Iranian patients with

Eyes are the organs that are most sensitive to SM. The first symptoms of SM exposure usually occur in the eyes. The Iranian patients with SM exposure reported itching and burning sensation of the eyes, leading to acute... 

Respiratory effects occur in a dose-dependent manner from the nasal mucosa to the terminal bronchioles (WHO, 1970 Balali-Mood et al., 1986). Acute pulmonary effects commence with a tracheobronchitis, followed by bronchopneumonia, adult respiratory distress syndrome, and even pulmonary emboli in severely intoxicated patients, which may lead to death, mostly during the second week after SM exposure. Chest X-ray (CXR) of the Iranian SM-intoxicated patients revealed fewer abnormalities than the clinical manifestations. However, the severely intoxicated patients showed abnormal CXR results. CXRs of an Iranian patient with bronchopneumonia caused by acute SM poisoning before and after treatment in 1985 are shown in Figure 5.2. 

FIGURE 5.2 Chest X-rays of an Iranian patient with bronchopneumonia due to acute SM poisoning before (right) and after (left) treatment... 

In humans the treatment of skin lesions is mostly symptomatic. Pruritus is a common problem among SM-exposed veterans. A number of treatments like antihistamines, local anesthetics, and corticosteroids are prescribed in order to control pruritus in Iranian patients. When Unna s Boot (a gauze bandage impregnated with glycerine, zinc oxide, and calamine lotion) and betamethasone were compared for the treatment of pruritis, Unna s Boot showed better results (Shohrati et al, 2007a). SM-induced pruritis in chemical warfare-injured veterans was treated with phenol (1%) and menthol (1%), and this combination significantly reduced the pruritis in comparison to placebo (Panahi et al, 2007). 

TDG + TOGO (3-Lyase metabolites Hb-valine adduct Hb-histidine adduct Iranian CW (5) 5-10 days 27-69 ng/ml (3/3) 0.5-5 ng/ml (4/5) 220 ng/ml (1/5) 0.3-0.8 ng/ml (4/4) 0.7-2.5 ng/ml Believed to include samples from some of the casualties above Patient with 220 ng/ml died (Black and Read, 1995a) Calculated on the basis of released amino acid adduct. Control <0.15 ng/ml Control < 0.3 ng/ml (Black et al., 1997a)... 

The most widespread and most open use of chemical weapons on a battlefield in recent decades was by Iraq in its conflict with Iran. This time the evidence of chemical use was conclusive. Undetonated shells were sampled and their contents were analyzed by several laboratories in Europe. A vesicant or blister agent (mustard) and a nerve agent (tabun) were identified. About 100 Iranian soldiers with chemical wounds were sent to European hospitals for care their wounds were consistent with vesicant (mustard) injury. A team appointed by the U.N. secretariat went to Iranian battlefields and hospitals and found chemical shells and patients with chemical injuries. The public outcry at the use of these weapons was less than overwhelming. Ignoring protests from the world community, Iraq continued to use these agents. 

A decrease of cell-mediated immunity has been observed in Iranian veterans 1,2, and 3 years after exposure (Zandieh et al., 1990). Natural killer (NK) cells, wWch are known to be one of the most important components of cellular immimity, have been found to be significantly lower in patients with severe respiratory complications 10 years after exposure (Ghotbi and Hassan, 2002). 

Electromyography (EMG) and nerve conduction velocity (NCV) of 40 Iranian veterans with severe late manifestations of SM poisoning revealed abnormalities in the peripheral nervous system of 77.5% of the patients. NCV disturbances were more common in sensory nerves compared with motor nerves and were more prevalent in the lower extremities than in the upper extremities. EMG recordings revealed a normal pattern in 24 (60%) patients, incomplete interference with normal amplitude in 6 (15%) patients, and incomplete interference with low amplitude in 10 (25%) patients. NCV and EMG disturbances in both upper and lower extremities were... 

Study of tissue samples from lungs of Iranian casualties who died as a result of exposure to mustard gas has revealed a pattern identical with that described above. In all, tissue from four patients was studied. Alveolar capillary congestion, haemorrhage, oedema, the formation of hyaline membranes and fibrosis were seen. The casualties died as a result of multi-system organ failure and the changes in the lung parenchyma were very similar to those seen in cases of Adult Respiratory Distress Syndrome (ARDS) (Maynard, unpublished observations). 

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