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Employment № 2. A chronic radial illness (HLB)

The urgency and value of the given theme are defined sohranjajuyoshchejsja by threat of the armed nuclear conflict, possibility of acts of terrorism and failures at the enterprises and the power equipments where radioactive sources of radiations are used.

The criminal reason of use of radioactive materials is possible also.

The employment purpose: by preparation for employment students should study features of development HLB, its clinic, diagnostics treatment and preventive maintenance.

The student should know:

- Aetiology and pathogenesis HLB.

- Classification HLB.

- tropnost radioactive substances to various organs.

- Features of clinic HLB depending on its severity level and a kind of a source of radiation.

- Criteria of severity level HLB.

- Groups of radioprotectors and feature of their application.

- Treatment HLB.

The student should be able:

- To define the reason of occurrence HLB.

- To put and formulate the developed diagnosis radial boyolezni.

- To establish the nearest and remote consequences HLB.

- To define the forecast of a condition amazed depending on the received exposure dose and a kind of a source of an irradiation.

- To define localisation of radioactive substance in organizyome the amazed.

- To calculate exposure doses at HLB.

- To carry out differential diagnostics HLB with OLB.

The questions studied earlier

And necessary for development of the given theme
Chair Questions The literature
1. Chair propeyo

devtiki internal illnesses

Methods obsledovayonija patients JU.S.Malov. propeyodevtika internal illnesses. - SPb.:

Spets-lighted., 2003

2. Chair patologiyocheskoj physiology Blood pathology Patofiziologija /

Under the editorship of V.J.ShaniYona. - SPb.: ELBI, 2005

3. Chair klinicheyoskoj and eksperimenyotalnoj farmakoloyogii Pharmacotherapy of anemias, immunodeyofitsita, infections, etc. Clinical farmayokologija and farmakoyoterapija / Under the editorship of V.G.Kukesa. - M: GEOTAR-MEDIA, 2006

The training maintenance

As a chronic radial illness (HLB) understand the general zayobolevanie, resulting long, povtorjajushchegoyosja ionising radiation influences on an organism in the small doses exceeding maximum permissible (no more than 0,1 Gr./year).

Allocate kinds HLB:

- From external concerning a uniform irradiation,

- From incorporation (a local irradiation),

- Sochetannye forms.

At a local irradiation in symptoms HLB prevail izmeneyonija a concrete organ in which there is an accumulation radioakyotivnogo a preparation.

Organotropy of some radionuclides:

Radon - lungs,

Strontium - bones,

Uranium, polonium - kidneys,

Polonium, plutonium - a liver,

Iodine - a thyroid gland.

HLB has the following characteristic of pathological process:

- The gradual beginning of disease;

- Long wavy current;

- Slow restoration of the organs changed to function and tkayonej.

In development of a chronic radial illness allocate:

The formation period (proceeds from several months till several years).

The basic syndromes of this period:

- The medullar;

- Nervously-vascular dystonia;

- The asthenic;

- Organic lesions TSNS.

The restoration period proceeds from 1-2 months to neyoskolkih years (depending on gravity of disease). Can be full or incomplete.

The period of the remote consequences (it is characteristic for HLB 2-3 steyopenej gravities) - onkopatologija, etc.

Clinical implications HLB:

- Headaches,

- Distortion of a dream,

- Asthenia,

- Depression of mass of a body,

- Depression libido,

- Lability of pulse and BP,

- Trophic changes of a skin,

- Leukopenia to 3,5х109 (at a serious current - a pancytopenia),

- Trombotsito-reticulocytopenia,

- Joining of infectious complications (at serious techeyonii).

For easy form HLB the basic syndrome is astheno - vegetative. From internal organs of changes is not present or they are minimum. Despite a favorable current and prakticheyoski clinical recover within 3-4 months, the remote consequences in the form of risk of a carcinogenesis the big.

At srednetjazheloj to form HLB:

- Clinical symptoms are more expressed and more a rack;

- Organic disturbances from the party vnutyorennih organs are more expressed;

- The pancytopenia is characteristic;

- Full recover is improbable.

Disease proceeds for years and demands constant treatment. There is a big danger hereditary genetic poroyokov.

Serious form HLB:

- The expressed disturbance of functions of all organs and systems oryoganizma;

- Joinings of infectious complications are frequent;

- The hypoplasia of an osteal brain is expressed;

- Recover is impossible.

Principles of treatment HLB:

1. A high-grade food.

2. An active impellent regimen, physical culture, resort leyochenie.

3. A vitamin therapy, trace substances.

4. Hemopoiesis stimulators.

5. Immunity stimulators.

6. Neurotropic preparations (sedative, stimulators).

7. The preparations accelerating deducing of radionuclides (penta - tsin, Unithiolum, trimefatsin, etc.).

8. In serious cases - transplantation of an osteal brain.

The literature

The basic:

1. Field medical therapy. The textbook / Under the editorship of V.M.Kljuzheva. - M: MIA, 2007.

2. Field medical therapy: a national management / Under the editorship of I.J.Bykova, A.L.Rakova, A.E.Sosjukina. - M: GEOTAR-MEDIA, 2007.

3. Internal illnesses. Field medical therapy / Under the editorship of A.L.Rakova. - SPb.: the VOLUME, 2003.

The additional:

4. Fedorchenko JU.L.course on field medical therapy. HaYObarovsk: DVGMU, 1997.

Other teaching materials:

Lectures on field medical therapy.

Stages of a self-rating of level of mastering of a recommended teaching material

Test tasks

1. At HLB easy severity level on the first place the symptoms bound to change of function act:

1) a locomotorium;

2) the central nervous system;

3) cardiovascular system;

4) hemopoiesis systems;

5) endocrine system.

2. Duration of the period at external otnosiyotelno a uniform irradiation in the doses exceeding maximum permissible, makes formation HLB:

1) 10 years;

2) 1 year;

3) 2-3 years;

4) 6 months;

5) 1 month.

3. The first period of a chronic radial illness:

1) primary reaction;

2) height;

3) the hidden;

4) formations;

5) initial implications.

4. To remote consequences HLB carry:

1) a myocardial infarction;

2) onkoprotsessy;

3) a chronic bronchitis;

4) hepatitises;

5) nephritises.

5. The second period of a chronic radial illness is called

Situational problems

Problem 1

Patient K - the radiotherapist. The general experience of work in the conditions of an irradiation - 12 years. A settlement total dose for all period obyoluchenija 2-2,5 Gr. With irregular distribution in various years because of safety precautions disturbance. Deterioration samochuvyostvija since 7th year of work when there were stupid headaches, irritability, a sleeplessness.

At the first hospitalisation the blood analysis: erythrocytes - 3,7 h 1012/l, haemoglobin - 140 g/l, the CENTRAL PROCESSING UNIT - 0,9, leucocytes - 3,5 h 109/l, bazoyofily - 0 %, eosinocytes - 2 %, juvenile - 1 %, band - 7 %, segmented - 38 %, lymphocytes - 42 %, monocytes - 10 %. An ESR of 8 mm/hour.

In a punctate of an osteal brain of 61000 cells in cubic mm. A Lejyokoeritroblastichesky parity 2:1 for the account preimushchestvennoyogo narrowings granulotsitarnogo a sprout, the maturing index nejtroyofilov is lowered to 0,45. At the given stage disease is regarded as a chronic radial illness of I severity level, the period foryomirovanija. After corresponding treatment of the patient it is recognised neyotrudosposobnym and it is translated for work with an exception of contact to radiation.

Repeated hospitalisation in 2,5 years. The state of health bolyonogo is much better: fatigability small, a dream good, headaches practically do not disturb.

The blood analysis: erythrocytes - 3,6 h 1012/l, haemoglobin - 138 g/l, the CENTRAL PROCESSING UNIT 0,9, leucocytes - 6 h 109/l, bazofily - 0 %, eosinocytes - 3 %, juvenile - 1 %, band - 4 %, segmented - 52 %, moyonotsity - 11 %, an ESR - 9 mm/hour. Thrombocytes 190 000. RetikulotsiYOty - 8: 1000.

Punctate of an osteal brain: the osteal brain does not represent sushchestyovennyh deviations from norm.

1. Formulate and prove the diagnosis.

2. Prescribe treatment.

3. Define homing possibility to former work.

Problem 2

The military man, 25 years. During operations neodnokratyono within a year was in zones of a residual radiation after nuclear explosion. Rules of protection against an irradiation often not were soyobljudeny. The total dose received by it within year, ravnjayolas 5 Gr.

Last 2 months there was a strong headache, odyshyoka, absence of appetite, a weight loss, the constipations replaced ponosayo
mi. Nasal bleedings two weeks ago have joined. NaYOpravlen in VPTG.

At entering: integuments acyanotic, wet. MnozheYOstvennye hemorrhages on a mucous oral cavity, not plentiful nasal bleeding. A Crocq's disease, an appreciable weight loss (weight of 70 kg at growth of 180 sm). Number of respirations in a minute 24. Pulse - 70 blows in a minute, ekstrasistolija. BP of 90/50 mm hg heart Borders are dilated, tones deaf persons. The stomach is blown up, the liver acts from under edge of a costal arch on 3 sm, slightly painful. The lien is not palpated.

The blood analysis: erythrocytes - 2 h 1012/l, haemoglobin - 90 gr./l, the CENTRAL PROCESSING UNIT 0,98, leucocytes - 1,0 h 109/l, bazofily - 0 %, eosinocytes - 0 %, band-23 %, segmented - 23 %, lymphocytes - 50 %, monocytes - 7 %.soe 10 mm/hour. The expressed anisocytosis of erythrocytes, toxic granularity of leucocytes, gipersegmentayotsija and a fragmentation of neutrophils. Reticulocytes - 0, thrombocytes - 30000.

Punctate of an osteal brain: sharp pauperisation of an osteal brain kleyotochnymi elements.

1. Formulate and prove the diagnosis.

2. Spend the differential diagnosis.

3. Prescribe treatment

Answers to test tasks

1 - 2); 2 - 3); 3 - 4); 4 - 2); 5 - restoration

Answers to situational problems

Problem 1

HLB from an external irradiation of 1 degree, the restoration period. Former work is forbidden. A workarrangement out of contact to an irradiation.

Problem 2

HLB from an external irradiation of III severity level, the formation period.

Treatment: a hemotransfusion, its components, blood substitutes, gemsta - ticheskaja therapy - Vicasolum, vitamin K, Acidum ascorbinicum.

The plan of practical employment the Beginning at 9-00. The termination at 12-15.

№ p/p Employment stages Time (mines) Carrying out place Tutorials
1 Introduction of students in employment 10 Educational room The Uchebnoyometodichesky grant to zanjayotiju № 2

2 Definition of initial level of knowledge (testiroyovanie) 15 Educational room Test tasks
3 Independent raboyota students: kuratsija patients. Survey bolyonogo with a blood pathology 60 Clinic chambers. An educational room The Uchebnoyometodichesky grant to zanjayotiju № 2. Case histories
Pe reryv 15 minutes
4 The decision educational zayodach.

The mastering control mayoteriala (total tesyotirovanie).

Discussion of results zayonjatija

60

20

10

Educational room Educational problems, test zadayonija
5 The task for following employment 5 Educational room The Uchebnoyometodichesky grant to zanjayotiju № 3

Rough basis of action

The medical-diagnostic algorithm at suspicion on hronicheyoskuju includes a radial illness:

1. Definition of probability of disease according to the anamnesis, to clinical symptoms and dosimetry indications.

2. Definition of the period of a chronic radial illness taking into account clinic and blood analyses.

3. Definition of severity level of illness.

4. Scoping of medical aid depending on gravity and the disease period.

Tasks for the control of results of mastering of a material

Test tasks

1. HLB can develop from:

1) internal infection;

2) a local irradiation;

3) the external;

4) sochetannogo influences;

5) all listed.

2. For development HLB exposure doses _____________ are required.

3. In current HLB allocate the disease periods:

1) 1;

2) 2;

3) 3;

4) 4;

5) 5.

4. In first period HLB from blood it becomes perceptible:

1) a lymphopenia;

2) a lymphocytosis;

3) normal quantity of lymphocytes;

4) a basophilia;

5) a monocytosis.

5. For the restoration period it is characteristic:

1) a moderate anaemia;

2) a serious anaemia;

3) a leukocytosis;

4) a pancytopenia;

5) a leukopenia.

6. HLB can develop from irradiations (frequency rate) ____________

7. In current HLB allocate _______ severity levels.

8. In first period HLB is the leader:

1) an intestinal syndrome;

2) the hemorrhagic;

3) astenovegetativnyj;

4) the infectious;

5) cardiovascular insufficiency.

9. In II period HLB longly remains:

1) an anaemic syndrome;

2) an asthenic syndrome;

3) an intestinal syndrome;

4) an infection;

5) cardiovascular insufficiency.

10. Strontium collects mainly in:

1) kidneys;

2) a liver;

3) TSNS;

4) lungs;

5) bones.

Answers to test tasks

1 - 5); 2 - exceeding PDD; 3 - 3); 4 - a lymphocytosis; 5 - 1);

6-regular; 7 - 3); 8 - 3); 9 - 2); 10 - 5)

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Scientific source V.V. Kazakevich. Field medical therapy and haematology. Publishing house GOU VPO Far East state medical university - 2010. 2010

Other medical related information Employment № 2. A chronic radial illness (HLB):

  1. THE LIST OF REDUCTIONS
  2. 1.2 Anemia at chronic illnesses
  3. variants of therapy of an anaemia at chronic illnesses and their efficiency
  4. the List of reductions
  5. THE LITERATURE LIST
  6. THE LITERATURE LIST
  7. Yefimov Olga Aleksandrovna. the ESTIMATION of EFFICIENCY of TREATMENT GLJUKOKORTIKOSTEROIDNYMI PREPARATIONS of LUNGS SICK of CHRONIC OBSTRUCTIVE ILLNESS. The DISSERTATION on competition of a scientific degree of the candidate of medical sciences. St.-Petersburg,
  8. the MAINTENANCE
  9. THE LIST OF REDUCTIONS
  10. INTRODUCTION
  11. 1.1. HOBL: risk factors, features of inflammatory process, the exacerbation reason
  12. 1.3. A combination chronic obstruktnvnoj illnesses of lungs n a bronchial asthma
  13. 2.1. The clinical characteristic of the surveyed patients
  14. 3.1.6. Clinical examples.