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[Importance of radioisotope angiography in the diagnosis of vascular diseases].

Radioisotope angiography demonstrates successfully occlusion of the abdominal aorta, aneurysms of the thoracic and abdominal aorta, and occlusion of the iliac and femoral arteries. In occlusion of the renal artery this method supplements contrast vasography of the kidneys providing a quantitative concept of the functional peculiarities and dynamics of the renal blood flow. The results of radioisotope angiography were in full agreement with the clinical picture of the disease and the findings of contrast X-ray angiography in 81.7% of cases; in 11.3% they coincided partly and only in 7% of cases the results were dissimilar.

Adolescent↗

Radioisotope section scanning.

Radioisotope section scanning, a relatively new imaging technique, can be regarded as "in vivo autoradiography." It permits, via computer utilization, reconstruction of a three-dimensional image of the distribution of a radioactive tracer within the body. Rapid progress in the design of instrumentation has allowed for initial clinical trials to be carried out. Worldwide, some 30 centers are currently engaged in research in this field, simultaneously ascertaining the physical performance characteristics and figures of merit of the different apparatuses and clarifying the most promising areas of clinical application. This paper is concerned only with radioisotope section scanning via standard radionuclides and radiopharmaceuticals. It does not address itself to work involving positron-emitting radionuclides. Data are given on the physical parameters and areas of clinical application of several types of available equipment.

Breast Neoplasms↗

[Enzymatic and radioisotopic methods of studying the liver functional state in rabbits].

Ten rabbits were used to carry out comparative investigations into the functional state of the liver, employing enzyme tests and radioisotope hepatography. It was found that the enzyme tests were more sensitive as compared to the radioisotope hepatography method in detecting the earliest and more slightly expressed parenchymal lesions of the liver.

Animals↗

[Structural changes in the brain in transient cerebral circulatory disorders detected in vivo by using computerized axial tomography and radioisotope cerebral scintigraphy].

Computer-aided axial tomography and radioisotopic (with 99mTc) scintigraphy of the brain were used for examining 54 patients with transient cerebral circulation disturbances, the clinical manifestations of which subsides within a period of less than 24 hours. In 28% of the patients, structural changes in the brain were revealed. The computer-aided tomography appeared to be more informative for their discovery, than the radioisotopic scintigraphy. On the basis of the data obtained the patients were divided into the following three groups: a) functional, i. e. having no lifetime structural changes in the brain detected at the moment of the examination (72% of all the patients), b) ischemic-infarctic one with a minor cerebral infarctions (13.5% of the patients), and c) hemorrhagic, with small-sized hemorrhagic foci in the brain (11.5% of the patients). The existence of the latter group should be regarded as a warning of dangers entailed by routine prevention and treatment of transient cerebral circulation disturbances with antiaggregants and anticoagulants. A new classification and terminology of the clinical symptoms caused by transient cerebral circulation disturbances are offered.

Cerebral Hemorrhage↗

[A case of radiation cataract resulting from accidental irradiation of radioisotope].

We studied light and electron microscopic findings in one case of cataract resulting from accidental radioisotope irradiation. A 53-year-old male, a radiographer, was irradiated by Ga-citrate which dropped accidentally into his left eye during a radioisotope procedure. Subsequently opacity appeared in the posterior and anterior subcapsular area of the left lens and increased in intensity. Intracapsular cataract extraction was performed one and a half years after the accident. The extracted lens was studied by light and transmission electron microscopy. Epithelial cells showed frequent stratification in some sites and disappeared in others in the equatorial region. Wedl cells and vacuoles were also seen in the posterior subcapsular area. Degeneration of lens fibers, including multilayered whorls, were observed in the cortex.

Accidents, Occupational↗

[Radioisotopic methods of estimating perfusion and viability (metabolism) of the myocardium].

Radioisotope methods play a special role in cardiological diagnostics. At present, studies of myocardial perfusion also allow the estimation of cardiomyocyte metabolism. These methods are suitable for the detection of stunned, hibernating or scarred myocardium as well. The radiopharmaceuticals which accumulate in myocardium proportionally to regional blood flow (thallium-201, MIBI-Tc99m, teboroxime-Tc99m, tetrophosmin-Tc99m, furifosmin-tc99m) are used for the estimation of perfusion. In the nuclear medicine departments myocardial perfusion imaging can be performed with planar or tomographic (SPECT) methods. The techniques have high sensitivity (80%, 90%) and specificity (90%, 80%) for detection of coronary artery diseases. The radioisotopic methods have higher sensitivity than other noninvasive techniques (ECG sensitivity-60%, specificity-85%, ECHO sensitivity-81%, specificity-89%). Positron emission tomography is still the "gold" standard for the estimation of myocardial viability. This method uses substrates for different metabolic pathways (acetate-C-11, amino-acids-C-11, fatty acids-C-11, fluorodeoxyglocuse-F-18) labelled with positron emitters. Modifications in thallium protocols make estimation of myocardial metabolism possible. Recently MIBI-Tc99m has also been used in the assessment of myocardial viability. Results of these studies are of great clinical importance. They allow to predict a success of a surgical revascularysation and the return of normal myocardial function.

Contrast Media↗

Significance of radioisotope bone marrow uptake on 99m technetium sulphocolloid scan in portal hypertension.

A prospective study of 101 consecutive patients of portal hypertension was carried out to study the possible relationships between bone marrow activity on 99m technetium labelled sulphocolloid scan and severity of liver disease, etiology of portal hypertension and cirrhosis, as well as presence and extent of collateral circulation, including esophageal varices. The patients were divided into 4 etiological groups: alcoholic cirrhosis (ALD), (38) non-alcoholic cirrhosis (NALD) (35) non-cirrhotic portal fibrosis (NCPF) (14) and extrahepatic portal vein obstruction (EHPVO) (14). Patients of cirrhosis were categorised according to modified Child-Pugh's classification. Esophageal varices were graded endoscopically as (1) no varix (2) small varices (< 5mm) (3) large varices (> 5mm). All patients underwent radionuclide imaging using 99m Technetium labelled sulphocolloid and bone marrow activity was studied. Evaluation of portasystemic collaterals was done ultrasonically. We found that 16.6%, 44.6% and 72.72% patients with Child A, B and C cirrhosis respectively, had increased marrow activity (p < 0.05). There was no significant difference between marrow activity of patients with ALD (52.6%) and NALD (40%). None of the non-cirrhotic patients demonstrated bone marrow uptake of radioisotope. There was no significant difference between bone marrow uptake presence of lienorenal collaterals and presence or size of esophageal varices. We thus conclude the bone marrow activity on radioisotope scanning depends only on the severity of liver disease and does not vary a according to the etiology of cirrhosis, or presence and extent of portasystemic collaterals, including esophageal varices.

Adult↗

Adaptive response of human lymphocytes to low-level radiation from radioisotopes or X-rays.

Human peripheral blood lymphocytes stimulated in vitro were exposed to low level irradiation ('adaptive dose') from radioisotopes ([3H]dThd, [14C]dThd, HTO and 32P). After 50 h in culture, they were irradiated with 50 rad of X-rays ('challenge dose') and fixed 3 h later. In another series, the lymphocytes received an adaptive dose of 5 rad of X-rays at 32 h after stimulation and a challenge dose of 150 rad at 48 h; the cells were fixed at 54 h. In cells that received both the adaptive and challenge doses, the frequencies of chromosomal aberrations (chromatid and isochromatid deletions) were lower than expected on the basis of additivity of the effects of the individual treatments. These results support those published from Wolff's laboratory in showing that human lymphocytes can become 'adapted' by prior exposure to low level irradiation so that they become less sensitive to the chromosome-breaking effects of X-rays delivered subsequently. The magnitude of reduction in frequencies in the 'adapted' cells, however, varied between the blood samples from different donors.

Carbon Radioisotopes↗

Radioisotopes in treatment of stage Ia ovarian cancer.

The role of radioisotopes in the treatment of ovarian carcinoma is discussed. The University of Iowa experience with prophylactic treatment of stage Ia ovarian cancer with radiogold is presented. Cumulative survival in 56 patients with epithelial cancers was 94.3%. In a prospective study, we compare the use of radiogold and total abdominal irradiation in the treatment of stage Ia ovarian carcinoma.

Adolescent↗

Radioisotopes in the treatment of ovarian cancer.

Ovarian cancer, currently, is the leading cause of death from malignancies arising in the female genital tract. Investigators and collaborative groups are focusing on this problem in an attempt to improve patient survival. The material reviewed has attempted to gather the data that relate to the use of radioisotopes in the treatment of ovarian cancer. The conclusions reached from this review are: Dose. The initial therapeutic dose of 198Au was empirically determined by Muller. This empirically determined dose was then used to estimate a dose of 32P, based on certain assumptions about these radiocolloids that have been shown to be erroneous. It would appear that the administered dose of 100-150 mCi of 198Au yields a significantly greater tissue dose than 10-15 mCi of 32P. Complications. Complications associated with 198Au are a result of a possibly excessive dose, delivered over a shorter period of time, with a significant gamma component. It is clear that in greater than 99 per cent of disintegrations each beta particle is associated with a gamma component. Distribution, dose distribution, and dose rate. These three critical factors have recently been evaluated for intraperitoneal 32P. It would appear that distribution is non-uniform, and thus dose distribution is not homogeneous, and that dose rate is low and may be ineffective in controlling ovarian cancer. Results of treatment. It would appear from a review of the literature that no prospective randomized well-controlled study as indicated the effectiveness of 32P over other treatment modalities. There is only circumstantial evidence for its effectiveness. The clinical applicability of 32P in the treatment of Stage I ovarian cancer, as part of a treatment protocol, awaits the results of well controlled prospective clinical trials.

Brachytherapy↗

Processing of antibody-radioisotope conjugates after binding to the surface of tumor cells.

BACKGROUND: Previous experiments indicated that most antibodies binding to cell surface antigens are internalized gradually and degraded within lysosomes, with a half-life of degradation of approximately 1 day, for most antibodies. The research discussed in this article extended our studies to eight additional antibodies reacting with six different antigens, including three antigens anchored in the membrane by glycosyl-phosphatidylinositol. The authors also tested antibodies labeled with 111indium, as well as 125iodine, to determine whether different radiolabels would be processed differently. METHODS: Antibodies were radiolabeled with 125I or with 111In bound to benzyl-DTPA. After binding to the surface of tumor cells in vitro, excess antibody was washed away, and the fate of the radiolabel was investigated over periods of 3-7 days. Radiolabel released into the supernatant or retained by the cells was analyzed to determine whether it was still on intact antibody. RESULTS: In 13 of the 15 antibodies that were tested, a similar pattern of irreversible binding and gradual catabolism was observed. Iodine conjugated to antibodies was released rapidly from the cell after antibody catabolism. In contrast, the 111In was retained within the cell much longer than 125I, with the rate of degradation and release into the medium being at least fivefold slower. More than 50% of the bound 111In was still present on the cells after 7 days. Biochemical analysis of the retained 111In extracted cells after 4-6 days demonstrated that it was no longer associated with antibodies and was in a low molecular weight form, probably still associated with the chelator benzyl-DTPA. CONCLUSIONS: Different radiolabels are processed by tumor cells differently, after catabolism of the antibody to which they originally were conjugated. The data suggest that the prolonged retention of 111In, relative to that of 125I, is due not to deiodination of iodine conjugates, but rather to intracellular retention of catabolic products containing 111In, perhaps within lysosomes. The use of radioisotopes that are retained within cells after antibody internalization and degradation may improve both radioimmunodetection and radioimmunotherapy of cancer.

Antibodies, Monoclonal↗

Triple radioisotope technique in etiologic evaluation of space-occupying lesions of the liver.

The findings from 43 patients with histologically proven focal liver disease examined by triple isotope tracer study are presented. The method consisted in a three step technique, the first step being an isotope scan after injection of 99mTc-sulfur colloid and 131I rose bengal. As a second step dynamic hepatic scintiangiography was carried out with 99mTc human serum albumin in order to assess the vascularity of a lesion detected on the initial scan. Thirdly, the patient was administered 67Ga to evaluate further the pathologic process. According to our results this triple radioisotope technique provides the clinician with valuable information on the possible etiology of focal liver disease.

Adenocarcinoma↗

Some indication fields of radioisotope examination of the kidneys and ureteral urine passage in infants.

This study presents a view of the knowledge the authors have gathered during 11 years of work with radioisotope examinations of the kidneys and ureteral urine passage performed in 34 children. As an important indication field they consider the conditions where excretory urography or separate functional examination, respectively, was impossible to perform or was otherwise contraindicated (anuria, uremia, coma, poor general condition, allergy to X-ray contrast substances, etc.). Scintigraphic examination is indicated even in cases where excretory urography fails to demonstrate filling of the kidneys and, on the basis of X-ray picture, it cannot be concluded whether it is a case of monolateral afunction, marked hypofunction or complete agenesis of the kidney. As the most suitable methods they consider phase scintigraphy of the kidneys together with simultaneous examination of particular parts of the kidneys and urinary passage by means of an analyser device for evaluation.

Humans↗

Tissue vitamin B-12 assay by a radioisotope dilution technique.

A method is described for the measurement of vitamin B-12 (B-12) in solid tissues by radioisotope dilution (RID) assay. The method is a modivication using double extraction of a serum B-12 RID assay which uses chicken serum as the B-12 binder. The method was developed and tested using human and bat liver specimens. Double extraction was shown to be more efficient than single extraction, and resulted in complete release of endogenous liver [57Co] B-12 administered to bats. Results using the RID assay in 16 humans and 17 bat liver specimens were compared with those obtained using the Lactobacillus leichmannii microbiological assay. Correlation was good, but the RID assay gave higher results using the microbiological assay appear to be due to inadequate extraction of B-12 from tissues.

Animals↗

A sensitive radioisotopic assay of myo-inositol: its application to rat pancreatic islets.

A radioisotopic procedure for the assay of myo-inositol is presented. It is based on the generation of NADH from NAD+ in the reaction catalyzed by myo-inositol dehydrogenase and the subsequent NADH-dependent conversion of 2-[U-14C]ketoglutarate to 14C-labeled L-glutamate in the reaction catalyzed by glutamate dehydrogenase. This method was applied to the measurement of myo-inositol in rat pancreatic islets. The myo-inositol islet content was decreased when the animals were fed a diet deprived of myo-inositol. When incubated in the absence of exogenous D-glucose, pancreatic islets, like parotid cells, released myo-inositol in the incubation medium. Over 90 min of incubation, a rise in extracellular D-glucose concentration increased the myo-inositol islet content, which was decreased, however, after incubation in the presence of carbamylcholine. These findings indicate that the myo-inositol content of islets is affected by nutritional and other environmental factors.

Animals↗

Radioisotope tracer study in a sludge hygienization research irradiator (SHRI).

A radioisotope tracer study has been carried out in a batch type sludge hygienization research irradiator with flow from top to bottom, the objective being to measure flow rate, circulation and mixing times and to investigate the hydrodynamic behaviour of the irradiator for identifying the cause(s) of malfunction. A stimulus-response technique with NH4(82)Br as a tracer was used to measure the above parameters. Experiments were carried out at three different flow rates, i.e 1.0, 0.64 and 0.33 m3/min. Three combined models based on a set of differential equations are proposed and used to simulate the measured tracer concentration curves. The obtained parameters were used to estimate dead volume and analyse hydrodynamic behaviour of the irradiator. The nonlinear regression problem of model parameter estimation was solved using the Marquardt-Levenberg method. The measured flow rate was found to be in good agreement with the values shown by the flow meter. The circulation times were found to be half of the mixing times. A simple approach for estimation of dose based on a known vertical dose-rate profile inside the irradiator is presented. About one-fourth of the volume of the irradiator was found to be dead at lower flow rates and this decreased with increase in flow rate. At higher flow rates, a semi stagnant volume was found with slow exchange of flow between the active and dead volumes.

Bromine Radioisotopes↗

Radioisotope synoviorthesis in rheumatoid arthritis.

Synoviorthesis with radioisotopes is indicated when joint inflammation is not totally controlled by drug prescription. Synoviorthesis should prevent osteoarticular destruction, especially in those cases where the patient does not feel any pain while taking analgesic and anti-inflammatory drugs. Several publications have shown the value of 90Y for treatment of the knee in rheumatoid arthritis. A dose of 4 mCi seems to be sufficient. For digital joints 169Er, a much weaker isotope, is used. Excellent and good results are obtained in 54.6% of cases. A recent double-blind study demonstrated a highly significant difference with saline (+ prednisolone acetate). Other joints, such as the wrist, elbow, shoulder, ankle or hip, can be treated with 198Au or, better, with 186Rh, which is an almost pure beta-emitter. Excellent and good results are seen in 50--60% of cases, depending on the joint. Treatment is well tolerated but patients younger than 40 years should not receive isotopes and the total dose administered should be less than 15 mCi.

Aged↗