Lungs exposed to nuclear catastrophe: one-year therapeutic programme in Chernobyl liquidators group.

The high prevalence of chronic respiratory problems in cleaning technicians (so-called "liquidators") of the destroyed reactor at Chernobyl and prolonged persistence of inhaled radioactive particles in their lungs suggested a substantial link between radioactive exposure and the diseases observed. Taking into account the importance of the problem, we started this study with the aim of establishing an effective and useful therapeutic program and assessing its efficacy during a one-year period of treatment. Chernobyl liquidators (n = 20) were screened by clinical history, physical examination, lung function test, chest radiograph, electrocardiogram, complete blood cell counts, serum chemistry, immunological blood tests, and complete BAL fluid investigation. One group of the patients (n = 10) underwent a special one-year treatment including polyvitamins, N-acetylcysteine, and therapeutic BAL every 3 months. The technique of therapeutic BAL has proven to be a promising and effective tool in the treatment of lung diseases induced by inhalation of radioactive particles.

[Respiratory and hemodynamic disorders in the participants in the cleanup of the aftermath of the accident at the Chernobyl Atomic Electric Power Station]. / Respiratornye i gemodinamicheskie narusheniia u lits, uchastvovavshikhsia v likvidatsii posledstvii avarii na Chernobyl'skoi AES.

After examination of cardiorespiratory function in 10 males exposed to Chernobyl accident unfavorable factors at the age of 31-45 years suffering from chronic obstructive bronchitis (7 cases) and mixed bronchial asthma (3 cases) it was established that the patients had ventilation disorders of mixed genesis (moderate obstructive and respiratory affections), frequently occurring decreased specific diffusion (DLCO/Va) in normal total diffusion capacity of the lungs, inefficient gas exchange, midly declined left ventricular pump capacity and contractility. In the above patients a relationship was found between parameters of central hemodynamics assessed at echo-CG and severity of ventilation impairment and respiratory insufficiency.

[Respiratory organ pathology in the participants in the cleanup of the accident at the Chernobyl Atomic Electric Power Station]. / Patologiia organov dykhaniia u lits, uchastvovavshikh v likvidatsii avarii na Chernobyl'skoo AES.

The authors performed this investigation to ascertain the role of radioactive dust inhalation in the onset of respiratory diseases and determination of clinicomorphological features of such pathology. The authors have found that work in conditions of massive dust exposure, stay in the dust zone for a month and longer in 1986-1987 were the decisive risk factors of respiratory impairment. The examination covered 28 patients who had acute symptoms of inhalation damage to respiratory system when performing their job in the contaminated zone. Later on they developed chronic progressive respiratory affection having the following clinicomorphological characteristics: 1) persistent cough with hard to expectorate sputum, addition of respiratory insufficiency, sluggish recurrent infection and inflammation, deterioration of working capacity and quality of life, 2) isolated decline of specific diffuse capacity of the lungs in combination with obstructive ventilation, 3) marked disturbances of cellular immunity (reduced fraction of T-helpers and increased fraction of T-suppressors), 4) x-ray picture of diffuse pneumosclerosis and hyperairiness of the lung tissue, 5) endoscopic evidence of inflammation and atrophy of the bronchial tree mucosa, 6) numerous alveolar macrophages with foreign inclusions in the lavage fluid, such markers of Chernobyl dust inhalation as Sr, Zr, I, Cs, Ce, Np, Pu, Am, Cm registered in alveolar macrophages at roentgenospectral and roentgenofluorescent microtests, 7) defective functional activity of alveolar macrophages (free radical activation). Long-term persistence of the Chernobyl dust in the lung tissue results in essential functional and morphological changes in cell composition of the alveolar area, lung tissue undergoes structural alterations contributing to specific respiratory diseases with typical clinicomorphological characteristics.

[The results of the combined programmed treatment of those who cleaned up the accident at the Chernobyl Atomic Electric Power Station who suffer from respiratory organ diseases]. / Rezul'taty kompleksnogo progammnogo lecheniia likvidatorov avarii na Chernobyl'skoi AES, stradaiushchikh zabolevaniiami organov dykhaniia.

Examination of respiratory system in subjects exposed to long-term inhalation of radioactive dust when engaged in repair works after the Chernobyl accident have revealed specific pathology of the respiratory organs caused by long-term persistence of radioactive dust in the lung tissue. A special regimen of combined treatment has been developed which included: bronchoalveolar lavage, antioxidants, broncholytics, mucolytics, extracorporeal procedures, physical rehabilitation. 1-year monitoring of subjects on this treatment versus untreated controls proved the above regimen beneficial as the patients exhibited less intensive clinical symptoms, less frequent exacerbations of infectious and inflammatory processes, higher quality of life. Some of the patients resumed work. Contrary to controls, the patients had no signs of progression. Therapeutic bronchoalveolar lavage led to elimination of a large percent of the radioactive dust which was present in the alveolar macrophages, thus ruling out the key factor of respiratory affections.