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96TABLE 5.33. Respiratory Morbidity among theAdult Population of Bryansk Province in Areas witha Level of Contamination above 5 Ci/km 2 , 1995–1998 (Fetysov, 1999a: table 5.1)Territory 1995 1996 1997 1998Klymovo 195.9 211.9 259.6 326.3Novozybkov 302.3 288.9 238.0 233.1Klintsy 142.5 126.2 336.8 474.5Krasnogorsk 196.6 163.6 182.0 183.4Zlynka 192.0 230.8 298.0 309.1Gordeevka 134.0 167.6 192.0 237.0Southwest 209.2 194.5 237.6 242.2Province 197.4 168.3 199.2 192.6Russia 213.6 196.6 219.2 n/aCombined external radiation and incorporatedradionuclide effects were expressed in a newform of chronic obstructive pulmonary diseasesyndrome (Chuchalin et al., 1998).9. Prolonged persistence of radioactive particlesis associated with the appearance ofcancer-related molecular abnormalities in thebronchial epithelium of former Chernobylcleanup workers. These include: K-ras (codon12) mutation; p16 (INK4A) promoter hypermethylation;microsatellite alterations at sevenchromosomal regions; and allelic loss at 3p12,3p14.2 (FHIT), 3p21, 3p22–24 (hMLH1), and9p21 (p16INK4A). The incidence of 3p14.2allelic loss was associated with decreased expressionof the FHIT mRNA in the bronchialepithelium as compared with a control groupof smokers (Chuchalin, 2002; Chizhykov andChizhykov, 2002).10. The frequency of the chronic bronchopulmonaryillnesses in liquidators increasedsignificantly over the first 15 years after thecatastrophe, with an increase up to 10-fold forsome illnesses. The diseases developed morerapidly and were more serious (Tseloval’nykovaet al., 2003).5.5.4. ConclusionIllnesses of the upper respiratory system (nasopharynxand bronchial tubes) were the initialconsequences of Chernobyl irradiation forthe general population and the liquidators inthe first days and weeks after the catastrophe.In some years the incidence of bronchopulmonaryillnesses decreased, but the severityincreased, reflecting significant impairment ofthe immune and hormonal systems. Some 10to 15 years later, respiratory morbidity in Belarus,Ukraine, and Russia remained significantlyhigher in the contaminated territories.For children of the Japanese hibakusha whowere not irradiated directly, the incidence ofrespiratory system illnesses was higher comparedto controls some decades after the bombardments(Furitsu et al., 1992). If such anincrease is observed after a single short-termirradiation, it is possible to assume that theChernobyl irradiation will cause increased respiratorysystem illnesses over the next severalgenerations.5.6. Urogenital Tract Diseases andReproductive DisordersIrradiation directly damages the kidneys,bladder, and urinary tract, as well as the ovariesand testicles, which not only are subject to directradiation effects, but are indirectly affectedthrough hormonal disruption. These disordersin structure and function result in damage tothe reproductive process.Although there have been some studies ofthe functional changes in the urogenital tract asa consequence of Chernobyl radiation, there isstill not enough information to explain all of theserious changes. It was unexpected, for example,to find increased levels of male hormonesTABLE 5.34. Respiratory Morbidity (per 10,000) among Russian Liquidators for the First 8 Years afterthe Catastrophe (Baleva et al., 2001)Year 1986 1987 1988 1989 1990 1991 1992 1993Morbidity 645 1,770 3,730 5,630 6,390 6,950 7,010 7,110