A Battle Against Deadly Dust

By Christine Gorman

"We are living in a new age of medicine." That was the appraisal last week of Dr. Robert Gale, a UCLA hematologist and veteran of the medical team that treated victims of the Chernobyl nuclear disaster last year. Gale had just returned from Rio de Janeiro, where with an international group of physicians he had spent ten days treating six badly irradiated victims of a bizarre accident in Brazil with an experimental drug called GM-CSF. "When it comes to these disasters," concluded Gale, who will soon return to Rio, "all the handbooks on treatment will have to be rewritten."

Indeed, Brazilian authorities were dealing with the worst known episode of radioactive contamination in the West. In mid-September, a hapless junkyard dealer in Goiania (pop. 1.2 million), a city about 120 miles southwest of Brasilia, had pried open a lead cylinder containing a capsule of radioactive cesium 137, an isotope used for treating cancer. The canister had been sold to him as scrap from an abandoned local medical clinic. During the next six days, more than 200 townspeople were exposed to and at least one even ate the deadly bluish powder before Brazilian officials could contain the contamination.

Days later, Dr. George Selidovkin, a radiation specialist at Moscow's Hospital No. 6 who had been part of the Chernobyl medical team, arrived in Brazil after receiving an urgent plea from the Vienna-based International Atomic Energy Agency. The ten most severely irradiated patients, dressed in protective clothes, gloves, boots and caps, had already been flown aboard a military plane to the Marcilio Dias naval hospital in Rio.

Selidovkin began by examining the patients' blood samples to determine how many of their infection-fighting white blood cells had been destroyed and the extent of genetic damage. By comparing the results to those from previous nuclear accident victims, the Soviet doctor determined that four of the patients had been exposed to about 600 rads, a degree of radiation absorption equivalent to 4,000 chest X rays. Technicians sprayed six of the patients with cold water and scrubbed them with soap to remove any cesium from their skin. In an attempt to cleanse their bodies of any cesium they might have swallowed, the team of doctors fed them an iron compound called Prussian blue, which soaks up cesium and blocks its absorption by the body.

Gale arrived in Rio on Oct. 17. By then some of the patients' radiation- ravaged bone marrow could not produce sufficient immune cells to fight off ever present bacteria. Doctors battled soaring fevers, infection and internal bleeding with sophisticated antibiotics and clotting agents. At Chernobyl, Gale and Selidovkin had tried to save severely affected technicians and fire fighters with bone-marrow transplants. The medical team in Rio decided against that surgical tactic, in part because the patients' bone marrow had not been irreversibly destroyed and because, from the nature of their exposure, some of the sickest patients had become radioactive.

"In Chernobyl, you had a nuclear fire that at the first stage affected the technicians in the plant," noted Selidovkin. "But there was no cesium 137 introduced into their bodies. Here the irradiation was both incorporated and local." Leide das Neves Ferreira, 6, who had eaten a cesium-tainted sandwich, continued to emit 25 rads a day, even after repeated efforts at decontamination. At that rate, the radioactivity in her body was destroying her bone marrow before it could produce white blood cells.

As a result, the doctors decided to try an untested therapy on Leide and five other patients who were likely to die. With Gale's guidance, they attempted to revitalize the irradiated bone marrow. GM-CSF, or granulocyte- macrophage colony-stimulating factor, is one of at least five hormones that boost the production of white blood cells in the marrow. In cancer patients, CSFs seem to offset the deleterious effects of radiation and chemotherapy on the marrow, thus making larger doses safer to use. Gale wondered if the hormones would work the same magic on people who had been accidentally irradiated.

Using special equipment flown in from the U.S., the doctors injected GM-CSF into each patient's vena cava, the central vein that leads to the heart. Within 48 to 72 hours, the white blood cell count increased in five of the six patients, but Leide died before the treatment could be evaluated. Within a week four of the six patients had died, overwhelmed by pneumonia, blood poisoning and hemorrhaging. But the other two seem to be recovering. "I can't be certain that they would have died if they had not got the treatment," Gale says. "But they did respond."

The drama of the radioactive junkyard is far from over. Doctors will watch ! the survivors closely, particularly for signs of leukemia and skin cancer. The event may have other repercussions as well. Three Mile Island, Chernobyl and Goiania have all shown that nuclear accidents can happen. Doctors are confident that they can meet medical needs in small incidents. However, larger accidents require more technology and resources than any one country can provide. "It would be irresponsible not to take advantage of what we, the Soviets and the Brazilians have learned," says Gale. "We should pool that knowledge." Grim practice may not make perfect. But it could save lives the next time.

With reporting by Laura Lopez/Rio de Janeiro and Edwin M. Reingold/Los Angeles