The clinical toxicology of sulfur mustard

Archives of Iranian Medicine

Volumn 8, Issue 3, 2005, Pages 162-179

  Balali Mood, Mahdi ^a   Hefazi, Mehrdad ^a  

^a MASHHAD UNIVERSITY OF MEDICAL SCIENCES   (Iran)

Author keywords

Chemical warfare agents; Mustard gas; Poisoning; Sulfur mustard; Toxic effects; Toxic exposure

Indexed keywords

ALPHA TOCOPHEROL; AZATHIOPRINE; BARBITURIC ACID DERIVATIVE; BECLOMETASONE; CALAMINE; CELL PROTEIN; CITRATE SODIUM; CORTICOSTEROID; CYSTINE; DEXAMETHASONE; HEPARIN; IPRATROPIUM BROMIDE; MAFENIDE; MORPHINE; MUSTARD GAS; MYDRIATIC AGENT; NICOTINAMIDE ADENINE DINUCLEOTIDE; NUCLEIC ACID; PARACETAMOL; PROMETHAZINE; SALBUTAMOL; SODIUM THIOSULFATE; STEROID; SULFADIAZINE SILVER; TOSYLCHLORAMIDE SODIUM;

AIRWAY OBSTRUCTION; ANXIETY DISORDER; ARMY; ASTHMA; BONE MARROW TOXICITY; BRONCHIECTASIS; CARCINOGENICITY; CELL DEATH; CELLULAR IMMUNITY; CHEMICAL WARFARE; CHRONIC BRONCHITIS; CHRONIC PAIN; DETOXIFICATION; DIAGNOSTIC PROCEDURE; DNA DETERMINATION; DRUG DOSE REGIMEN; ENVIRONMENTAL EXPOSURE; EYE TOXICITY; FEMALE FERTILITY; GAS POISONING; GASTROINTESTINAL TOXICITY; HOMEOSTASIS; HUMAN; INFECTION; IRAN; IRAQ; KERATITIS; LETHAL DOSE; LUNG FIBROSIS; LUNG TOXICITY; MALE FERTILITY; MOOD DISORDER; MUCOSA CELL; NONHUMAN; OCCUPATIONAL EXPOSURE; PERIPHERAL NEUROPATHY; PHYSICAL CHEMISTRY; POSTTRAUMATIC STRESS DISORDER; PROTEIN DETERMINATION; REVIEW; SEDATION; SKIN TOXICITY; SYNTHESIS; TERRORISM; TOXICITY TESTING;

EID: 21344444356     PISSN: 10292977     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (148)

1. Okumura T, Takasu N, Ishimatsu S, et al. Report of 640 victims of the Tokyo subway sarin attack. Annals Emerg Med. 1996; 28: 129-136.
2. World Health Organization. Health Aspects of Chemical and Biological Weapons. New York: World Health Organization; 1970.
3. United Nations Security Council. Report of the mission dispatched by the Secretary General to investigate allegations of the use of chemical weapons in the conflict between the Islamic Republic of Iran and Iraq. April 25, 1988. S/19823 and S/19823/Addendum 1. 1988. New York, USA, United Nations.
4. Carnes SA, Watson AP. Disposing of the U.S. chemical weapons stockpile: an approaching reality. J Am Med Assoc. 1989; 262: 653-659.
5. Alexander SF. Medical report of the Bari Harbor mustard casualties. Mil Surg. 1947; 101: 1-17.
6. Stockholm International Peace Research Institute (SIPRI). The Problem of Chemical and Biological Warfare: A Study of the Historical, Technical, Military, Legal, and Political Aspects of Chemical and Biological Warfare and Possible Disarmament Measure. Stockholm, Sweden: Almgvist and Wiskell International; 1971.
7. United Nations Security Council. Report of the mission dispatched by the Secretary General to investigate allegations of the use of chemical weapons in the conflict between the Islamic Republic of Iran and Iraq. July 25, 1988. S/20063 and S/20063/Addendum 1. 1988. New York, USA, United Nations.
8. Marrs TC, Maynard RL, Sidell FR. Chemical Warfare Agents: Toxicology and Treatment. Chichester, UK: John Wiley and Sons; 1996.
9. Somani SM. Chemical Warfare Agents. New York, USA: Academic Press; 1992.
10. Renshaw B. Mechanisms in Production of Cutaneous Injuries by Sulfur and Nitrogen Mustards, in: Division 9, National Defense Research Committee, Comp. Chemical Warfare Agents and Related Chemical Problems. Washington, DC, USA: Office of Scientific Research and Development: 1946.
11. Cullumbine H. Medical aspects of mustard gas poisoning. Nature. 1947; 159: 151-153.
12. Cameron GR, Carleton HM, Shhort RHD. Pathological changes induced by Lewisite and allied compounds. J Pathol Bacteriol. 1946; 58: 411-422.
13. Ball CR, Robert JJ. Estimation of interstrand DNA cross-linking resulting from mustard gas alkylation of HeLa cells. Chem Biol Interact. 1972; 4: 2297-2303.
14. Walker IG. Interstrand bifunctional alkylation of DNA in mammalian cells treated with mustard gas. Can J Biochem. 1971; 49: 332-336.
15. Crathorn AR, Robert JJ. Mechanism of cytotoxic action of alkylating agents in mammalian cells and evidence for the removal of alkylated groups from deoxyribonucleic acid. Nature. 1966; 211: 150-153.
16. Wheeler GP. Studies related to the mechanisms of cytotoxic alkylating agents: a review. Cancer Res. 1962; 22: 651-688.
17. Rankin PW, Jacobson MK, Mitchell VR, Busbee DL. Reduction of nicotinamide adenine dinucleotide levels by ultimate carcinogens in human lymphocytes. Cancer Res. 1980; 40: 1803-1807.
18. Eklow L, Moldeus P, Orrenius S. Oidation of glutathione during hydroperoxide metabolism: a study using isolated hepatocytes and glutathione reductase inhibitor 1, 3-bis(2-chloroethyl)-1-nitrosurea. Eur J Biochem. 2004; 138: 459-463.
19. Maynard RL. Chemical warfare agents. In: Ballantyne B, Marrs T, Turner P, eds. General and Applied Toxicology. London, UK: MacMillan Press Ltd; 1995: 1123-1156.
20. Balali-Mood M, Navaeian A. Clinical and paraclinical findings in 233 patients with sulfur mustard poisoning. In: Heyndrickx A, ed. Proceedings of the Second World Congress on New Compounds in Biological and Chemical Warfare. Ghent, Belgium: Rijksuniversiteit; 1986: 464-473.
21. Maynard RL, Meredith TJ, Marrs TC, Vale JA. Management of chemical warfare injuries (Letter). Lancet. 1991; 337: 122.
22. World Health Organization. Chemical agents. In: Perry-Robinson JP, ed. Public Health Response to Biological and Chemical Weapons. 2nd ed. Geneva, Switzerland: World Health Organization; 2004: 164-701.
23. Dacre JC, Goldman M. Toxicology and pharmacology of the chemical warfare agent sulfur mustard. Pharmacol Rev. 1996; 48: 289-326.
24. Papirmeister B, Feister AJ, Robinson SI. Medical Defense against Mustard Gas: Toxic Mechanisms and Pharmacological Implications. Boca Raton, USA: CRC Press; 1991.
25. McNamara BP, Owens EJ, Christensen MK, Vocci FJ, Ford DF, Rozimarek H. Toxicological Basis for Controlling Levels of Mustard in the Environment. EB-SP-74030. U.S. Army Armament Command. Biomedical Laboratory, Edgwood Arsenal, Aberdeen, USA: Aberdeen Providing Ground; 1975.
26. Sidell FR. Clinical Notes on Chemical Casualties Care, USAARMICD Technical Memorandum. U.S. Army Medical Research Institute of Chemical Defense. Aberdeen, USA: Aberdeen Providing Ground; 1990.
27. Sidell FR, Hurst CG. Clinical considerations in mustard gas poisoning. In: Somani SM, ed. Chemical Warfare Agents. San Diego, USA: Academic Press; 1992.
28. Stepanov AA, Popov VN. Chemical Weapons and Principles of Antichemical Defense. Translated by Joint Publication Research Service. JPRS 15107. Washington, DC, USA: JPRS; 1962.
29. Mandel M, Gibson WS. Clinical manifestations and treatment of gas poisoning. J Am Med Assoc. 1917; 69: 1970-1971.
30. Pickard HL. Ocular action of dichloroethyl sulfide (mustard gas). Am J Ophthalmol. 1919; 3: 136.
31. Gates M, Moore S. Mustard gas and other sulfur mustards, in: Division 9, National Defense Research Committee. Chemical Warfare Aagents and Related Chemical Problems. Washington, DC, USA: Office of Scientific Research and Development; 1946: 30-58.
32. Warthin AS, Weller CV, Herrman GR. The ocular lesions produced by dichloroethyl sulfide (mustard gas). J Lab Clin Med. 1918; 4: 785-832.
33. Balali-Mood M. Clinical and laboratory findings in Iranian fighters with chemical gas poisoning. In: Heyndrickx A, ed. Proceedings of the First World Congress on New Compounds in Biological and Chemical Warfare. Ghent, Belgium: Rijksuniversiteit; 1984: 254-259.
34. Dahl H, Gluud B, Vangested P, Norn M. Eye lesions induced by mustard gas. Acta Ophthalmol. 1985; 173 (suppl): S30-S81.
35. Geerates WJ, Abedi S, Blanke RV. Acute corneal injury by mustard gas. South Med J. 1977; 70: 348-351.
36. Khakshoor A. Ocular injuries of sulfur mustard gas. The First International Medical Congress on Chemical Warfare Agents in Iran. Mashhad, Iran: Mashhad University of Medical Sciences; June 13-16, 1988: No. 36.
37. Mann I, Oirie A, Pulliniger BD. An experimental and clinical study of the reaction of the anterior segment of the eye to chemical injury, with special references to chemical warfare agents. Br J Ophthalmol. 1948; Monograph Supplement XIII.
38. Giraud H. The first symptoms of intoxication from mustard gas. J Med Chir Prat. 1917; 88: 890-894.
39. Warthin AS, Weller CV. The lesions of the respiratory and gastrointestinal tracts produced by mustard gas (dichloroethyl sulfide). J Lab Clin Med. 1919; 4: 229-264.
40. Willems JL. Clinical management of mustard gas casualties. Ann Med Mil Belg. 1989; 3: S1-S61.
41. Sohrabpour H. Clinical manifestations of chemical agents on Iranian combatants during the Iran-Iraq conflict. In: Heyndrickx A, ed. Proceedings of the First World Congress on New Compounds in Biological and Chemical Warfare. Ghent, Belgium: Rijksuniversiteit; 1984: 291-297.
42. Freitage L, Firusian N, Stamatis G, Grescheuchua D. The role of bronchoscopy in pulmonary complications due to mustard gas inhalation. Chest. 1991; 100: 1436-1441.
43. Balali-Mood M, Farhoodi M, Panjvani FK. Report of three fatal cases of war gas poisoning. In: Heyndrickx A, ed. Proceedings of the Second World Congress on New Compounds in Biological and Chemical Warfare. Ghent, Belgium: Rijksuniversiteit; 1986: 475-482.
44. Hosseini K, Moradi A, Vessal K. Pulmonary manifestations of mustard gas injury: a review of 61 cases. Iran J Med Sci. 1989; 14: 20-26.
45. Keshmiri M. Pulmonary cause of death from chemical warfare agents: the Halabche experience. Iran J Med Sci. 1989; 14: 10-19.
46. Momeni A, Enshaeih S, Meghadi M, Amindjavaheri M. Skin manifestations of mustard gas: a clinical study of 535 patients exposed to mustard gas. Arch Dermatol. 1992; 128: 1207-1213.
47. Smith WJ, Dunn MA. Medical defense against blistering chemical warfare agents. Arch Dermatol. 1991; 127: 1207-1213.
48. Smith HW, Clowes GA, Marshal JV. On dichloroethyl sulfide (mustard gas). IV. The mechanism of absorption by the skin. J Pharmacol Exp Ther. 1919; 13: 1-30.
49. Mellor SG, Rice P, Cooper GJ. Vesicant burns. Br J Plast Surg. 1991; 44: 434-437.
50. Karalliedde L, Wheeler H, Maclehose R, Murray V. Possible immediate and long-term health effects following exposure to chemical agents. Public Health. 2000; 114: 238-248.
51. Helm UK, Balali-Mood M. Cutaneous lesions produced by sulfur mustard. The First International Medical Congress on Chemical Warfare Agents in Iran. Mashhad, Iran: Mashhad University of Medical Sciences; June 13-16, 1988: No. 90.
52. Vedder EB. The Medical Aspects of Chemical Warfare. Baltimore, USA: Williams and Wilkins; 1925.
53. Warthin AS, Weller CV. The Medical Aspects of Mustard Gas Poisoning. London, UK: Henry Kimpton; 1919.
54. Chiesman WE. Diagnosis and treatment of lesions due to vesicants. Br Med J 1944; 2: 109-112.
55. Balali-Mood M, Tabarestani M, Farhoodi M, Panjvani FK. Study of clinical and laboratory findings of sulfur mustard in 329 war victims. Med J IR Iran. 1991; 34: 7-15.
56. Tabarestani M, Balali-Mood M, Farhoodi M. Hematological findings of sulfur mustard poisoning in Iranian combatants. Med J IR Iran. 1990; 4: 190.
57. Anslow WP, Houk CR. Systemic pharmacology and pathology of sulfur and nitrogen mustards. In: Anslow WP, Houk CR, eds. Chemical Warfare Agents and Related Chemical Problems. Washington, DC, USA: National Defense Research Committee; 1946: 440-478.
58. Tabarestani M, Farhoudi M, Balali-Mood M. Stem cell and erythroid precursors disorders in three patients with sulfur mustard poisoning. The First International Medical Congress on Chemical Warfare Agents in Iran. Mashhad, Iran: Mashhad University of Medical Sciences; June 13-16, 1988: No. 10.
59. Kumar PVN, Tabei SZ, Sotoodeh M. Aplastic anemia in chemical warfare injury patients. The First International Medical Congress on Chemical Warfare Agents in Iran. Mashhad, Iran: Mashhad University of Medical Sciences; June 13-16, 1988: No. 11.
60. Graef I, Karnofsky DA, Jaeger V, Krichesky B, Smith HW. The clinical and pathologic effects of the nitrogen and sulfur mustards in laboratory animals. Am J Pathol. 1948; 24: 1-47.
61. Canelli AF. Contrbuto alia conoscenza dell' intossicazione acuta da "Yperite" ed in particolare del suo reperto anatomo-patologico. Rivista Ospedaliera Italiana. 1918; 8: 2-7.
62. Balali-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. Ghent, Belgium: Rijksuniversiteit; 1986: 489-495.
63. Shirazi SF, Balali-Mood M. Comparison of early and late toxic effects of sulfur mustard poisoning in a two-year period. The First International Medical Congress on Chemical Warfare Agents in Iran. Mashhad, Iran: Mashhad University of Medical Sciences; June 13-16, 1988: No. 73.
64. Khateri S, Ghanei M, Keshavarz S, Soroush M. 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; 45: 1136-1143.
65. Balali-Mood M, Hefazi M, Mahmoudi M, et al. Evaluation of delayed toxic effects of sulfur mustard poisoning in severely intoxicated Iranian veterans. J Med CB R Def. 2005: 3. Available from: URL: http://www.JMedChemDef.org/issue_0301/Balali-Mood_0405.html.
66. Afshinniaz F, Ghanei M. Relationship of the chronic respiratory symptoms with spirometric and laboratory parameters. (Dissertation). Isfahan University of Medical Sciences: Isfahan, Iran; 1995.
67. Sandall TE. The later effects of gas poisoning. Lancet 1992; 2: 857-859.
68. Ghanei M, Fathi H, Mohammad MM, Aslani J, Nematizadeh F. Long-term respiratory disorders of claimers with subclinical exposure to chemical warfare agents. Inhal Toxicol. 2004; 16: 491-495.
69. Bijani KH, Moghadamnia AA. Long-term effects of chemical weapons on respiratory tract in the Iran-Iraq war victims living in Babol (North of Iran). Ecotoxicol Environ Saf. 2002; 53: 422-424.
70. Bagheri MH, Hosseini SK, Mostafavi SH, Alavi SA. High-resolution CT in chronic pulmonary changes after mustard gas exposure. Acta Radiol. 2003; 44:: 241-245.
71. Emad A, Rezaian GR. The diversity of effects of sulfur mustard gas inhalation on respiratory system 10 years after a single heavy exposure: analysis of 197 cases. Chest. 1997; 112: 734-738.
72. Gilchrist HL, Matz PB. Residual Effects of Warfare Gases. Washington, DC, USA: U.S. Government Printing Office; 1933.
73. Somani SM, Babu SR. Toxicodynamics of sulfur mustard. Int J Clin Pharmacol Ther Toxicol. 1989; 27: 419-435.
74. Balali-Mood M. Evaluation of late toxic effects of sulfur mustard poisoning in 1428 Iranian veterans. The Seminar on Late Complications of Chemical Warfare Agents in Iranian Veterans. Tehran, Iran: Veteran Foundation; 1992; 15-37.
75. Hosseini K. Development of bronchiectasis, a late sequel of mustard gas exposure. Iran J Med Sci. 1998; 23: 81-84.
76. Ghanei M, Mokhtari M, Mohammad MM, Aslani J. Bronchiolitis obliterans following exposure to sulfur mustard: chest high-resolution computed tomography. Eur J Radiol. 2004; 52: 164-169.
77. Ghanei M, Akhlaghpoor A, Mohammad MM, Aslani J. Tracheobronchial stenosis following mustard gas inhalation. Inhal Toxicol. 2004; 16: 845-849.
78. Aslani J. Late respiratory complications of sulfur mustard. In: Cheraghali AM, ed. Prevention and Treatment of Complications of Chemical Warfare Agents. Tehran, Iran: Chemical Warfare Research Center; 2000: 76-79.
79. Aghanouri R, Ghanei M, Aslani J, Keivani-Amine H, Rastegar F, Karkhane A. Fibrogenic cytokine levels in bronchoalveolar lavage aspirates 15 years after exposure to sulfur mustard. Am J Physiol Lung Cell Mol Physiol. 2004; 287: L1160-L1164.
80. Emad A, Rezaian GR. Immunoglobulins and cellular constituents of the BAL fluid of patients with sulfur mustard gas-induced pulmonary fibrosis. Chest 199; 115: 1346-1351.
81. Samieepour M, Ghanei M. Evaluation of the relationship between cytotoxic and pathologic findings in chemical warfare-injured veterans. (Dissertation). Fatemieh University of Medical Sciences: Ghom, Iran; 2001.
82. Sohrabpour H. Evaluation of late toxic effects of sulfur mustard poisoning with electron microscopy of lung biopsies. (Dissertation). 1992. Shaheed Beheshti University of Medical Sciences: Tehran, Iran; 1992.
83. Easton D, Peto J, Doll R. Cancers of the respiratory tract in mustard gas workers. Br J Ind Med. 1988; 45: 652-659.
84. Nishimoto Y, Burrows B, Miyanishi M, Katsuta S, Shigenobu T, Kettel LJ. Chronic obstructive lung disease in Japanese poison gas workers. Am Rev Respir Dis. 1970; 102: 173-179.
85. Brown EC. Pulmonary effects following chronic exposure to HS vapor. In: Medical Division Report No. 187. Washington, DC, USA: U.S. Army Chemical Center; 1949: 1-31.
86. Warthin AS, Weller CV. The pathology of skin lesions produced by mustard gas (dichloroethyl sulfide). J Lab Clin Med. 1918; 3: 447-479.
87. Fekri AR, Janghorbani M. Late cutaneous complications in Iranian veterans. The Seminar on Late Complications of Chemical Warfare Agents in Iranian Veterans. Tehran, Iran: Veteran Foundation; 1992: 57-89.
88. Khehr NW. Late manifestations in former mustard gas workers with special consideration of the cutaneous findings. Zeitschrift fur Hautkrankheiten. 1984; 59: 1161-1170.
89. Wada S, Nishimoto Y, Miyanishi M, Katsuta S, Nishiki M. Review of Okuno-Jima poison gas factory regarding occupational environment. Hiroshima J Med Sci. 1962; 11: 75-80.
90. Inada S, Hiragun K, Seo K, Yamura T. Multiple Bowen's disease observed in former workers of a poison gas factory in Japan with special references to mustard gas exposure. J Dermatol. 1978; 5: 49-60.
91. Blodi FC. Mustard gas keratopathy. Int Ophthalmol Clin. 1971; 2: 1-13.
92. English F, Benett Y. The challenge of mustard gas keratopathy. Med J Austr. 1990; 152: 55-56.
93. Hughes WF. Mustard gas injuries to the eyes. Arch Ophthalmol. 1942; 27: 582-601.
94. Pleyer U, Sherif Z, Baatz H, Hartmann C. Delayed mustard gas keratopathy: clinical findings and confocal microscopy. Am J Ophthalmol. 1999; 128: 506-507.
95. Javadi MA, Kazemi-Moghadam M. Ocular effects of sulfur mustard poisoning. In: Cheraghali AM, ed. Prevention and Treatment of Complications of Chemical Warfare Agents. Tehran, Iran: Chemical Warfare Research Center; 2000: 82-101.
96. Solberg Y, Alcalay M, Belkin M. Ocular injury by mustard gas. Surv Ophthalmol. 1997; 41: 461-466.
97. Krumbhaar EB, Krumbhaar HD. The blood and bone marrow in yellow cross gas (mustard gas) poisoning. J Med Res. 1919; 40: 497-506.
98. Dayhimi I, Bahar K, Eliasy H. The effect of sulfur mustard gas (SMG) on the immune system. The First International Medical Congress on Chemical Warfare Agents in Iran. Mashhad, Iran: Mashhad University of Medical Sciences; June 13-16, 1988: No. 12.
99. Razavi SM, Mahmoudi M, Keyhani A, Eslami MB, Eftekhar B. Study of some components of complement system in Iranian combatants poisoned with mustard gas. The First International Medical Congress on Chemical Warfare Agents in Iran. Mashhad, Iran: Mashhad University of Medical Sciences; June 13-16, 1988: No. 58.
100. Hassan ZM, Ebtekar M. Immunological consequences of sulfur mustard exposure. Immunol Lett. 2002; 83: 151-153.
101. Zandieh T, Marzaban S, Tarabadi F, Ansari H. Defects of cell-mediated immunity in mustard gas injury after years. (Abstract). Scan J Immunol. 1990; 32: 423.
102. Ghotbi L, Hassan Z. The immunostatus of natural killer cells in people exposed to sulfur mustard. Int Immunopharmacol. 2002; 2: 981-985.
103. Yokogama MW. Recognition of natural killer cells. Curr Opin Immunol. 1993; 5: 67-73.
104. Pechuta CM, Rall DP. Relationship of mustard agent and Lewisite exposure to carcinogenesis. In: Pechuta CM, Rall DP, eds. Veterans at Risk, the Health Effects of Mustard Gas and Lewisite. Washington DC, USA: National Academy Press; 1993: 81-111.
105. Wada S, Nishimoto Y, Miyanishi M, Kambe S, Miller RW. Mustard gas: a cause of respiratory neoplasia in man. Lancet. 1968; 2: 1161-1163.
106. Manning KP, Kegg DCG, Stell PM, Doll R. Cancer of the larynx and other occupational hazards of mustard gas workers. Clin Otolaryngol. 1981; 6: 165-170.
107. Beebe G. Lung cancer in World War I veterans: possible relation to mustard gas injury and 1918 influenza epidemic. J Natl Cancer Inst. 1960; 25: 1231-1252.
108. Case RM, Lea AJ. Mustard gas poisoning, chronic bronchitis, and lung cancer: an investigation into the possibility that poisoning by mustard gas in the 1914-1918 war might be a factor in the production of neoplasia. Br J Prev Soc Med. 1955; 9: 62-72.
109. Ghanei M, Vosoghi AA. An epidemiologic study to screen for chronic myelocytic leukemia in war victims exposed to mustard gas. Environ Health Prespect. 2002; 110: 519-521.
110. Zakeripanah M. Hematological malignancies in chemical war victims. The 5th Seminar on Study of Chronic Effects of Chemical War Gases on Veterans. Tehran, Iran: Tehran University Press; 1991.
111. Sasser LB, Cushing JA, Dacre JC. Two-generation reproduction study of sulfur mustard in rats. Reprod Toxicol. 1996; 10: 311-319.
112. Azizi F, Keshavarz A, Roshanzamir F, Nafarabadi M. Reproductive function in men following exposure to chemical warfare with sulfur mustard. Med War. 1995; 11: 34-44.
113. Ghanei M, Rajaee M, Khateri S, Alaeddini F, Haines D. Assessment of fertility among mustard-exposed residents of Sardasht, Iran. Reprod Toxicol. 2004; 18: 635-639.
114. Hellman U. Catamnestic studies of persons injured with Blister gas with special consideration of psychiatric late and permanent injuries. (Dissertation). University of Marburg: Germany; 1970.
115. Lohs K. Delayed Toxic Effects of Chemical Warfare Agents. Stockholm, Sweden: Almqvist and Wilksell International; 1975.
116. Tabatabaee SM. Study of psychiatric complications of poisoning with chemical warfare agents. The First International Medical Congress on Chemical Warfare Agents in Iran. Mashhad, Iran: Mashhad University of Medical Sciences; June 13-16, 1988: No. 66.
117. Balali-Mood M, Moodi JR. Report of the third study on late toxic effects of sulfur mustard poisoning. The First International Medical Congress on Chemical Warfare Agents in Iran. Mashhad, Iran: Mashhad University of Medical Sciences; June 13-16; 1988: No. 65.
118. Thomsen AB, Erkisen Y, Smidt-Nielsen K. Chronic neuropathic symptoms after exposure to mustard gas: a long-term investigation. J Am Acad Dermatol. 1988; 39: 187-190.
119. Black RM, Brewsterk K, Clarke RJ, Hambrook JL, Harrison JM, Howells DJ. Biological fate of sulfur mustard, 1,1′-thiobis(2-chloroethane): isolation and identification of urinary metabolites following intraperitoneal administration to rat. Xenobiotica. 1992; 22: 405-418.
120. Black RM, Read RW. Biological fate of sulfur mustard, 1,1′-thiobis(2-chloroethane): identification of β-lyase metabolites and hydrolysis products in human urine. Xenobiotica. 1995; 25: 167-173.
121. Wils ERJ, Hulst AJ, De Jong AL, Verwij A, Boter HL. Analysis of thiodiglycol in urine of victims of an alleged attack with mustard gas. J Anal Toxicol. 1985; 9: 254-257.
122. Wils ERJ, Hulst AJ, van Laar J. Analysis of thiodiglycol in urine of victims of an alleged attack with mustard gas, part II. J Anal Toxicol. 1988; 12: 15-19.
123. Black RM, Read RW. Detection of trace levels of thiodiglycol in blood, plasma, and urine using gas chromatography electron capture negative ion chemical ionization mass spectrometry. J Chromatogr. 1988; 449: 261-270.
124. Black RM, Read RW. Improved methodology for the detection and quantitation of urinary metabolites of sulfur mustard using gas chromatography tandem mass spectrometry. J Chromatogr Biomed Appl. 1995; 665: 97-105.
125. Fidder A, Moes GWH, Scheffer AG, et al. Synthesis, characterization, and quantification of the major adducts formed between sulfur mustard and DNA of calf thymus and human blood. Chem Res Toxicol. 2005; 7: 199-204.
126. Fidder A, Noort D, De Jong LPA, Benschop HP, Hulst AJ. N7-(2-hydroxyethylthioethyl)-guanine: a novel urinary metabolite following exposure to sulfur mustard. Arch Toxicol. 1996; 70: 854-855.
127. van der Schans GP, Scheffer AG, Mars-Groenendijk RH, Fidder A, Benschop HP, Baan RA. Immunochemical detection of adducts of sulfur mustard to DNA of calf thymus and human white blood cells. Chem Res Toxicol. 1994; 7: 408-413.
128. Benschop HP, van der Schans GP, Noort D, Fidder A, Mars-Groenendijk RH, De Jong LPA. Verification of exposure to sulfur mustard in two casualties of the Iran-Iraq conflict. J Anal Toxicol. 1997; 21: 249-251.
129. Langenberg JP, van der Schans GP, Spruit HE, et al. Toxicokinetics of sulfur mustard and its DNA-adducts. Drug Chem Toxicol. 1998; 21 (suppl): 131-147.
130. Noort D, Benschop HP, Black RM. Biomonitoring of exposure to chemical warfare agents: a review. Toxicol Appl Pharmacol. 2002; 184: 116-126.
131. Black RM, Clarke RJ, Harrison JM, Read RW. Biological fate of sulfur mustard: identification of valine and histidine adducts in hemoglobin from casualties of sulfur mustard poisoning. Xenobiotica. 1997; 27: 499-512.
132. Heydari A, Balali-Mood M. Nursing care of patients with sulfur mustard poisoning. The First International Medical Congress on Chemical Warfare Agents in Iran. Mashhad, Iran: Mashhad University of Medical Sciences; June 13-16, 1988: No. 75.
133. Vojvodic V. Necessary prehospital procedures in case of chemical warfare agents casualties. The First International Medical Congress on Chemical Warfare Agents in Iran. Mashhad, Iran: Mashhad University of Medical Sciences; June 13-16, 1988: No. 36.
134. Foster JH, Lewis MR, Jacobs JK. Thiosulfate protection against the toxic effects of nitrogen mustard in perfusion of the liver. Am Surg. 1962; 28: 461-464.
135. Connors TA. The protection against the toxicity of all alkylating agents by thiols: the mechanism of protection and its relevance to cancer chemotherapy. Europ J Cancer. 1966; 2: 293-305.
136. Connors TA, Jeney A, Jones M. Reduction of the toxicity of 'radiomimetic' alkylating agents in rats by thiol pretreatment. Biochem Pharmacol. 1964; 13: 1545-1550.
137. Callaway S, Pearce KA. Protection against systemic poisoning by mustard gas, di(2-chloroethyl) sulfide, by sodium thiosulfate and thiocit in the albino rat. Br J Pharmacol. 1958; 13: 395-398.
138. Colardyn F, De Bersaques J. Clinical observations and therapy of injuries with vesicants. The First World Congress on New Compounds in Biological and Chemical Warfare. Ghent, Belgium: Rijksuniversiteit; 1984: 254-259.
139. Sidell FR. Chemical warfare agents. In: Viccellio P, ed. Emergency Toxicology. Philadelphia, USA: Lipincott-Raven Publishers; 1998: 255-266.
140. Keshavarz S. Cutaneous complications of sulfur mustard. In: Cheraghali AM, ed. Prevention and Treatment of Complications of Chemical Warfare Agents. Tehran, Iran: Chemical Warfare Research Center; 2000: 104-111.
141. Rice P, Brown RF, Lam DG, Chilcott RP, Bennett NJ. Dermabrasion - a novel concept in the surgical management of sulfur mustard injuries. Burns 2000; 26: 34-40.
142. Graham JS, Schomacker KT, Glatter RD, Briscoe CM, Braue EHJ, Squibb KS. Efficacy of laser debridement with autologus split-thickness skin grafting in promoting improvement healing of deep cutaneous sulfur mustard burns. Burns 2002; 28: 19-30.
143. Bernstam L, Hartman E. The effect of war gases and other chemicals on the eyes of civilian population. Bull Ny Acad Med. 1943; 19: 356-367.
144. Borak J, Sidell FR. Agents of chemical warfare: sulfur mustard. Ann Emerg Med. 1992; 21: 93-98.
145. Murray V, Volans GN. Management of injuries due to chemical weapons. Br Med J 1991; 302: 129-139.
146. Rosenwasser OD. Complications of topical ocular anesthetics. Int Ophthalmol Clin. 1989; 29: 152-158.
147. Mann IA. A study of eighty-four cases of delayed mustard gas keratitis fitted with contact lenses. Br J Ophthalmol. 1944; 28: 441-447.
148. Willems JL. Controversies regarding diagnosis and treatment in Iranian chemical war casualties brought to Europe. The First International Medical Congress on Chemical Warfare Agents in Iran. Mashhad, Iran: Mashhad University of Medical Sciences; June 13-16; 1988: No. 86.