1. Acute Radiation Disease: Acute Radiation Vasculitis. DMITRI POPOV. PHD, RADIOBIOLOGY. MD (RUSSIA) ADVANCED MEDICAL TECHNOLOGY AND SYSTEMS INC. CANADA. INTERVACCINE@GMAIL.COM

2. Acute Radiation Vasculitis.  Vasculitis is a disease process characterized by inflammation, necrosis and hemorrhage of blood vessels and whose signs and symptoms are attributable to tissues and internal organs damaged by compromised vasculature.  This damage is mediated by thrombosis, ischemia and spread of inflammation to adjacent tissue.  Stuart S Leicht, MD, FAAD, FACP Professor of Medicine Chief, Division of Dermatology Quillen College of Medicine.  General definition for vasculitis.  http://www.remm.nlm.gov/download.htm#win http://www.remm.nlm.gov/download.htm#win

3. Acute Radiation Vasculitis.  Acute Radiation Vasculitis is a disease process characterized by acute immune reaction, generalized inflammation, acute cell necrosis and hemorrhage of blood vessels and whose signs and symptoms are attributable to tissues and internal organs secondary damaged by compromised vasculature.  This damage is mediated by acute immune reaction, micro-thrombosis, ischemia and development of inflammation in the adjacent tissue.

4. Acute Radiation Vasculitis  Classification of Acute Radiation Vasculitis.  Acute Radiation vasculitis:  Large-vessel vasculitis.  Medium-sized-vessel vasculitis.  Small-vessel vasculitis.

5. Acute Radiation Vasculitis.  Acute Radiation Disease.  Acute Radiation Cerebrovascular Syndrome – Acute Radiation Vasculitis of cerebrovascular blood system of circulation.  Acute Radiation Cardiovascular Syndrome – Acute Radiation Vasculitis of coronary blood system circulation of heart.  Acute Radiation Gastro-Intestinal Syndrome – Acute Radiation Vasculitis of gastro-intestinal blood system circulation.  Acute Radiation Hematopoietic Syndrome - Acute Radiation Vasculitis of blood vessels of blood marrow.

6. https://www.google.ca/search?q=blood+vessels+of++bone+marrow+image&espv=2&biw=1366&bi h=667&source=lnms&tbm=isch&sa=X&ved=0CAYQ_AUoAWoVChMIxuSQrNzyxwIVS4CSCh3QLwna#i mgrc=FsHneyCEihhaJM%3A

7. Acute Radiation Vasculitis  Acute Radiation Pneumonitis – Acute Radiation vasculitis of blood vessels of lungs.

8. Acute Radiation Vasculitis.  Acute Radiation Pneumonia.  https://www.google.ca/search?q=lungs+gas+exchange+images&espv=2&biw=1366&bih=667&tbm=isch&imgil=HQd0lh10RuAzBM%25 3A%253Br6Kgc79_885CYM%253Bhttp%25253A%25252F%25252Fhyperphysics.phy- astr.gsu.edu%25252Fhbase%25252Fbiology%25252Frespir.html&source=iu&pf=m&fir=HQd0lh10RuAzBM%253A%252Cr6Kgc79_885CYM% 252C_&ved=0CDAQyjdqFQoTCLuizoDe8scCFcgSkgodn9oLww&ei=ncD0VfvfH8ilyASfta- YDA&usg=__o3XA4ppJ_87F770T1bQzPrbD5tY%3D#imgdii=HQd0lh10RuAzBM%3A%3BHQd0lh10RuAzBM%3A%3B50dJEccey32jNM%3A&i mgrc=HQd0lh10RuAzBM%3A&usg=__o3XA4ppJ_87F770T1bQzPrbD5tY%3D

9. Acute Radiation Vasculitis  Acute Radiation Hepatitis – Acute Radiation Vasculitis and disorder of blood circulation of liver.  The clinical course of acute radiation hepatic necrosis resembles an acute, toxic radiation injury to the liver with sudden and precipitous onset, marked elevations in serum aminotransferase levels, and early signs of hepatic (or other organ) dysfunction or failure despite minimal or no jaundice. Rapid recovery after withdrawal of the agent depend on dose of radiation. Other organ failure, such as lung, kidney or bone marrow, may also be present and may overshadow the hepatic injury. Acute hepatic necrosis is typically caused by a direct hepato toxin and is usually dose dependent and “expected”, rather than idiosyncratic.  http://livertox.nih.gov/Phenotypes_ahn.html

10. Acute Radiation Vasculitis.  Acute Radiation Hepatotoxicity. Symptoms. Usually abrupt onset of nausea, weakness, fatigue and abdominal pain; somnolence and mental clouding may occur early. Itching is rare and jaundice appears later. Other organ failure (kidney, lung, bone marrow) may be prominent.  http://livertox.nih.gov/Phenotypes_ahn.html

11. Acute Radiation Vasculitis.  Acute/Chronic Radiation Nephropathy is kidney injury and impairment of function caused by ionizing radiation. It may occur after irradiation of one or both kidneys, and it may result in kidney failure.  Classic radiation nephropathy occurs after bilateral, local kidney irradiation. It is a syndrome of chronic renal failure, occurring months or years after renal irradiation. Acute radiation nephropathy develops 6-12 months after irradiation, whereas chronic radiation nephropathy develops years later. Radiation nephropathy has also been discovered to cause chronic renal failure after hematopoietic stem cell transplantation (HSCT), also called bone marrow transplantation (BMT). An excess occurrence of chronic kidney disease is reported in long-term survivors of the atomic bomb explosions at Hiroshima and Nagasaki. http://emedicine.medscape.com/article/243766- overviewchronic renal failurehttp://emedicine.medscape.com/article/243766- overview

12. Acute Radiation Vasculitis.  Previous exposure to a sufficient dose of ionizing radiation is a necessary element in the patient's history. External-beam irradiation is usually a clear- cut feature in the history, and it should have encompassed the kidney areas. Use of a radioactive isotope in therapeutic doses may not be obvious. Classically, exposure of the kidneys to x-rays or gamma rays in a dose higher than 2000 cGy (rads) is required to cause radiation nephropathy. However, a 10-Gy single-fraction dose is sufficient to cause chronic renal failure after BMT.  http://emedicine.medscape.com/article/243766-overview http://emedicine.medscape.com/article/243766-overview

13. Acute Radiation Vasculitis.  Because radiation nephropathy is a delayed injury, renal disease that quickly follows kidney irradiation (ie, within hours or days) is usually caused by some other factor. Classic acute radiation nephropathy occurs 6-12 months after irradiation, and chronic radiation nephropathy may not develop for years. Similarly, proteinuria or hypertension ascribed to radiation nephropathy does not develop for months or years.  Expected symptoms of radiation nephropathy and BMT nephropathy are the same as those observed in patients with chronic renal disease. Nocturia may develop due to the loss of urine concentrating ability. Retention of salt and water may lead to edema and an increase in blood pressure. Anemia may occur, with fatigue, dyspnea, and loss of endurance. Loss of appetite, nausea, and weight loss may occur when there is a severe reduction in renal function. http://emedicine.medscape.com/article/243766-overview http://emedicine.medscape.com/article/243766-overview

14. Acute Radiation Vasculitis. Acute Radiation Cutaneous Vasculitis. Injury to the skin and underlying tissues from acute exposure to a large external dose of radiation is referred to as cutaneous radiation injury (CRI). http://emergency.cdc.gov/radiation/pdf/criphysicianfactsheet.pdf CRI can occur with radiation doses as low as 2 Gray (Gy) or 200 rads2 and the severity of CRI symptoms will increase with increasing doses.

15. Acute Radiation vasculitis vs vasculopathy.  DIFFERENTIAL VASCULITIS VS VASCULOPATHY.  A vasculopathy may be defined as a dysfunction or non-immunologic injury of small blood vessels or capillaries that leads to local vascular insufficiency, thrombosis and sometimes SECONDARY vascular inflammation.  They are common and may clinically resemble vasculitis and therefore must be clinically differentiated. They also may be valuable clues to other serious processes.  Stuart S Leicht, MD, FAAD, FACP Professor of Medicine Chief, Division of Dermatology Quillen College of Medicine.

16. Acute Radiation Vasculitis.  A. Acute Radiation vasculitis is a Immunologic injury of blood vessels.  B. http://www.intechopen.com/books/current-topics-in-ionizing-radiation- research/radiation-toxins-molecular-mechanisms-of-toxicity-and- radiomimetic-properties-

17. Acute Radiation Vasculitis.  Prodromal stage (within hours of exposure)—This stage is characterized by early erythema (first wave of erythema), heat sensations, and itching that define the exposure area. The duration of this stage is from 1 to 2 days. Latent stage (1–2 days postexposure)—No injury is evident. Depending on the body part, the larger the dose, the shorter this period will last. The skin of the face, chest, and neck will have a shorter latent stage than will the skin of the palms of the hands or the soles of the feet. Manifest illness stage (days to weeks postexposure)—The basal layer is repopulated through proliferation of surviving clonogenic cells. This stage begins with main erythema (second wave), a sense of heat, and slight edema, which are often accompanied by increased pigmentation. The symptoms that follow vary from dry desquamation or ulceration to necrosis, depending on the severity of the CRI.

18. Acute Radiation Vasculitis.  Third wave of erythema (10–16 weeks postexposure, especially after beta exposure)—The exposed person experiences late erythema, injury to blood vessels, edema, and increasing pain. A distinct bluish color of the skin can be observed. Epilation may subside, but new ulcers, dermal necrosis, and dermal atrophy (and thinning of the dermis layer) are possible. Late effects (months to years postexposure; threshold dose ~10 Gy or 1000 rads)—Symptoms can vary from slight dermal atrophy (or thinning of dermis layer) to constant ulcer recurrence, dermal necrosis, and deformity. Possible effects include occlusion of small blood vessels with subsequent disturbances in the blood supply (telangiectasia); destruction of the lymphatic network; regional lymphostasis; and increasing invasive fibrosis, keratosis, vasculitis, and subcutaneous sclerosis of the connective tissue. Pigmentary changes and pain are often present. Skin cancer is possible in subsequent years. Recovery (months to years)

19. Acute Radiation Vasculitis.  http://www.hopkinsvasculitis.org/vasculitis/symptoms-vasculitis/#skin http://www.hopkinsvasculitis.org/vasculitis/symptoms-vasculitis/#skin  More about skin vasculitis.