Radionuclide monitoring in Northern Ireland of the Chernobyl nuclear reactor accident

Northern Ireland received higher radiation doses due to the radionuclide contamination from the Chernobyl nuclear reactor accident than did the south of England. Levels of radioactive iodine (¹³¹I) and caesium (¹³⁷Cs) in cows' milk in Northern Ireland increased to 166 and 120 Bq/l respectively in May 1986, but had decreased by factors of one million, and of twenty-five, respectively, by 1 September 1986. The resultant radiation doses represent less than one per cent of those received by a Northern Ireland individual over a period of 40 years from natural background radiation sources. The added risk to any individual from the Chernobyl accident will therefore be very small and may best be judged in the context of the enormously greater risk of death due to potentially preventable diseases, such as smoking-related lung cancer, and coronary heart disease.     

Diffuse pulmonary metastases with negative 18FDG positron emission tomography/computed tomography and positive post-radioiodine therapy scan of papillary thyroid cancer

A female papillary thyroid cancer patient with diffuse micronodular pulmonary metastases was confirmed only by post radioactive iodine (RAI) therapy whole body scan (RxWBS).Her diagnostic iodine-131 whole body scan (DxWBS),chestCT and 18FDG PET/CT scan were all negative.Attention and pitfalls of this case concerning surgical and RAI dosemanagement are against current international guidelines on thyroid cancer.     

Diffuse pulmonary metastases with negative ¹⁸FDG positron emission tomography/computed tomography and positive post-radioiodine therapy scan of papillary thyroid cancer

A female papillary thyroid cancer patient with diffuse micronodular pulmonary metastases was confirmed only by post radioactive iodine (RAI) therapy whole body scan (RxWBS). Her diagnostic iodine-131 whole body scan (DxWBS), chest CT and 18FDG PET/CT scan were all negative. Attention and pitfalls of this case concerning surgical and RAI dose management are against current international guidelines on thyroid cancer.     

Reactor accidents. Public health strategies and their medical implications

In a reactor accident with release of radioactivity, the major potential public health risks are likely to result from radioiodines, particularly iodine 131, which can be readily volatilized and dispersed. They are rapidly absorbed and concentrated by the thyroid, which could result in substantial thyroidal radiation. Although some forms of radiation can cause thyroid cancer in humans, 131I has not been shown to do so, and 40 years of safe experience with this radionuclide in routine clinical thyroid testing and treatment has been reassuring. Nevertheless, since 131I has been shown to cause thyroid neoplasms in animals, efforts to minimize unwarranted exposure seem advisable. Potassium iodide, administered at an appropriate time, will effectively block thyroid uptake, but it has potential toxicity and may be difficult to distribute effectively and safely on a large scale in an emergency. Evaluation of the risks and benefits of potassium iodide use is essential to establishing sound public health policy but awaits additional scientific information.     

Detection of thyroid malignancy in a hot nodule by fluorine-18-fluorodeoxyglucose positron emission tomography

Carcinoma of the thyroid arising in an autonomously functioning or "hot" nodule is uncommon. The majority of thyroid carcinomas present as a "cold" nodule on radionuclide scintigraphy. We report a poorly-differentiated thyroid carcinoma developing in a long-standing "hot" nodule in a 51-year-old Chinese woman. Fluorine-18-fluorodeoxyglucose positron emission tomography (FDG PET) showed focal FDG uptake in the thyroid nodule, as well as in the cervical and pulmonary hilar lymph nodes. This case illustrates that the incidence of thyroid carcinoma in a "hot" nodule is not negligible. The role of FDG PET in the differentiation of benign from malignant thyroid nodules is still unclear. In contrast, FDG PET has been shown to have a role in the follow-up of thyroid cancer patients after thyroidectomy and subsequent radioactive iodine-131 (I-131) ablation. It may be useful in the identification and localisation of recurrent cancer foci in patients with elevated thyroglobulin levels but a negative I-131 whole body scan.     

Immediate medical consequences of nuclear accidents. Lessons from Chernobyl

The immediate medical response to the nuclear accident at the Chernobyl nuclear power station involved containment of the radioactivity and evacuation of the nearby population. The next step consisted of assessment of the radiation dose received by individuals, based on biological dosimetry, and treatment of those exposed. Medical care involved treatment of skin burns; measures to support bone marrow failure, gastrointestinal tract injury, and other organ damage (ie, infection prophylaxis and transfusions) for those with lower radiation dose exposure; and bone marrow transplantation for those exposed to a high dose of radiation. At Chernobyl, two victims died immediately and 29 died of radiation or thermal injuries in the next three months. The remaining victims of the accident are currently well. A nuclear accident anywhere is a nuclear accident everywhere. Prevention and cooperation in response to these accidents are essential goals.     

浅谈“大剂量~(131)Ⅰ清除分化型甲状腺癌残灶”的早期副反应

目的探讨大剂量131I清除分化型甲状腺癌残灶的早期副反应,以便更好的减少、预防~（131）Ⅰ治疗后早期副反应的发生。方法回顾了65例在我科行~（131）Ⅰ治疗的分化型甲状腺癌患者。密切观察及记录~（131）Ⅰ治疗后早期副反应。结果 65例131I治疗的甲状腺癌患者中,12例（17.6%）患者存在不同程度的乏力、嗜睡、头昏、心慌的全身反应;11例（12.3%）患者出现消化道反应;23例（35.4%）患者出现颈部水肿（NE）;8例（12.3%）患者出现放射性甲状腺炎（RT）;4例（6.2%）患者出现放射性涎腺炎。结论大剂量131I治疗分化型甲状腺癌是十分安全、有效的治疗手段,但需要采取必要的预防措施,尽量减少早期并发症的发生,提高患者的生活质量。     

消化道肿瘤裸鼠碘-131 标记短肽 Tyr-GX1 的显影特征

目的 分析碘-131（131I）标记短肽酪氨酸修饰的血管靶向肽（Tyr-GX1）在荷结肠癌与胃 癌裸鼠体内的显影特征。方法 采用Iodogen 碘标法标记Tyr-GX1,检测其标记率和稳定性。建立荷结肠 癌、胃癌裸鼠模型（分别设置为结肠癌组和胃癌组）,均注射131I 标记短肽Tyr-GX1,观察24 h 后显影特 征。结果 纸层析法结果表明,131I 标记短肽Tyr-GX1 的标记率较高,为（95.67±0.79）% ;放射化学纯度为 （96.68±1.68）%。24 h 稳定性测试显示,131I 标记短肽分别与人血清、乙二胺四乙酸、生理盐水、半胱氨酸混 合后标记率仍然维持在90% 以上。结肠癌组、胃癌组裸鼠尾静脉注射131I 标记的短肽Tyr-GX1 后8 h 开始裸 鼠右后肢背侧荷瘤部位放射性浓聚较心血池本底升高,并随着时间延长而升高;结肠癌组16 h 时达峰值随后 稍有降低,荷瘤部位和心血池本底放射性摄取比值（T/NT）均>1。结肠癌组与胃癌组T/NT 比值在不同时 间、不同组间及变化趋势上有差异（P <0.05）。随着时间延长,结肠癌组和荷胃癌组裸鼠心、肺、肝、肾、胃、 肌肉、肿瘤、血液和甲状腺组织中Tyr-GX1 摄取率逐渐降低（P <0.05）,其中肝、肾组织均具有较高的放射 性。结肠癌组和胃癌组1、6、12 和24 h 肿瘤组织的摄取率均高于心脏、甲状腺、胃和肌肉组织（P <0.05）。 结论 131I 标记短肽Tyr-GX1 对结肠癌和胃癌裸鼠肿瘤血管靶向性较好,与恶性肿瘤组织有较高的结合率, 而结肠癌与胃癌的放射性浓聚和达峰时间有所不同;131I 标记短肽Tyr-GX1 可能在消化道恶性肿瘤血管靶向 诊断和治疗方面具有潜在价值。     

放射性甲状腺癌合并慢性放射性甲状腺炎的相关问题探讨

目的探讨放射性甲状腺癌合并慢性放射性甲状腺炎的病理特点、诊断及两者的相关性。方法回顾分析汉中市中心医院肿瘤外科2011年6月~2013年7月收治的3例放射性甲状腺癌合并慢性放射性甲状腺炎患者的临床资料,对照国家制定的放射性甲状腺癌与慢性放射性甲状腺炎的诊断标准,进行分析探讨。结果 3例患者术后病理类型为甲状腺乳头状癌合并慢性淋巴细胞性甲状腺炎;根据最新诊断标准,2例诊断为放射性甲状腺癌合并慢性放射性甲状腺炎,1例仅诊断为甲状腺乳头状癌合并慢性放射性甲状腺炎,不能诊断为放射性甲状腺癌。结论放射性甲状腺癌的绝大多数病理类型为甲状腺乳头状癌;慢性淋巴细胞性甲状腺炎是慢性放射性甲状腺炎是一种病理类型;从事放射介入工作时间3年8个月,甚至更短时间,就能发生放射性甲状腺癌;慢性放射性甲状腺炎可以转变为放射性甲状腺癌。     

^131I首次清除分化型甲状腺癌残留组织的影响因素探讨

目的观察^131I首次“清甲”的疗效及分析其影响因素。方法确诊分化型甲状腺癌（DTC）患者经手术治疗后行^131I治疗,然后按手术方式、术后治疗时间^131I的剂量进行分类,观察首次“清甲”的疗效。结果“清甲”成功率：甲状腺全切88．5％,次全切除44．4％;“清甲”时间术后1～2个月92．7％,1年以上50．0％;^131I剂量2．96GBq为47．6％,4．44GBq为82．8％。结论DTC治疗应以甲状腺全切及颈淋巴结清扫为首选治疗方式,术后1～2个月为^131I“清甲”最佳时机,首次“清甲”^131I剂量以4．44GBq（120mci）为宜。     

131I治疗Graves病个体化剂量研究

目的 研究Craves病(GD) 131I治疗个体化剂量方法.方法 177例按吸收剂量计算131I治疗剂量的病人,对比其治疗前后示踪和治疗剂量的甲状腺吸碘率(RAIU)和有效半衰期(EHL)的差别,治疗前后甲状腺体积由核素显像(RI)及B超(BUS)重复测量,抗体检测.结果 177例中,131I一次治愈144例,占81.4％,甲功正常110例,占62.1％,早发甲减34例,占19.2％;未愈33例,占18.6％.治疗前后24hRAIU (76.9±8.90)％和(73.9±10.9)％(t=2.69,P＜0.01)、EHL(5.2±0.8)d(n=177)和(5.0±0.6)d(n=165) (t=2.62,P＜ 0.01).抗体阳性甲减率28.5％高于阴性组12.1％ (x2=8.2,P＜0.01).结论 GD131I治疗前质量起决定作用;治疗剂量131I RAIU和EHL低于示踪剂量;甲状腺抗体阳性对疗效有影响.     

Mortality of employees of the United Kingdom Atomic Energy Authority, 1946-1979

An analysis was conducted of 3373 deaths among 39 546 people employed by the United Kingdom Atomic Energy Authority between 1946 and 1979, the population having been followed up for an average of 16 years. Overall the death rates were below those prevailing in England and Wales but consistent with those expected in a normal workforce. At ages 15-74 years the standardised mortality ratios (SMRs) were 74 for deaths from all causes and 79 for deaths from all cancers. Mortality from only four causes was above the national average--namely, testicular cancer (SMR 153; 10 deaths), leukaemia (SMR 123; 35 deaths), thyroid cancer (SMR 122; three deaths), non-Hodgkin's lymphoma (SMR 107; 20 deaths)--but in none was the increase significant at the 5% level. Half of the authority's employees were recorded as having been monitored for exposure to radiation, their collective recorded exposure being 660 Sv (65 954 rem). Among these prostatic cancer was the only condition with a clearly increased mortality in relation to exposure. Of the 19 men who had a radiation record and died from prostatic cancer at ages 15-74 years, nine had been monitored for several different sources of exposure to radiation. The standardised mortality ratios were 889 (six deaths) in employees monitored for contamination by tritium, 254 (nine deaths) in those monitored for contamination by other radionuclides, and 385 (nine deaths) in those with dosimeter readings totalling more than 50 mSv (5 rem); but the same nine subjects tended to account for each of these significantly raised ratios. Because multiple exposures were common and other relevant information was not available the reason for the increased mortality from prostatic cancer in this population could not be determined and requires further investigation. Excess mortality rates of 2.2 and 12.5 deaths per million person years per 10 mSv (1 rem) were estimated for leukaemia and all cancers, respectively. The confidence limits around these estimates were wide, included zero, and made it unlikely that the International Commission on Radiological Protection's cancer risk coefficients were underestimated by more than 15-fold. Thus despite this being the largest British workforce whose mortality has been reported in relation to low level ionising radiation exposure, even larger populations will need to be followed up over longer periods before narrower ranges of risk estimates can be derived.     

Graves病的~(131)I治疗及其影响因素

近年来甲亢的治疗模式在某些地区发生了较大的变化,131I被愈来愈多地应用到甲亢的治疗中。131I治疗甲亢具有发挥作用迅速,1次服药即可通过破坏甲状腺组织达到彻底治愈甲亢、避免日后复发等诸多优点,但甲亢治愈率的提高往往伴随着甲状腺功能减退发生率的增加,其影响因素颇多。对Graves病的131I治疗及其影响因素进行综述有助于提高对该病的认识。     

日本福岛核电站事故对人体健康影响及医学防护

日本福岛核电站事故对人类的危害可能仅次于前苏联的切尔诺贝利核电站事故,此次事故对抢险人员、附近居民和受放射性污染人员带来的健康影响,既有近期辐射损伤,也有远期生物效应,主要是以小剂量照射的远期辐射生物效应为主;飘落到我国的微量放射性尘埃远不足以对人体构成损伤.防护方面主要是利用房屋、衣物、口罩等进行屏蔽,及时清洗去除放...     

Severe radiation thyroiditis after radioactive iodine for treatment of Graves’ disease

Radiation thyroiditis resulting from radioactive iodine-131 treatment for Graves’ disease is an uncommon complication. Although a majority of patients are asymptomatic or manifest mild symptoms that can be managed conservatively, published literature describing severe radiation thyroiditis resulting in significant morbidity is lacking. We herein report on six patients with severe radiation thyroiditis that resulted in hospitalisation, including an unusual complication of myopericarditis.     

Radiotherapy in thyroid cancer.

Although resection is the mainstay of treatment of thyroid cancer, and radioactive iodine (131-1) is curative in a small number of patients with differentiated cancers, external irradiation is much more effective than is generally believed. This has been clearly shown in a review of 138 patients with thyroid cancer referred to a cancer centre, in most cases after an initial operation. External irradiation should be considered in all patients except those with pure papillary tumours that have been completely excised. It should be used (a) in conjunction with surgery if there is even a remote doubt as to the completeness of excision; (b) in conjunction with 131-1 in treating inoperable primary tumours or metastatic lesions; () alone for differentiated tumours (primary or metastatic) that do not take up 131-1; and, (d) perhaps combined with chemotherapy, for medullary and anaplastic tumours.     

日尿排泄131I值估算甲状腺癌患者体内残留活度

目的通过测定分化型甲状腺癌患者131I治疗后日尿排泄131I的活度值来估算患者体内残留的131I活度,并结合国家标准预测患者的出院时间。方法测量35例分化型甲状腺癌患者服131I后不同时间各次尿液的放射性活度,计算每位患者不同时间尿液排泄的总活度,进而估算患者体内残留的总活度。结果 ＂清甲＂及＂清灶＂治疗患者于服131I后第1d尿液内排泄的放射性活度分别为2401.5 MBq、4144.5MBq（占服131I总活度的64.9%、71%）,而且＂清甲＂及＂清灶＂治疗后患者第1d体内残留131I活度分别为926.9MBq、1081.1MBq（占总131I活度的25.1%、17.2%）,其后患者尿液内排泄的131I活度及患者体内残留131I活度下降幅度缓慢。20例＂清甲＂及15例＂清灶＂治疗的患者,达到国家标准的出院时间分别为3.1±2.2d、1.9±1.1d。结论甲状腺癌患者服用大剂量131I后短期内对周围环境和人有影响,所以患者必须入院并在规范的辐射防护病房隔离平均2-3d（48-72h）以上方可出院。     

碘131治疗重度甲状腺肿大伴机能亢进征38例临床观察

目的 评价碘-131对重度甲状腺肿大伴机能亢进征的疗效和安全性。方法 确诊重度甲状腺肿大伴甲亢后,根据现有公式和触诊经验确定甲状腺质量,按每克甲状腺组织实际投入3.7~5.55 MBq计算治疗剂量,1次口服确定剂量后随访观察治疗效果和副作用,部分病例进行了第2次甚至第3次碘-131治疗。结果 38例患者经过1~3次碘-131治疗后全部获得治愈,其中第1次治愈23例(60.5%),第2次治愈13例(34.2%),第3次治愈2例(5.3%),4例发生甲低(10.5%),无1例患者发生甲亢危象和呼吸困难。结论 碘-131治疗重度甲状腺肿大伴甲亢安全又有效,可以作为常规治疗方法。     

Thyroid nodules in the population living around Chernobyl.

OBJECTIVE--To determine the baseline incidence, prevalence, and characteristics of thyroid nodules in the population living around the Chernobyl nuclear power plant and to compare the findings with unexposed populations. DESIGN--Prevalence study. Population samples from seven highly contaminated villages were compared with six nearby control villages of the same size and type. The data were obtained as part of the International Chernobyl Project conducted in 1990. SETTING--The study was conducted 4.5 years after the Chernobyl reactor accident that released large quantities of radionuclides, including radioiodine. PATIENTS OR OTHER PARTICIPANTS--Population samples of approximately 100 persons residing in both highly contaminated villages and control villages since the accident were compared. Individuals were selected on the basis of birth date as being 5, 10, 40, or 60 years old at the time of the study. All persons selected underwent a thyroid examination. INTERVENTIONS--None. MAIN OUTCOME MEASURES--Two main outcome measures were used, both for thyroid nodularity: clinical palpation and high-resolution ultrasonography. RESULTS--There was no significant difference in thyroid nodularity between the study groups. Nodules were palpated in 0.7% of children and 2.9% of adults. Discrete nodules were found by ultrasonography in 0.5% of children and 14.9% of adults. Multinodular goiter was found in 3% of adults. Nodules were more common in females. CONCLUSIONS--Four and a half years after the Chernobyl accident, the incidence, prevalence, and characteristics of thyroid nodules were the same in population samples from both highly contaminated and control settlements and similar to results reported for unexposed populations in other countries.     

碘-131治疗重度甲状腺肿大伴机能亢进征38例临床观察

目的 评价碘-131对重度甲状腺肿大伴机能亢进征的疗效和安全性。方法 确诊重度甲状腺肿大伴甲亢后．根据现有公式和触诊经验确定甲状腺质量，按每克甲状腺组织实际投入3.7～5．55MBq计算治疗剂量，1次口服确定剂量后随访观察治疗效果和副作用，部分病例进行了第2次甚至第3次碘-131治疗。结果 38例患者经过1～3次碘-131治疗后全部获得治愈，其中第1次治愈23例(60．5％)，第2次治愈13例(34．2％)，第3次治愈2例(5．3％)，4例发生甲低(10，5％)，无1例患者发生甲亢危象和呼吸困难。结论 碘-131治疗重度甲状腺肿大伴甲亢安全又有效，可以作为常规治疗方法。