Epidemiologic and clinical evaluation of thyroid cancer in children coming from the Gomel region (Belarus).

This study reviews the epidemiology of thyroid cancer during childhood from the environs of Gomel in Belarus and the clinical data of 64 children aged 4 to 16 years from this area who had been diagnosed with differentiated thyroid carcinoma following the nuclear accident of Chernobyl. One case of thyroid cancer in children (aged < 15 years at diagnosis) was observed during the period 1981-1985 (rate = 0.5; expressed as annual averages per million children under age 15 years in the region of Gomel and period identified) before the Chernobyl accident. Twenty-one cases of thyroid cancer in children were observed during 1986-1990 (rate = 10.5) and 143 (rate 97) during 1991-1994 after the Chernobyl accident. During the first 7 months of 1995, there were 33 more cases of thyroid cancer observed in children. Three children with thyroid cancer were born since 1986 in the Gomel region. A total of 64 children aged 4 to 16 years from this area who had been diagnosed with differentiated thyroid carcinoma had been reviewed by us during the period May to November 1994. The female/male ratio was 1.4:1.0. At the time of the first diagnosis the mean age of the children was 9.4 +/- 2.8 years, and at the time of the accident their mean age was 3.8 +/- 2.4 years. More than 90% of the patients were less than 6 years of age and 3 were still in utero at the time of the accident. The period of latency between the accident and the first diagnosis was 5.6 +/- 1.5 years. Their ages at the time of the first diagnosis and their ages at the time of the accident were significantly correlated (p = 0.001); there was no significant correlation between the age of each child at the time of the accident and the latent period before the onset of carcinoma. The aggressiveness of the tumor, evaluated on the basis of T stage, lymph node status, and lung metastases, did not correlate with age at the time of the first diagnosis or with the age at the time of the accident. The susceptibility of the thyroid to the carcinogenetic effects of radiation, particularly during the first years of life (< 5 years) has clearly been demonstrated. However, there appears to be no correlation between the aggressiveness of the tumor and the age of the patient

Overzicht van klachten en diagnoses van patienten van de Witrussisch-Nederlandse polikliniek te Gomel (Oktober 1991 - September 1993)

Het rapport geeft een overzicht van de medische consumptie van 4500 personen welke gezien werden op de Witrussische-Nederlandse polikliniek te Gomel in Wit-Rusland van oktober 1991 tot september 1993. Dit Witrussisch-Nederlands samenwerkingsverband werd opgezet in het kader van een Nederlands Humanitair Hulpproject ten gevolge van het reactorongeval te Tsjernobyl in 1986. In een nieuw computersysteem voor patientenregistratie werden personalia, klachtenpatroon, diagnose, behandelingsstrategie en voorgeschreven therapie of medicatie geregistreerd. Met name werd gekeken naar klachten welke verband houden met blootstelling aan ioniserende straling. De populatie bestond voor 75% uit liquidatoren, mensen met een (beroepsmatige) mogelijk verhoogde blootstelling. Cardiovasculaire, gastro-intestinale of neurologische klachten, en klachten van het bewegingsapparaat waren het meest frequent, evenals het aantal diagnoses in deze subgroepen. Het patroon van klachten en diagnoses was vergelijkbaar met dat van een Nederlandse polikliniek interne geneeskunde, verhoogd waren struma, gastritis, maag- en dunnedarmzweren. Diagnoses welke gerelateerd kunnen zijn aan blootstelling aan ioniserende straling werden geanalyseerd. Een maligniteit werd 23x vastgesteld. Een groot aantal schildklieraandoeningen werd gediagnostiseerd. In 54 gevallen werd een haematologische ziekte vastgesteld, waarvan 5 maligniteiten. Cataract werd in 19 gevallen gediagnostiseerd. In alle gevallen liggen de getallen lager dan in een Nederlandse populatie van dezelfde grootte. Bij de behandelingsplannen werd het hoge aantal voorschrijvingen van homeopathische middelen (50%) geweten aan schaarste en onbekendheid met voorschrijven van westerse geneesmiddelen.This report provides a survey of the medical consumption of 4500 patients seen at the Belarussian-Dutch Outpatient Clinic in Gomel, Belarus during 1991-1993. This clinic was established in the framework of Dutch humanitarian aid following the Chernobyl reactor accident in 1986. A computerized patient registration programme was introduced. Special attention was paid to complaints that could be related to possible enhanced radiation exposure of the patients. The patient population consisted approximately 75% of liquidators, persons who may have been exposed to higher doses of radiation than the general public. Complaints affecting cardiovascular, gastro-intestinal, neurological and locomotor systems were uttered most frequently, consequently most diagnoses were related to these disciplines. The quantity of types of complaints and diagnoses were in agreement with each other, except for thyroid disease. The pattern of complaints and diagnoses was roughly comparable to the situation in a general outpatient clinic internal medicine in the Netherlands and the number of goitre, gastritis, gastric and duodenal ulcers was higher. Diagnoses that could be attributed to increased radiation exposure were analyzed. A large number of cases of thyroid disease were diagnosed. Haematologic disease was registered in 54 cases, five of these concerned malignant disease. Cataract was diagnosed in 19 cases, both lower than in a Dutch population of similar size. The same accounted for malignant disease (23x). Treatment plans consisted of different therapies and medication. The high percentage of prescriptions of homeopathic remedies (50%) may be due to scarcity of and unfamiliarity with prescribing western medication.VW