The article deals with consequences seen in track driver after prolonged exposure to radiation caused by "lost" gamma-source (cesium-137) that long remained in receptacle of the vehicle's left door. Radiation dose averaged 8 Gy. The authors presented clinical manifestations, changes in peripheral blood and bone marrow, cytogenetic data by progression of radiation hemopoiesis hypoplasy to myelodysplastic syndrome and to acute leukaemia.

The analysis was performed on 514 blood lymphocytes from a person accidentally exposed to 137Cs. Blood samples were collected 1 year after exposure three times at intervals of one month. Terminal deletions and simple translocations were found to predominate in all cases. No differences between these cases were observed on analysing total frequency of stable chromosome aberrations. However, the frequency of terminal deletions decreased and frequencies of exchange-type aberration increased with time after exposure. Chromosome #4 was more involved in stable aberrations than it would be expected from the relative chromosome lengths. Clonal aberrations del-ter (5)(q31 or 32) were found.

The discovery in 1995 of a 48 GBq (1.3 Ci) Cs-137 source in the door pocket of a truck is described. The truck driver had been seriously irradiated to an average whole-body dose of approximately 8 Gy. His exposure was, however, inhomogeneous and protracted over about 5 months. The reconstruction of his dose is described in this paper. A measurement by electron spin resonance on a tooth provided a fixed point cumulative dose estimate of 7.7 Gy and from this the dose distribution to other parts of his body was calculated by considering the source-site distances for a driver in a seated posture. Biological dosimetry by extensive conventional and fluorescence in situ hyridisation cytogenetic studies was also carried out on peripheral blood lymphocytes. Good agreement in dose estimates from both cytogenetic endpoints and the physical calculations was obtained.

The clinical condition and treatment of a driver who was overexposed to an unshielded Cs-137 source that was in his truck for about 5 months is described. Bone marrow and blood changes are presented as he progressed from pancytopaenia to myelodysplasia with features of refractory anaemia and then anaemia with an excess of blasts and transformation to frank myelomonocytic leukemia. He died about 22 months after the discovery of the source from an overwhelming hepatitis B infection concurrent with immunosuppression following cytostatic treatment for the leukaemia.

The success in acute myeloblastic leukemia (AML) treatment for the last 10 years has been referred to growing intensity of chemotherapy. The efficacy of treatment has been assessed in 56 patients under 60 years of age. Double induction of remission according to the scheme TAD-9 (2-day administration of cytosar) and consolidation by large-dose cytosar (1 g/m2) with rubomycin have increased the frequency of 2-year recurrence-free running from 13 to 35%. Resistance to treatment was absent. Maintenance prolonged total and recurrence-free survival. Mycosis and hepatitis were factors responsible for inadequate intensity of chemotherapy. These need more advanced prevention. The intensive double induction and consolidation did not raise general toxicity and immediate lethality compared to standard regimens which proved inferior to the proposed treatment.

Considerable data suggest that very high doses of acute total body radiation destroy most hematopoietic stem cells and that recovery is possible only after a bone marrow transplant. We review data from a radiation accident victim exposed to about 10-Gy or more acute total body radiation. Total dose and uniformity of distribution were confirmed by physical measurements (paramagnetic resonance), computer simulation, and biologic dosimetry (granulocyte kinetics and cytogenetic abnormalities). Treatment consisted of supportive measures, transfusions, and hematopoietic growth factors (granulocyte-macrophage colony-stimulating factor and interleukin-3). Hematopoietic recovery occurred slowly. Granulocytes were detectable throughout the postexposure period, exceeding 0.5 x 10(9)/L by day 37. There was slower and incomplete recovery of red blood cells and platelets. Increases in blood cell production were paralleled by morphologic changes in bone marrow biopsies. Gastrointestinal toxicity was moderate. Death from a probable radiation pneumonitis infection occurred on day 130. These data indicate the possibility of hematopoietic recovery after approximately 10 Gy or more acute total body radiation without a transplant. They also suggest that lung rather than gastrointestinal toxicity may be dose-limiting under these circumstances.

The previous experience gained with the treatment of acute radiation sickness supported during the treatment of the victims to the disaster at the Chernobyl NPP has shown the multimodality treatment to be indispensable for the bone marrow syndrome, particularly in terms of correcting postradiation thrombocytopenia and counteracting bleeding sickness. The use of the whole blood was found to be inadvisable because of the low efficacy, with the risk of transfusion complications being fairly high. Adequate replacement therapy with donor's platelets is capable of a complete modifying of the hemorrhagic syndrome.

Clinical efficacy of intravenous gentamicin in combination with oral use of gentamicin, ristamicin and nystatin was studied in 1977. In 1980-1984 two antiinfectious regimens were tested: intravenous administration of gentamicin in combination with total decontamination (oral use of gentamicin and nystatin) and selective decontamination (biseptol with nystatin of amphoglucamine). It was shown that the incidence of severe infections in the patients under the observation dropped against the controls. The incidence and spectrum of infectious complications in cases with acute myelodepressions were proved to depend on the intestinal autoflora inhibition.

Clinical efficacy of intravenous gentamicin in combination with oral use of gentamicin, ristomycin and nystatin was studied in 1977. In 1980-1984 two antiinfectious regimens were tested: intravenous administration of gentamicin in combination with total decontamination (oral use of gentamicin and nystatin) and selective decontamination (biseptol with nystatin of amphoglucamine). It was shown that the incidence of severe infections in the patients under the observation dropped against the controls. The incidence and spectrum of infectious complications in cases with acute myelodepressions were proved to depend on the intestinal autoflora inhibition.

The paper is concerned with the results of therapy of 115 patients with acute radiation syndrome after the Chernobyl accident. The chief methods of the effective therapy of bone marrow syndrome are antimicrobial drugs and fresh donor platelet mass transfusions. Hemopoietic stem cell transplantation (allogenic bone marrow or embryonic hepatocytes) is indicated and effective in a very limited number of patients in accident irradiation. Severe beta-burns of the skin remain an unsolved problem as a result of their spreading. Organizational principles of therapy of a great number of patients with acute radiation syndrome in a specialized hospital were described.