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The surgical management of benign and malignant thyroid neoplasms in marshall islanders exposed to hydrogen bomb fallout

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Abstract

On March 1, 1954, a serious fallout accident occurred during the United States atomic testing program at Bikini in the Trust Territory of the Pacific Islands. Following the detonation of a large thermonuclear device (known as Bravo) an unexpected shift in winds resulted in deposition of radioactive debris on several inhabited atolls in the Marshall Islands. During the early post-detonation period military, sea, and air surveys traced the hottest portion of the parabolic cloud as it drifted in an ever widening pattern of diminishing concentration eastward and southeast of Bikini. The center of the cloud passed North of the Rongelap Atoll, which was the nearest inhabited atoll. This report concerns the development of thyroid lesions, the special circumstances encountered during thyroid surgery, and the results of the surgical management of benign and malignant lesions that were subsequently encountered in this population.

Résumé

Le 1 mars 1954, un accident de retombée radio-active s'est produit pendant les essais atomiques à Bikini dans le Territoire Trust des Iles du Pacifique. Des débris radio-actifs sont tombés sur les atolls inhabités des Iles Marshall après la détonation d'un énorme appareil thermonucléaire, en raison d'un changement inattendu des conditions climatiques. Juste après la détonation, une surveillance militaire aérienne et maritime a permis de suivre les déplacements de la portion la plus chaude du nuage parabolique. Celui-ci s'est déplacé vers l'est et le sud-est tout en diminuant d'intensité et en se dispersant. Le centre du nuage radio-actif est passé au nord de l'atoll Rongelpa, atoll peuplé le plus près. Cet article rapporte le développement des lésions thyroïdiennes, les conditions particulières et les résultats de la chirurgie des lésions bénignes et malignes de la thyroïde rencontrées dans cette population dans les suites de cet accident.

Resumen

En marzo I de 1954 sucedió un grave accidente de contaminación en el curso del programa de ensayos atómicos de los EUA en Bikini en el Pacífico. Después de la detonación de un gran artefacto termonuclear, un inesperado cambio en la dirección de los vientos causó el depósito de desechos radioactivos en varios islotes habitados en las Islas Marshall. En la fase inmediatamente siguiente a la detonación, el seguimiento militar, marino y aéreo rastreó la porción más “caliente” de la nube parabólica en la medida que se movilizaba en un patrón de decreciente concentración hacia el este y hacía el sudeste de Bikini. El centro de la nube pasó al norte del islote Rongelap, que era el islote habitado más cercano.

El presente informe se refiere al desarrollo de lesiones tiroideas, las circunstancias especiales que fueron encontradas en el curso de la cirugía y los resultados del manejo quirúrgico de la lesiones benignas y malignas halladas en esta población.

Se realizó el estudio anual de 245 personas expuestas, en el curso de 37 años o en el curso natural de su vida. Se han operado 77 personas irradiadas y personas control por la presencia de masas tiroideas. En 8/23 casos de carcinoma se halló extensión ganglionar. También se encontraron pequeños carcinomas multicéntricos y adenomas atípicos, además de adenomas, presumiblemente debido a que toda la glándula estuvo en riesgo. Se realizó tiroidectomía total o casi total como procedimiento de elección, sin mortalidad ni complicaciones mayores. Se presentó un caso de hipoparatiroidismo postoperatoria y otro de hipocalcemia asintomática, detectada sólo 20 años después de la cirugía. Esta serie presenta el desarrollo secuencial de neoplasias tiroideas como resultado de una exposición única a radioyodos a partir de la contaminación de una población.

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  1. Department of Surgery, Case Western Reserve University at Cleveland Metropolitan General Hospital, Cleveland, Ohio, USA

    Brown M. Dobyns M.D., Ph.D. & Barbara A. Hyrmer B.S.

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  2. Barbara A. Hyrmer B.S.
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Dobyns, B.M., Hyrmer, B.A. The surgical management of benign and malignant thyroid neoplasms in marshall islanders exposed to hydrogen bomb fallout. World J. Surg. 16, 126–139 (1992). https://doi.org/10.1007/BF02067128

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