NOTE The report of the Committee without its annexes appears as Official Records of the General Assembly, Sixty-third Session, Supplement No. 46. The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries. The country names used in this document are, in most cases, those that were in use at the time the data were collected or the text prepared. In other cases, however, the names have been updated, where this was possible and appropriate, to reflect political changes. Scientific Annexes Annex A. Medical radiation exposures Annex B. Exposures of the public and workers from various sources of radiation INTROdUCTION 1. In the course of the research and development for and the application of atomic energy and nuclear technologies, a number of radiation accidents have occurred. Some of these accidents have resulted in significant health effects and occasionally in fatal outcomes. The application of technologies that make use of radiation is increasingly widespread around the world. Millions of people have occupations related to the use of radiation, and hundreds of millions of individuals benefit from these uses. Facilities using intense radiation sources for energy production and for purposes such as radiotherapy, sterilization of products, preservation of foodstuffs and gamma radiography require special care in the design and operation of equipment to avoid radiation injury to workers or to the public. Experience has shown that such technology is generally used safely, but on occasion controls have been circumvented and serious radiation accidents have ensued. 2. Reviews of radiation exposures from accidents have been presented in previous UNSCEAR reports. The last report containing an exclusive chapter on exposures from accidents was the UNSCEAR 1993 Report [U6]. 3. This annex is aimed at providing a sound basis for conclusions regarding the number of significant radiation accidents that have occurred, the corresponding levels of radiation exposures and numbers of deaths and injuries, and the general trends for various practices. Its conclusions are to be seen in the context of the Committee's overall evaluations of the levels and effects of exposure to ionizing radiation. 4. The Committee's evaluations of public, occupational and medical diagnostic exposures are mostly concerned with chronic exposures of …

sources and effects of ionizing radiation

Background and Purpose— For a biomarker to serve as an auxiliary or surrogate outcome measure, it must be tightly correlated with and causally related to functional clinical outcome. Vessel recanalization is a potential surrogate outcome marker for functional outcome in trials of thrombolytic and mechanical recanalization therapies in acute stroke, but the correlation of recanalization and clinical outcome has not been previously systematically reviewed. Methods— Through Medline search, we identified and abstracted recanalization and outcome data from all articles published between 1985 and 2002 that assessed vessel recanalization, either spontaneous or therapeutically induced, in acute ischemic stroke. Results— Fifty-three studies encompassing 2066 patients reported recanalization rates. Recanalization rates categorized according to intervention were: spontaneous (24.1%), intravenous fibrinolytic (46.2%), intra-arterial fibrinolytic (63.2%), combined intravenous–intra-arterial (67.5%), and mechanical (83...

The Impact of Recanalization on Ischemic Stroke Outcome A Meta-Analysis

Background: Cerebral venous and sinus thrombosis (CVST) is a rather rare disease which accounts for <1% of all strokes. Diagnosis is still frequently overlooked or delayed as a result of the wide spectrum of clinical symptoms and the often subacute or lingering onset. Current therapeutic measures which are used in clinical practice include the use of anticoagulants such as dose-adjusted intravenous heparin or body weight-adjusted subcutaneous low-molecular-weight heparin (LMWH), the use of thrombolysis and symptomatic therapy including control of seizures and elevated intracranial pressure. Methods: We searched MEDLINE (National Library of Medicine), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Library to review the strength of evidence to support these interventions and the preparation of recommendations on the therapy of CVST based on the best available evidence. Review articles and book chapters were also included. Recommendations were reached by consensus. Where there was a lack of evidence but consensus was clear we stated our opinion as good practice points. Results and conclusions: Patients with CVST without contraindications for anticoagulation (AC) should be treated either with body weight-adjusted subcutaneous LMWH or with dose-adjusted intravenous heparin (level B recommendation). Concomitant intracranial haemorrhage (ICH) related to CVST is not a contraindication for heparin therapy. The optimal duration of oral anticoagulant therapy after the acute phase is unclear. Oral AC may be given for 3 months if CVST was secondary to a transient risk factor, for 6–12 months in patients with idiopathic CVST and in those with ‘‘mild’’ thrombophilia, such as heterozygous factor V Leiden or prothrombin G20210A mutation and high plasma levels of factor VIII. Indefinite AC should be considered in patients with recurrent episodes of CVST and in those with one episode of CVST andsevere thrombophilia, such as antithrombin, protein C or protein S deficiency, homozygous factor V Leiden or prothrombin G20210A mutation, antiphospholipid antibodies and combined abnormalities (good practice point). There is insufficient evidence to support the use of either systemic or local thrombolysis in patients with CVST. If patients deteriorate despite adequate AC and other causes of deterioration have been ruled out, thrombolysis may be a therapeutic option in selected cases, possibly in those without large ICH and threatening herniation (good practice point). There are no controlled data about the risks and benefits of certain therapeutic measures to reduce an elevated intracranial pressure (with brain displacement) in patients with severe CVST. However, in severe cases with impending herniation craniectomy can be used as a life-saving intervention (good practice point).

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1468-1331.2010.03011.x

EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients

can be recommended strongly to anyone interested in the modern treatment of neoplastic diseases. This monograph presents a discussion of the current concepts of clinical and pathological classification of Hodgkin's disease, approaches to therapy and clinical management. Among the advantages of the presentation are the excellent compilations of the classifications of the disease and tabulations of results achieved to date with regard to therapy and survival. While the author has carefully reviewed the pertinent material, his comments and conclusions are inexplicable in many instances. Examples include the recommendation for radical surgery in early or focal disease. None of the surgical series is a randomized prospective study nor do the majority include an adequate number of cases for statistical validity to warrant the author's recommendation. In presenting Kaplan's results with radical radio-therapy, there is an excellent reproduction of data showing the superiority of radical versus conventional radiotherapy. The author comments nevertheless that conventional therapy is \"fairly satisfactory !\" The scheme for radiotherapy of Stage I is reasonable, but the method employed is not that of most centers utilizing the radical approach in this country. For Stage III disease the plan seems less comprehensible since it involves treatment of involved but not adjacent areas. If it is intended to be \"curative,\" there is inadequate therapy for adjacent areas. If it is intended to be palliative, it would be unnecessary to treat asymptomatic although involved areas. The discussion of chemotherapy consists of general comments regarding efficacy and toxicity without a well defined analysis of comparative responses derived from objective assessment. A few opinions are cited without data to support the claims. In presenting clinical problems in the management of the disease, there are references to the immunological studies of patients with Hodgkin's disease, but no description of the specific immunologic status. Extra-nodal Hodgkin's disease as a specific entity also appears to have been neglected. In summary, this monograph provides an interesting review of some advances in Hodgkin's disease. The quality of the presentation in terms of organization and conclusions could be improved. The diagnosis and proper understanding of neurologic disorders depend heavily on thorough knowledge of the structure of the nervous system, and of the relationships between structure and function. Dr. Brodal's work represents an authoritative exposition of these relationships. The present edition is a thorough revision of the original book, published in English in 1946. Comparison of the two volumes provides a …

Neurological Anatomy in Relation to Clinical Medicine

Cranial nuclear magnetic resonance (NMR) scans were performed on 13 healthy volunteers and 140 patients with a broad spectrum of neurologic disease and compared with x-ray computed tomography (CT) scans. The NMR scans included a variety of sequences reflecting proton density, blood flow, T1, and T2 as well as transverse, sagittal, and coronal images. White matter, gray matter, and cerebrospinal fluid were clearly distinguished in the normal brain with inversion-recovery (IR) sequences, and normal progressive myelination was demonstrated in infants and children. Acute hemorrhages displayed short T1 values, but other pathologic processes such as infarction, infection, demyelination, edema, and malignancy were associated with long T1 values. Cysts had very long T1 values (about that of cerebrospinal fluid). Spin-echo (SE) sequences showed increased values of T2 in a variety of conditions and highlighted lesions against the relatively featureless background of the remaining brain. With inversion-recovery scan...

Clinical NMR imaging of the brain: 140 cases

PURPOSE To evaluate the efficacy, safety, and results of direct thrombolytic therapy in intracranial dural sinus thrombosis by infusion of alteplase (recombinant tissue plasminogen activator). METHODS Nine patients were treated during a 2-year period for intracranial dural sinus thrombosis. A microcatheter was placed directly into the thrombus in the dural sinus via the transfemoral route. Thrombolysis was initiated with a rapid injection of 10 mg of alteplase over 10 minutes, followed in 3 hours by a continuous infusion of 50 mg, then a continuous infusion at 5 mg per hour until complete thrombolysis or a total dose of 100 mg per day had been reached. Repeat thrombolysis was tried the following day if complete recanalization did not occur at 100 mg per day. RESULTS Successful recanalization with improvement of symptoms was achieved in all cases. Time required for complete thrombolysis was between 8 and 43 hours. The total dose of alteplase ranged from 50 to 300 mg. Complications of a small intrapelvic hemorrhage and oozing at a femoral puncture site occurred in separate cases, but were not related to the amount of infused alteplase. MR venograms obtained 1 to 4 weeks after the procedure showed no evidence of reocclusion of the dural sinuses. CONCLUSION Direct fibrinolytic therapy with alteplase is safe, fast, and effective in treating dural sinus thrombosis. However, to prevent hemorrhagic complications, further studies are required to determine its optimal dose and proper rate of administration.

http://www.ajnr.org/content/ajnr/18/4/639.full.pdf

Direct endovascular thrombolytic therapy for dural sinus thrombosis: infusion of alteplase.

Direct Endovascular Thrombolytic Therapy for Dural Sinus Thrombosis: Infusion of Alteplase

Although radiologic findings in radiation-induced lung disease are well described in the literature, the influence exerted on these findings by different radiation methods is not well understood Radiation treatment of non-small cell lung cancer varies depending on the location and extent of disease Irradiation with oblique beam angles results in unusual distribution of radiation-induced lung disease Small cell lung cancer is treated with irradiation concurrent with or following chemotherapy, and portal arrangements are controversial In breast cancer, use of tangential beam portals may induce radiation pneumonitis or fibrosis at the peripheral lung anterolaterally Use of supraclavicular portals may produce lesions in the lung apex that appear similar to pulmonary tuberculosis In esophageal cancer, radiation portals with a 5-6-cm margin above and below the tumor are generally recommended, and computed tomography (CT) frequently demonstrates radiation-related lung damage adjacent to the mediastinum In mediastinal tumors, the mantle field includes all the major lymph node regions above the diaphragm Radiation pneumonitis varies from minimal to extremely marked change in the paramediastinal areas and in both apices CT is more sensitive to radiation-induced lung disease than chest radiography and demonstrates related changes earlier Furthermore, it more clearly depicts the precise distribution and pattern of disease Familiarity with the imaging findings in radiation-induced lung disease produced by different radiation methods will help radiologists interpret abnormalities seen at chest radiography and CT in affected patients

Radiation-induced Lung Disease and the Impact of Radiation Methods on Imaging Features

Ten computed tomography (CT) brain scans were evaluated in nine patients with acute carbon monoxide poisoning. The most common CT feature was symmetrical bilateral basal ganglia abnormalities. The lesions appeared as symmetrical low density areas, more dense than cerebrospinal fluid in the early stage and as well defined and more lucent lacunae in the late stage. A second feature was symmetrical and diffuse white matter low density areas. The low density areas, attributed to edema, were poorly defined and faintly lucent in the early stage. They became better defined and more lucent later as permanent necrotic changes developed. Ventricular dilatation and sulcal widening developed as late changes.

http://www.ajnr.org/content/ajnr/1/5/399.full.pdf

Acute Carbon Monoxide Poisoning: Computed Tomography of the Brain

Internal radiation therapy with subsegmental arterial injection of iodine 131(131I)-labeled iodized oil (Lipiodol; Laboratorie, Guerbet, France) was evaluated in 24 patients with nodular hepatocellular carcinoma (HCC) ranging from 2.5 to 8.0 cm in size. 131I Lipiodol (555 to 2220 MBq in 3 to 8 ml) was injected depending on the tumor size. Tumor reduction was seen in 88.9% of tumors smaller than 4.0 cm in diameter, 65.5% of tumors between 4.1 to 6.0 cm, and 25.0% of tumors larger than 5.1 cm. The tumor size reduction corresponded to the gradual drop of serum alpha-fetoprotein (AFP) levels and devascularization on follow-up angiography. Adverse reactions from treatment included fever, mild abdominal pain, nausea, and elevation of transaminases. These were mild and well tolerated by patients. This method provided long-term local control without complications related to the thyroid, lung, gastrointestinal tract, and bone marrow.

Jung Ho Suh

Papers

Direct endovascular thrombolytic therapy for dural sinus thrombosis: infusion of alteplase.

Direct Endovascular Thrombolytic Therapy for Dural Sinus Thrombosis: Infusion of Alteplase

Radiation-induced Lung Disease and the Impact of Radiation Methods on Imaging Features

Acute Carbon Monoxide Poisoning: Computed Tomography of the Brain

Nodular hepatocellular carcinoma. Treatment with subsegmental intraarterial injection of iodine 131-labeled iodized oil.