RE WSITORY

COLLECTION

BOX NO.

FOLDER

DOE-OHRE

PLUTONIUII INJECTION

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Hp-3 i This patient, a forty-nine year old white female, was admitted to the hospital with com-

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plaints of pigmentation of the skin, pyurit ic- dermatitis and dependent edema. Initial clinical studies were carr ied out in November. and December 1945, a t which time diagnoses of hepa- titis of unknown etiology and hypoproteinemia were made. She was admitted for follow-up examination in October 1946, when she appeared in good health. : . 2 L/;1 t m ,-- - / :

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CENTER FOR HUMAN RADIOBIOLOGY

CHR Exams

1973 Date

Medical Reports from Physicians and Hospi ta ls

Correspondence

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INTRA-LABORATORY MEMO

March 5 , 1973

TO: CHR Records Room

FROM: J. Rundo, K. F. Eckerman

SUBJECT: In vivo counting - case 40-009

1.

2.

3.

4.

T h i s subject, a 75-year old white ~ . ~ ~ ~ . female, ~ _ . . was hospitalised at the

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from the subject ' s purative burden of plutonium-239. We drove t o ; spent most of February 7 setting up and testing t h e equipment and made our measurements on the morning of February 8. After making background measurements on a control subject, we dismantled t h e equipment tha t afternoon and drove back on February 9.

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, in t h e care of We took electronic equipment and attempt to detect uranium L X-rays

By mid-morning , t he proportional counter and associated electronic equipment were set up, tes ted and operating satisfactorily. A 40-minute background gave 6 . 2 counts/minute in t h e energy band 14-23 keV and this band was used for a l l measurement results reported below.

The principal problems encountered were of a mechanical nature; securing t h e counter to the detector mounting was the main one. The local workshop personnel made a bracket which was used successfully but there were severe, diff iculties in presenting the counter to t h e patient because (a ) t h e room was very s m a l l (about 5 feet x 6 feet), (b) t h e suspension device was cumbersome and inflexible, and (c) there was only a tilting chair and no bed or stretcher.

Three measurements were made of t h e subject 's X-ray emission: from t h e general region D f t h e liver, from t h e l P f t s ide at t h e sax? level, and from the left side of t h e face. Two background measure- ments were made on a female control subject, who was not however a particularly good m a t c h because s h e weighed 55 kg compared with t h e pat ient ' s 65 kg. that it was impossible to get the counter a s close to her body surface as K O rnar or' t he patient.

T h i s is not considered too important except

8 0 0 5 8 5 2 ANL-26 11!-681

TO: CHR Records Room -2- March 5, 1973

5 . T h e resul ts are sunmarised in the following table (counter background not subtracted). Apparently soine activity was detected from t h e left and right upper quadrants. , i

Case 40-009 Control subject Difference Location c/min. c/m in. c/min.

Face 8.7 f 0.7 7.7 f 0.6 1 . o i 0.9

L. side 11.6 f 0.8 9.4 f 0.7 2.2 f 1.1 Liver 12.5 f 0.8 (9.4 f 0.7)" 3.1 f 1.1

*Assumed to be t h e same as the measured value on t h e left side.

6 . A crude calibration was made at CHR with a point source buried at 25 different positions in a solid phantom. The calibration factor was 0.15 c/min per nCi 239Pu. Attributing al l the counts observed from t h e patient 's liver region to plutonium in t h e l iver, we deduce a liver content of 20 nCi. T h i s is only 6.7% of t h e injected dose of 300 nCi, whereas three out of five autopsied patients had in excess of 20% in t h e liver. T h e other two showed advanced liver disease. It should be noted that patient 40-009 had infectious hepatitis at t h e t i m e plutonium was administered and th i s may have affected t h e liver deposition. be placed on t h e figure of 20 nCi because of the crudity of t h e calibration; it is likely to be low rather than high but it is difficult to envisage it being low by more than a factor of two and certainly not as much as a factor of ten.

Not too much reliance should

7. The response observed from t h e left upper quadrant could have come from the median portion of t h e liver, as the counter could not be placed completely to t h e left or-right of ths mid-line. An alter- native possibility would be a contribution from plutonium deposited in t h e lower ribs but t h i s would apply equally to t h e counts observed from the liver region, and allowance for th i s would make our estimate of t h e liver content surprisingly low.

8 0 0 5 6 5 3

TO: CHR Records Room -3: March 5, 1973

8. Time and especially the mechanical arrangements in the shield did not permit more extensive investigations of possible X-ray emissions from bone, but it seems clear that even at t h i s level of activity it is doubtful if the plutonium can be detected. This substantiates a statement made by one of us a t the U.N. Geneva Conference in 1958 (Proceedings, vol. 23, page 111).

dk

cc: A. F. Stehney R. E. Rowland Christine Waterhouse, M. D. Margaret Littman, M. D.

8 0 0 5 8 5 4

Center for Human Radiobiology Peripheral Leucocyte Chromosome Analysis

Case # . GQq

A sarnp2e of perip heparinized tube Leucocytes were cultured, using standarkl culture techniques including PHA stimulation. The cultures were terminated after 50-53 hours. Slides were examined following standard Giemsa staining.

3.h</73 and a sample of . 37 cells was obtained. The sample Slides were scored on

consisted of sufficiently well spread cells with 46 or more centromeres. copy of the cytogenetic unit 's score shee t is attached.

Results were as follows:

Number

77

% hyperdiploid cells 2-sc

Cells with 46 centromeres

Cells with > 4 6 centrome@es 2

Rings + dicentrics (and associated fragments) C

Chromosome minutes e

Acentric fragments i - Tota 1 chromosome aberrations per cell , D /

Chromatid deletions

Gaps

C

G Total chromatid aberrations per cell J @ 8 - - T o t a l aberrations per - cell - - Q P

A

Date of report 7/1/72 Submitted by e/

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SCHOOL OF MEDICINE AND DENTISTRY A N D

STRONG MEMORIAL HOSPITAL 260 CRITTENDEN BOULEVARD

ROCHESTER. NEW YORK 14620 February 28, 1973

Margaret S . Littman, M.D. Argonne National Laboratory 9700 South Cass Avenue Argonne, I l l i n o i s 60439

Dear Doctor L i t tman :

Enclosed are copies of the 1945 adaiss ion of Case No. 40-009, I hope these g i v e you the information you wish.

S incere ly ,

(Miss) Dorie Sul l ivan, secretary to Chris t ine Waterhouse, M.D.

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CHR E x a m s

Medical Reports from Physicians and Hospiials-

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: ., Explanation of Symbols: Count; PLlN E Polynorphonurlear Cells; LY!.iPIi3 - L) mpboc) tes, COS.= Coslnoghles; 8ASO. = Baso$lles; MONO. = Monocytes; BUN = B!@ud Lire3 Nltrogcn. XP:J = Kon-Protein Nimogen; LTEA Cl. = Urca Excre- hon in Per Cent of Piorma1 at One How.

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'i < I 1 subjscts before plutonium injectioii and at freycmt intervals [ha-eafter. wer8 analyzed for plutonium by the cupferron extraction procedure subsequent to ashing.

A l l tissue samples

1 The data in Table 3 show the results oi analyses of the various samples for 111c:onium. i

iThc? resul ts obtained by Russell and Rlichs~r! (13) ( r e fe r r ed to as Chi. I, ET, nl) and Hamilton :;(et 31 (14) ( r e fe r r ed to as Cal. I ) a r e presented also. Two im;jortar?t poults must ba kept in juhd when consickrbg these data: ( 1 ) The saciples of human tissues were, for obvious rea- /sans, rather unsatisfactory. In most cases they were too sulall, poorly reprejeritative and ; w e usually what c d d be obtained under the circun?sfances rather than w h t -,-;ere desired;

- i(2) The subjects ware chronically ill and/or elderly and the results may not represeni exactly i lk distribution of plutonium in tissues of healthy persons oi average working zge. These kih, howwer, are all that are available and, therefore, must pzovid? tlic basis ior our pres- ent coilcept of the distribution of plutonium in the organs a d tissues of mm. T'ltey must also provide a basis for comparison with the results obtained from the numerous studies of

1 plutonium deposition in experimental animals.

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. iL3 Pu02++ 2nd P& - citrate is localized in bone. E the veiL&ia, sterix '&ha 2s r ep res snk t ive bones of the dieleton, and th? avercgd ~1c:onbc:n c $ 1

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PRIVACY ACT MATERIAL R€M

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ARGONNE u . NATIONAL

' LABORATORY INTRA-LABORATORY MEMO

TO: CHR File

FROM: M . S . Littman, M.D.

SUBJECT:

February 5 , 1973

P RlVACY ACT MATERIAL REMOVEL I

40-009 - f ' J LO- J

Copy of portion of chart of case 40-009

Th i s ow was admitted to ,. I having been tran from 'Hospital where she had been hospitalized for three days.

c&-x- v I < ' < a t . < cl' C C f / t I q since

She had an acute episode of abdominal pain and swelling for the She had been followed medically a t

1945. l a s t five days.

Present I l lness

For many years the patient has had constipation and associated diverticulosis. She took metarnucil. During Christmas holidays dietary indiscretions and consumption of many sweets occurred. She noticed gradual abdominal swelling that worsened five days previous to admission, ar,d crampy, sharp pain over the entire abdomen developed. Her local

Hospital with the diagnosis of paralytic i leus secondary to peritonitis resulting from a perforated diverticulum. X-rays showed dilated loops of small bowel. Barium enema was negative except for multiple diverticula. Treatment consisted of nasogastric suctfon, ampicillin 500 mg. q. 6 h. After three days she was transferred to Strong Memorial Hospital.

physician, , examined her a t home and sent her to 1 CQ-.-d:r, i

Past History

She had been followed at Strong Memorial Hospital since 1945, admitted then for peripheral edema and skin rash of several weeks' duration. Laboratory studied' showed hypoproteinemia, mild elevated bilirubin and thymol turbidity. Diagnosis w a s mild hepatitis and treatment consisted of diet and bed rest. There was complete recovery.

In 1946 she was admitted because of a skull fracture subsequent to falling. She had bloody spinal fluid and bleeding from the right ear. Residual complaints for months after discharge consisted of vertigo and

PRIVACY ACT MATERIAL REMOVED .-26 I 1 1-69)

CHR File Page 2 February 5 , 1973

. .

In 1953 a cyst ic lesion of the left third rib'was resected. Pathological diagnosis was "neurofibroma".

In 1955 she had abdominal distress and gas after meals. A large hiatus hernia w a s found.

In 1962 glucose tolerance test was diabetic, and in 1968 it was proved that abnormal glucose tolerance test was related to weight changes. Being overweight had always been a problem, weight 140-155 lbs. Her height was 5 f t . 1.5 inches.

In 1970 arthritis developed in hands, feet and sacroiliac joints and pain was controlled by eight Bufferin tablets per day.

In 1971 she had an iron deficiency anemia produced by a prolonged diet of milk and crackers. Serum iron was 28 p g. %, iron binding capacity 480 p g . %, and hematocrit was 27. Therapy consisted of iron, and hematocrit was increased to 44.

Family History

Widowed, one son, - - , relationship is strained and cause not known. One sister with crippling rheumatoid arthritis, died in 1972. No history of arthritis in other fam;ly members.

Physical Examination

Blood pressure 140/88

She was not jaundiced. Abdomenwas obese and distended. There w a s no tenderness on palpation, but there was rebound tenderness in all four quadrants. She had no edema.

Laboratory Data

C1 - 103 m E q . / L . , COz 2 7 m E q . / L . , K 3 . 6 m E q . / L . NA - 1 4 2 mEq . /L . , N - 6 mg. %

Hospital Course

Patient received I.V. fluids initially, then liquid diet. Ampicillin VGS c ~ i ~ t i n ~ ~ d for sew~crsl days. U r i ~ r y mt-put w s s satisfactory, thouqh low. First bowel movement w a s on January 3 1 , and weighed 2 2 2 gm.

(7 ? 7 9 ccg. U ,J - 3 . A. M . Brues, M.D. A. F. Stehney Medical Fkisistants

/

* . . .

THE UNIVERSITY OF ROCHESTER

SCHOOL OF MEDICINE AND DENTISTRY AND

STRONG MEMORIAL HOSPITAL 260 C R I T E S D E N BOULEVA?.D

ROCHESTER, NEW YOIK 14620 . .

Argonne N a t i o n a l Labora to ry 9700 S . Cass Avenue Argonne, I l l i n o i s 60439

1 - - - - - - 5 -- _ _

B i l l i n g f o r h o s p i t a l i z a t i o n of ')

Research P a t i e n t

J a n u a r y 28 t o February 18, 1973

2 1 days at $132.29 $2,778.09

Your Purchase Order $762107 d a t e d 1-11-73

-

Send check t o the a t t e n t i o n of Mr, David J. Fanning

Ud C.cUA WnEC ' -

C E N T E R F O R H U M A N R A D I O B I O L O G Y

March 8 , 1973

Christix~ Waterhouse, M.D. Dfrector, Metabolic Unit Strong Memorial Eospftal .

Rochester, Ne# York 14600

Dear Dr, -Waterhouse:

Maqr thanks for the wpy of t h s 1945 medical r ea r& cn case 40-009. They P i e quite conplete an;! wil! he valuakie when skzisd in parallel with t ! e recent laboratory data.

Her blocd sar;;pie for c ~ r o ~ o s o ~ a studies, unfamnately, was

Wf th b2 s t rcga rd s ,

not good, though the other drawn at the same tine, was excellent.

Sincerely p u r s ,

,-- Margaret S. Lfttnan, M.D.

J MSL/ft

cc: CHR RR A. F, Stehney

3 0 0 5 r l o i flADIOLOGICA1 A N 2 F N L 1RC)NhlENTAL RES'.' PC'I DIVISION, ARGONNE NATIONAL LABORATORY

970G 53 i t t i Czss Avenue, Argoi:pr, lliittoi; 60439 Telephone 332-739-771 1

ARGONNE N AT1 0 N AL LA90 RATORY

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' I

P. RLJLGtm- _ . FROM: A. F. Stehney

SUBJECT: Phone call from, 1 - -- --- ----- -

'on 12-20-72 . - I've rewritten m y notes of t h e above date when Dr. talked to m e after being unable to reach you. A summary of the conversation about some patients exposed to radioactive materials is given below for your information. - .

I. Death certificates on 1 2 "HP" cases (11 a t Rochester, f a t Oak Ridge..

Dr. 2 persons died at home, probably in i is presently unknown, was in , record of h i s death in ; HP12, to be traced.

C ~ - * . , has 5 DC's; 3 persons are living in Rochester;

._

County. 1 person County Home, but no

1 person is County to 1957.

11.- Clinical tests a t Rochester.

1. Dr. Christine Waterhouse sees one man (HP6) and one woman (HP3) regularly in her clinic. T h e other woman (HP8) is in her 70's and lives crosstown; it may be difficult to get her in for a metabolik study. The other -2 persons probably can be brought in anytime; if not, an outpatient study might be tried.

.

,

Note: HP6 has Addison's and h a s already lived 40 -012-

yo-6 i F 15 years beyond expectancy.

HP8 has schleraderma and has already lived 20 years beyond expectancy.

HP3 is in normal health. +a c~

2. The ward cost will be o n l y $90 per day per person, because of USPHS support for the ward. T h i s includes routine hematology, creatininz clearance and liver function.

,1314 4 1973

L-26 (11-68)

. . . . R. E. Rowland: -2- January 4, 1973

(- 11. 3. Dr. Waterhouse wants u s to provide t h e following:

a. A list of what we want done:

. . . . . . . : . . (1) Metabolic study. . . . . . . . . . . . . . . . .

. - . . (2) Medical exam. . . :

. . . . . . . b. Containers and shipping instructions far excreta.

. . . . . . . . . . ...

. . . , ........ ~ .... . . . . . . . : . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 * . . ...... - . . . . . .

. .

. .

. .

c. A billing account number with t h e Strong Memorial Hospital.

Possible medical procedures:

a. Iliac crest biopsy for material for autoradiographs.

b. Blood chromosomes, Dr. Waterhouse may want to do t h i s study.

c. Skeletal X-rays - Dr. Waterhouse may want to do only a partial survey.

d. . Correlation of enzymes vs. Pu in blood(?). Dr. Durbin 25 m l blood for study will contact Utah; we may need

a t Utah and ANL.

5. Other persons: . -

'a. Dr. Newell Stannard's secretary, Rose Steinberg, may be able to help u s a s a day to day contact person a t . Rochester. /

b. We should contact B i l l Moss at LASL to let him know we may be sending samples for analysis- soon.

dk

cc: A. M. Brues , i7JI.D. P. M. Failla J. E . Fai-rLialii M. S . Littman, M.D.

J. H. Maisnall B. C. Patten j. Runcio H. A. Schu1t.z