The said medical care involves the speedy diagnosis and treatment of acute and sub-acute disorders caused by radiation exposure in humans, including thermal burns, hemorrhage, reduced leukocyte counts, gastrointestinal disorders, and epilation. It also involves concerted efforts by experts specialized in various organs or in the fields of surgery, internal medicine or gynecology for accurate diagnosis and treatment of late radiation effects that may occur several years after exposure, including malignant tumors, such as leukemia, thyroid cancer and breast cancer as well as cataracts. Recently, in Hiroshima, the first-stage, second-stage, and third-stage relief systems are being established to deal with radiation emergencies, with the Hiroshima University Hospital and Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital acting as core institutions.

What is the "expertise that has accumulated in Hiroshima from the medical care of A-bomb survivors," which HICARE has effectively used for the radiation exposed throughout the world?In what form has such expertise been accumulated in Hiroshima?

The results of the diagnosis and treatment of various diseases occurring in A-bomb survivors in Hiroshima have been reported by physicians engaged in the treatment of these survivors in various medical journals. A representative publication of this kind is the Proceedings of Late A-bomb Effects Research Meetings (Hiroshima Igaku), which is published every year. In addition to reports on treatment results, there are also books which cover accumulated information regarding radiation dose evaluations and studies in the fields of basic medicine, including pathology. Two representative books are as follows: (1) Hiroshima and Nagasaki: The Physical, Medical, and Social Effects of the Atomic Bombings (compiled by The Committee for the Compilation of Materials on Damage Caused by the Atomic Bombs in Hiroshima and Nagasaki and published by Iwanami Shoten; the first issue published in July 1979) and (2) Effects of A-bomb Radiation on the Human Body (compiled by the Hiroshima International Council for Health Care of the Radiation-exposed and published by Bunkodo; the first issue of the first edition published in March 1992). English versions are also available for these books.

What kinds of findings will be available by applying the expertise from the medical care of A-bomb survivors to those exposed to radiation in Semipalatinsk or Chernobyl?

Based on the results of the treatment of A-bomb survivors in Hiroshima, it is considered that hematological disorders, lymphocyte chromosome aberrations and thyroid dysfunctions have possibly occurred in those exposed to radiation in Semipalatinsk or Chernobyl soon after their exposure. It was predicted that leukemia might develop in those working at the Chernobyl nuclear power plant on the day of the accident and those engaged in clean-up work. It was also predicted that thyroid cancer might develop among the local people. Actually, it has become clear that, in Chernobyl, thyroid cancer developed among children, who are highly sensitive to radiation, starting as early as four years after the accident.

What kinds of on-site medical support activities are being performed by medical teams dispatched to other countries by HICARE?

A medical team mainly consists of physicians engaged in the treatment of A-bomb survivors in Hiroshima. It visits various places overseas where A-bomb survivors live or there are many exposed people, and provides support for disease diagnosis and other areas from the professional standpoint. Treatment should be, of course, performed by local physicians, but the dispatched team provides advice for medication and surgery. Team members also cooperate in the improvement of the medical expertise of local physicians and others.

What kind of training is provided in Hiroshima to physicians invited by HICARE from overseas?

HICARE trainees receive training from experts of various fields, so that they can obtain extensive knowledge regarding the treatment of those exposed to radiation. Those who provide training include physicians engaged in the treatment of A-bomb survivors in Hiroshima, experts of specific organs or diseases, experts in basic radiology engaged in the estimation of the radiation doses of exposed people or exposed sites, and physicians engaged in histopathological diagnosis. Furthermore, in addition to general training concerning A-bomb exposure and the medical examination/treatment of the exposed, those trainees can undergo training in radiation-related fields in which they are particularly interested.

What are "fine-needle aspiration cytodiagnosis," "Papanicoloaou staining," and "Giemsa staining" included in the HICARE training?

A syringe with an injection needle is placed on a special pistol-shaped tool. The tube inside the syringe is drawn to produce negative pressure within the syringe. Because of the negative pressure, cells come into the syringe from the edge of the needle inserted into a tumor. A specimen thus aspirated is strongly pushed out on a slide glass and stained for cytodiagnosis.

There are two methods for staining the specimen thus obtained. One is the Papanicoloaou method, with which the specimen is fixed in ethanol for staining. This method enables easy diagnosis of the cell nucleus. The other method is Giemsa staining, with which the specimen is stained after quick air-drying. With this method, follicular cells and colloids, as well as the chromatin pattern of the nucleus can be seen clearly. Those engaged in cancer diagnosis seem to prefer Papanicoloaou staining.