Protocol for the treatment of radiation injuries.

Despite adequate precautionary measures and high-quality safeguard devices, many accidental radiation exposures continue to occur and may pose greater risks in the future, including radiation exposure in the space environment. The medical management of radiation casualties is of major concern to health care providers. Such medical management was addressed at The First Consensus Development Conference on the Treatment of Radiation Injuries, Washington, DC, 1989. The conference addressed the most appropriate treatment for the hematopoietic and infectious complications that accompany radiation injuries and for combined radiation and traumatic/burn injuries. Based on the evidence presented at the conference, a consensus statement was formulated by expert physicians and scientists. The recommended therapies, including a suggested algorithm incorporating these recommendations for the treatment of radiation injuries, will be discussed.

Iron deficiency and anemia among Indian women in Fiji.

In June 1979, 245 Hindu and 240 Moslem women of childbearing age (14-45 yr) living in a semi-rural area north of Lautoka were tested for anemia and for iron-deficiency. Ninety-six (39%) of the 245 Hindu women and 77 (32%) of the 240 Moslem women were anemic according to World Health Organization criteria. Most of the cases of anemia were due to iron-deficiency. The prevalence of anemia did not change significantly with advancing age or increasing parity. Hookworm ova were found on examination of a single specimen of feces in 27 (14%) of 195 Hindu and 50 (24%) of 209 Moslem women. The presence of hookworm did not correlate with anemia. The red cell folate level was less than 160 micrograms/l in 117 (24%) of 478 women and the serum vitamin B12 level was less than 100 ng/l in 47 (10%) of 476 women. Subnormal levels of these vitamins did not correlate with anemia. The serum ferritin was determined to assess tissue iron stores. Two-hundred-and-twenty-four (46%) of 484 Indian women tested had serum ferritin values of less than 10 microgram/l; 400 (83%) had ferritin values of less than 26 microgram/l. The high prevalence of iron deficiency appears to be due predominantly to dietary factors.

Aryl sulfatase A in acute nonlymphocytic leukemia.

To ascertain whether estimation of urinary aryl sulfatase A (ASA) is a reliable noninvasive technique for monitoring disease activity in adult acute nonlymphocytic leukemia, we studied the excretion pattern of this enzyme during active disease, partial remission, and complete remission in ten patients and compared the results with those of ten healthy volunteers. There was no significant difference in enzyme excretion between complete remission cases and the control group. Patients with partial remission and active disease had significantly different urinary enzyme levels from each other and from the control and complete remission groups. Estimation of urinary ASA is a useful noninvasive method of monitoring disease activity in adult acute nonlymphocytic leukemia.

Use of modified subcutaneous right-atrial catheter for venous access in leukaemic patients.

A large-diameter indwelling subcutaneous right-atrial catheter was inserted in 25 patients with haematological malignancies and neutropenia to provide ready access to the venous system for all infusions and blood aspirations. The median duration of catheter placement was 70 days. In 23 patients (92%) the catheter was used successfully until remission or death. Catheter-related exit-site infectons, generally mild, occurred in 14 patients (56%), Staphylococcus epidermidis being the predominant organism cultured. Septicaemia occurred in 11 neutropenic patients (44%). In 2 patients the same organism was grown from blood and exit site. The use of this catheter greatly facilitates patient care and support, minimises discomfort, and is associated with an acceptable rate of complications.