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PubMed2004

The neoplastic transformation potential of mammography X rays and atomic bomb spectrum radiation.

Considerable controversy currently exists regarding the biological effectiveness of 29 kVp X rays which are used for mammography screening. This issue must be resolved to enable proper evaluation of radiation risks from breast screening. Here a definitive assessment of the biological effectiveness of 29 kVp X rays compared to the quality of radiation to which the atomic bomb survivors were exposed is presented for the first time. The standard radiation sources used were (a) an atomic bomb simulation spectrum and (b) 2.2 MeV electrons from a strontium-90/yttrium-90 (90Sr/90Y) radioactive source. The biological end point used was neoplastic transformation in vitro in CGL1 (HeLa x human fibroblast hybrid) cells. No significant difference was observed for the biological effectiveness of the two high-energy sources for neoplastic transformation. A limiting relative biological effectiveness (RBE(M)) of 4.42 +/- 2.02 was observed for neoplastic transformation by 29 kVp X rays compared to these two sources. This compares with values of 4.67 +/- 3.93 calculated from previously published data and 3.58 +/- 1.77 when the reference radiation was 200 and 220 kVp X rays. This suggests that the risks associated with mammography screening may be approximately five times higher than previously assumed and that the risk-benefit relationship of mammography exposures may need to be re-examined.

Cell Transformation, Neoplastic↗
PubMed1976

Radiation therapy among A-bomb survivors.

Survey of hospitals and clinics where atomic bomb survivors and their comparisons reported having received radiation therapy confirmed that 137 were so treated. The malignancies of five subjects were possibly related to their earlier radiation therapy rather than their atomic bomb radiation exposure, stressing the importance of recording all medical X-ray exposures as a potential variable in epidemiological studies of cancer etiology.

Environmental Exposure↗
PubMed1995

Researching the Oklahoma City bombing.

The authors present a literature retrieval strategy for investigators who plan to conduct research on the Oklahoma City bombing. To facilitate a comprehensive review of the scholarly research on disasters, mass emergencies, and terrorism, a multidatabase search strategy is strongly encouraged. Secondly, a wealth of current information and data on the bombing are available on "popular" and "news" files.

Adaptation, Psychological↗
PubMed1981

Malignant neoplasms among atomic bomb survivors following radiation therapy.

A second follow-up survey for radiation therapy exposure among a fixed cohort of A-bomb survivors originally numbering 20 000 persons identified 55 more who had received radiation therapy, and 7 more therapy-associated malignancies. In the previous and present investigations, 12 postirradiation malignancies were identified among 190 cohort members (6%) who received radiation therapy. This investigation underscored the necessity for documenting exposures to ionizing radiation for medical reasons, especially exposures incurring relatively high doses, among persons at relatively high risk of developing neoplasms, such as A-bomb survivors, and in malignancy epidemiology to exclude bias in estimates of risk.

Adolescent↗
PubMed1988

Studies of cancer among the Japanese A-bomb survivors.

Studies of cancer among the Japanese survivors of the A-bombs dropped on Nagasaki and Hiroshima are the major source of information on radiation carcinogenesis in humans. They have already made important contributions to the estimation of the risk of radiation-induced cancer and to our understanding of key factors influencing risk, especially tissue sensitivity, age at exposure, and the temporal distribution of radiogenic cancers. The size of the exposed population still surviving virtually guarantees the continued productivity of the research conducted in Hiroshima and Nagasaki. It should not be supposed, however, that these studies will ever provide all the information needed for radiation protection standards or risk estimation. The experience of the A-bomb survivors simply does not include all important aspects of radiation exposure for which information is needed. Moreover, despite the size of the sample remaining under study, it is most unlikely that direct, empirical estimates can be made that will remove the necessity for dependence upon mathematical models to derive estimates of risk in the low-dose region.

Adolescent↗
PubMed2003

The Bali bombing: the Royal Darwin Hospital response.

After the Bali bombing on 12 October 2002, injured Australians were evacuated to Darwin. The first patients arrived at the Royal Darwin Hospital (RDH) 26 hours after the blasts. RDH assessed and resuscitated 61 patients (including 20 intensive care patients, with 15 requiring ventilation, 19 surgery and more than 20 escharotomies). RDH evacuated 48 patients to burns centres around Australia within 36 hours of the first patient arrivals at the hospital and 62 hours after the bomb blasts. The response was successful, but improvements are needed in coordination between the different groups involved in such operations.

Air Ambulances↗
PubMedDate not supplied

Communication issues during bomb threats.

How should healthcare security professionals handle a bomb threat? How can a large complex best be searched? The author discusses why he believes the judicial use of radios and cellular phones during emergencies can enhance security's ability to handle bomb threat situations, and offers guidelines to follow.

Explosions↗
PubMed1998

The Birmingham abortion clinic bombing: preparing for an escalation of violence.

Reproductive healthcare clinics and hospitals that perform abortions are facing increased security concerns following the latest major incident of violence directed at such facilities--the January 29 bombing of a Birmingham, AL, abortion clinic that killed an off-duty police officer and seriously wounded a nurse. As of publication date, the FBI had issued an arrest warrant and was still searching for Eric Robert Rudolph, 31, as a suspect in the bombing, the first fatal one of an abortion clinic. A $100,000 reward is being offered to anyone providing information that leads to his arrest and conviction. This report will provide further details on abortion clinical violence and additional information on how such facilities--whether freestanding or hospital based--can better protect themselves.

Abortion, Legal↗
PubMed1999

The role of exposure in posttraumatic stress in youths following the 1995 bombing.

This study investigated the relative impact of various forms of exposure to the 1995 Oklahoma City bombing in middle and high school students seven weeks after the incident. We assessed 3210 youths with an instrument that probed for physical, television, and emotional exposure to the bombing and subsequent posttraumatic stress symptomatology and television reactivity. The majority of youths were exposed through physical proximity--hearing and/or feeling the blast--and through television viewing. These types of exposure, as well as emotional exposure, constituted important variables in the development of posttraumatic stress symptoms and television reactivity. Youths with immediate family casualties were more symptomatic than those without.

Adolescent↗
PubMed1999

Effects of radiation on the longitudinal trends of total serum cholesterol levels in the atomic bomb survivors.

The effects of radiation on the long-term trends of the total serum cholesterol levels of the Hiroshima and Nagasaki atomic bomb survivors were examined using data collected in the Adult Health Study over a 28-year period (1958-1986). The growth-curve method was used to model the longitudinal age-dependent changes in cholesterol levels. For each sex, temporal trends of cholesterol levels were characterized with respect to age, body mass index, city and birth year. We then examined whether the temporal trends differed by radiation dose. We showed that the mean growth curve of cholesterol levels for the irradiated subjects were significantly higher than that for the unirradiated subjects, and that the increase was greater for women than for men. No difference in dose response was detected between Hiroshima and Nagasaki. An increased mean level of cholesterol was evident for irradiated women in general, but a notable increase was apparent in males only for the youngest birth cohort of 1935-1945. The difference in the mean cholesterol levels between the irradiated and unirradiated subjects diminished past 70 years of age. It is not known whether this is due to natural progression or is an artifact of nonrandom variation in the rate of participation in the examinations. The maximum predicted increase at 1 Gy for women occurred at age 52 years for the 1930 cohort: 2.5 mg/dl (95% CI 1.6-3.3 mg/dl) for Hiroshima and 2.3 mg/dl (95% CI 1.5-3.1 mg/dl) for Nagasaki. The corresponding increase for men occurred at age 29 years for the 1940 cohort: 1.6 mg/dl (95% CI 0.4-2.8) for Hiroshima and 1.4 mg/dl (95% CI 0.3-2.6) for Nagasaki. Controlling for cigarette smoking did not alter the dose-response relationship. Although the difference in the mean growth curves of the irradiated and unirradiated groups was statistically significant, there was a considerable overlap in the individual growth curves of the two groups. The significant sex difference and the greater magnitude of radiation effects in women suggest that hormonal changes resulting from radiation exposure, such as accelerated menopause, is an area worth investigating to delineate the mechanisms underlying the increased cholesterol levels of the irradiated female subjects. This increase may also partially explain the increased rate of coronary heart disease seen in the atomic bomb survivors.

Adolescent↗
PubMed1999

Effects of radiation on incidence of primary liver cancer among atomic bomb survivors.

We describe the radiation risk for primary liver cancers between 1958 and 1987 in a cohort of atomic bomb survivors in Hiroshima and Nagasaki, Japan. The analysis is based on a comprehensive pathology review of known or suspected liver neoplasms that generated 518 incident, first primary cases, mostly hepatocellular carcinoma. Excess relative risk from atomic bomb radiation was linear: 0.81 per sievert weighted liver dose (95% CI [0.32, 1.43]; P < 0.001). Males and females had similar relative risk so that, given a threefold higher background incidence in males, the radiation-related excess incidence was substantially higher in males. Excess risk peaked for those with age at exposure in the early 20s; there was essentially no excess risk in those exposed before age 10 or after age 45. Whether this was due to a difference in sensitivity or possible confounding by other factors could not be addressed retrospectively in the full cohort. A paucity of cholangiocarcinoma and hemangiosarcoma cases suggested that they are not significantly associated with whole-body radiation exposure, as they are with the internal alpha-particle-emitting radiological contrast medium Thorotrast. Because most of the radiation-related excess cases occurred among males, it is important to ascertain what factors put men at greater risk of radiation-related liver cancer.

Cohort Studies↗
PubMed1999

Bomb threats and searches: time to reassess procedures and retrain employees.

Recent incidents of bomb detonations require preparedness on the part of healthcare and other organizations, say security experts. This article reviews proactive steps being taken by hospitals in Atlanta, GA, to handle bomb threats. Experts present advice on how to deal with callers who make such threats.

Disaster Planning↗
PubMed2000

Physical and chemical evidence remaining after the explosion of large improvised bombs. Part 1: firings of ammonium nitrate/sugar and urea nitrate.

Recent criminal acts in the United Kingdom, United States and other countries have demonstrated the dangers to public safety from the criminal use of improvised explosives on a large scale. Four sets of trials were carried out over four years, partly in collaboration with the United States Federal Bureau of Investigation, involving the firing of large bombs, mostly fertilizer based. The principal objectives of the firings were to measure the physical effects of the explosions upon objects representative of those that would be found at a real bomb scene and to recover any chemical traces deposited on these objects. The results are intended for use as an aid in determining the approximate size and type of an explosive employed in a terrorist attack. This paper describes the background behind the trials, the procedures for preparation of witness materials and charges, and the collection and analysis of physical and chemical evidence.

Criminology↗
PubMed2000

[Hand injuries caused by self-made bombs. Observations and reconstructoin techniques. Report of 7 cases].

The authors report on their experience of sodium chlorate bomb injuries of the hand observed in seven boys. The thumb was damaged in all cases. This digit was amputated in five cases, was totally saved in one case and partially saved in another case. In four cases, the preservation of damaged tissues in the emergency procedure allowed a secondary reconstruction of the thumb, thus making it possible to achieve a prehensile and sensitive hand. In these former four cases, a posterior interosseous flap was performed to ensure the primary or secondary skin coverage. In two cases, the major lesions necessitated an amputation at the radiocarpal level. In one of these two cases, coverage of the amputated stump by a free gracilis muscle flap made it possible to minimize the level of amputation and to wear a functional prosthesis. Sodium chlorate bombs are made with an unstable chemical mixture. These reactives provoke high-energy injuries with a short range of dispersion. The damages depend on the prehensile mode, which explains why the thumb and the index finger are always injured. These blast injuries were limited to the hand and the skin coverage could be done with a distally based posterior interosseous flap. In spite of the impressive lesions observed in such young patients, a conservative attitude could be taken in an emergency situation with the aim to perform further reconstructive procedures.

Adolescent↗
PubMed2001

The impact of the Oklahoma City bombing on children in the community.

This study examined the influence of exposure on post-traumatic stress symptomatology in children following the 1995 Oklahoma City bombing. Over 2,000 children were surveyed 7 weeks after the bombing. Initial reaction and emotional exposure were important predictors of post-traumatic stress symptomatology in the full sample. Children who reported no physical or emotional exposure had significantly lower scores than exposed children on television viewing, initial reaction, and post-traumatic stress symptomatology. Within the nonexposed group, those with high television exposure had significantly more post-traumatic stress symptoms. Children with strong initial reactions should be followed over time, and disaster-related television viewing should be carefully monitored.

Child↗
PubMed1962

Leukaemia in Nagasaki atomic bomb survivors from 1945 through 1959.

This review of the Nagasaki leukaemia experience during a period of 14 years after the detonation of the atomic bomb, together with comparisons with data from Hiroshima and from other series of post-radiation leukaemia cases, again demonstrates beyond reasonable doubt the leukaemogenic effect on man of ionizing radiation. An increased risk of leukaemia following doses probably as low as 100 rads (air-entry dose) of whole-body radiation is demonstrated on the basis of the available estimates of atomic bomb radiation doses. At doses above this level the increase in leukaemia incidence may be linearly related to the radiation dose. The data are too limited to allow of an evaluation of the risk represented by doses at the lower levels of radiation; but it seems clear that, if a threshold dose for leukaemia induction exists, it is lower than the threshold dose for the clinical expression of acute radiation syndrome.The sex and age distribution of radiation-induced leukaemia and the types of leukaemia observed are also discussed.

Aged↗
PubMed1992

Radiation-related ophthalmological changes and aging among Hiroshima and Nagasaki A-bomb survivors: a reanalysis.

The relationship of ionizing radiation to the age-related ophthalmological findings of the 1978-1980 ophthalmological examination of A-bomb survivors of Hiroshima and Nagasaki has been reanalyzed using DS86 eye organ dose estimates. The main purpose of this reevaluation was to determine whether age and radiation exposure, as measured using the recently revised dosimetry information (DS86), have an additive, synergistic, or antagonistic effect. The data in this study are limited to axial opacities and posterior subcapsular changes, for which a definite radiation-induced effect has been observed in Hiroshima and Nagasaki A-bomb survivors. The best model fitting for axial opacities gives a significant positive effect for both linear dose and linear age-related regression coefficients and a significant negative effect for an interaction between radiation dose and age. Such a negative interaction implies an antagonistic effect in that the relative risks in relation to radiation exposure doses become smaller with an increase in age. On the other hand, the best-fitting relationship for posterior subcapsular changes suggested a linear-quadratic dose and linear age-related effect. The estimate of the quadratic dose coefficient shows a highly negative correlation with age, but the negative quadratic dose term is extremely small and is of little biological significance.

Adult↗
PubMed1951

The physician and the atomic bomb.

ATOMIC DETONATIONS ARE ESSENTIALLY OF TWO TYPES: contaminating and non-contaminating. The only non-contaminating burst is the high air burst, since it does not result in the contamination of the ground with radioactive bomb residue. This type of burst results in blast, thermal and ionizing radiation injury (often combined in the same patient). The only injurious agent peculiar to atomic warfare is ionizing radiation. With a high air burst these effects are due mainly to gamma rays, and they are no longer present after the first few seconds following the explosion. Although only about 15 per cent of the deaths resulting from this type of burst are likely to be due primarily to ionizing radiations, exposure to the latter may well complicate recovery from trauma. Since there is a latent period of a number of days between the initial and later symptoms and signs of whole body radiation exposure, it does not constitute an emergency and can be treated after the initial period of the disaster has passed. With the detonation of a contaminating burst (a surface, underwater or underground burst) the radii of damage from blast and thermal radiation are considerably less than with a high air burst. Two types of radiation may result from the radioactive fog (base surge) formed after an underwater burst-transit radiation and deposit or continuing radiation. The deposit radiation includes that resulting from inhaled or ingested radioactive material as well as that deposited on clothes or skin. Bomb residue contains material which would localize in bones if it entered the body, and much of it has a long radioactive and biological half-life. It would thus bombard the radiosensitive bone marrow for long periods.Fortunately, the materials which would localize in bone are poorly absorbed from the gastrointestinal tract and lungs. In general radiation injury to a person exposed to a contaminating burst should be reckoned primarily in terms of the penetrating gamma radiation to which he was exposed, rather than in terms of possible internal radiation from ingested or inhaled contaminants. The principles of broad planning, careful triage, decentralization of medical aid, intelligent stockpiling, and the greatest good to the greatest number are to be stressed in medical defense planning. The best appraisal of exposure and its degree of seriousness is, as it is with disease in general, an accurate clinical evaluation by the physician. The tempo of the disease is an important aid in evaluating severity of exposure. The use of the dosimeter in judging the fate of a given individual is, at least at present, of limited value.

Gamma Rays↗