study of response of human beings accidentally exposed to significant fallout radiation

95 Pages·1998·6.99 MB·English

TNEMUCODGNIKCARTELI?lSDNALSILLAHSRAM
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OPERAlION CASTLE - FINAL REPORT PROJCCT 4 1 ,
Study of Response of Human Beings
Accidentally Exposed to
Significant Fallout Radiation
yb
E. .P ,etiknorC ,rednammoC .CM NSU
V. .P ,dnoB M.D., Ph.D.
L. E. ,gninworB Lt. ,.loC ,CM ASU
.W H. ,nampahC Lt., ,CSM NSU
. -
.S H. ,nhoC Ph.D.
.iJ .A ,dranoC ,rednammoC .CM NSU
.C L. ,mahnuD M.D.
.R .S ,rraF Lt., ,CM NSU
, :i
,llaH ,rednammoC ,CM NSU
W. S.
.iI Sharp, Lt. ,)gj( NSU
N. .R ,namluhS Lt., NSU
MC,
lavaN Mcdicttl ,adncht!cB Rosearch ,,n,:;yrllM II
dntr
.U .S lavaN Radiological Ddcnsc buL
naS I:rancisco, ainrofilaC
,
.’
y:
ABSTRACT
FOIIOWIII~ IIIP noitanot>(d of lohS 1 1111 inikiB llotA OII 1 Mi1r1*h l!)!i4, 28 Amt*ri1*:111s i1nd 2J!l
ol
Marshallc~sc~ WC~I’Cc ~xl)osc~t f;~llouI. OW huntlrt~d fifty -HOVIVI of 111~ M;~rsh;rll~~~ w(*~-t- OII lJ(i~+lk
.1101\1 64 ’(’I’lW 011 lLm~c’l;lp ,llolA iLId IH ’YI*(W IIO btht nt*Ight111rinK ;~loll of AIIIIIKII~;I~~. Thcs 28
Aij1~~r11~:111s WI~I‘I’ on IConl:c~r1k Atoll. Tht* ~)rt*sc~nc’t~ of s1Knific*;ml l’al1~1uI WI lhc~st* i;Iolls was I~rst
~1~~11~f~111111I11v~ 1;1I ~‘IV~~IIY~III~ dosi11i1~lt~1-, 101~~11~~01111 Ron~t~rlk, WhC~ll IhIS dtYlc*c~ wt*nt (dr sc*illt~ at
ool IIII’ h1. sl101.lly dh. ths 1lt~I111rali on. Kmc~rKc~ncy surveys tIt~It~ctc~d radii11 it,11 OII t t(h inhabilcd
~llrllls , x1111c Sv;lc.u;lticjll of 111h;tljil;1nts to the* Navxl StaI1on at Kwi1jaltbi11 was l1ro111l1tly carried out.
~csolt I,( J~cil~;~lcr;r OI hcihw lthl slaudividni were
‘1’111, c!xposcti was ~nl~ulatcd fro111 thtl intensities
b(tlt tuollaf .lairrtam ehT slaudividni no palegnoR
IIUII~~ OII ISI;III~IS iI11d lhtb tl1~*;1y cbxponc11t of the
l~rv~~c*~cr yllctl;i~tixo‘J)~Jla 57I r, those no eanigniliA deviecer yletamixorppa 69 r, dna the -irhtmA
d!cvihtScltr na egareva detaluclac dose of 76 r. ehT esellahsraM no kiritU -er
cans 01) liongt~rtk
d!cv+c*c yleta,nixorppa 4I r. ehT tuollaf no ,palegnoR ,eanigniliA dna ot a ressel tnetxe no -egnoR
kir was yltcnitsid .elbisiv No tuollaf was devresbo no .kiritU A tnacifingis rebmun of -idni
slaudiv no palegnoR dereffus morf dlim aesuan dna eno or two slaudividni detimov no the yad
of the .erusopx?r htiW the noitpecxe of aesuan ni eno eanigniliA ereht;.laudividni were on other
etinifed lanitsetniortsag smotpmys ni the other esellahsraM or the .snaciremA ehT -raM
esellahs no palegnoR dna ,eanigniliA dna the snaciremA decneirepxe ot a gniyrav eerged -nrub
gn~ fo thr seye dna gnihcti of the niks morf 1 ot 3 .syad Later, sngis of noitaidar yrujni dedulcni
etinifed noitalip>c ni the palegnoH dna eanigniliA ,spuorg dna the tnempoleved of ,yttops -repus
,lai:tif detnemgiprepyh niks snoisel that detamauqsed morf the retnec of the snoisel .sdrawtuo
niks egamad was tneiciffus ot tluser ni raw, gnipeew .snoisel erehT was
In some cases the
on lluf ssbcnkcihI sisorcen of the .niks ehT snaciremA depoleved ylno ronim niks snoisel tuohtiw
.Jr~citar~c~(lu acrlchT w(*rtt kirltU .sevitan llA snoisel d~~la~ch yldijtar htiw
IIO skin Icsionu in 111~
r~chlrul nwoltkJ;~lr)I of I wt niks deton gnirud I wI doirep of lavr*csbo .noi .ciJlu.citor*clM
IIO (‘XUIII -
t1;11IO II (II ~IIC~~JS~~*So f Iha, suoish(l 4cwohs ~*II;LIIK~*H uSunlly ;tsso(*i:1lc~d wilh ratii;tl 1011 i11Jury. Fully
~CSOIII gnIniam*cr odiHni of sgnidliub or stuh *(rb(w d*cl‘(~ttorp OI :(lliyrLiv
~‘loll~c~l ~~~tl~v~tiuals :1111i
h!(~~rg~(I~ tnorf tn~cirr~~ol~cv~ilt of .snois~~I
H~!n1;1I~~l11~1~~r h;ugc++ wt.r11 dthf1111lt> in II1tb Iio11~t~lap,
d*cra!tppa dna was tnetsisrep for
Ailirlginilc~, :III~ Ih(b A111c~ri1*;11tK r’c1tips. Lyinphopc~nia pruml)t ly
I: prolo1~cd l1c~r1od of lin1c. Neutropenia occurred in all fo eht slaudividni htiw liiitinl muminim
1 htI yad dewollof yb na esaercni
valut~s occurring around th1, in the counts i111d a secondary
45th .yad ehT tsom tnetsisnoc cigolotameh egnahc was the -ed
minimum around the 4Olh to
noisser)I ni the teletalp .stnuoec steletalP were woleb lamron nehw tsrif detnuoc no the 10th
yad of erusopxe-tsop dna ylevissergorp decreased gniniatta a muminim neewteb the 25th dna
30th .yad hguohtlA yrevocer decnemmoc gniwollof siht ,muminim the teletalp stnuoc had ton
denruter ot lamron yb the noitelpmoc of the laitini yduts no the 76th erusopxe-tsop .yad ehT
ecnedicni of suoirav yrotaripser dna suoenatuc snoitcefni was lacitnedi ni lla erusopxe spuorg
dna erob on pihsnoitaler ot the cigolotameh .segnahc
yranirU noitercxe of sepotosioidar was .deiduts llamS stnuoma of evitcaoidar lairetam
were .dnuof setamitsE of latot ydob nedrub etacidni that there si on gnol mret hazard dna that
noitsegni dna noitalahni of sepotosi did ton etubirtnoc yltnacifingis ot the laitini noitaidar
.erusopxe
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FOREWORD
(a) nA 1Iti-r!tvo dcscriptiou of hcae dctwation, includinp ,dleiy thgieh fo ,tsrub dnuorg orez
r0
,noitacol !clnil ,noitanoted tneibnm cirehpsontta snoitidnoc at noitanoted t itnc>, c~tc.. for the
cqwration.
r0
0,) I)is~ussicm all t:cej~ml .stluser
)c( A yra)nlnus fo h*c~;:c ,tcbtjorp gnidulcni sevitcejbo dna .stlusrr
((1) A ~(t~cl)l~tro~ :(nitslI lo all stroper cowrinK the Mllitnry Efftwts ?‘ost .margorP
l~cI~at*()I strobqtr OII yrt*c~n~solt dna lanr~ctni tcaoidar rvi ~‘o~~ti~~~~i~~;ltI~~~~ lliw VJ~ dehs~l~tup sa
slir~~ni~~l~qlu~ IO siht .tro>qcr
Muc.11 fo thcb Ir;cid!cln t~~rnlinology in this rcq~ort si explainctd in l)i~rc~nthc~sc~s for the bewflt
of the Inynlm. .
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PREFACE
*tdui*(lli I;
()114*1x11 01t (‘AS’I’I ,I5 (lid 1101 I~IOIII~V~I~~I~p ro~r:ltir. ‘1’11~I~h hrl ic*il~biils III i~ro]t*~t 4. 1
s~ciroll;ro~lt;I dllI; ii*trl;~)~~r)lnu 101’
W(‘I’(’ tll.;lWll 11~0111 Vill’lOllS Wc’l’c’ (Olilily ;I IlOl~l ~lrogI’;1IIl wtlcw
IIII;~IT ll;r~t))o IIOL
I\I(~ JOIIII 1K)i) AM’ Mtvl~c*al I~c~sc~;IJ~~~II UTIS org;~~~i~.cxi :rllcsr liitb II;I~ h~gtui.
dnr; ,>tni*tld*tM .CKA Lt 1oC .,I E.
i)r. .Iohn C. ilu~hc~r. i)iroclor, i)ivtsion oI Hiology ;wd
,CM .ASU no‘tcruS of the demrA so.(roF snopattW .t’ccjorP d~ctc~tl~ts the -jorp
I~IYJWI~IIIR, Sl~cr~al
t:to rlcciffo dna detsouqcr that the noitceles lacinhcet dna lanoisseforp -moc
of p,crsonnel bc
d!c:cn!ttn .ylotaidommI Rear larimdA ecneralC ,nworB ytupeD noegruS ,lareneG lacideM -eD
.tne~ntra~l ,NSU evag etaidemmi dna etelpmoc troppus of lla lavan lacidem research seitivitca
dna dengissa ytilibisnopser ot TPAC naV .notpiT ,CM ,NSU dna RDC yrraH Etter, ,CM ,NSU of
the cimotA esnefeD ,noisiviD uaeruB of enicideM dna ,yregruS ,NSU for the noitatnemelpmi of
the .tcejorp
ecniS elttil deliated noitamrofni was elbaliava tuoba dose dna laitini ,ygolotamotpmys the
research maet was dezinagro ot edulcni the gniwollof stnelat for the noitutitsnoc of the -reme
ycneg lacidltm :mact lanretni ,enicidem ,ygolotameh noitaidar ygolonhcet dna .ygoloiboidar nI
t ,()I noit.ccllcs l~tnnosr~cp thcx sisahpme was decalp no past ecneirepxe ni lacidemoib research
of
dlbcif htiw *(inrola .snopaew nI ,noitidda snoisivorp were edam for a dnows nolehxt fo
III (he,
ni :csa.c yeht were .dedeen ,ylgnidroccA a btvitnrverp *tnicidlcm tinu of
sl)(ac’i;rl izc4 Ix~rsonnc~l
11~~ <:orlltrlarltlt~r in-Ch!c>f, lhc:ific ,teelF was detrela for rlbissop ~tigoloir~tt~nb ;s*ciduts doolb
snaicinii.c dna sesrun wt’rc d*cifiton ni !tsac lidno*c snoi dbtifitsuj
I);Jrlk ~J(~I.SOIIII(~~, ;III~ ;~tltl~l IOIGII
ri*~lI s*t’t~vr’ts ii1~claji;wK .aeru rl;?cR larimdA w~tmolohlraR .~II;KOH .CM ,NSU .cifi’ca’I
III IIIc-
t~(*tl‘*l l~;.c~dbtM lfO ,rbt:(I ~J~(II;II(*(IIII~I 31dam ylla dcdccn la*cid~cm s~t1lili~caf of bcht ciCi*c%l t>cclF
~rv;ll1;l1Jl~~.
l~ctino~:r!c’i btr’tw dcn1alb0 nihtiw the latnenitnoC stimil of the .U .S for 111th h*(rr;rs~tr maet
:swollOr
ilh
lavaN lacideM hcrabcsblH etutitsnI )IRMN(
4 lacidcnr sreciffo .sI( .P ,etiknorC tcejorp ,reciffo .R .A ,dranoC N. .R .namluhS dna
.R .S )rraF
2 lacidem ecivres corps sreciffo .W( H. nampahC dna .R Sharp)
6 dets.ilnc nem (C. .R ,epiS .P .K Schork, .C .P .A ,emortS .W .C ,rrtltulC .R E. ,llesnaH
J. .S )ybmaH
.U .S lavaN lacigoloidaR esnefeD yrotarobaL (NRDL)
1 nailivic M.D. (V. .P )dnoB
1 iacidem ecivres corps reciffo (L. J. )htimS
4 detsilne nem .W( H. ,sbbiG J. .C ,eirdncH .W .S ,aznogrA J. )naganalF
noi;:iviD of ygoloiB dna ,enicideM CEA
2 nailivic M.D.‘s (C. L. mahnuD dna .G V. )yoReL
demrA secroF laicepS snopaeW tcejorP )PWSFA(
1 ymrA lacidbtM reciffO (L. E. )gninworB
yranimilerP ;:,tiduts had ~r!c!cb edam yb CDH .W .S ,llaH ,CM ,NSU noitatS lt:.cilt,tM r*c*ciffO
itm: lloitnninrallro~(!(lt of thr t’c~tjor’i 4. I -nosr~cp
and his st:~Tf, iptlivitlual~ was wall untlcrw;ry whc-11
1
III; of ’tIlI
‘l’llt~ pr0jtsc.l 0111(.1’1. ~‘0~1llll~~utis Il~Olt~SSl~~llill ;lllti It*t’ll~llt~;1I ll1c~~IlLlt~!s 0I IlIt- Krc’rlI)
for
IIII~IV t~xt~~~ll~~nt it~olivalioir. iirili;ilivt~. ;III~I ~tbIu~rl;~~y lt1t1~ I~~)LII’s 01 ~5x1I ’iI work 111~11W t’I’t’ (‘5
ehl
Yefltiitl for ilt~t~trl~l~Jli~ll~ll~~~ of the clinic-al anti reutrnrclr thjertivt-s. ;llltI for lilt’ l’ill’itl t’OI
,tilI .dIhtif tI d~rzisailpln~t tarlI >thl work was
Icc11or1 of thr prcliiniu;~ry d;rla in IS iI c.otbIJt~t’;itivt~
rova!ticnc ni hcihw lla ylltiutullI lncdnc)qd nopu h!tIilt .rsrhlo lthT gnilliw slroffr of ll~i -no‘(
wt*rc
d+cnrec tilsno*( clhakranl~tr elpmaxe of -maet work dna >c*tifircas of lanosrtcp
uted it ;1mb11 IU~:S ;IIK~
sbtrlsed for ehI ehI tcejorp at .egral
good of
ehT srohtua hsiw ot express rieht edutitarg dna ssendetbedni ot Dr. nhoJ .C ,rlthguB TPAC
naV ,noljliT dira CDH yrraH ;rettE TPAC .W E. ,mulleK ,CM ,NSU dna TPAC .T L. ,nomlliW
gnidnanrntoC dlla evitu.cktxE ,sreciffO .ylevitcepser ;IRMN TPAC .R .A ,srenniH ,NSU ,rolctcrlD
..IDRN dna TPAC .A .~1 .eknhc3t ,CM ,NSU etaicossA ,rotceriD ;LDRN lla of niohw uvag -nu
it~tlimil dna decudtr rvitartsinimda serudrcorp ot a erab ,muminim suht gnikam ti
SUiJfJor!
elbissop for !tht tinu ot eb drlbmcssa dna yawrednu ni a rettam of .sruoh
nO lavirra at ,nielajawK MDAR .R .S .ekralC ,NSU gnidnammoC ,reciffO .U .S
NiIVXl Sta-
4.1 hliw lla achl seitilicaf at sih .laso)laid sA ,tlus!cr I;
t~on. Kwajaltbin, supI)orltld Projocl ;I
yrolr;robal 24 sruoh after lavirra
and 1.11n1c was t!slal~I ishtxti and opemt ing within of tlltx projtM
l’c’rscmnc~l.
hsiw ol egdelwonkca the* gnidnatstuo snoilubirtnoc IO laC .C .S
I)rojtx*l pt~rsonut~l also
,PWSFA TPAC H. H, ,thgiaH ,:CM ,NSU noisiviD of -tliM
Maup~n, MC, USA. F’icbld Ct)nluliLrld,
y-tat ,noita*cil)qlA ;CEA laC .K ,FASU laicepS snopaeW ;retneC TPAC dlanoD
Hou~hltm, MC,
,NSU CAPCNIC ;l~trlF Drs. .T L. ,nampihS‘ .T ,etihW dna .P sirraH of Los somalA
Dt~mt~nI, MC,
cilrtnbcicS ;yrotarobaL Dr. nodroG ,gninnuD noisiviD of ygoloiB dna .enicideM ,CEA dna Dr.
.G V. .yoR>c,L ytisrevinU of .ogacihC gniruD lla phases of the ylrae care of the deso)lxc -idni
,slaudiv the gniogerof detapicitrap as hcum as rieht other yramirp seitud dluow .timrep nI
nlcitidda the srohtua hsiw ot knaht meht for the evisnetxe dna etelpmoc data hcihw yeht detcelloc
ni bcht sllota or rieht emoh seirotarobal dna yldnik dehsinruf ot the tcejorp .lennosrep
ehT suounitnoc pleh dna noitarepooc of tsurT yrotirreT sevitatneserper dna ri*tht dia ni
gniniatbo yrassecen lortnoc data no evitan esellahsraM at orujaM si ybereh .dcgd~tlwonkca
ehT srohtua arc ylralu*cltrap detbedni ot Mr. nhoJ .niboT siH pleh as r’ct’trprctni dna s1~1
an
~tvlsnrtxe ogdclwonk of ehI csellahsraM egaugnal dna stibah were .>tlbaulavnt tnatnclu~ci~I .1. .S
.nospmohT ,CM ,NSU d>thsinruf sih records no the) exposed slaudivtdni It~(ll;iiiint;tiio~~td yb >(hl
laidar ,tilI 92-PV nordauqs stat dcnoi Ia .nielajawK
IOI~ Kroul) of
~(h’I‘ srohtua hsiw ylll;i*tcps~c ol ssc’rpxbc rieht noitarimda for the lncllccxe boj ,cnoit yb ~t111
.U .S lavaN .o)II:I
n~txiit~al pt~rsonnt~l of 11~~ Dinpt~nuary, Kwnjalcin, in coii;pIt~ling lht* t~xlt~ns~vt~
ItillI !trt(w it*criult~tr ot niatbo a tpmor)l laitini taulavXt noi of ,thl tir’avch y I)(
ratory c~x;+rllitl;ll IONS
lht! r:ttlial ioii injury.
.A dooW of the yIisr!tvinU of ainrofilaC +oH
Tti(s aulh~rs ;kr(’ dt~t~ply gratt!ful 10 Dr. David
,l1;tip naS ,o*csi.cnarF neplA dna ssiM Pat naoR of NRDL, for ~llb~~ulliVI~I dia
;IIKI Dr. Edward L.
ni gniyrrac tuo ~t111 la’ci~olo~tta~lolsi~I taulavc noi of niks .snoisel ehT ltvisnetxe Inoc r 1ub1 snoi 0r
Mr. H. H. relllccH data, dna of Mr. .C .A suahdnoS fu (ht.
in the statistical analyses of the
NRDL nI dosage snrtitt:lucla~t are yl.:ufetarg .degdelwonkca
8
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CONTENTS
l’iK(’
TCARTSBA ........ . . 3
~l~lOWEIlOF ........ . . 5
ECAFERP ........ . 7
SNOlTARTSU>ILI ....... . . 01
SB>IBAT ......... . . . 12
RETPAHC I .NOITCUDOHTNI .... . . . 15
1.1 scvil*c~(jbO ........ . . . 15
1 2. larenoG noiLpir:csb(D of the Exposed ipuorG . . . 15
1 .3 Evacuation and ylraE Care of the Exposed spuorG . . 51
I .4 noilamltsE of elohW ydoB lanretxE Dose . . . . 16
6.1 clt;mit%l of Maximal nikS Dose morf the dnuorG . . 22
RETPAHC 2 LACINILC SNOITAVRESBO DNA YPAREHT . . 24
2.1 tnI noitcuder . . . . . . . . . 24
2.2 smotpmyS dna sngiS detaleR ol noitaidaR yrujnI . . 24
2.3 lacinilC noitavresbO dna yllarehT as detaleR ot lacigolotameH
sgnidniF . . . . . . . . . . . . 25
2.4 ehT Effect of na cimedipE of reppU yrotaripseR noitcefnI no na detaidarrI
noitalupoP . . . . . . , . . . . 26
2.5 nosira)lmoC htiw the kirilU puorG of sesaesiD neeS ni the palegnoR dna
caniKniliA spuorG gniruD the doireP of noitavresbO . . . . . . 29
2.6 secnahC ni thgieW as na noitacidnI of ecnabrutsiD ni the llarevO
lobatbtM msi . . . . . . . . . . . . . 30
2.7 tchT sl*c!cffK of ycnangerP . . . . , . . . . . . 31
2.8 noissu*(st)I no !thI *CSU of scitoibitnA ni siht )luorG dna ni noitaidaR
.yrujni . . . . . . . . . . . . . . 33
HETPAHC 3 NIKS ,SNOISEL ,NOITALIPE DNA LIAN NOITATNEMGIP . . . . 34
3.1 --noitcudortnI ylraE ygolotamotpmyS elbarefeR ot the nikS . . . . 34
3.2 nikS snoiseL . . . . . . . . . . . . . 34
3.3 noitalipE . . . . . . . . . . . . . . 39
3.4 liaN noitatnemgiP . . . . . . . . . . . . 40
3.5 srotcaF gnicneulfnI the ytireveS of nikS snoiseL . . . . . . 41
3.6 noit~:l~crro:C htiw lacigolotam~cH sgnidniF , . . . , . . 12
5
_1---_- ---.-___ -.- .-.- - .--..-.-- _~ _ _
CONTENb (Continkdj
I’XKI
7.3 I)lscwssicm . . . . . .I ‘.PI
3 .H Crmvlusious . . . . . . . . 4:)
RETPAHC 4 YGOLOTAMEH . . . . . . , . 36
4.1 Introduction . . . . . . . . . . . s;;t
4.2 larcncG Methods . . . . . . . . . . 36
4.3 Methods of Treating Data, Control Groups. . . . . . (4
4.4 Hcnmtolo~i~;~l Findings, Gwwral . . . . . . . 56 ,
4.5 Rongc*lap Group . . . . . . . . . . 97
4.6 ~caniKniliA Gruup . . . . . . . . . . HO
4.7 kiritU Group . . . . . . . . . . no
4.8 kir~cgmc~I )snacirwnA( . . . . . . . . HO
Gnmp
1!.4 Moucwytc-s ;~rrtl Eosinophilt~s. llA Groups . . . . . . 81
4.10 Ht~rmlwrit, llA Groulw . . . . . . . . . 18
4.1 I M~~rl~holo~y of I+rlphvral Hlotd . . . . . . . 81
21.4 C:clulp;lrlsc)n of Hc~ru:clologiic’ul Findings iu Childrcu dna ,stludA
pal!cgnoR Group . . . , . . . . . 82
4.13 I)isc:ussicm . . . . . . . . 82
RETPAHC 5 LANRETNI EVITCAOIDAR NOITANIMATNOC . . . 9H
!i. 1 Introduction ......... . 98
5.2 lacisyhP tnemnorivnE seidutS ...... . 98
5.3 laminA seidutS ....... , .. . 91
5.4 namuH seidutS .......... . . 92
5.5 .noissucsiD ......... . . 96
5.6 .noisulcnoC ......... _ 96
RETPAHC 6 SNOITADNEMMOCER ...... . 79
.SECNEREFER .......... . 89
ILLUSTRATIONS
IlET’lAHC 1 NOlTCU~IOIITNI
1 . I $crlT I ,iving aerA no pl;l:(gno(I ,dnalsI 1aridnI gni the Light,
O~N:II-~~I)I~ ()I noitcurls~niC . . . . . . . 71
1 .2 margotsiH of noitropor’l of latoT Dose detubirtnoC yb euolraV
ygrenE snoigeR morl the tuollaF noitaidaR . . . . . 81
1.3 evitalumuC Dose as a noilcnuF of emiT retfA the noitanoteD . . 21
1.4 evitarapmoC Depth Doses roi la,retaliB erusopxE morf a llamS
ecruoS and Multiple ecruoS n4 erusopxE htiw 96-tlaboC . . . 21
1.5 evitarapmoC Depth Doses ni a motnahP naM of laitinI cimotA bmoB
noitaidaR dna noitaidaR morf a dleiF of noissiF stcudorP . . . 22
RETPAHC 2 LACINILC SNOITAVRESBO DNA YPAREHT
,’
2.1 ehT doolB tnuoC segnahC ni a owT Year dlO dlihC htiw reveF . . . 27
2.2 ehT doolB tnuoC segnahC ni a ytfiF Year dlO naM htiw reveF . . . 28
.
,
.--._ _.__.-
ml__ __-__ ---_ ------.-- --- --- --~. -...._. . . ._-._
I LLusT#Ail~ol\zs’ (Cdnt iiied)
CIET’IAH‘( 3 NIKS .SNOISEL .NOITALI’IE DNA ,LIAN NOITATNEMGI’I
. 73
rolo:( s*ctr;l’I
3 . 1 ylrt;:b Ilyl"~~IIi~nIc~IIt(~d M;l~ulol);I~)~lli~t. Nt*<‘k L~~I+~oII~$ 111 6
Ihys. Cast J!), Age‘ 15, F. . . . . . . .
3 2. N(s(.k I ~(*SIOIIS ;It 28 I);I~H. Wrt I)~*S~t~~;Itl~ilIot I\. Wl\it(a (‘oIo~ IS
C:;tlitttliI\t* I ,ot ion. C;IH(L 78. AKP 37, b’. . . . . . .
3 .:i lb~lCgmcsnli nl: Supc~rllc*i;~l Ncc*k l,t~sions aI 40 Days. Hyl)c~~~)i~ltlc~lltc~d
Arcbas III~~ C~~~~l~l~l~~t .d~c~ll;~na~lcs~l)I ~ly cHIiC 24, ‘egA 15, .F . .
3.4 lit*;~l(*d Nc1c.k I ,c-sions ;It 7’7 1);~~s Sllowinc: Dusky I’I~Illt*lltilt ion (II
k’cl;3I of .k*cb(N Casct 39, ItRA 15 .F . . . . . . .
3.5 d~cln,cnlglrlrc)lyH desiaR seuqal’I dna calluB no musroD of teeF dna
seoT at 28 .syaD enO noiseL no Left tooF Shows Deeper .tnemevlovnI
teeF were lufniaP at sihT .emiT . . . . . . , ’ )b(94
3.6 snoiseL 10 syaD Later. ealluB evaH ,nekorB noitamauqseD si
yllaitnessE ,etelpmoC dna snoiseL evaH .delaeH teeF on regnoL lufniaP . . 49(h)
3.7 snoiseL 6 syaD Later gniwohS noitatnemgipeR Except for llamS Scar
no musroD of Left tooF at etiS of Deepest noiseL . . , ,
. 49(b)
3.8 evisnetxE snoiseL ni ,y?B egA 13, Case 26 . . . . _ . 51((,)
3.9 evisnetxE snoiseL ni ,yoB egA .3; Case 26 . . . . . * 51((.)
3.10 ~(lohW Body weiV of snoiseL ni emaS Case as setalP -.8.3 3.9 . . . 53((.1)
3.11 elohW ydoB wlciV of snoiseL ni emaS Case as setalP 9.3-8.3 . . . 53((.1)
3.12 noitamauqs~c)I of Back f~a placS at 28 .syaD noitalipE derruccO
r~cilra?l ni d!ttamt:uqs!t~I .aerA (See etalP 3.14.) Note tnetsisreP
lar~c*(lU Left Ear. . . . . . . . . . . 55((f)
IOII of
3.13 n*cbtthKiE syaD .rlttaL placS snoiseL evaH delaeH htiW nottatnemgipcR
’I)( .nikS No riaH htworG tnedivE ni detalipE .saerA Ear noitareclU
slsisr~cP htiW elttiL .tnemevorpmI . . . . . . . . 55(d)
3.14 noilalipE ni naM at 18 .syaD Case 79, egA 41. placS snoiseL tneserP
in saerA of .noitalipE emaS( Case as ni setalP 3.12 dna 3.13.) . . . )Z((75
3.15 yttopS noitalipE ni .yoB egA 13, at 28 .syaD Case 26. Note placS
snoiseL ni saerA of .noitalipE emaS( Case as ni setalP ).11.3-..8.3 . . 57(e)
3.16 noilalipE ni 7 Yr. dlO lriG at 28 .syaD Case 72. . . . . . 57(c)
3.17 detnemgiP sdnaB ni ranulimeS aerA of slianregniF at 77 syaD . . . 57(1&)
3.18 (X100, H&E) :simredipE evisnetxE lamredipesnarT egamaD htiW
L,ess devlovnI senoZ no rehtiE ediS . . . . . . . . 59(.0
3.19 (X100, H&E) :simredipE sedacrA of laminiM egamaD ruccO ni
noitaleR ot yrotercxE stcuD of Sweat .sdnalG . . . . . * 59(f)
3.20 (X400, H&E) >tsaC( #26) lamredipesnarT egamaD htiW noitazinagrosiD
of th(* naihgiplaM reyaL . I . . . . . . . * j/.(95
3.21 (X100, H&E) (Case # 63) lamredipesnarT egamaD htiW noitazinagrosiD
of the naihgiplaM reyaL . . . . . . . . . . )l(95
3.22 (X100, H&E) (Case #75) Loose noitanimaL of lnutartS lnuenroC htiW
Outward yrallipaP snoitcejorP dna tnatluseR ”esoguR“ >(rnaraoppA . . 61 (,r)
3.23 (x400, H&E) (Case #75) emaS as 3.22. lanoisaccO raelcunircP
cimsalpotyC solaH ni diM mutartS musolunarG . . . . . * 61(5_)
3.24 ,001x( H&E) (Case #39) Narrow esoguR simredipE htiW yrallipaP
snoisnetxE drawnwoD of mutartS iihgiplaM . . . . . . )g.C16
-_--__- ___ -____ .__ ._._ _-- .--_~ ._._.-- - ---. .-. - - - _
. . . .
RETPAHC 4 YGOLOTAMEH
4.1 laireS stgnahC ni clihportucN slwoC of palegnoR puorG for wahT
Lws nahI 5 Years dnr; rctwrG naht 5 sraltY of egA . . . .
67
4.2 laireS w~nahC 111 ~tlyw~hpmyL tnuoC of pal~cgnotI puorG for *tsohT
SS~CL nl:hI 5 ~ri;eli a11d r~ttli~trG nahI 5 SrIistY of ’tgA . . . . m
4 .3 t~;rapnroC btvi laireS s’tgnlih:( ni ehI laloT ,eiy’cokutL ,~tlihportwN
dna ~tly~coh~lmy,I ltsohT r*tti:orG naht 5 nrarY ,dlO
st~r~JtC III
~~i;l~t~~~tJt~I Croup I , . . . . , . . . . ti!)
4.4 ni lcsohT ss+tL 15 Years dna
IL;I.I~~S 1’1~11 l*tl~~ s’t~ltlillI< III;II~ ~~ttt&cC
than 15 sr~;*tY of 14~A III 1ho ~lal~cgnoR tiuorG . . . . 70
4.5 St-rml Ir;l11’7 I .*tly.cokwt, Nwlrt~~~l~llt~,
itlltl IJY Ill~tlt~t~yl t2 COUlll Ill
sna*tir*cmA . . . . . . . . . 71
I~:x~~owtl
4.6 ltilrcS t~tl~tl~;i’l S~IIUJ~~ ni dltswlxE sn~i~ir!tmA . . . . . 72
4.7 lwrb(S clihponisoE slnuoC no esohT Ltw nahI dna retaerG naht 5
Years of egA of thr palegnoH puorG . . . . . . . 73
4.8 laireS slircolameH for llA Exposed spuorG . . . . . 74
4.9 evitalumuC elihportueN stnuoC for the ,palegnoR eanigniliA dna
orujaM spuorG at the emiT of Peak noisserpeD , . . . 75
4.10 evi.talumuC etycohpmyL stnuoC for the ,palegnoR eanigniliA dna
orujaM spuorG at the emiT of noisserpeDkaeP . . . . 76
4.11 evitalumuC teletalP stnuoC for the ,palegnoR ,eanigniliA kiritU
dna oru]aM spuorG at the emiT of Peak noisserpeD . . . . 77
RETPAHC 5 LANRETNI EVITCAOIDAR NOITANIMATNOC
5.1 ,lleW palegwR . . . . . . . . . . _ . 09
5.2 ,nretsiC palegnoR . . . . . . . . . . 09
5.3 hparqtidaroluA of palcgnoR nekcihC ,aibiT ~%1 , 21 Hr erusopxE
lalninA de:tifir*taS 45 syaD .erusopxe-tsoP . . . . . 19
5.4 hpargoidarotuA of palegmtR giP ,aibiT 42 Hr .erusopxE laminA
d:cciflrcaS 58 syaD erusopxe-tsoP . . . . . . . 29
TABLES
RETPAHC 1 NOITCUDORTNI
1 l. Exposed dna lortnoC desopxenU spuorG . . . . . . 16
RETPAHC 2 LACINILC SNOITAVRESBO DNA YPAREHT
2.1 sesaesiD that deraeppA gniruD noitavresbO of the palegnoR dna
eanigniliA spuorG . . . . . . . . . . 92
2.2 sesaesiD that deraeppA gniruD noitavresbO of the kiritU puorG . . 30
2.3 thgieW ,segnahC palegnoR dna eanigniliA spuorG . . . . 31
2.4 doolB stnuoC no tnangerP ,slaudividnI palegnoR dna eanigniliA
spuorG . . . . . . . . . . . . 32
5.2 stneitaP detaerT htiW scitoibitnA ., . . . . . . 32
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