of excess risk and its variation by age at exposure and over time following exposure. Comparisons of RERF data with data from medically irradiated populations have yielded additional information on the influence of population and underlying breast cancer rates on radiation-related risk. Epidemiological investigations of breast cancer cases and matched controls among atomic bomb survivors have clarified the role of reproductive history as a modifier of the carcinogenic effects of radiation exposure. Finally, a pattern of radiation-related risk by attained age among the survivors exposed during childhood or adolescence suggests the possible existence of a radiation-susceptible subgroup. The hypothetical existence of such a group is lent plausibility by the results of recent family studies suggesting that heritable mutations in certain genes are associated with familial aggregations of breast cancer. The recent isolation and cloning of one such gene, BRCA1, makes it likely that the hypothesis can be tested using molecular assays of archival and other tissue obtained from atomic bomb survivor cases and controls.

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10.) Chronic cutaneous damage after accidental exposure to ionizing radiation: the Chernobyl experience.
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SO - J Am Acad Dermatol 1994 May;30(5 Pt 1):719-23
AU - Peter RU; Braun-Falco O; Birioukov A; Hacker N; Kerscher M; Peterseim U; Ruzicka T; Konz B; Plewig G
AD - Department of Dermatology, Ludwig-Maximilians-University of Munich, Germany.
MT - Human; Support, Non-U.S. Gov't
PT - JOURNAL ARTICLE
AB - BACKGROUND: The hazards of acute radiation exposure are well known. Bone marrow failure from total body gamma or neutron irradiation is the most clinically relevant aspect of acute radiation disease. With nonhomogeneous exposure, as is characteristic in accidents, other organ systems, such as the skin, may be more important in determining clinical prognosis. This became obvious in the two worst radiation accidents since 1945, the Chernobyl accident in April 1986 and the Goiania accident in September 1987. OBJECTIVE: Our purpose was to describe the characteristic chronic sequelae of accidental cutaneous radiation in a group of patients who survived the Chernobyl nuclear power plant accident. METHODS: Fifteen patients with the delayed type of the cutaneous radiation syndrome were examined between September 1991 and January 1992. All patients had a history of acute radiation disease. The exposure pattern was characterized by partial body exposure with high doses of beta and gamma irradiation from radioactive water, steam, or dust. RESULTS: Radiation-induced lesions were confined primarily to the legs and distal arms, but sometimes involved up to 50% of the total body surface. In addition to telangiectases, radiation keratoses, and radiation ulcers, hemangiomas, hematolymphangiomas, splinter hemorrhages in the distal nail bed, lentiginous hyperpigmentation, and severe subcutaneous fibrosis were noted. No malignant transformation could be detected. Associated diseases included cataracts, chronic hepatitis, and recalcitrant bacterial and herpesvirus infections. CONCLUSION: After accidental partial body exposure to high doses of beta and gamma irradiation, the predominant involvement of the skin, described as the cutaneous radiation syndrome, can become the characteristic feature. This causes longlasting, serious diagnostic and therapeutic problems.

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11.) Immediate medical consequences of nuclear accidents. Lessons from Chernobyl.
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SO - JAMA 1987 Aug 7;258(5):625-8
AU - Gale RP
MT - Human; Support, U.S. Gov't, P.H.S.
PT - JOURNAL ARTICLE
AB - The immediate medical response to the nuclear accident at the Chernobyl nuclear power station involved containment of the radioactivity and evacuation of the nearby population. The next step consisted of assessment of the radiation dose received by individuals, based on biological dosimetry, and treatment of those exposed. Medical care involved treatment of skin burns; measures to support bone marrow failure, gastrointestinal tract injury, and other organ damage (ie, infection prophylaxis and transfusions) for those with lower radiation dose exposure; and bone marrow transplantation for those exposed to a high dose of radiation. At Chernobyl, two victims died immediately and 29 died of radiation or thermal injuries in the next three months. The remaining victims of the accident are currently well. A nuclear accident anywhere is a nuclear accident everywhere. Prevention and cooperation in response to these accidents are essential goals.

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12.) Caring for survivors of the Chernobyl disaster. What the clinician should know.
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SO - JAMA 1995 Aug 2;274(5):408-12
AU - Weinberg AD; Kripalani S; McCarthy PL; Schull WJ
AD - Department of Medicine, Baylor College of Medicine, Houston, Tex 77030, USA.
MT - Human; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.
PT - JOURNAL ARTICLE
AB - The health status of approximately 1 million immigrants in the United States and Israel may have been adversely affected by radiation exposure as a result of the Chernobyl nuclear power plant disaster and cleanup efforts. Many of these immigrants suffer from significant psychological distress, fearing that they have a radiation-induced illness. Based on a review of the literature and our experience from the US National Chernobyl Registry Coordinating Center, we recommend that medical management of these immigrants include routine physical examination, with particular attention to the thyroid gland. Adults should receive regular cancer screening as well as routine blood chemistry tests, thyroid function tests, complete blood cell count, and urinalysis. Children should be examined regularly, with attention to the thyroid and overall body growth. It is reasonable for children to undergo thyroid studies, a complete blood cell count, or neuropsychiatric testing if there is clinical suspicion of a disorder. Given the long latency period for disease induction by radiation exposure, it is still too early to fully assess and draw conclusions concerning the possible health effects of the Chernobyl disaster, and long-term follow-up of all potentially affected individuals is important.

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13.) Significant increase in trisomy 21 in Berlin nine months after the Chernobyl reactor accident: temporal correlation or causal relation? [see comments]
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CM - Comment in: BMJ 1994 Jul 16; 309(6948):139-40; Comment in: BMJ 1994 Nov 12; 309(6964):1298; discussion 1300
SO - BMJ 1994 Jul 16;309(6948):158-62
AU - Sperling K; Pelz J; Wegner RD; Dorries A; Gruters A; Mikkelsen M
AD - Institut fur Humangenetik, Freie Universitat Berlin, Germany.
MT - Human; Support, Non-U.S. Gov't
PT - JOURNAL ARTICLE
AB - OBJECTIVE--To assess whether the increased prevalence of trisomy 21 in West Berlin in January 1987 might have been causally related to exposure to ionising radiation as a result of the Chernobyl reactor accident or was merely a chance event. DESIGN--Analysis of monthly prevalence of trisomy 21 in West Berlin from January 1980 to December 1989. SETTING--Confines of West Berlin. RESULTS--Owing to the former "island" situation of West Berlin and its well organised health services, ascertainment of trisomy 21 was thought to be almost complete. A cluster of 12 cases occurred in January 1987 as compared with two or three expected. After exclusion of factors that might have explained the increase, including maternal age distribution, only exposure to radiation as a result of the Chernobyl reactor accident remained. In six of seven cases that could be studied cytogenetically the extra chromosome was of maternal origin, confirming that nondisjunction had occurred at about the time of conception. CONCLUSION--On the basis of two assumptions--(a) that maternal meiosis is an error prone process susceptible to exogenous factors at the time of conception; (b) that owing to the high prevalence of iodine deficiency in Berlin a large amount of iodine-131 would have been accumulated over a short period--it is concluded that the increased prevalence of trisomy 21 in West Berlin in January 1987 was causally related to a short period of exposure to ionising radiation as a result of the Chernobyl reactor accident.

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14.) The global impact of the Chernobyl reactor accident.
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SO - Science 1988 Dec 16;242(4885):1513-9
AU - Anspaugh LR; Catlin RJ; Goldman M
AD - Lawrence Livermore National Laboratory, Livermore, CA 94550.
MT - Human; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.
PT - JOURNAL ARTICLE
AB - Radioactive material was deposited throughout the Northern Hemisphere as a result of the accident at the Chernobyl Nuclear Power Station on 26 April 1986. On the basis of a large amount of environmental data and new integrated dose assessment and risk models, the collective dose commitment to the approximately 3 billion inhabitants is calculated to be 930,000 person-gray, with 97% in the western Soviet Union and Europe. The best estimates for the lifetime expectation of fatal radiogenic cancer would increase the risk from 0 to 0.02% in Europe and 0 to 0.003% in the Northern Hemisphere. By means of an integration of the environmental data, it is estimated that approximately 100 petabecquerels of cesium-137 (1 PBq = 10(15) Bq) were released during and subsequent to the accident.

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15.) Pediatric thyroid cancer after the Chernobyl disaster. Pathomorphologic study of 84 cases (1991-1992) from the Republic of Belarus.
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SO - Cancer 1994 Jul 15;74(2):748-66
AU - Nikiforov Y; Gnepp DR
AD - Department of Pathology, Minsk Medical Institute, Belarus.
MT - Female; Human; Male
PT - JOURNAL ARTICLE
AB - BACKGROUND. During the initial period after the Chernobyl accident, large amounts of radioactive iodine were released in fallout, resulting in serious exposure to the thyroid gland in the residents of areas around the nuclear power station. Beginning in 1990, a definite increase in the incidence of thyroid cancer was noted in children of the Republic of Belarus. METHODS. Morphologic and clinical features of 84 cases of post-Chernobyl thyroid carcinoma in Belarussian children from 5 to 14 years of age are reported. The latent period for tumor development was 4-6 years, with a mean of 5.8 years. RESULTS. Papillary carcinoma was found in 83 patients and medullary carcinoma in one. Besides typical papillary carcinoma (14%), solid (34%), follicular (33%), mixed (10%), and diffuse sclerosing (9%) variants were observed. The follow-up period ranged from 8 months to 2.5 years. One patient died, local recurrence developed in 2, and cervical lymph node metastases developed in 10. To date, the incidence of local recurrence or metastatic disease after surgery was significantly higher in patients 5-8 years of age and in residents of areas nearest to the Chernobyl station. CONCLUSIONS. Post-Chernobyl pediatric thyroid carcinoma is characterized by a short latency, a higher proportion of tumors arising in young children, and an almost equal sex ratio. Microscopically, these tumors were usually aggressive, often demonstrating intraglandular tumor dissemination (92%), thyroid capsular and adjacent soft tissue invasion (89%), and cervical lymph node metastases (88%). Papillary carcinoma was diagnosed in 99% of cases, with an unusually high frequency of solid growth patterns. Morphologic changes in nonneoplastic thyroid tissue were present in 90% of the glands, and the most specific findings were vascular changes and perifollicular fibrosis.

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16.) Orofacial manifestations from accidental exposure to caesium 137 in Goiania, Brazil.
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SO - J Oral Pathol Med 1990 Aug;19(7):322-5
AU - Gomes MA; Wascheck C de C; Scully C; Almeida O de P; Bozzo L
AD - Nucleo de Odontologia, Fundacao Leide das Neves Ferreira, Goiania, Golas, Brazil.
MT - Female; Human; Male
PT - JOURNAL ARTICLE
AB - The accidental close exposure of over 200 adults and children to a caesium-137 (137Cs) source in Goiania, Brazil in 1987 produced significant short-term morbidity in about 50 patients, and four deaths within a few weeks. Some 57% of those maximally exposed to radiation, developed orofacial lesions, notably purpura, spontaneous bleeding, ulcers and/or acute candidiasis. These lesions were probably mainly the consequences of depression of bone marrow elements by the radionuclide. Though the oral lesions that may follow iatrogenic exposure to ionizing radiation are well recognized this appears to be the first report on the oral sequelae of a serious radiation accident.

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17.) Soft tissue sarcoma and military service in Vietnam: a case-control study [published erratum appears in J Natl Cancer Inst 1987 Nov; 79(5):1173]
=======================================================================
SO - J Natl Cancer Inst 1987 Oct;79(4):693-9
AU - Kang H; Enzinger FM; Breslin P; Feil M; Lee Y; Shepard B; Enziger F [corrected to Enzinger FM]
AD - Department of Medicine and Surgery, Veterans Administration, Washington, DC 20006-3868.
MT - Human; Male
PT - JOURNAL ARTICLE
AB - A case-control study was conducted in men who were of draftable age during the Vietnam conflict to examine the association of soft tissue sarcomas (STSs) with military service in Vietnam as well as other host and environmental risk factors. A total of 217 STS cases selected from the Armed Forces Institute of Pathology were compared to 599 controls for Vietnam service, occupational and nonoccupational exposure to various chemicals, occupational history, medical history, and life-style (smoking, alcohol, coffee, etc.). Military service information was verified by a review of the patient's military personnel records. Other information was ascertained from a telephone interview with either subjects or their next of kin. Cases and controls were stratified on the basis of the hospital type (civilian, Veterans Administration, and military); the Mantel-Haenszel estimate of the odds ratio (OR), adjusted for the effects of the stratification variable, was calculated. Vietnam veterans in general did not have an increased risk of STS when compared to those men who had never been in Vietnam (OR, 0.85; 95% confidence interval, 0.54-1.36). Subgroups of Vietnam veterans who had higher estimated opportunities for Agent Orange exposure seemed to be at greater risk of STSs when their counterparts in Vietnam were taken as a reference group. However, this risk was not statistically significant.

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18.) Postservice mortality among Vietnam veterans. The Centers for Disease Control Vietnam Experience Study.
=======================================================================
SO - JAMA 1987 Feb 13;257(6):790-5
MT - Human; Male
PT - JOURNAL ARTICLE
AB - The postservice mortality (through December 1983) of a cohort of 9324 US Army veterans who served in Vietnam was compared with that of 8989 Vietnam-era Army veterans who served in Korea, Germany, or the United States. Over the entire follow-up period, total mortality in Vietnam veterans was 17% higher than for other veterans. The excess mortality occurred mainly in the first five years after discharge from active duty (rate ratio, 1.45; 95% confidence interval, 1.08 to 1.96) and involved motor vehicle accidents, suicide, homicide, and accidental poisonings. Thereafter, mortality among Vietnam veterans was similar to that of other Vietnam-era veterans, except for drug-related deaths, which continued to be elevated. An unexpected finding was a deficit in deaths from diseases of the circulatory system among Vietnam veterans. The excess in postservice mortality due to external causes among Vietnam veterans is similar to that found among men returning from combat areas after World War II and the Korean War.

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19.) Dermatology in a war zone: a Persian Gulf experience.
=======================================================================
SO - Int J Dermatol 1992 Jul;31(7):494-7
AU - Pehr K; Kornfeld BW
AD - McGill University Faculty of Medicine, Montreal, Quebec, Canada.
MT - Comparative Study; Female; Human; Male
PT - JOURNAL ARTICLE
AB - The clinical experience of two US Army dermatologists during the recent Gulf War (Operation Desert Shield/Storm) are presented with comparison with dermatologic experience in previous wars and in civilian practice.

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20.) Psychiatric implications of missile attacks on a civilian population. Israeli lessons from the Persian Gulf War.
=======================================================================
SO - JAMA 1992 Aug 5;268(5):613-5
AU - Bleich A; Dycian A; Koslowsky M; Solomon Z; Wiener M
AD - Medical Corps, Israel Defence Force, Tel Aviv Israel University.
MT - Human
PT - JOURNAL ARTICLE
AB - OBJECTIVE--To determine the proportion of hospitalized patients who had stress reactions as a result of missile attacks during the Persian Gulf War and evaluate the factors that influenced their evacuation. DESIGN--Review of medical records of patients hospitalized as a result of missile attacks. SETTING--During the Persian Gulf War in the winter of 1991, Israel received 18 missile attacks involving 39 surface-to-surface Scud missiles. The uncertainty in time, place, and type of warhead, conventional or chemical, was a source of chronic stress and the immediate cause for many traumatic stress reactions at or near the missile attack sites. PARTICIPANTS--Data from victims who were injured after each missile attack were available through a central hookup between 12 local hospitals and the Medical Corps of the Israeli Defence Force. MAIN OUTCOME MEASURE--The number of persons diagnosed in the hospital as psychological casualties after each missile attack. RESULTS--Approximately 43% of the 773 casualties evacuated to hospitals were diagnosed as psychological casualties, and an additional 27% had mistakenly injected themselves with atropine. Data also indicated that triage of psychological casualties to hospitals was more a function of the rescue team's training and preparation than the severity or extent of injury or damage. CONCLUSIONS--Optimal treatment during events that cause mass casualties requires proper preparation of rescue teams as well as reorganization of the hospital's psychiatric services. The threat of chemical warfare affected the number and nature of stress reactions.

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21.) Q fever meningoencephalitis in a soldier returning from the Persian Gulf War.
=======================================================================
SO - Clin Infect Dis 1993 Apr;16(4):489-96
AU - Ferrante MA; Dolan MJ
AD - Department of Neurology, Wilford Hall USAF Medical Center, Lackland Air Force Base, Texas 78236.
MT - Case Report; Human; Male
PT - JOURNAL ARTICLE; REVIEW (47 references); REVIEW OF REPORTED CASES
AB - Acute infection with Coxiella burnetti usually results in a self-limited illness requiring a high index of clinical suspicion for diagnosis. Although headache is a common presentation of acute infection with this agent, focal neurological deficits are considered to be limited to chronic infection, most commonly caused by emboli from endocarditis. We report the case of a soldier returning from Desert Storm who presented with headache and a crescendo pattern of transient ischemic attacks and had serology consistent with an acute Q fever infection. The English-language literature on central nervous system infection caused by Coxiella burnetti is reviewed.

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22.) Effect of the Gulf War on infant and child mortality in Iraq [published erratum appears in N Engl J Med 1992 Dec 10; 327(24):1768] [see comments]
=======================================================================
CM - Comment in: N Engl J Med 1993 May 6; 328(18):1358
SO - N Engl J Med 1992 Sep 24;327(13):931-6
AU - Ascherio A; Chase R; Cote T; Dehaes G; Hoskins E; Laaouej J; Passey M; Qaderi S; Shuqaidef S; Smith MC; et al
AD - Department of Epidemiology, Harvard School of Public Health, Boston, MA 02138.
MJ - Infant Mortality [trends]; War
MN - Child, Preschool; Infant, Newborn; Infant; Iraq; Socioeconomic Factors
MT - Human; Support, Non-U.S. Gov't
PT - JOURNAL ARTICLE
AB - BACKGROUND. Increased malnutrition and morbidity among Iraqi children after the onset of the Persian Gulf war have been reported by several fact-finding missions. The magnitude of the effect of the war and the economic embargo on child mortality remains uncertain, however. METHODS. We conducted a survey of 271 clusters of 25 to 30 households each, chosen as a representative sample of the Iraqi population. The households were selected and the interviews conducted by an international team of public health professionals independent of Iraqi authorities. In each household all women 15 to 49 years of age were interviewed, and the dates of birth and death of all children born on or after January 1, 1985, were recorded. RESULTS. The study population included 16,076 children, 768 of whom died during the period surveyed (January 1, 1985, to August 31, 1991). The age-adjusted relative mortality for the period after the war began, as compared with the period before the war, was 3.2 (95 percent confidence interval, 2.8 to 3.7). No material change in the relative risk was observed after adjustment for region of residence, maternal education, and maternal age. The increase in mortality after the onset of the war was higher among children 1 to less than 12 months old (relative risk, 4.1; 95 percent confidence interval, 3.3 to 5.2) and among those 12 to less than 60 months old (relative risk, 3.8; 95 percent confidence interval, 2.6 to 5.4) than among those less than 1 month old (relative risk, 1.8; 95 percent confidence interval, 1.4 to 2.4). The association between the war and mortality was stronger in northern Iraq (relative risk, 5.3) and southern Iraq (relative risk, 3.4) than in the central areas (relative risk, 1.9) or in Baghdad (relative risk, 1.7). CONCLUSIONS. These results provide strong evidence that the Gulf war and trade sanctions caused a threefold increase in mortality among Iraqi children under five years of age. We estimate that more than 46,900 children died between January and August 1991.

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23.) Atropine poisoning in children during the Persian Gulf crisis. A national survey in Israel [see comments]
=======================================================================
CM - Comment in: JAMA 1992 Aug 5; 268(5):642-4
SO - JAMA 1992 Aug 5;268(5):630-2
AU - Amitai Y; Almog S; Singer R; Hammer R; Bentur Y; Danon YL
AD - Department of Pediatrics, Hadassah University Hospital, Mt Scopus, Jerusalem.
MT - Female; Human; Male; Support, Non-U.S. Gov't
PT - JOURNAL ARTICLE
AB - OBJECTIVE--To evaluate the effects of high doses of atropine in children accidentally injected with automatic atropine injectors. These were distributed in Israel during the Persian Gulf Crisis as an antidote for chemical warfare agents. DESIGN AND SETTING--A national survey in pediatric emergency departments in Israel, involving 22 medical centers, with prospective data collection in 14 centers. PATIENTS--Children (n = 268) presenting to emergency departments following misuse of automatic atropine injectors. MAIN OUTCOME MEASURES--Documentation of atropine dose and clinical manifestations; determination of a clinical severity score and its correlation with atropine dose; measurements of serum atropine levels in six patients. RESULTS--Over a period of 4 months, 268 cases were reported, of which 240 were clinically evaluated. The most common site of injection (75%) was the finger or palm. Doses were up to 17-fold higher than standard doses for age. In 116 children (48%), systemic effects of atropine were observed, and 20 (8%) had severe atropinization. Seizures and life-threatening arrhythmias were not reported, and there were no fatalities. The severity of atropinization was correlated with the dose following a classic nonlinear, dose-response relationship. Serum atropine levels (6.2 to 61.0 ng/mL) were much higher than those observed after administration of therapeutic doses. CONCLUSIONS--The high incidence of injection in the hand implies accidental use of automatic atropine injectors among children. The lack of mortality or life-threatening complications from injection of large doses of atropine attests to its relative safety in children. The low risk from atropine injections weighed against expected benefit as a lifesaving antidote justifies the distribution of personal atropine injectors to children at risk of organophosphorus nerve agent attack.

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24.) Iraqi missile attacks on Israel. The association of mortality with a life-threatening stressor [see comments]
=======================================================================
CM - Comment in: JAMA 1995 Apr 19; 273(15):1221
SO - JAMA 1995 Apr 19;273(15):1208-10
AU - Kark JD; Goldman S; Epstein L
AD - Department of Social Medicine, Hadassah Medical Organization, Jerusalem, Israel.
MT - Female; Human; Male; Support, Non-U.S. Gov't
PT - JOURNAL ARTICLE
AB - OBJECTIVE--The imminent deadline for the 1991 Persian Gulf War and, subsequently, the 18 missile attacks by Iraq on Israel represented an unusual, short-term, life-threatening stressor for an entire nation. We studied mortality in Israel in January and February 1991 to determine whether excess deaths were precipitated on days of missile attacks. DESIGN--A time-series mortality study. SETTING--The state of Israel. PARTICIPANTS--All Israelis aged 25 years and older. MAIN OUTCOME MEASURE--Daily mortality by sex, age, region, underlying cause, and place of death. RESULTS--On January 18, 1991, the day of the first strike on Israeli cities, a 58% increment in total mortality occurred in the Israeli population (95% confidence interval [CI], 34% to 86%; P .0001), a 77% excess (95% CI, 40% to 120%) in women and a 41% excess (95% CI, 10% to 79%) in men. This excess mortality occurred largely in the targeted Tel Aviv-central coastal plain and Haifa regions from cardiovascular causes and mainly out of hospital, significantly more so (P .01) in women than men. Subsequently, on 16 attack days no overall excess was noted, yet a 10% increase in out-of-hospital deaths occurred. CONCLUSIONS--Likely explanations for the initial increase in mortality include acute emotional stress coupled with breathing difficulties induced by gas masks and extended stay in sealed rooms with resultant hypoxia in susceptible individuals. Women were more vulnerable than men. The absence of elevated total mortality in the subsequent attacks suggests a rapid adaptation to the circumstances surrounding the war. The policy of an unventilated sealed room may have been detrimental.

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25.) Effect of Iraqi missile war on incidence of acute myocardial infarction and sudden death in Israeli civilians [see comments]
=======================================================================
CM - Comment in: Lancet 1991 Nov 23; 338(8778):1336; Comment in: Lancet 1992 Feb 1; 339(8788):303
SO - Lancet 1991 Sep 14;338(8768):660-1
AU - Meisel SR; Kutz I; Dayan KI; Pauzner H; Chetboun I; Arbel Y; David D
AD - Department of Cardiology, Meir General Hospital, Sapir Medical Center, Tel-Aviv, University Sackler School of Medicine, Kfar Saba, Israel.
MT - Comparative Study; Female; Human; Male
PT - JOURNAL ARTICLE
AB - The Iraqi missile attack on Israel provided a unique opportunity to study the effects of fright due to a perceived threat of annihilation on the incidence of acute myocardial infarction (MI) and sudden death among the civilian population. During the first days of the Gulf war we noted a sharp rise in the incidence of acute MI and sudden death in our area compared with five control periods. Patient population in the various study periods did not differ significantly in age, sex ratio, hospital mortality, or proportion of patients in whom the acute event was the first presentation of coronary disease. However, during the first period of the war there were more cases of anterior wall MI and more patients received thrombolytic therapy than during control periods. Despite the continuing missile threat, the incidence of acute MI reverted to normal after the initial phase of the Gulf war.

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26.) Veterans worry that unexplained medical problems a legacy of service during Gulf War.
=======================================================================
SO - Can Med Assoc J 1995 Mar 15;152(6):944-7
AU - Robinson A
MT - Human
PT - JOURNAL ARTICLE
AB - Some Canadians who served in the military in the Persian Gulf 4 years ago complain of a range of symptoms commonly described as Gulf War syndrome. Although the syndrome is not recognized as a clinical entity, symptoms include fatigue, lack of sleep, depression, cognitive problems, rashes, bone aches, lassitude, lack of motivation, forgetfulness, mood changes irritability and diarrhea. The medical branch of the Department of National Defence has established programs to inform, guide diagnosis and reach out to symptomatic veterans of the Persian Gulf conflict. Civilian physicians who provide similar care to military personnel who participated in the conflict are invited to call the medical branch (613 996-3752) for further information.

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27.) The McConnell missile accident. Clinical spectrum of nitrogen dioxide exposure.
=======================================================================
SO - JAMA 1980 Sep 12;244(11):1221-3
AU - Yockey CC; Eden BM; Byrd RB
MT - Case Report; Human; Male
PT - JOURNAL ARTICLE
AB - Twenty-four men were refueling a missile when a large spill of oxidizer occurred. Three crewmen were exposed to very high concentrations of the oxides of nitrogen. One died within minutes. Severe respiratory distress syndrome developed in the other two, one of whom survived. Twenty-one other workers were exposed to minimal to moderate concentrations of the gas. Most remained asymptomatic while six had shortness of breath, cough, or hemoptysis. The three with persistent symptoms received corticosteroid therapy; the complaints resolved in two. Corticosteroid therapy for four asymptomatic patients who had moderate hypoxemia two weeks after the accident may have aborted the second stage of nitrogen dioxide injury. Six patients with minimal exposure had persisting headaches, visual disturbances, and emotional difficulties. These latter findings may represent an unusual complication of exposure to these gases.

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28.) Verification of exposure to sulfur mustard in two casualties of the Iran-Iraq 
conflict.
=======================================================================
Benschop HP; van der Schans GP; Noort D; Fidder A; Mars-Groenendijk RH; de Jong LP
TNO Prins Maurits Laboratory, AA Rijswijk, The Netherlands.
J Anal Toxicol (UNITED STATES) Jul-Aug 1997 21 (4) p249-51 ISSN: 0146-4760
Language: ENGLISH
Document Type: JOURNAL ARTICLE 
Journal Announcement: 9711
Subfile: INDEX MEDICUS
The exposure of two Iranian victims of the Iran-Iraq conflict (1980-1988) to 
sulfur mustard was established by immunochemical and mass spectrometric analysis of 
blood samples taken 22 and 26 days after alleged exposure. One victim suffered from 
skin injuries compatible with sulfur mustard intoxication but did not have lung 
injuries; the symptoms of the other victim were only vaguely compatible with sulfur 
mustard intoxication. Both patients recovered. Immunochemical analysis was based 
on detection of the N7-guanine adduct of the agent in DNA from lymphocytes and 
granulocytes, whereas the N-terminal valine adduct in globin was determined by gas 
chromatography-mass spectrometry after a modified Edman degradation. The valine 
adduct levels correspond with those found in human blood after in vitro treatment 
with 0.9 microM sulfur mustard.

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29.) Skin manifestations of mustard gas in a group of 14 children and teenagers: a clinical study.
=======================================================================
SO - Int J Dermatol 1994 Mar;33(3):184-7
AU - Momeni AZ; Aminjavaheri M
AD - Department of Dermatology, Isfahan University of Medical Sciences, Iran.
MT - Female; Human; Male
PT - JOURNAL ARTICLE
AB - BACKGROUND. During the Iraq-Iran war (1980-1988), a group of patients exposed to mustard gas (one of the chemical warfare agents used by Iraq) were referred to our dermatology department. This group included a subgroup of 14 children and teenagers. In this article, we attempted to review the skin manifestations of these patients. METHODS. A group of patients, including 14 children and teenagers, exposed to mustard gas were studied. Laboratory tests including blood cell counts, hemoglobin, hematocrit, urine analysis, etc., were determined. RESULTS. Among the most frequent disorders were facial involvement (78%), which dominated the clinical picture, followed by genital (42%), truncal, and axillary lesions (both 14%). Eosinophilia was the most prominent laboratory disorder seen in 12% of the patients. Skin lesions started 4-18 hours after exposure. Erythema developed within 20-30 hours after exposure, followed by blisters. CONCLUSIONS. The time of onset of manifestations had been shorter and severity of the lesions higher in children and teenagers compared with adults. Both phenomena could be attributed to the more delicate skin of the young patients. Genital manifestations were less frequent in this subgroup while ophthalmic, pulmonary, and gastrointestinal lesions were more frequently encountered in children than in adults. The unfortunate consequences of exposure to such chemicals reminds once again the urgency of international treaties to effectively ban the use of chemical weapons.

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30.) A serious skin sulfur mustard burn from an artillery shell.
=======================================================================
SO - J Emerg Med 1994 Mar-Apr;12(2):159-66
AU - Ruhl CM; Park SJ; Danisa O; Morgan RF; Papirmeister B; Sidell FR; Edlich RF; Anthony LS; Himel HN
AD - Department of Plastic Surgery, University of Virginia School of Medicine, Charlottesville 22908.
MT - Case Report; Human; Male; Support, Non-U.S. Gov't
PT - JOURNAL ARTICLE
AB - Despite the Geneva Protocol of 1925 and the Paris Conference on Prohibition of Chemical Weapons in 1989, sulfur mustard and other chemical weapons continue to pose a hazard to both civilians and soldiers. The presence of artillery shells containing sulfur mustard, both in waters where these shells were dumped and in old battlefields, presents a problem in times of peace, especially for those who collect wartime memorabilia. Past literature has reported several hundred incidents involving fishermen who inadvertently pulled leaking shells aboard their fishing vessels, thereby exposing themselves to the vesicant chemical. Other literature reports exposure to children who found the chemical shells in old battlefields. The purpose of this article is to report the first case of a serious sulfur mustard burn that occurred after removing the detonator from an old artillery shell in a historic battle field near Verdun, France. The circumstances surrounding the injury, the diagnosis and management of injuries secondary to sulfur mustard, and the long-term consequences to the patient are presented and discussed. Although skin grafting has been used in the management of other chemical burn injuries, this report is the first to describe the need for split-thickness skin grafts in the management of a patient with sulfur mustard burns.

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31.) Tear gas--harassing agent or toxic chemical weapon?
=======================================================================
SO - JAMA 1989 Aug 4;262(5):660-3
AU - Hu H; Fine J; Epstein P; Kelsey K; Reynolds P; Walker B
AD - Channing Laboratory, Brigham and Women's Hospital, Boston, Mass.
MT - Human; Support, Non-U.S. Gov't
PT - JOURNAL ARTICLE; REVIEW (48 references); REVIEW, TUTORIAL
AB - Tear gas has gained widespread acceptance as a means of controlling civilian crowds and subduing barricaded criminals. The most widely used forms of tear gas have been o-chlorobenzylidenemalononitrile and omega-chloroacetophenone. Proponents of their use claim that, if used correctly, the noxious effects of exposure are transient and of no long-term consequences. The use of tear gas in recent situations of civil unrest, however, demonstrates that exposure to the weapon is difficult to control and indiscriminate, and the weapon is often not used correctly. Severe traumatic injury from exploding tear gas bombs as well as lethal toxic injury have been documented. Moreover, available toxicological data are deficient as to the potential of tear gas agents to cause long-term pulmonary, carcinogenic, and reproductive effects. Published and recent unpublished in vitro tests have shown o-chlorobenzylidenemalononitrile to be both clastogenic and mutagenic. Sadly, the nature of its use renders analytic epidemiologic investigation of exposed persons difficult. In 1969, eighty countries voted to include tear gas agents among chemical weapons banned under the Geneva Protocol. There is an ongoing need for investigation into the full toxicological potential of tear gas chemicals and renewed debate on whether their use can be condoned under any circumstances.

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32.) Use of phenytoin in healing of war and non-war wounds. A pilot study of 25 cases.
=======================================================================
SO - Int J Dermatol 1989 Jun;28(5):347-50
AU - Modaghegh S; Salehian B; Tavassoli M; Djamshidi A; Rezai AS
AD - Department of Orthopedic Surgery, Shahid Rahnomoon Hospital, University of Medical Science of Iran, Tehran.
MT - Human
PT - CLINICAL TRIAL; JOURNAL ARTICLE
AB - Nineteen patients with war-related missile wounds and six with refractory civilian ulcers were treated with topical phenytoin sodium powder daily for up to 4 weeks. The mean healing time was 2 weeks for missile wounds, compared to historical controls requiring 6-8 weeks. Healing time was 4 weeks for civilian ulcers that had been unresponsive to any treatment over the previous 5 months. Twenty-two patients had complete healing, three required skin grafts. Wider use of this safe, inexpensive, readily available and easy-to-use agent is suggested because of its positive effect on wound healing and rapid pain relief.

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33.) Missile injuries to the temporal bone.
=======================================================================
SO - South Med J 1995 Jan;88(1):72-8
AU - Stack BC Jr; Farrior JB
AD - Division of Otolaryngology-Head and Neck Surgery, University of South Florida College of Medicine, Tampa.
MT - Case Report; Female; Human; Male
PT - JOURNAL ARTICLE
AB - Gunshot injuries to the head and neck are frequently seen in patients brought to a level I trauma center. These injuries result in great morbidity and mortality and a significant expenditure of health care dollars. Missile injuries to the temporal bone, though less common, can likewise be devastating. Common sequelae include vertigo, deafness, facial nerve paralysis, and death. A series of missile injuries to the temporal bone treated at Tampa General Hospital during 1993 prompted a review of head and neck missile injuries in our trauma registry over the past 4 years (1989 to 1993). More than 100 patients were shot in the head or neck; 25 of them had injury to the temporal bone. Outcomes included facial nerve injury (8), deafness (9), vertigo (3), and death (13).

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34.) Tympanic membrane perforation in survivors of a SCUD missile explosion.
=======================================================================
SO - Otolaryngol Head Neck Surg 1994 Feb;110(2):211-21
AU - Patow CA; Bartels J; Dodd KT
AD - 85th Evacuation Hospital, U.S. Army, Dhahran, Kingdom of Saudi Arabia.
PT - JOURNAL ARTICLE
AB - On February 25, 1990, an Iraqi SCUD missile exploded inside a building housing United States military personnel in Dhahran, Kingdom of Saudi Arabia. One hundred seventy-two individuals who were near the impact site at the time of the blast were interviewed and examined to determine blast injury to the ear. Tympanic membrane (TM) perforation was used as the clinical marker for aural blast injury. Thirty-four personnel had unilateral TM perforation and 28 had bilateral TM perforation. Eighty-six sustained sufficient injury to be hospitalized. Fifty-nine of hospitalized personnel (70%) had TM perforation. Of a total of 90 TM perforations, 39% were estimated to be 25% or less of the tympanic membrane surface area, 36% were 26% to 50%, 16% were 51% to 75%, and 10% were greater than 75%. Morphology of the perforations and estimated proximity to the blast were documented. Personnel distant from the blast, in open doorways or wearing headphones, had relative protection from TM perforation. Historic nuclear blast data were used to estimate the SCUD blast waveform based on measurements of the SCUD impact crater. A mathematical model based on the estimated waveform was validated against the actual field data by comparing the proximity and incidence of TM perforations in the SCUD missile explosion.

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35.) The relationship between skin cancers, solar radiation and ozone depletion.
=======================================================================
SO - Br J Cancer 1992 Jun;65(6):916-21
AU - Moan J; Dahlback A
AD - Institute for Cancer Research, Montebello, Oslo, Norway.
MT - Human; Support, Non-U.S. Gov't
PT - JOURNAL ARTICLE
AB - During the period 1957-1984 the annual age-adjusted incidence rate of cutaneous malignant melanoma (CMM) increased by 350% for men and 440% for women in Norway. The annual exposure to carcinogenic sunlight in Norway, calculated by use of measured ozone levels, showed no increasing trend during the same period. Thus, ozone depletion is not a cause of the increasing trend of the incidence rates of skin cancers. The incidence rates of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) increase with decreasing latitude in Norway. The same is true for CMM in Norway, Sweden, and Finland. Our data were used to estimate the implications of a future ozone depletion for the incidence rates of skin cancer: a 10% ozone depletion was found to give rise to a 16-18% increase in the incidence rate of SCC (men and women), a 19% increase in the incidence rate of CMM for men and a 32% increase in the incidence rate of CMM for women. The difference between the numbers for men and women is almost significant and may be related to a different intermittent exposure pattern to sunlight of the two sexes. The increasing trend in the incidence rates of CMM is strongest for the trunk and lower extremities of women, followed by that for the trunk of men. The increasing incidence rates of skin cancers as well as the changing pattern of incidence on different parts of the body is most likely due to changing habits of sun exposure. Comparisons of relative densities of CMM, SCC, LMM and SCC falling per unit area of skin at different parts of the body indicate that sun exposure is the main cause of these cancer forms although other unknown factors may play significant roles as well. For the population as a whole sun exposure during vacations to sunny countries has so far been of minor importance in skin cancer induction.

=======================================================================
36.) Annual exposures to carcinogenic radiation from the sun at different latitudes and amplification factors related to ozone depletion. The use of different geometrical representations of the skin surface receiving the ultraviolet radiation.
=======================================================================
SO - Photochem Photobiol 1990 Nov;52(5):1025-8
AU - Dahlback A; Moan J
AD - Institute of Physics, University of Oslo, Norway.
MT - Human
PT - JOURNAL ARTICLE
AB - In most calculations of annual fluences of carcinogenic light as well as of the radiation amplification factor and of biological amplification factors associated with ozone depletions, the radiation is assumed to fall on a horizontally oriented plane surface. This is obviously a bad approximation of the surface of the human body. In order to evaluate the importance of using a realistic geometric representation of the surface of the human body we here present calculations of the flux of carcinogenically effective radiation falling on three different bodies: a vertically standing cylinder, a sphere and a horizontally oriented surface. The exposure to carcinogenic radiation depends strongly on the surface geometry. However we find that the radiation amplification factors are almost independent of the surface geometry chosen. The biological amplification factors for the three geometrical representations are also similar to within 20%. The total amplification factor for the increase in the incidence of non-melanoma skin cancer related to ozone depletion is about 17% larger when a cylindrical representation is used compared to when a plane horizontal surface is considered.

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37.) Direct estimates of cancer mortality due to low doses of ionising radiation: an 
international study. IARC Study Group on Cancer Risk among Nuclear Industry Workers [see comments]
=======================================================================
CM - Comment in: Lancet 1995 Jan 28; 345(8944):253
SO - Lancet 1994 Oct 15;344(8929):1039-43
MT - Human; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.
PT - JOURNAL ARTICLE
AB - When setting standards for protection against ionising radiation it has been usual to extrapolate from experience with high-dose short-term exposure--studies based on atom bomb survivors and patients exposed to radiation therapeutically. Those who work in the nuclear industry are exposed to low-level predominantly gamma radiation for longer periods, and provide an alternative direct source of information. We have combined mortality data from seven cohort studies on nearly 96,000 nuclear industry workers monitored for external radiation in Canada, UK, and USA to assess directly the carcinogenic effects of protracted low-dose exposure to ionising radiation. The excess relative risk for death from leukaemia, excluding chronic lymphocytic leukaemia, was 2.2 per Sv (90% Cl 0.1 to 5.7). This estimate is intermediate between the linear estimate of 3.7 per Sv and the linear-quadratic estimate (as used in recent leukaemia risk assessments) of 1.4 per Sv derived from Japanese atomic bomb survivors' data. The excess relative risk for death from all cancers, excluding leukaemia, was -0.07 per Sv (90% Cl -0.4 to 0.3). This estimate is consistent with a range of risks varying from negative to nearly twice those estimated from atomic bomb survivors (0.18 per Sv). These are the most precise direct estimates so far made of carcinogenic risk after protracted exposure to low-dose ionising radiation. They provide little evidence that the estimates that form the basis of current radiation protection recommendations are appreciably in error.

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38.) A summary of mortality and incidence of cancer in men from the United Kingdom who participated in the United Kingdom's atmospheric nuclear weapon tests and experimental programmes.
=======================================================================
SO - Br Med J (Clin Res Ed) 1988 Jan 30;296(6618):332-8
AU - Darby SC; Kendall GM; Fell TP; O'Hagan JA; Muirhead CR; Ennis JR; Ball AM; Dennis JA; Doll R
AD - University of Oxford, Gibson Laboratories, Radcliffe Infirmary.
MT - Human; Male
PT - JOURNAL ARTICLE
AB - Altogether 22,347 men who participated in the United Kingdom's atmospheric nuclear weapon tests and experimental programmes in Australia and the Pacific Ocean between 1952 and 1967 were identified from the archives of the Ministry of Defence and followed up. Their mortality and incidence of cancer were compared with those in 22,326 matched controls selected from the same archives. The risk of mortality in the participants relative to that in the controls was 1.01 for all causes and 0.96 for all neoplasms. Thirty eight causes of death were examined separately. Significant differences in mortality were found for leukaemia, multiple myeloma, and other injury and poisoning, with higher rates in the participants, and for cancers of the prostate and kidney and chronic bronchitis, with higher rates in the controls. The mortality from leukaemia and multiple myeloma in the participants was slightly greater than would have been expected from national values (standardised mortality ratios of 113 and 111, respectively), but in the controls it was substantially lower (standardised mortality ratios of 32 and 0, respectively). Examination of the rates of leukaemia and multiple myeloma in groups of participants showed very little difference between groups characterised by recorded doses of external radiation or type of test participation and failed to indicate any specific hazard. Evidence obtained from participants who reported themselves voluntarily (or were reported by relatives or friends) suggested that 17% of participants may have been omitted from the main study group but that any resulting bias was small. Most of the differences observed between the participants and controls were interpreted as due to chance, but some may be due to differences in smoking habits. Participation in the test programme did not seem, in itself, to have caused any detectable effect on the participants' expectation of life, apart from possibly causing small risks of developing leukaemia and multiple myeloma.


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39.) Sulfur mustard induces apoptosis and necrosis in endothelial cells.
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Dabrowska MI; Becks LL; Lelli JL Jr; Levee MG; Hinshaw DB
Department of Surgery, VA Medical Center, Ann Arbor, Michigan 48105, USA.
Toxicol Appl Pharmacol (UNITED STATES) Dec 1996 141 (2) p568-83 ISSN: 0041-
Language: ENGLISH
Document Type: JOURNAL ARTICLE 
Journal Announcement: 9704
Subfile: INDEX MEDICUS
Sulfur Mustard (SM) is a vesicant or blistering chemical warfare agent, for which 
there still is no effective therapy. Endothelial cells are one of the major 
cellular targets for SM. The mechanism of endothelial cell death during SM injury 
is poorly understood. We studied the effect of exposure of endothelial cells to 0-
1000 microM SM over the time course of 2-24 hr to determine the role of apoptotic 
and necrotic patterns of cell death in endothelial injury induced by SM. SM 
concentrations < or = 250 microM induced exclusively apoptosis which was observed 
after 5 hr in 30% of endothelial cells. Exposure to SM concentrations > or = 500 
microM caused apoptosis and necrosis to the same extent in 60-85% of all cells after 
5 to 6 hr. Necrosis was accompanied by a significant (approximately 50%) depletion 
of intracellular ATP, while in apoptotic cells ATP remained at the level similar to 
healthy cells. Interestingly, disruption of the long actin filament stress fibers 
and rounding of cells preceded other features of apoptosis--DNA fragmentation, 
membrane budding, and apoptotic body formation. In apoptotic cells, microfilaments 
formed constricted perinuclear bands, which were not observed in necrotic cells. 
Pretreatment with 50 mM N-acetyl-L-cysteine (NAC), a sulfhydryl donor and 
antioxidant, nearly eliminated the apoptotic features of cell death but did not 
prevent necrosis in response to SM. NAC pretreatment alone induced reorganization 
of actin filaments into an enhanced network of long stress fibers instead of a 
dominant cortical band of actin. NAC pretreatment prevented loss of cell adherence 
and cell rounding following exposure to 250 microM SM. The effect of NAC on 
cytoskeletal organization and its ability to eliminate SM-induced apoptosis suggests 
that actin filament organization may be an important element in cellular 
susceptibility to apoptotic stimuli.

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40.) Radiation accidents and nuclear energy: medical consequences and therapy [clinical conference]
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SO - Ann Intern Med 1988 Nov 1;109(9):730-44
AU - Champlin RE; Kastenberg WE; Gale RP
AD - Department of Medicine, UCLA School of Medicine 90024.
MT - Human; Support, U.S. Gov't, P.H.S.
PT - JOURNAL ARTICLE; REVIEW (112 references); REVIEW, TUTORIAL
AB - After the accidents at Chernobyl, the Soviet Union, and in Goiania, Brazil, there is increasing concern about the medical risks from radiation accidents. This overview summarizes the principles of nuclear energy, the biologic effects of accidental radiation exposure, the emergency response to nuclear accidents, and approaches to treating radiation injuries. Also discussed are the related issues of reactor safety, the disposal of radioactive waste, and the proliferation of nuclear weapons. With the increasing use of radioactive materials for power, weapons, and medical diagnostics, the medical community needs to understand the health consequences of radiation exposure.

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41.) Mortality of employees of the Atomic Weapons Establishment, 1951-82.
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SO - BMJ 1988 Sep 24;297(6651):757-70
AU - Beral V; Fraser P; Carpenter L; Booth M; Brown A; Rose G
AD - Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine.
MT - Female; Human; Male; Support, Non-U.S. Gov't
PT - JOURNAL ARTICLE
AB - A total of 22,552 workers employed by the Atomic Weapons Establishment between 1951 and 1982 were followed up for an average of 18.6 years. Of the 3115 who died, 865 (28%) died of cancer. Mortality was 23% lower than the national average for all causes of death and 18% lower for cancer. These low rates were consistent with the findings in other workforces in the nuclear industry and reflect, at least in part, the selection of healthy people to work in the industry and the disproportionate recruitment of people from the higher social classes. At some time during their employment 9389 (42%) of the workers were monitored for exposure to radiation, the average cumulative whole body exposure to external radiation being 7.8 mSv. Their mortality was generally similar to that of other employees, even when exposures were lagged by 10 years. The rate ratio after a 10 year lag in workers with a radiation record compared with other workers was 1.01 (95% confidence interval 0.92 to 1.10) for all causes of death and 1.06 (0.89 to 1.27) for all malignant neoplasms. The only significant differences were for prostatic cancer (rate ratio 2.23; 95% confidence interval 1.13 to 4.40) and for cancers of ill defined and secondary sites (rate ratio 2.37; 1.23 to 4.56). Cancers of lymphatic and haemopoietic tissues were notable for their low occurrence in the study population, with only four deaths from leukaemia and two from multiple myeloma in workers with a radiation record, 9.16 and 3.55 deaths respectively being expected on the basis of national rates. Among workers who had a radiation record 3742 (40%) were also monitored for possible internal exposure to plutonium, 3044 (32%) to uranium, 1562 (17%) to tritium, 638 (7%) to polonium, and 281 (3%) to actinium. In these workers mortality from malignant neoplasms as a whole was not increased, but after a 10 year lag death rates from prostatic and renal cancers were generally more than twice the national average, these excesses arising in a small group of workers monitored for exposure to multiple radionuclides. Though mortality from lung cancer in workers monitored for exposure to plutonium was below the national average, it was some two thirds higher than in other radiation workers, the excess being of borderline statistical significance. Mortality from malignant neoplasms as a whole showed a weak and non-significant increasing trend with increasing level of cumulative whole body exposure to external radiation.(ABSTRACT TRUNCATED AT 400 WORDS).

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42.) Medical responsibility and thermonuclear war.
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SO - Ann Intern Med 1982 Sep;97(3):426-32
AU - Cassel C; Jameton A
MT - Human; Support, Non-U.S. Gov't
PT - JOURNAL ARTICLE
AB - The attention of physicians is being drawn to the issue of nuclear weapons and nuclear war, creating controversy about whether a political concern is appropriate for health care professionals. The use of nuclear weapons would incur human death and injury on a scale both unprecedented and unimaginable, and possibly damage the ecosphere far beyond the weapons' immediate effects. Medical supplies and facilities would be nonexistent; no meaningful medical response would be possible. A physician's responsibility to prevent nuclear war is based on the imperative to prevent a devastating incurable disease that cannot be treated. Such an imperative is consistent with the historic tradition of the social responsibility of health professionals, and can be justified by philosophical argument.

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43.) The medical profession and nuclear war. A social history.
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SO - JAMA 1985 Aug 2;254(5):644-51
AU - Day B; Waitzkin H
MJ - Nuclear Warfare; Physicians
MN - American Medical Association; Attitude of Health Personnel; Civil Defense; History of Medicine, 20th Cent.; International Cooperation; Organizations [history]; Politics; Public Policy; United States
MT - Human; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.
PT - HISTORICAL ARTICLE; JOURNAL ARTICLE
AB - Since World War II, individual physicians and medical organizations in the United States have cooperated with the federal government in preparing for nuclear war. While most physicians have maintained a neutral stance, a minority have resisted federal policies. Health professionals participated actively at the wartime laboratories that developed the atomic bomb and in the medical research that followed Hiroshima and Nagasaki. Professional organizations helped with civil defense planning for nuclear conflict during the Cold War of the late 1950s and early 1960s. Medical resistance to nuclear war began in the same period, gained wide attention with the growth of Physicians for Social Responsibility in the early 1960s, declined during the Vietnam War, and vastly increased in the early 1980s. Activism by health professionals usually has responded to government policies that have increased the perceived risk of nuclear conflict. The recent return of civil defense planning has stimulated opposition in medical circles. Ambiguities of medical professionalism limit the scope of activism in the nuclear arena. These ambiguities concern the interplay of organized medicine and government, tensions between science and politics, and the difficulties of day-to-day work in medicine while the arms race continues.
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DATA-MEDICOS/DERMAGIC-EXPRESS No (25) 20/12/98 DR. JOSE LAPENTA R. DERMATOLOGO
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Dr. Jose Lapenta R.
Maracay, Venezuela
[email protected]

Produced by Dr. Jose Lapenta R. Dermatologist 
               Maracay Estado Aragua Venezuela 1.998  
            Telf: 0416-6401054- 02432327287-02432328571