A case study of selected medical findings among plutonium injectees.

Available medical records of plutonium injectees exposed in experimental studies of plutonium biokinetics under Manhattan Engineer District auspices have been reviewed for subsequent medical findings potentially related to the plutonium exposures. Five subjects who had been injected with approximately 11 kBq 239Pu, and one injected with 3.5 kBq 238Pu, had useful follow-up medical data. Bone lesions dominated the findings: none of six subjects with follow-up for bone conditions lacked bone lesions clearly or potentially caused, or worsened, by plutonium. Roentgenograms of three subjects, read by a radiologist experienced reading films of radium cases, demonstrated possible to likely plutonium effects. Two cases of osteoporosis or non-specific degenerative changes were seen, associated with a hip fracture and vertebral fractures. Areas of increased bone density were seen, as well as numerous dystopic calcifications and one unusual case of widespread pathologic calcification on bone surfaces probably due to a plutonium-related calciphylactic reaction. Non-skeletal findings include labyrinthitis with inflammatory mastoid changes, conduction deafness, and a benign neurofibroma directly adjacent to bone. The radium literature contains similar observed findings, but interpretation of these limited clinical observations is hampered by lack of quantitative data on humans exposed to radium with respect to prevalence of non-specific ear, mastoid, and skeletal symptomatologies or x-ray findings, or cumulative incidence rates of bone fractures or of other physical disabilities related to ear, mastoid, or bone damage. Disability and invalidism late in life can be risk factors for earlier mortality.