British Journal of Radiology (2005) Supplement_27, 55-61
© 2005 British Institute of Radiology
doi: 10.1259/bjr/82968815
British Journal of Radiology Supplement_27 (2005),55-61 © 2005 The British Institute of Radiology
Multi-organ involvement and failure in a radiation accident: the Chinese experience of 1963
Ye GenYao, MD and
Yu Changlin, MD
Department of Radiation Medicine and Clinical Hematology, North Taiping Road Hospital, Beijing 100039, PR China
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Abstract
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In 1963, six cases of acute radiation sickness resulting from an accidental non-uniform 60Co 
-ray irradiation of approximately 10 Ci were treated first in Hefei, Anhui province, and were then transferred to our hospital. The whole body average doses were estimated to be 2 x 102 cGy to 
8 x 103 cGy. Two of patients died of intestinal acute radiation sickness within 2 weeks. Autopsy findings revealed findings consistent with multi-organ failure. Four cases survived, and one of them recovered from septicaemic shock. Loss of hair, systemic infection, high fever and bleeding occurred in five cases. The essential therapeutic measures were strict isolation, preventive treatment with anti-infection drugs, fresh blood transfusion and sometimes infusion of formed blood elements. Among the survivors, two cases received homologous bone marrow transfusion. The general conditions of four cases followed-up for a period of 24–40 years are apparently good, with transparent lens, normal thyroid function and normal immunological reactions, except one patient who had a low serum immunoglobulin G level. Three cases showed subnormal adrenocortical activity and impairment of sex gland function. Patient A died from a car accident 24 years after the radiation accident. Patient C gave birth to a daughter and a son; the latter had severe mental retardation. Serial electroencephalographic changes occurred only in those cases who received high cranial doses. In all the cases, persistence of chromosome aberrations in peripheral lymphocytes was observed. Owing to local high doses, the remote regional effects led to amputation of one leg in patient D and to pathological fracture of the femur in patient A.
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A brief account of the accident [1]
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On 11 January 1963, a 60Co -ray source of approximately 10 Ci used for irradiation of seeds was taken by a rural child to his home. Six people were exposed to an accidental non-uniform -ray irradiation; five of them for a period of 5–9 days (the child's mother, two brothers, a sister and himself), and another person, the child's uncle who happened to stay at their home overnight, for 9 h. The -ray irradiation from the 60Co source resulted in acute radiation sickness of all six persons, accompanied by different degrees of localised radiation injury.
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The radiation doses [2]
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The radiation doses estimated by physics dosimetrists in the six patients are listed in Table 1
and Figure 1. The estimated whole body average doses, essential clinical findings and therapeutic outcomes of the six patients are presented in Table 2.
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Figure 1. Isodose curves of (a) patient E, (b) patient F, (c) patient A, (d) patient B, (e) patient C and (f) patient D.
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Table 2. Estimated whole body average dose, essential clinical findings, diagnosis and therapeutic outcomes in six patients
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Essential clinical findings [1, 3, 4]
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In the early stage after irradiation, most of the patients showed general malaise, lassitude, anorexia, nausea and vomiting, and some of them also experienced dull pain in the abdomen. There was a striking depletion of bone marrow nucleated cells, the degree of which was closely correlated with the radiation dose. The erythroid precursors were somewhat more sensitive to radiation than those of the granuloid system. The decrease in number of leukocytes per day in each patient was correlated with the radiation dose received; the higher the radiation dose they received, the greater the decrease in the level of leukocytes per day. During the early convalescent period, monocytes recovered rather earlier in the peripheral blood than did granulocytes and reticulocytes.
Systemic infections and high fever occurred in five patients (A, B, C, E and F). The time of onset of these symptoms depended upon the severity of the disease (see Table 2
). Positive blood cultures were obtained in three severe cases: Escherichia coli (patient E); Staphylococcus sp. (patient F); and Clostridium perfringens (patient A). At the climax of the disease, the blood pressure of patient A dropped to 80/60 mmHg, and the number of blood cells further decreased during the febrile period. As soon as the high fever subsided, the number of granulocytes began to recover almost immediately.
Loss of hair was observed in all cases except the two patients who received the lowest dose of radiation over the scalp (Figure 2). Skin radiation burns occurred in areas where the patients received a high local radiation dose (Figures 3–6).
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Figure 2. (a,b) Epilation on the scalp of patient C (24 January 1963); (c) regrowth of hair of patient C (13 February 1963).
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Figure 3. Extensive radiation skin burn with slough and ulcer on the buttocks of patient A (11 February 1963).
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The principles of therapy and the essential therapeutic measures were complete rest and adequate nutrition, and control of the ward and all nursing services to avoid contamination. During the latent period of radiation sickness, preventive treatment comprising anti-infection drugs and blood transfusions were given as indicated. When infection and fever emerged, antibiotics were administered owing to positive blood cultures or the existence of infection foci (Figure 7). Homologous bone marrow transfusion was prescribed to three patients who presumably received lethal doses of radiation and suffered a serious degree of immunosuppression. Other patients were treated with fresh leukocytes and platelets (Table 3). After appropriate therapy, the patients eventually recovered from the crisis and entered a period of convalescence at approximately 1 month post irradiation. Thus, the acute radiation syndrome essentially improved after a period of approximately 2 months.
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Figure 7. Clinical course and treatment of (a) patient A, (b) patient B, (c) patient C and (d) patient D. WBC, white blood cell count; RBC, red blood cell count.
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Autopsy findings [5]
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In patient E, the principle pathological findings were acute radiation enteritis with extensive pseudomembranous necrosis accompanied by bacterial and mycotic infection, acute radiation atrophy and necrosis of colonic mucosa, and acute radiation bone marrow atrophy with depletion of haematopoietic cells. Acute radiation lymphoid tissue atrophy was noted in the spleen, lymph node, thymus, tonsils etc. In some deep necrotic parts of the tonsils, there were bacteria in clumps but no granulocytic cell reaction. Acute radiation skin burns were noted, involving the right chest, abdomen, inner side of the thigh and local areas on both hands. There was acute radiation necrosis of germinal cells in both testes. Extensive spot haemorrhage appeared in the cauda equina, external membrane of the vagus nerve trunk, and lumbar sympathetic chain. There was acute radiation necrosis of the right auricle and external membrane of the right ventricle, parietal layer of the anterior wall of heart, external membrane of the thoracic aorta, subserosa of the stomach, spleen and partial intestine, subpleura of the upper lobe of the right lung, left lung, mucosa of the bilateral renal pelvis, right abdominas rectus and diaphragm. Dilatation and congestion of capillaries and interstitial oedema in most internal organs were observed. Acute vacuolar changes in cells of the central nervous system, degenerative changes in epithelial cells of the renal tubules, and decrease of lipoid in the adrenal cortex were also noted.
In patient F, there was acute radiation mucosal atrophy and necrosis of the small intestine and most of the colon, and acute radiation bone marrow atrophy with depletion of haematopoietic cells. Acute radiation lymphoid tissue atrophy was noted in the spleen, lymph node, thymus and tonsils, where the most lymphocytes had disappeared. Acute radiation skin burns were noted involving the lower part of the left chest, abdomen, external side of the thigh and right subscapular region. Extensive spot haemorrhage appeared in the mucosa of the small intestine (diffuse) and colon (patchy), oesophageal mucosa, lower third of the soft tissue between the trachea and oesophagus, hilar lymph nodes, anterior wall of the heart, right auricle, upper and lower lobes of the right lung, tonsils, spleen, testis, neck nerve node etc, as well as dilatation and congestion of capillaries in nearly all internal organs. Oedema in the colonic wall, anterior lobe of the hypophysis, adrenal glands, myocardium, hepatic parenchyma and perivascular region of the brain parenchyma, and degenerative changes in epithelial cells of the testis and epithelial cells of the renal tubules were observed, as well as a decrease of lipoid in the adrenal cortex. In addition, there was focal cortical atrophy, gastric dilatation and lysis of Nissl's bodies in the nerve cells of the brain (Figures 8–13.)
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Follow-up study [6]
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Among these cases, four were followed-up for a period of 24–40 years. The general conditions of the patients are apparently good as judged from the results of examinations of certain endocrine function, sensory organs and others, but in three of the patients the adrenocortical response to adrenocorticotropic hormone (ACTH) was subnormal. The local radiation dose received at the region of the gonads in the female patient A (age 44 years) was estimated to be 1800 cGy, and in a male patient B (age 20 years) it was estimated to be 730 cGy, which are rather high. This led to the rapid onset of amenorrhoea and permanent sterility, respectively. In view of the fact that the sterile man (patient B) retained normal sexual activity, it is likely that the testicular hormone secretory cells are more radioresistant than the germinal cells. Another girl, patient C (age 13 years), received a whole body average dose of 4 x 102 cGy and approximately 180 cGy over the ovarian region. However, subsequent development and function of the sexual organs were not affected. She gave birth to a daughter and a son after marriage. The physical and intellectual development of the daughter appeared normal, but the son had apparent severe mental retardation. Karyotype analysis and chromosome examination of the daughter revealed no abnormalities. Another man, a patient of 39 years of age, showed transient aspermia after exposure to 210 cGy of irradiation over the testicular region, but recovered uneventfully afterwards.
Immunological tests of the patients showed normal rate of lymphocyte transformation and E-rosette formation. Serum contents of immunoglobulin A (IgA), IgG, IgE and IgM were within the range of normal variations, except for one patient whose IgG level was obviously subnormal.
Patient A died from a car accident 24 years after the radiation accident. In all the cases, persistence of chromosome aberrations in peripheral lymphocytes was observed. Changes in electroencephalograms occurred only in those patients who received high cranial doses. In these cases, paroxysmal median and high 
waves were observed in the frontal, parietal and temporal regions. High dose local irradiation up to 20 000 cGy at the region of the left tibia and fibia of a male patient (patient D) caused severe burns of the skin and at a later stage, damage of the bone. As a result, the left leg of this patient was amputated for necrosis of the tibia and fibia 4 years later following repeated skin pedicle grafting and other conservative treatment. Another female, patient A, continued to have an unhealed small skin ulcer over her left leg after repeated skin grafting and she suffered from a pathological fracture of the femur of the same leg 10 years after the radiation accident, which was reunited after surgical intervention.
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References
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- Shi Yuanming, Xu Haichai, Chen Di, et al. The dose estimation in victims of Sanlian radiation accident. In: Zhao Xiang, Liang Deming, Ye Weixing, editors. Collected papers on clinical research of the twenty three victims of acute radiation sickness. Beijing, China: Nuclear Energy Publication Co, 1985:2–4. [In Chinese.]
- Tian Nue, Ye Genyao, Jiang Benrong, et al. The clinical report of 6 acute radiation sickness patients. In: Zhao Xiang, Liang Deming, Ye Weixing, editors. Collected papers on clinical research of the twenty three victims of acute radiation sickness. Beijing, China: Nuclear Energy Publication Co, 1985:5–52. [In Chinese.]
- Luo Yi, Kuan Pegen. The clinical changes in nervous system of 4 acute radiation sickness patients. In: Zhao Xiang, Liang Deming, Ye Weixing, editors. Collected papers on clinical research of the twenty three victims of acute radiation sickness. Beijing, China: Nuclear Energy Publication Co, 1985:86–97. [In Chinese.]
- Su Xing, Wang Mingchao, Yu Wanfeng. The bacteriological examination report of victims involved in Sanlian radiation accident. In: Zhao Xiang, Liang Deming, Ye Weixing, editors. Collected papers on clinical research of the twenty three victims of acute radiation sickness. Beijing, China: Nuclear Energy Publication Co, 1985:160–6. [In Chinese.]
- Li Guoming, Liu Xitong, Wu Zhedong. The autopsy report of 2 deceased patients. In: Zhao Xiang, Liang Deming, Ye Weixing, editors. Collected papers on clinical research of the twenty three victims of acute radiation sickness. Beijing, China: Nuclear Energy Publication Co, 1985:211–37. [In Chinese.]
- Ye Genyao, Qian Fongwei, Zhang Shifong, et al. 17 years follow-up studies in 4 acute radiation sickness patients. In: Zhao Xiang, Liang Deming, Ye Weixing, editors. Collected papers on clinical research of the twenty three victims of acute radiation sickness. Beijing, China: Nuclear Energy Publication Co, 1985:238–60. [In Chinese.]
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Abstract
A brief account of...
