| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ||||||||||||||||||||||||||||||||||||||||||||||
Preface by the Editors |
The medical experiences gained in the treatment of three patients exposed to mixed neutron-
irradiation in a criticality accident in Tokai-mura (Japan) on 30 September 1999 resulted in the re-opening of discussions regarding pathogenetic mechanisms of a "radiation disease". In two of the three patients, an essentially lethal radiation exposure was survived, by one patient for 83 days and by the other for 211 days, owing to the excellent patient care delivered as well as to a significant although transient haematopoietic recovery as a consequence of haematopoietic stem cell transplantation using peripheral blood stem cells in one case and umbilical cord-derived stem cells in the other. This unique medical management using "blood-derived stem cells" for the first time in radiation accident medical care resulted in the opportunity to observe and follow the appearance and course of radiation syndromes beyond the time of an "essentially irreversible" haematopoietic failure. It became obvious that the radiation syndromes observed were the consequence of post-traumatic multi-organ involvement complicated by radiation injury of all cells in the organism, resulting in radiation-induced impairment of regenerative processes.
On this background, it was considered to be a challenge to the "radiation medicine expert community" to re-visit the signs and symptoms of acute radiation syndrome in as many patient case histories as possible as well as all pertinent information on the course of disease in these patients.
It was recognised that the usefulness of the term "acute radiation syndrome" needs to be reconsidered in its ability to describe the clinical course of a "radiation disease" and that, in addition, the terms "haematopoietic, gastrointestinal, central nervous system (CNS) or cutaneous form" of the acute radiation syndrome do not necessarily reflect the complexity of the clinical course nor do they describe the primary or secondary consequences for the impairment of health of the patients.
A new look appeared timely to review and analyse the pathogenetic principles and mechanisms involved. It was expected that the time is ripe to develop new diagnostic and therapeutic concepts addressing the consequences of whole body radiation exposure on the basis of multi-organ involvement. It is inevitable that such an involvement may well result in multi-organ failure if all biological potentials are exhausted to cope with the damages inflicted on cells, cell systems and organs, as well as their interplay and regulatory mechanisms.
Thus, it was the scope and purpose of the Advanced Research Workshop:
The Workshop discussed the essential topics in six sessions. The first scientific session was centred on patient case reports from radiation accidents that occurred previously in China, Israel, Japan, Norway, Russia and the USA. These reports presented the facts of the clinical courses as they were actually observed and forced the medical doctors in charge to act as competently as possible. An introductory systematic overview of 110 radiation accident case histories collected in the database system SEARCH (System for Evaluation and Archiving of Radiation Accidents based on Case Histories) discussed the extent, severity and clinical consequences of radiation-induced multi-organ involvement and failure.
A second session of the Workshop dealt with pathogenetic mechanisms that are operative in multi-organ involvement from the viewpoint of different organ systems, such as the CNS, respiratory system, renal system, gastrointestinal system and cutaneous system, etc.
A third scientific session addressed current research in the various international research groups using recent tools of experimental radiation biomedicine research and resulting in new considerations as to the relative significance of cellular and subcellular injuries and regulatory mechanisms.
The question regarding new options to cope clinically with multi-organ involvement was presented in several contributions in a fourth session, including the potential use of stem cell therapy as well as skin treatment, and led to a comprehensive proposal for the medical management of patients with multiple organ dysfunction.
In addition, two presentations addressed unsolved problems in radiation medicine relevant to the understanding of the complexity of the radiation syndromes. As an overall summary, a final paper discussed challenges for radiation accident medical management and future research.
The major sponsors of this Workshop were the German Armed Forces Medical Services and the Pharmacia Foundation for Epidemiology and Preventive Medicine. The Editors would like to express their sincere gratitude for this generous support. They also appreciate the support of the Faculty of Medicine, University of Ulm, and the excellent facilities at the Science Conference Center Schloss Reisensburg of the University of Ulm (WZR). This centre once again proved its charm and potential to "catalyse" the interchange between scientists and it is well recognised as a major component in paving the way for transnational and transdisciplinary scientific co-operation.
Also gratefully acknowledged is the contribution of the Executive Secretary, Ms Colette Steinwachs, of the Radiation Medicine Research Group of the University of Ulm (recognised as the WHO-Collaborating Center for Radiation Accident Management). Her efforts before, during and after the Workshop proved to be indispensable for the success of the Workshop and for the fact that the proceedings can now be published in this supplement of the British Journal of Radiology.
Final thanks are expressed to the British Institute of Radiology (BIR) for being prepared to publish the proceedings of the Workshop as a supplement. The BIR was also prepared to make sure that all scientific contributions are referenced in the appropriate information systems (i.e. Medline). If these proceedings are a bit late in coming out, it is due to some participants who, unfortunately, took their time to submit (if at all) their requested manuscripts because of other professional duties.
We thank all colleagues who contributed actively and competently to this Workshop and are convinced that the outcome will result in new approaches to deal with the old problems of radiation-induced disease in humans.
The Editors
(T M Fliedner, V Meineke, M Akashi, N Dainiak and P Gourmelon)
| ||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| BJR | DMFR | IMAGING | ALL BIR JOURNALS |
