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The Annals of Pharmacotherapy Feb 2008To increase awareness of the widespread environmental prevalence of the chemical warfare agent mustard gas, examine the acute and chronic toxic effects to exposed... (Review)
Review
OBJECTIVE
To increase awareness of the widespread environmental prevalence of the chemical warfare agent mustard gas, examine the acute and chronic toxic effects to exposed humans, and discuss medical treatment guidelines for mustard gas exposures.
DATA SOURCES
Literature retrieval of medical case reports and clinical studies was accomplished using PubMed and the Cochrane Database (1919-March 2007). Search terms included mustard, mustard gas, sulfur mustard, chemical warfare, blister agents, vesicants, and war gas. Historical information and current events were accessed through military field manuals and Internet searches.
STUDY SELECTION AND DATA EXTRACTION
All articles in English identified from the data sources were evaluated. Adult and pediatric populations were included in the review.
DATA SYNTHESIS
Mustard gas and other chemical weapons are feared for their use as weapons of terror; however, the major threat of mustard gas lies elsewhere. Tons of this chemical agent were produced for war, then subsequently buried in landfills, disposed of at sea, or left to decay in storage facilities. There are documented and anecdotal reports of chemical weapon burial sites and ocean dumps across the globe spanning from the Arctic Circle to Australia. Numerous accidental exposures have occurred over the past decade. Mustard gas is corrosive to the skin, eyes, and respiratory tract. Extensive exposures can also affect other organ systems. Its ability to cause harm to multiple organ systems at extremely low doses in virtually any environmental condition makes it an extremely dangerous agent. Immediate decontamination of people exposed to mustard gas liquids and vapors is paramount. Supportive care and long-term followup is necessary for exposed persons. Research is under way to find antidotes or treatment methods for mustard gas exposure, but currently there are no definitive treatment guidelines.
CONCLUSIONS
Mustard gas is a weapon, but also a prevalent environmental threat. Recognizing the immense environmental presence of mustard gas disposal sites and the signs and symptoms of exposure will help speed treatment to those accidentally or purposefully exposed.
Topics: Acute Disease; Animals; Chemical Warfare Agents; Chronic Disease; Decontamination; Environmental Exposure; Humans; Mustard Gas
PubMed: 18212254
DOI: 10.1345/aph.1K445 -
Report on Carcinogens : Carcinogen... 2011
Topics: Animals; Carcinogenicity Tests; Carcinogens, Environmental; Chemical Warfare Agents; Environmental Exposure; Humans; Mice; Molecular Structure; Mustard Gas
PubMed: 21860487
DOI: No ID Found -
Trends in Pharmacological Sciences Apr 1991The devastating effects of mustard gas were first observed in World War I. The advent of the Gulf War fueled renewed fears of further use of toxic gases in battle, with... (Review)
Review
The devastating effects of mustard gas were first observed in World War I. The advent of the Gulf War fueled renewed fears of further use of toxic gases in battle, with the possible exposure of large civilian populations--while understanding of the mechanism of action of the alkylating sulfur mustards was still quite restricted. In this article Uri Wormser discusses the structure--activity studies that are available, and the limited pharmacological measures that can be taken to protect against mustard gas attack. In addition to systemically administered sulfhydryl agents, new percutaneous preparations are being developed in the author's laboratory which offer better protection than is possible with simple adsorbant powders.
Topics: Animals; Humans; Mustard Gas
PubMed: 2063482
DOI: 10.1016/0165-6147(91)90534-y -
IARC Monographs on the Evaluation of... 1975
Review
Topics: Animals; Bronchitis; Carcinogens; Chemical Warfare; Drug Evaluation, Preclinical; Female; Humans; Lethal Dose 50; Lung Neoplasms; Male; Mice; Mice, Inbred C3H; Mustard Compounds; Mustard Gas; Neoplasms; Rats; Respiratory System
PubMed: 791832
DOI: No ID Found -
Prehospital and Disaster Medicine 2009Sulfur mustard is a member of the vesicant class of chemical warfare agents that causes blistering to the skin and mucous membranes. There is no specific antidote, and... (Review)
Review
Sulfur mustard is a member of the vesicant class of chemical warfare agents that causes blistering to the skin and mucous membranes. There is no specific antidote, and treatment consists of systematically alleviating symptoms. Historically, sulfur mustard was used extensively in inter-governmental conflicts within the trenches of Belgium and France during World War I and during the Iran-Iraq conflict. Longitudinal studies of exposed victims show that sulfur mustard causes long-term effects leading to high morbidity. Given that only a small amount of sulfur mustard is necessary to potentially cause an enormous number of casualties, disaster-planning protocol necessitates the education and training of first-line healthcare responders in the recognition, decontamination, triage, and treatment of sulfur mustard-exposed victims in a large-scale scenario.
Topics: Chemical Terrorism; Chemical Warfare Agents; Disaster Planning; History, 20th Century; Humans; Mustard Gas
PubMed: 19557954
DOI: 10.1017/s1049023x0000649x -
International Journal of Dermatology Oct 1991
Review
Topics: Chemical Warfare; Decontamination; Humans; Mustard Gas; Poisoning; Protective Clothing; Respiratory Protective Devices
PubMed: 1955218
DOI: 10.1111/j.1365-4362.1991.tb02608.x -
Survey of Ophthalmology 1997Sulfur mustard is a chemical warfare agent which was widely used during World War I and more recently in conflicts in the Middle East. This highly toxic compound causes... (Review)
Review
Sulfur mustard is a chemical warfare agent which was widely used during World War I and more recently in conflicts in the Middle East. This highly toxic compound causes severe dermal, gastrointestinal, respiratory and ocular injuries. It acts as an alkylating agent that induces structural changes and, hence, destruction of nucleic acids and proteins, impairing the cell's normal homeostasis and eventually causing its death. Sulfur mustard reacts rapidly with ocular tissues, and after a latent period of a few hours the patient starts suffering from severe eye pain, photophobia, excessive lacrimation and blindness. The injury, which is restricted to the anterior segment of the eye, may cause long-lasting incapacity in large numbers of casualties. Approximately 0.5% of the severely wounded victims may develop late complications which require prolonged ophthalmologic observation and therapy. In light of the ever-present threat of mustard chemical warfare against military and civilians, physicians worldwide should be aware of its grave effects and know how to care for its victims.
Topics: Chemical Warfare; Eye Burns; Humans; Mustard Gas
PubMed: 9220568
DOI: 10.1016/s0039-6257(97)00021-0 -
Lancet (London, England) Feb 1991
Topics: Burns, Chemical; Cough; Humans; Male; Military Personnel; Mustard Gas
PubMed: 1671450
DOI: 10.1016/0140-6736(91)91208-c -
American Journal of Ophthalmology Nov 1953
Topics: Cornea; Corneal Diseases; Humans; Mustard Gas; Mustard Plant
PubMed: 13104566
DOI: 10.1016/0002-9394(53)91787-5 -
International Journal of Clinical... Sep 1989Mustards have become an important topic of global discussion in recent years. The latest extensive reports and conference of 145 nations in Paris (January 13, 1989)... (Review)
Review
Mustards have become an important topic of global discussion in recent years. The latest extensive reports and conference of 145 nations in Paris (January 13, 1989) reveal that several countries have stockpiled large quantities of mustard gas. This situation creates an imminent danger to accidental or intentional exposure of this gas to civil populations throughout the world. In view of the sparse literature on the toxic nature of mustard gas, we have tried to present an integrated panorama of this compound and its derivatives. In this article, efforts were made to review mustard gas--its chemical nature, mode of action, methods available for its analysis in biological fluids and target organs, absorption, distribution, metabolism and excretion and its toxicity to various organs. The effects of mustard poisoning may be local, systemic, or both, depending on environmental conditions, exposed organs, and the extent and duration of exposure. The toxic effects of mustard include inhibition of mitosis, NAD depletion, decreased tissue respiration and finally cell death. Most of the toxic effects are related to alkylation of DNA. Mustards are also selective in their accumulation in fat tissue. The immediate organs affected after mustard exposure are skin, eyes, and lungs. Sulfur mustard has also been reported to be a potent carcinogen. Burns caused by mustard are severe and require long healing periods. Depending on the type and time of exposure, mustard renders persons disabled temporarily or permanently. Various antidotes such as sodium thiosulfate, dexamethasone, promethazine, heparin, vitamin E and atropine have been recommended for combating mustard poisoning. Protective clothing can substantially reduce the toxic effects of mustard exposure. The best possible way of eliminating mustard hazard is to ban its use completely.
Topics: Chemical Warfare; History, 20th Century; Humans; Mustard Compounds; Mustard Gas
PubMed: 2681003
DOI: No ID Found