Vol 75, No 5 (1994)

Frequent natural disasters, man-made disasters and social upheavals significantly affect the quality of life and the ecological space in which we live. In the changed conditions, the shortcomings of health care and the higher medical school became obvious, which based their priorities on the concept of organopathological medicine.

The radiation accidents in the South Urals and Chernobly present specific problems for public health of Tatarstan Rebublik. Among these is primarily the necessity to create the special-purpose prophylactic medical examination of the eliminators of radiation accidents. The conception to provide emergency medical service in radiation accidents in Tatarstan Republik is considered in connection with the initiation of technogenic contamination by radium-226 at a number of enterprises. The emphasis is on the suggestion to provide extrahospital medical service to the victims of radiation, chemical, transport accidents with regard to the possibilities of the Republik Center of emergency medical service of the Ministry of Publik Health of Tatarstan Republik.

Medico-biological consequences of radiation accidents are considered in the context of linear relationship on the model of «dose-effect» and probabilistic stochastic changes without a threshold. If the first group of changes occurs proportionally to the individual irradiation dose, so the second group is reliably tracked by the calculation of the collective irradiation dose. The damage caused to public health by the Chernobyl accident is approximately 20 times smaller than by nuclear explosions in Hirosima and Nagasaki. The principles to develop the new normative documents on radiation safety are presented.

The radiation situation in Tatarstan Republik is estimated as normal. The emphasis is placed upon the possibility of radioactive contamination of subsoil waters in the south of the republik after spills of liquid radioactive wastes by the Dmitrovgrad scientific institute of nuclear reactors (the Ulyanovsk region). The reconstruction of the existing burial place of radioactive wastes and the creation of inter-district points for storing of collected radioactive subsil are necesseary.

The protective material against radiation (beta-, gamma- and roentgen) obtained by means of mechanical filling of porous polimeric materials with water metal suspensions is developed. The filler content in the material and consequently, leaden equivalent quantity vary in the wide range (between 0,1 and 0,9 mm Pb) and are regulated in the process of material production. A number of protective products for the use in extreme radiation condiations, in regulated repairs at industrial works, as well as roentgen-protective means for medical scientific and industrial institutions and works is developed.

The formula is proposed for the calculation of contamination density by gamma-active caesium isotopes by radiation background and vice versa: 1 Ci/km²= (7,55±0,44) µR/h. This equation practically corresponds to our calculations by Zhuravlev reference: 1 Ci/km²=7,7 µR/h. The hematologic nomograms allow a physician to be quickly oriented in the diagnosis and medical assortment of acute damages of persons by uniform gamma-irradiation in the range of doses between 1 and 10 Gy. Adapted to the Chernobyl accident conditions the calculation method of the determination of small doses of chronic irradiation by the Blare mathematical model is simple and convenient. By its results it is close to the probabilistic model of chronic irradiation used by the international group «Chernobyl project».

The gravity extent of the effect of radiation factors of the accident on population is analysed. The unfavourable demographic situation on the territories contaminated by radionucleoids, death rate and sickness rate of population are practically identical with the corresponding indicators in these regions which are not contaminated by the accident discharge products. The psychical deadaptation of 50% of the population as a result of radiophobia belongs to the medical consequences of the accident. The establishing psychotherapeutic service is bound to protect from this factor offect. Particular emphasis is placed upon the rate increase of endocrinie and oncologic diseases with short latent period undoubtedly associated with the rise of the collective irradiation dose.

The sickness rate of blood and hemopoietic organs of eliminators of the accident at the Chernobyl nuclear station is estimated. The necessary information is obtained from the data base of the Branch record. The general sickness rate of this type of diseases is 2,86±0,3 to 1000 observed persons. In women anemias are 6 times more frequent. The malignant tumors of hemopoietic and lymphatic tissue are revealed in 6 patients. The dependence on the irradiation dose is not established.

The agressive factor type, its dose, geometry and effect intensity determine the content change nature of adenylic acids, hormones and electrolytes in blood and tissue.

Intermittent hydrarthrosis is a disease characterized by inflammatory changes in the joints. The etiology of this ailment is unknown, however, a relationship with an allergic condition and endocrine disorders is noted. The clinical picture is characterized by a sudden onset. More often, the knee joints are involved in the pathological process, less often the ankle, hip. The joints of the hands are extremely rarely affected. In the absence of violations of the general condition against the background of a normal temperature, pain and swelling of one, possibly two joints suddenly appear. The joint increases in volume due to the accumulation of exudate. Periarticular tissues change slightly. The function of the joint suffers little. The disease is cyclical. In connection with the rare spread of intermittent hydrarthrosis, we present our own observation of such a patient.

Precision clinical topometry is the most important attribute of pre-radiation preparation of patients. Its underestimation and implementation of radiation therapy on the basis of schematic planning, according to various authors, can cause the development of radiation injuries from 6-10% to 61.2% in patients with malignant tumors of the oral cavity and oropharyngeal region. This is due to the sharp gradient of the absorbed radiation dose arising from the inhomogeneity of the irradiated volume. The adequacy of the performed topometric studies is in direct proportion to the radiation damage.

The development and implementation of precision methods for pre-radiation topodosimetric preparation has significantly reduced the frequency of radiation injuries. The use of the VDF and NSD factors made adjustments to the planning of bioequivalent radiation regimes. Despite this, radiation complications remain a frequent limiting factor in radiation therapy. Recent studies have shown that the development and formation of radiation damage seems to be a complex and diverse process, not all aspects of which have been sufficiently studied. In the overwhelming number of patients who have undergone radiation therapy, there is a decrease in immunity parameters [12]. In the development of radiation injuries, the infection of the radiation zone [17], the prevalence of the malignant process [4], and regional circulatory disorders [6] are of direct importance. The conditions that predispose to the occurrence of radiation damage are trauma and inflammation. The frequency of radiation damage increases with the use of various types of chemotherapy, especially in combination with radiation therapy and hyperthermia [10]. The listed factors, which determine the development of distant radiation damage, create a prerequisite for the development of measures that protect the healthy tissues surrounding the tumor [8].

The ubiquitous spread of staphylococcal diseases among the population, as well as the lack of reliable means of protection and fight against them, make the issues of obtaining immunological preparations very urgent [1, 3].

Overcoming social skepticism about the future of nuclear power and other highly efficient industries using fissile materials is, in our opinion, a matter of time, because in the near foreseeable future there is no other technically and economically feasible alternative to nuclear power due to the imminent fuel and energy crisis. However, it is bewildering the efforts of apologists for nuclear energy to minimize the degree of harmful radiation effects on the human body and on entire groups of people (NPP personnel, participants in the liquidation of the consequences of the Chernobyl accident, the population evacuated from the affected areas and the population of the regions that found themselves in the path of the radioactive cloud after the accident on ChNPP). Many studies, numerous publications of specialists in various fields, from nuclear physicists to physicians and biologists, have been devoted to the fulfillment of this very dubious task. These publications are systematized, carefully selected and published in special brochures, collections and whole books, in which there are no skeptical statements and research results of those specialists who adhere to a slightly different point of view or strongly reject the concept of "35 rem in a lifetime". Their opinion can be found mainly only with a careful study of the collections of reports at highly specialized thematic conferences, meetings, seminars, and even then mainly in the biomedical direction. But all their persistent calls to reconsider the concept of radiation, affecting people in a dose exceeding 35 rem per life, are met with fierce hostility, declared incompetent, populist or politically opportunistic, or even simply anti-scientific.

On December 23-24, 1993, a scientific conference was held at the St. Petersburg Military Medical Academy (VMedA): "Actual problems of the pathophysiology of extreme conditions", dedicated to the 100th anniversary of the birth of Academician of the USSR Academy of Medical Sciences, Major General of Medical Service I.R. Petrov, Head of the Department of Pathological Physiology of the Medical Academy of Medical Sciences (1939-1963), Professor-Consultant of the Military Medical Academy (1963-1968), Chairman of the All-Union Society of Pathophysiologists (1960-1968), Honorary Chairman of this Society (1968-1970).

The conference was attended by scientists from Kazan, Moscow and St. Petersburg, faculty and cadets of the Kazan Institute for Advanced Training of Physicians, Hematology, and hygienists-radiologists of cities and regions of the Republic of Tatarstan.

On April 11, 1994, at the 97th year of his life, a prominent therapist, scientist, teacher, public figure and Honored Scientist of the Russian Federation and the Republic of Tatarstan, Professor Leopold Matveyevich Rakhlin, died.

Acute radiation reactions in patients with malignant neoplasms of the larynx are a constant factor accompanying radiation therapy. The intensity and speed of their manifestation are ambiguous and depend on the stage of the malignant process.