RESUMEN
The full-scale invasion of Ukraine by Russian military forces on 24 February 2022 put the radiological well-being of the people in Ukraine under unprecedented threat. Apart from the risks linked to operating nuclear power plants, there was substantial evidence of looting of facilities of all kinds, including those holding radioactive materials, as well as the scope for physical disturbance of radioactively contaminated areas and waste storage facilities. The actions of Russian military personnel invading Ukraine through the territory of the Chornobyl Exclusion Zone (the ChEZ) were of serious concern. Before its shutdown a few days after the beginning of the occupation, the automated radiation monitoring system of the ChEZ recorded sharp increases in the gamma-background in several areas which indicated some non-typical processes taking place on its territory. The State Nuclear Regulatory Inspectorate of Ukraine (SNRIU) and its technical support organisation, the Scientific and Technical Centre for Nuclear and Radiation Safety (SSTC NRS), as well as the rest of the professional nuclear community in Ukraine and worldwide, recognised the potential for movement of the radioactive contamination (reaching 101-104kBq m-2Cs-137 in the most of the territory) by the Russian military machinery and personnel to areas outside the ChEZ, creating locally contaminated spots along the routes taken by the invaders towards Kyiv. Certain apprehensions were caused by the inventory carried out after the liberation of the ChEZ which revealed the theft of calibration sources and radioactive samples from laboratories located in Chornobyl. As soon as this information became available to the public, it caused a wide response and anxiety, as a result of which SNRIU made a decision to conduct a radiation survey of the liberated territories in the Kyiv region. The survey was conducted between June and December 2022 by SSTC NRS specialists with the support of DSA. The scope of the survey was limited by available time and resources; however, the total route of the survey was about 840 km, and covered more than 50 settlements and a limited part of the ChEZ. The radiation survey combined the continuous gamma-dose rate measurements by the detectors installed in the laboratory vehicle and additional manual measurements at specified points. As a result of the radiation survey, no deterioration of the radiation situation was observed in the liberated territories. No contaminated objects, radiation sources, or other radioactive material removed from the ChEZ were found either. Measurements of the Cs-137 soil contamination in the ChEZ, although limited, corresponded to the results which had been obtained before the war. It can be concluded that in the surveyed territories, the direct impact on the public in the form of additional radioactive contamination removed from the ChEZ in February-March 2022 was negligible. The same applies to the radiation consequences of forest fires that occurred in the ChEZ during its occupation. However, due to the damage of the radiation monitoring system, explosive hazard, and destruction of transport infrastructure, the consequences of the occupation of the ChEZ by Russian troops will be long-term.
Asunto(s)
Accidente Nuclear de Chernóbil , Personal Militar , Exposición a la Radiación , Humanos , Radioisótopos de Cesio/análisis , Ucrania , Ocupaciones , Exposición a la Radiación/análisisRESUMEN
PURPOSE OF THE STUDY: Available studies on Scarf osteotomies of the first metatarsal (M1) and first phalange (P1) shortening and varus displacement have reported good results, but have have not focused on complications. We reviewed a consecutive series of 475 feet operated on over a five year period. Our goal was to determine the incidence of complications and to compare our data with reports in the literature. We wanted to know if association with Weil osteotomy on the lateral metatarsals affects the rate of complications. MATERIAL AND METHODS: We used the following inclusion criteria: hallux valgus>35 degrees, adult subject, with or without impact on the lateral ray, no prior foot surgery, no systemic disease, no other co-morbid condition. We distinguished two groups: group 1 with isolated first ray disease, and group 2 with hallux valgus and lateral metatarsalgia requiring surgery. RESULTS: We determined the incidence of each complication. Metatarso-phalangeal joint (MTP1) stiffness was the most frequent complication: incidence declined with postoperative time: 41.7% at day 35, 5.7% at day 120. The joint was very stiff with defective pulp weight-bearing in 1.3% of the feet at 12 months. Late wound healing was observed in 5.7% of feet and secondary osteotomy displacement in 1%. Incidence of other complications, including operative site infection, was less than 1%. General complications were: reflex dystrophy (1.3%) and deep vein thrombosis (0.6%). Excepting a longer period of postoperative stiffness, we were unable to identify any change in the rate of postoperative complications in feet with an associated Weil osteotomy of the first ray. DISCUSSION: Our findings confirm that Scarf M1 osteotomies with varus shortening of P1 generates fewer complications than the techniques used earlier. Certain complications have disappeared: nonunion after M1 and P1 osteotomy, great toe claw, symptomatic iatrogenic hallux valgus. Complications with a very low incidence in all series are: operative site infection, osteonecrosis of the M1 head, fracture of M1 at weight bearing. Notching of the two osteotomy pieces with elevation of the metatarsal head and transfer metatarsalgia has been reported by authors using short diaphyseal osteotomies. A stiff MTP1 remains the most frequent complication. Overtly stiff joints (30% loss of range of motion) were observed in 4.6% of our patients at 12 months; 1.3% had major stiffness (20 degrees extension, 0 degrees plantar flexion). This stiffness has been reported by others using the same technique but the risk factors have not been identified. CONCLUSION: This prospective work enabled us to establish the rate of secondary complications of first ray surgery for M1 Scarf osteo-tomy and P1 osteotomy. Complications are rare, a further argument favoring use of these osteotomies. This statistical study enables us discuss the risk of complications at the preoperative interview, keeping in mind the specific elements inherent in each particular situation.