Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-24T04:49:36.440Z Has data issue: false hasContentIssue false
  • English
  • Français

Delayed head and neck complications of sulphur mustard poisoning in Iranian veterans

Published online by Cambridge University Press:  02 July 2009

R Zojaji ,
M Balali-Mood ,
M Mirzadeh ,
A Saffari  and
M Maleki
R Zojaji*
Affiliation:
Department of Otolaryngology, Mashhad Branch, Islamic Azad University, Mashhad, Iran
M Balali-Mood
Affiliation:
Department of Medicine, Medical school, Medical Toxicology Research Centre, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
M Mirzadeh
Affiliation:
Department of Paediatrics and Internal Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
A Saffari
Affiliation:
Department of Paediatrics and Internal Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
M Maleki
Affiliation:
Department of Dermatology, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
*
Address for correspondence: Dr Ramin Zojaji, 5, 10th Hashemieh, Hashemieh Blvd, Mashhad, Iran, 9178648451. Fax: 0098 511 8828979 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Sulphur mustard is a chemical warfare agent which was used against Iranian combatants and civilians between 1983 and 1988. The purpose of this study was to document the delayed toxic effects of sulphur mustard in Iranian veterans, focussing on head and neck complications.

Patients and methods:

This was a two-year, prospective, descriptive study of 43 male Iranian veterans aged 34 to 48 years (mean 41.8 years) who were moderately disabled or worse due to sulphur mustard poisoning. Investigations were performed with consent, including haematological, biochemical and immunological tests, spirometry, chest X-ray, high resolution computed tomography of the lungs, and skin biopsies. Further investigations and interventions were performed as clinically indicated.

Results:

The most affected sites were the lungs (95 per cent), peripheral nerves (77 per cent), skin (73 per cent), eyes (68 per cent), and head and neck (16.2 per cent). Of seven patients with mostly head and neck complications, four had a skin disorder (hyperpigmentation in all four, an erythematous, papular rash in two, and dry skin in one). Two patients had thyroid cancer (undifferentiated thyroid carcinoma in one and papillary carcinoma of a thyroglossal cyst in the other, 12 and 14 years after sulphur mustard exposure, respectively). One patient had nasopharyngeal carcinoma, 12 years after sulphur mustard exposure.

Conclusion:

Carcinomas of the thyroid and nasopharynx in three patients with sulphur mustard exposure are reported for the first time.

Keywords

Chemical Warfare AgentSulphur MustardThyroglossal CystCancerHead And Neck
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 10 , October 2009 , pp. 1150 - 1154
Copyright
Copyright © JLO (1984) Limited 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Balali, M. Clinical and laboratory findings in Iranian fighters with chemical gas poisoning. Arch Belg 1984;Suppl.:254–59Google ScholarPubMed
2Pechuta, CM, Rall, DP. Chemistry of sulphur mustard. In: Pechuta, CM, Rall, DP. (eds) Veterans at Risk, the Health Effects of Mustard Gas and Lewisite. Washington DC: National Academy Press, 1993;71–80Google Scholar
3Papirmeister, B, Feister, AJ, Robinson, SI, Ford, RD. Medical Defence Against Mustard Gas: Toxic Mechanisms and Pharmacological Implications. Boca Raton, Florida: CRC Press, 1991Google Scholar
4Balali-Mood, M, Navaeian, A. Clinical and paraclinical findings in 233 patients with sulfur mustard poisoning. In: Heyndrickx, B, ed. Proceedings of the Second World Congress on New Compounds in Biological and Chemical Warfare: Toxicological Evaluation; 1986 Aug 24–27; Ghent. Ghent: Ghent University Press, 1986;464–73Google Scholar
5Balali-Mood, M, Farhoodi, M, Panjvani, FK. Report of three fatal cases of war gas poisoning. In: Heyndrickx, B, ed. Proceedings of the Second World Congress on New Compounds in Biological and Chemical Warfare: Toxicological Evaluation; 1986 Aug 24–27; Ghent. Ghent: Ghent University Press, 1986;475–82Google Scholar
6Dacre, JC, Goldman, M. Toxicology and pharmacology of the chemical warfare agent sulfur mustard. Pharmacol Rev 1996;48:289–326Google ScholarPubMed
7Ball, CR, Roberts, JJ. Estimation of interstrand DNA cross-linking resulting from mustard gas alkylation of cells. Chem Biol Interact 1972;4:2297–303CrossRefGoogle Scholar
8Balali-Mood, M. First report of delayed toxic effects of Yperite poisoning in Iranian fighters. In: Heyndrickx, B, ed. Proceedings of the Second World Congress on New Compounds in Biological and Chemical Warfare: Toxicological Evaluation; 1986 Aug 24–27; Ghent. Ghent: Ghent University Press; 1986;489–95Google Scholar
9Tabarestani, M, Balali-Mood, M, Farhoodi, M. Hematological findings of sulphur mustard poisoning in Iranian combatants. Med J Islamic Rep Iran 1990;4:185–90Google Scholar
10Balali-Mood, M, Tabarestani, M, Farhoodi, M. Clinical and laboratory findings in Iranian combatants with sulphur mustard poisoning. Medical Journal on Mashhad University of Medical Sciences 1991;34:5–12Google Scholar
11Balali-Mood, M. Evaluation of late toxic effects of sulfur mustard in 1428 Iranian veterans. In: Chemical Veterans Expert Commitee. Proceedings of the Seminar on Late Complications of Chemical Warfare Agents in Iranian Veterans, 1992; Tehran, Iran. Tehran: Tehran University Press, 1992;15–37Google Scholar
12Balali-Mood, M, Hefazi, M. Sulphur mustard – the pharmacology, toxicology and medical treatment of sulphur mustard poisoning. Fundam Clin Pharmacol 2005;19:275–315CrossRefGoogle ScholarPubMed
13Balali-Mood, M, Hefazi, M, Mahmoudi, M, Jalali, E, Attaran, D, Maleki, M et al. Evaluation of delayed toxic effects of sulfur mustard poisoning in severely intoxicated Iranian veterans: a cross-sectional study. J Med Chem Biol Radiol Def 2005;3:1–19Google Scholar
14Balali-Mood, M, Hefazi, M. The clinical toxicology of sulphur mustard. Arch Iran Med 2005;8:162–79Google Scholar
15Balali-Mood, M, Hefazi, M, Mahmoudi, M, Jalali, E, Attaran, D, Maleki, M et al. Long-term complications of sulphur mustard: poisoning in severely intoxicated Iranian veterans. Fundam Clin Pharmacol 2005;19:713–21CrossRefGoogle ScholarPubMed
16Hefazi, M, Attaran, D, Mahmoudi, M, Balali-Mood, M. Late respiratory complications of mustard gas poisoning in Iranian veterans. Inhal Toxicol 2005;17:587–92CrossRefGoogle ScholarPubMed
17Mahmoudi, M, Hefazi, M, Rasti, M, Balali-Mood, M. Long-term hematological and immunological complications of sulfur mustard poisoning in Iranian veterans. Int J Immunopharmacol 2005;5:1479–85CrossRefGoogle ScholarPubMed
18Balali-Mood, M, Hefazi, M. Comparison of early and late toxic effects of sulfur mustard in Iranian veterans. Basic Clin Pharmacol Toxicol 2006;99:273–82CrossRefGoogle ScholarPubMed
19Bijani, KH, Moghadamnia, AA. Long-term effects of chemical weapons on respiratory tract in Iraq-Iran war victims living in Babol (north of Iran). Ecotoxicol Environ Saf 2002;53:422–4CrossRefGoogle ScholarPubMed
20Calvet, JH, Jarrean, PR, Levame, M, D'Ortho, MP, Lorino, H, Harf, A et al. Acute and chronic respiratory effects of sulfur mustard intoxication in Guinea pigs. J Appl Physiol 1994;76:681–8CrossRefGoogle Scholar
21Hefazi, M, Maleki, M, Mahmoudi, M, Balali-Mood, M. Delayed complications of sulfur musatrd poisoning in the skin and the immune system of Iranian veterans 16 to 20 years after exposure. Int J Dermatol 2006;45:1025–31CrossRefGoogle ScholarPubMed
22Dabrowska, MI, Becks, LL, Lell, JL, Levee, MG, Hinshaw, DB. Sulfur mustard induces apoptosis and necrosis in endothelial cells. Toxicol Appl Pharmacol 1996;141:568–83CrossRefGoogle ScholarPubMed
23Davis, KG, Aspera, G. Exposure to liquid sulfur mustard. Ann Emerg Med 2001;37:653–6CrossRefGoogle ScholarPubMed
24Easton, DF, Peto, J, Doll, R. Cancer of the respiratory tract in mustard gas workers. Br J Ind Med 1988;45:652–9Google ScholarPubMed
25Emad, A, Rezaian, GR. The diversity of the effect of sulfur mustard gas inhalation on respiratory system 10 years after a single heavy exposure: analysis of 197 cases. Chest 1997;112:734–8CrossRefGoogle ScholarPubMed
26Fekri, AR, Janghombani, M. Late dermal complications in Iranian veterans. In: Chemical Veterans Expert Committee. Proceedings of the Seminar on Late Complications of Chemical Warfare Agents in Iranian Veterans; 1992; Tehran, Iran. Tehran: Tehran University Press, 1992;57–89Google Scholar
27Ghanei, M, Vosoghi, AA. An epidemiologic study to screen for chronic myelocytic leukemia in war victims exposed to mustard gas. Environ Health Perspect 2002;110:519–21CrossRefGoogle ScholarPubMed
28Keshmiri, M. Pulmonary cause of death from chemical warfare agents: the Halabche experience. Iranian J Med Sci 1989;14:10–19Google Scholar
29Khateri, S, Ghanei, M, Keshavarz, S, Soroush, M, Haiens, D. Incidence of lung, eye and skin lesions as late complications in 34,000 Iranians with wartime exposure to mustard agent. J Occup Environ Med 2003;452:1136–43CrossRefGoogle Scholar
30Wada, S, Nishimoto, Y, Miyanishi, M, Kambe, S, Miller, RW. Mustard gas as a cause of respiratory neoplasia in man. Lancet 1968;ii:1161–3CrossRefGoogle Scholar
31Manning, KP, Skegg, DCG, Stell, PM, Doll, R. Cancer of the larynx and other occupational hazards of mustard gas workers. Clin Otolaryngol 1981;6:165–70CrossRefGoogle ScholarPubMed
32Zojaji, R, Balali, M, Saffari, A, Ghiasi, T. Papillary carcinoma of thyroglossal duct cyst – a unique case report in a chemical warfare veteran. In: Proceedings of the 10th Asian Ocean ORL-HNS Congress; 2004 Feb; Kuala-Lumpur, Malaysia. 2004;Vol. 59, Suppl A, 199 pp.Google Scholar