Accidental Radiation Injury to the Hand

Berger, Maurice; Hurtado, R; Dunlap, James P.; Mutchinick, O; Velasco, M.; Tostado, R A; Valenzuela, J; Ricks, Robert C.

doi:10.1097/00004032-199703000-00001

Cited by 14 publications

(1 citation statement)

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“…The foreign part of our series is therefore exposed to the same type of biases as the large international series which have been previously reported by UNSCEAR [14], IAEA [15] and the Radiation Emergency Assistance Center/Training Site (REAC/TS) [16,17]. The 1993 UNSCEAR report (annex D) actually insists on the likely 'underreporting of non-fatal accidents' [14].…”

Section: Discussionmentioning

confidence: 90%

The 1951-98 experience of the Paris Institut Curie Radiopathology Unit: a preliminary report

Cosset¹,

B²,

Dubray³

et al. 1999

J. Radiol. Prot.

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From 1 January 1951 to 30 June 1998, 696 patients presented spontaneously or were referred to the French Institut Curie Radiopathology Unit following a more or less severe accidental irradiation. Of these, 568 patients came from France, while 128 were sent by various foreign countries. The very great majority of irradiation accidents occurred in the workplace, particularly in industry. Interestingly, 'non-nuclear' industry was responsible for three times more events than the nuclear industry. While incidental irradiation of the public by lost radioactive sources was exceedingly rare in France, it seemed to be more frequent in our cohort of foreign patients. Radiation phobia accounted for about 10% of cases in the French cohort, but the number of cases did not seem to increase with time. Overall, the accrual of patients over time appears to be stable, with 10 to 25 new cases consulting each year. Fortunately, a majority of cases corresponded to low-level irradiation (and even no irradiation at all). In the French cohort, only 21.6% of patients, showing deterministic effects, required some form of treatment, with 4.9% considered as 'severe' cases. Not unexpectedly, more patients required treatment in the foreign cohort (35.2%), with 24.2% of severe cases, including four deaths. The main features of this database are consistent with the data previously reported by the IAEA, UNSCEAR and REAC/TS. Although the number of severe cases is small, it should still be considered to be too high, especially as most of these accidents could have been easily avoided if a few basic radioprotection rules had been fully respected.

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Section: Discussionmentioning

confidence: 90%

The 1951-98 experience of the Paris Institut Curie Radiopathology Unit: a preliminary report

Cosset¹,

B²,

Dubray³

et al. 1999

J. Radiol. Prot.

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Literature Review and Global Consensus on Management of Acute Radiation Syndrome Affecting Nonhematopoietic Organ Systems

Dainiak¹,

Gent²,

Carr³

et al. 2011

Disaster med. public health prep.

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ABSTRACTObjectives:The World Health Organization convened a panel of experts to rank the evidence for medical countermeasures for management of acute radiation syndrome (ARS) in a hypothetical scenario involving the hospitalization of 100 to 200 victims. The goal of this panel was to achieve consensus on optimal management of ARS affecting nonhematopoietic organ systems based upon evidence in the published literature.Methods:English-language articles were identified in MEDLINE and PubMed. Reference lists of retrieved articles were distributed to conferees in advance of and updated during the meeting. Published case series and case reports of ARS, publications of randomized controlled trials of relevant interventions used to treat nonirradiated individuals, reports of studies in irradiated animals, and prior recommendations of subject matter experts were selected. Studies were extracted using the Grading of Recommendations Assessment Development and Evaluation system. In cases in which data were limited or incomplete, a narrative review of the observations was made.Results:No randomized controlled trials of medical countermeasures have been completed for individuals with ARS. Reports of countermeasures were often incompletely described, making it necessary to rely on data generated in nonirradiated humans and in experimental animals. A strong recommendation is made for the administration of a serotonin-receptor antagonist prophylactically when the suspected exposure is >2 Gy and topical steroids, antibiotics, and antihistamines for radiation burns, ulcers, or blisters; excision and grafting of radiation ulcers or necrosis with intractable pain; provision of supportive care to individuals with neurovascular syndrome; and administration of electrolyte replacement therapy and sedatives to individuals with significant burns, hypovolemia, and/or shock. A strong recommendation is made against the use of systemic steroids in the absence of a specific indication. A weak recommendation is made for the use of fluoroquinolones, bowel decontamination, loperamide, and enteral nutrition, and for selective oropharyngeal/digestive decontamination, blood glucose maintenance, and stress ulcer prophylaxis in critically ill patients.Conclusions:High-quality studies of therapeutic interventions in humans exposed to nontherapeutic radiation are not available, and because of ethical concerns regarding the conduct of controlled studies in humans, such studies are unlikely to emerge in the near future.(Disaster Med Public Health Preparedness. 2011;5:183–201)

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Thumb reconstruction with a wrap‐around free flap in hand radiation injury

Lee

Park

et al. 2012

Microsurgery

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We describe a patient with hand radiation injury that was caused by (192)Ir radiation source exposure. The cutaneous symptoms that appear after local radiation exposure follow a certain time pattern consisting of the prodromal, manifestation, subacute, chronic, and late stages. Although the clinical characteristics of each stage are well known, limited cases of photographic demonstrations to the progressive local radiation reaction have been reported. We demonstrate characteristics of serial necrotic changes in the fingers after radiation exposure in photographs. Initially, blisters, mild erythema, and swelling were present in the exposed fingers. However, at 3 years postexposure, total necrosis, severe flexion deformity, and bony exposure were present in the exposed fingers. For restoration of hand function, we performed a transmetacarpal, metacarpophalangeal, and transphalangeal amputation of the second, third, and fourth fingers, respectively. After debridement of the necrotic thumb tissue, a wrap-around free flap from the hallux was performed for thumb reconstruction. At 2 years postoperatively, the free flap survived well and graft bone union had occurred. The patient's hand function had improved such that he could grip a large object using the reconstructed thumb and the fifth finger.

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Accidental Radiation Injury to the Hand

Cited by 14 publications

References 0 publications

The 1951-98 experience of the Paris Institut Curie Radiopathology Unit: a preliminary report

The 1951-98 experience of the Paris Institut Curie Radiopathology Unit: a preliminary report

Literature Review and Global Consensus on Management of Acute Radiation Syndrome Affecting Nonhematopoietic Organ Systems

Thumb reconstruction with a wrap‐around free flap in hand radiation injury

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