Synthesis and preclinical evaluation of BOLD-100 radiolabeled with ruthenium-97 and ruthenium-103

BOLD-100 (formerly IT-139, KP1339), a well-established chemotherapeutic agent, is currently being investigated in clinical trials for the treatment of gastric, pancreatic, colorectal, and bile duct cancer. Despite numerous studies, the exact mode of action is still the subject of discussions. Radiolabeled BOLD-100 could be a powerful tool to clarify pharmacokinetic pathways of the compound and to predict therapy responses in patients using nuclear molecular imaging prior to the therapy. In this study, the radiosyntheses of carrier-added (c.a.) [97/103Ru]BOLD-100 were performed with the two ruthenium isotopes ruthenium-103 (103Ru; β-, γ) and ruthenium-97 (97Ru; EC, γ), of which in particular the latter isotope is suitable for imaging by single-photon emission computed tomography (SPECT). To identify the best tumor-to-background ratio for diagnostic imaging, biodistribution studies were performed with two different injected doses of c.a. [103Ru]BOLD-100 (3 and 30 mg kg-1) in Balb/c mice bearing CT26 allografts over a time period of 72 h. Additionally, ex vivo autoradiography of the tumors (24 h p.i.) was conducted. Our results indicate that the higher injected dose (30 mg kg-1) leads to more unspecific accumulation of the compound in non-targeted tissue, which is likely due to an overload of the albumin transport system. It was also shown that lower amounts of injected c.a. [103Ru]BOLD-100 resulted in a relatively higher tumor uptake and, therefore, a better tumor-to-background ratio, which are encouraging results for future imaging studies using c.a. [97Ru]BOLD-100.

Adaptation of the RODOS system for analysis of possible sources of Ru-106 detected in 2017

In this work, we present a method to use the European nuclear emergency response system RODOS for analysis of potential sources of airborne radioactivity of an unknown origin. The method is based on a solution of adjoint equations, without modification of the code of long-range atmospheric dispersion model MATCH used in RODOS. The method has been successfully applied to the Ru-106 accident of 2017. The obtained spatial distribution of the correlation between simulations and measurements which could be achieved with source located in a given place, is in a qualitative agreement with analogous results published in other works. The high correlation is centered on the Ural Mountains; this is explained by a very wide expansion of the plume. However, the location of the maximum correlation obtained in this work is in the northern part of Russia, close to a military test site on Novaya Zemlya. This location is far away from the reprocessing plant Mayak in the South-Eastern Urals mentioned in other investigations as the most probable location of the source. In the results presented here, the correlation at the source location corresponding to the Mayak plant is still quite high (0.49); release inventory from this source of about 300 TBq could explain the observed measurements.

Source estimation of an unexpected release of Ruthenium-106 in 2017 using an inverse modelling approach

For the first time since the Chernobyl accident, detectable concentrations of ruthenium-106 were measured across Europe in September and October 2017. The source of this radioactive cloud remains unconfirmed. In this paper we present a forensic inverse modelling study to simultaneously estimate the source location, timing and magnitude of the unexpected ruthenium-106 release using 473 measurements of atmospheric concentration. To do this, we introduce a novel method, which estimates the uncertainty in the often unknown transport error using a Markov chain Monte Carlo approach. We corroborate the conclusions of other studies which suggest the source location is in the Southern Ural region of Russia, where the Mayak nuclear complex is located. Assuming that the Mayak nuclear complex is the most plausible release location, the method estimates that 441±13 TBq was released 12:00-18:00 UTC 24 September 2017, assuming a six hour release window.

An episode of Ru-106 in air over Europe, September-October 2017 - Geographical distribution of inhalation dose over Europe

Between the end of September and early October 2017, ¹⁰⁶Ru was recorded by air monitoring stations across parts of Europe. In the environment, this purely anthropogenic radionuclide can be detected very rarely only. As far as known, ¹⁰⁶Ru is only used in radiotherapy and possibly in radiothermal generators. Therefore, the episode drew considerable interest in the monitoring community, although the activity concentrations and resulting exposure were far below radiological concern. Health consequences can be practically excluded except possibly near the source. ¹⁰⁶Ru in aerosols could be detected for several weeks and in some regions of Central and Eastern Europe tens, up to over 100 mBq/m³ were measured as one-day means. Discussions about a possible source continue until today (early 2019). Atmospheric back-modelling led to trajectories likely originating in the Southern to Northern Ural region of Russia and possibly Northern Kazakhstan. Suspiciously, no other anthropogenic radionuclides have been observed alongside, except minute concentrations of comparatively short-lived ¹⁰³Ru (half life 39 d vs. 376 d for ¹⁰⁶Ru). Due to the absence of other anthropogenic radionuclides, a reactor accident can be excluded, although both Ru isotopes are fission products generated in nuclear reactors. The exposure resulting from ¹⁰⁶Ru activity concentration in air exceeded 200 mBq × d/m³ in some parts of Central and Eastern Europe. This leads to inhalation doses of up to about 0.3 μSv regionally, assuming the radiologically most efficient speciation, lacking better information, and inhalation dose conversion factors from ICRP 119. We show an interpolated map of the dose distribution over parts of Europe where sufficient measurements are available to us. Overlaying population density, we give an estimate of collective dose. The opportunity is also used to give a short review of origin, properties and use of ¹⁰⁶Ru, as well as of accidents which involved release of this radionuclide.

Recurrence of choroidal melanoma after Ru- 106 brachytherapy

AIM

The aim of the study was to analyse the recurrence rates of choroidal melanoma treated with Ru-106 brachytherapy with or without adjunctive transpupillary thermotherapy.

MATERIAL AND METHODS

We analysed medical records of 97 patients treated with Ru-106 brachytherapy with or without adjunctive transpupillary thermotherapy who subsequently presented with recurrence. All patients were treated at the Department of Ophthalmology and Ocular Oncology in Krak6w between 1995 and 2006.

RESULTS

The mean time to recurrence was 29.15 months and tended to be shorter in larger melanomas. The 5-year recurrence rate determined using Kaplan-Meier estimator was 28.69%. Marginal recurrence was the most common type of recurrence, especially in tumors adjacent to the optic disc. The recurrence rates were the highest for all types of recurrence after the use of COB plaque with or without adjunctive transpupillary thermotherapy.

CONCLUSION

The highest incidence of recurrence was shown in the second year following the Ru-106 brachytherapy and the time to recurrence tended to be shorter in larger melanomas. Marginal recurrence was the most common type of recurrence, especially in tumors adjacent to the optic disc.

Diagnosis and treatment control of choroidal melanomas--the role of B-scan and Doppler-technique

B-scan guided pulsed Doppler ultrasonography was applied in 62 patients with unilateral malignant melanoma. Prior to radiotherapy Doppler frequency shifts were detected in all but one neoplasm. The average systolic tumour blood flow velocity was recorded as 18.8 +/- 7.6 cm/s. Frequency shifts after radiotherapy are described. Probably the methods will find a place in the evaluation of indeterminate fundus lesions and in the follow-up of irradiated ocular melanomas.

Ultrasonographic three-dimensional scanning for determination of intraocular tumour volume

Important prognostic information may be gained from knowing the volume and the rate of growth of intraocular tumours, such as choroidal melanomas. An ultrasonographic 3-D scanning system based on rotation of a commercial sector scanning transducer applied directly onto a closed eyelid was designed to measure such volume. Control of movement, data acquisition, and image analysis are accomplished by means of a microcomputer and application-specific software. The elapsed time for scanning and digitizing 20 cross-sectional images is about 1 sec. Outlines of specific structures are traced manually. The system var tested through repeated measurements of known volumes of meat. The mean variation coefficient of these measurements was 2.8%. The traced volumes were linearly dependent on gain setting of the system requiring a fixed setting for accurate estimates. The procedures of scanning and tracing contributed about equally to the total variance. This method allows repeatable, reliable, and easily generated quantitative measurements of volume with a great potential for use in the diagnosis of malignant tumours and control of the effectiveness of radiotherapy.

Transretinal Choroidal Tumor Biopsy with a 25-Gauge Vitrector

OBJECTIVE

To describe and evaluate transretinal biopsy of choroidal tumors using 25-gauge vitrectomy instrumentation.

DESIGN

Retrospective, consecutive, noncomparative case series.

PARTICIPANTS

Fourteen patients undergoing choroidal tumor biopsy at an ocular oncology center.

METHODS

The biopsies were performed under local or general anesthesia, alone or in combination with ruthenium plaque or tantalum marker insertion. Immunohistochemistry was performed on all samples, and some melanomas were also analyzed cytogenetically.

RESULTS

Surgery was uneventful in all cases. A positive tissue diagnosis was made in 13 of 14 patients, albeit at the second attempt in 1 patient. The only failure occurred because the tumor was calcified.

CONCLUSION

Transretinal choroidal biopsy with 25-gauge instrumentation yields a larger sample than fine-needle aspiration biopsy, usually producing sufficient tissue for cytogenetic studies. We did not identify safety concerns in this series of patients. Insufficient samples can occur in some patients, and further studies are needed to understand the reason for such failure.

Modelling the vertical distribution of radionuclides in soil. Part 1: the convection-dispersion equation revisited

The convective-dispersive transport and linear sorption model is discussed for the vertical migration of radionuclides in soil. An alternative procedure of solving the corresponding system of partial differential equations is presented as well as the special solution for the pulse-like fallout initial condition. Idealizations and simplifications of the model and properties of the solution are discussed. The model is fitted to a set of 528 measured radionuclide soil profiles and the resulting model parameters, apparent convection velocity v and apparent dispersion constant D, are evaluated statistically. Typical orders of magnitude of the velocities and the diffusion constants of Chernobyl-134Cs are 0.3 cm/year and 0.3 cm2/year, respectively. The mobilities of the radionuclides are ranked as 137Cs (global fallout) < 134Cs < 106Ru, 125Sb. Significant regional differences (related to different soils and geological properties below ground) of v and D exist. These analyses also indicate that v and D are not mere fitting parameters, but can be given a real physical interpretation. While in most cases, the convection-dispersion equation (CDE) model produces good descriptions for near-surface soil layers, potentially important limitations are its failure to describe "young" profiles shortly after fallout.

Photocrosslinking in ruthenium-labelled duplex oligonucleotides

The formation of a photoadduct between a [Ru(1,4,5,8-tetraazaphenanthrene)(2)4,7-diphenylphenanthroline](2+) complex chemically attached to a synthetic oligonucleotide, and a guanine moiety in a complementary targeted single-stranded DNA molecule was studied for ten 17-mer duplexes by denaturing gel electrophoresis. This photoadduct formation leads to photocrosslinking of the two strands. The percentage quenching of luminescence of the complex by electron transfer was compared to the resulting yield of photocrosslinked product. This yield does not only depend on the ionisation potential of the guanine bases, which are electron donors, but also on other factors, such as the position of the guanine bases as compared to the site of attachment of the complex. The photocrosslinking yield is higher when the guanine moieties are towards the 3' end on the complementary strand as compared to the tethering site. Computer modelling results are in agreement with this preference for the 3' side for the photoreaction. Interestingly, the photocrosslink is not alkali labile. Moreover, a type III exonuclease enzyme is blocked at the position of photocrosslinking.

Validation and verification of the ICRP biokinetic model of 32P: the criticality accident at Tokai-Mura, Japan

Regrettably, a criticality accident occurred at a uranium conversion facility in Tokai-mura, Ibaraki, Japan, on 30 September 1999. Radioactivities of 32P in urine, blood and bone samples of the victims, who were severely exposed to neutrons, were measured. 32P was induced in their whole bodies at the moment of the first nuclear release by the reaction 31P (n, gamma) 32P and 32S (n, p) 32P. A realistic biokinetic model was assumed, as the exchange of 32P between the extracellular fluid compartment and the soft tissue compartment occurs only through the intracellular compartment, and the model was used for preliminary calculations. Some acute excretion of 32P, caused by decomposition or elution of tissues which occurred at the time of the accident, may have happened in the victims' bodies in the first few days. The working hypotheses in the present work should initiate renewed discussion of 32P biokinetics.

The measurement of three dimensional dose distribution of a ruthenium-106 ophthalmological applicator using magnetic resonance imaging of BANG polymer gels

The BANG (MGS Research Inc., Guilford, CT) polymer gel has been used as a dosimeter to determine the three-dimensional (3D) dose distribution of a ruthenium-106 (Ru-106) ophthalmologic applicator. An eye phantom made of the BANG gel was irradiated with the Ru-106 source for up to 1 h. The phantom and a set of calibration vials were scanned simultaneously in a GE 1.5 T MR imager using the Hahn spin-echo pulse sequence with a TR of 2000 ms and two TEs of 20 ms and 100 ms. The T(2) values were evaluated on a pixel-by-pixel basis using custom-built software on a DEC alpha workstation and converted to dose using calibration data. Depth doses and isodose lines of the Ru-106 eye-plaque were generated. It is concluded that the BANG gel dosimetry offers the potential for measuring the 3D dose distributions of an ophthalmologic applicator, with high spatial resolution and relatively good accuracy.

[Comparative study of beta irradiation (106Ru/106Rh) and gamma irradiation (125I) on the rabbit eye]

We compared beta irradiation (106Ru/106Rh) to gamma irradiation (125I) on the normal rabbit eye, using ophthalmic plaques to deliver doses similar to those recommended in man for choroidal melanoma treatment. A detailed dosimetry was performed and the animals were followed up by clinical and histological examinations during 1 year. The mean total doses were either comparable, or larger with iodine-125, but the globes treated with ruthenium-106 exhibited more damaging effects: total destruction of the chorioretina on the plaque site, abnormalities of the retinal vessels and of the close nerve fiber layers, cavernous atrophy of the optic nerve. In the eyes treated with iodine-125, only the external retinal layers were destroyed.

Systemic and regional hemodynamics assessment in rats with fluorescent microspheres

The aim of this study was to validate in rats an alternative to the radioactive microspheres (RM) reference technique, the fluorescent microspheres (FM), for the simultaneous determination of cardiac index (CI) and regional blood flows (RBF). Validation of the FM method was performed in three steps: (a) comparison of CI and RBF values obtained simultaneously by FM and RM, (b) determination of the repeatability of the measurements by using two successive injections of FM, and (c) evaluation of the ability of the FM method to assess vasodilating effects (by using dipyridamole). CI values (range, 242-513 ml/min x kg; n = 20) obtained with FM correlated with those obtained with RM (r = 0.82: p<0.001), and agreement was found between FM and RM (error 95% confidence interval for one pair, +/-125 ml/min x kg). FM RBF values, although smaller than corresponding RM RBF values, were correlated with the latter (range, 0.1-7 ml/min x g; n = 71; r = 0.99; p< 0.001). Agreement was dependent on RBF values, e.g., error 95% confidence intervals for one pair were 0.08-0.13 and 3.86-6.48 for 0.1 and 5 ml/min x g, respectively. Two successive FM injections at a 10-min interval (conscious rats) provided similar values (n = 14) for CI (306+/-24 vs. 346+/- 18 ml/min x kg), and renal (5.1+/-0.2 vs. 6.2+/-0.3 ml/min x g), left (6.1+/-0.3 vs. 5.8+/-0.4 ml/min x g) and right (4.8+/-0.4 vs. 4.7+/-0.3 ml/min x g) myocardial RBF. Corresponding error 95% confidence intervals were +/-187 ml/min x kg, +/-2.8, +/-2.2, and +/-2.0 ml/min x g, respectively. Dipyridamole (2, 4, 6, and 8 mg/kg x min for 10 min, i.v.; n = 9-13 per group, conscious rats) significantly and dose dependently increased left and right myocardial blood flows, whereas renal blood flow was not affected. We conclude that the FM technique (a) is reliable and in agreement with the RM method, (b) provides repeatable measurements of systemic and regional hemodynamics, and (c) allows detection and quantification of vasodilating effects in rats.

Advances in the purification of the mitochondrial Ca2+ uniporter using the labeled inhibitor 103Ru360

For many years the calcium uniporter has eluded attempts of purification, partly because of the difficulties inherent in the purification of low-abundance hydrophobic proteins (Reed and Bygrave, 1974). Liquid-phase preparative isoelectric focusing improved the fractionation of mitochondrial membrane proteins. A single 6-h run resulted in a 90-fold increase in specific activity of pooled active fractions over a semipurified fraction, allowing for enrichment of the calcium transport function in cytochrome oxidase vesicles. An additional powerful tool in the isolation of the uniporter was the use of the labeled inhibitor 103Ru360 as an affinity ligand; by following this procedure a protein of 18 kDa was purified in nondenatured, but rather inactive, form. The labeled protein corresponds to the protein that showed Ca2+ transport activity.

Transpupillary thermotherapy: results in 50 patients with choroidal melanoma

OBJECTIVE

To evaluate the efficacy and safety of transpupillary thermotherapy in treating choroidal melanoma.

METHODS AND PATIENTS

To perform transpupillary thermotherapy, infrared diode laser energy at 810 nm was used with a beam diameter of about 3 mm and 1-minute exposure time. All 50 patients had choroidal melanoma. We performed transpupillary thermotherapy in 21 tumors that had responded insufficiently to 800 Gy ruthenium 106 brachytherapy; it was combined with 800 Gy106Ru brachytherapy for 10 tumors greater than 5 mm in height and with 600 Gy for 19 tumors 5 mm or less in height.

RESULTS

All but 1 tumor exhibited reduction in tumor height within a mean follow-up of 20.5 months (range, 6-49 months). In 41 eyes (82%), the tumor flattened completely. Visual acuity was 20/60 or better in 43 eyes (86%) before treatment and in 14 eyes (28%) at the last examination because of radiation vasculopathy. Neovascular glaucoma developed in 1 eye, and total retinal detachment developed in 2 eyes. Tumor recurrence was observed in 1 patient.

CONCLUSIONS

Although long-term results are necessary to properly appraise this new therapy, transpupillary thermotherapy may be useful as a complementary modality to brachytherapy.

Hepatic hypoperfusion after intestinal reperfusion

BACKGROUND

Intestinal ischemia-reperfusion injury (IIR) induces hepatic and pulmonary dysfunction and thus has been used as a model of multiple organ failure syndrome. This study examines the hypothesis that hepatic blood flow is markedly reduced in this injury model.

METHODS

Sprague-Dawley rats underwent 120 minutes of intestinal ischemia and 60 minutes of reperfusion (IIR). Hepatic blood flow was measured with radiolabeled microspheres and Doppler flow probes. Hepatic dysfunction was quantitated by measuring bile flow and serum alanine aminotransferase and hepatic tissue adenosine triphosphate levels. Sham-operated animals served as controls.

RESULTS

Intestinal ischemia reduced portal flow by 66% when compared with sham-operated animals (p = 0.0001) but had no effect on hepatic arterial flow. In contrast, reperfusion reduced hepatic artery flow by 80% when compared with controls (p = 0.002) with most of this change occurring within 5 minutes of reperfusion. IIR induced a 63% reduction in bile flow (p < 0.05), a fivefold rise in serum alanine aminotransferase level (p < 0.0002), and a 33% reduction in hepatic adenosine triphosphate level (p < 0.05).

CONCLUSIONS

These data suggest that IIR induces profound hepatic hypoperfusion, which is temporally related to acute hepatic dysfunction. This observation suggests that hepatic ischemia may contribute to IIR-induced liver injury.

Hemodynamic effects of hypothyroidism induced by methimazole in normal and portal hypertensive rats

Portal hypertension is accompanied by a hyperdynamic circulatory state that shares some similarities with thyrotoxicosis. This study was conducted in order to investigate the hemodynamic effects of hypothyroidism in a rat model with portal hypertension induced by partial portal vein ligation (PVL). Four groups of 10 rats each were studied: normal control and hypothyroid rats, and PVL control and hypothyroid rats. Hypothyroidism was induced by methimazole 0.04% in drinking water. Hemodynamic measurements were performed using the radioactive microsphere technique. Induction of hypothyroidism was confirmed by elevated TSH levels. In the PVL groups, hypothyroidism ameliorated the hyperdynamic circulation. Portal venous inflow and portal pressure dropped significantly: 7.1 +/- 0.2 vs 4.8 +/- 0.3 ml/min/100 g body wt (P < 0.01) and 13.4 +/- 0.9 vs 10.9 +/- 0.8 mm Hg; (P < 0.01), respectively. In normal rats, hypothyroidism was manifested by a hypodynamic circulatory state. These results demonstrate that hypothyroidism induced by methimazole is followed by amelioration of the hyperdynamic circulation, normalization of portal venous inflow, and reduction of portal pressure.

Tissue preparation technique for microsphere assays of blood flow

A simple method for preparing standardized tissue samples for microsphere assay of tissue blood flow is described. By reduction of tissue samples into a liquid state and centrifugation of the microspheres to the bottom of conical-shaped counting vials, the microspheres within all tissue and blood reference samples attain the same counting geometry. The validity and reproducibility of this technique has been established for planar-configured gamma-ray detectors in an in-situ porcine kidney model. A positive correlation coefficient of r = 0.99 was observed between the total kidney blood flow, as measured by a calibrated Transonic flow probe, and the microsphere reference sample technique.

Transpupillary thermotherapy in choroidal melanomas

OBJECTIVE

To determine safety and efficacy of transpupillary thermotherapy (TTT) as a new treatment for choroidal melanoma.

METHODS AND PATIENTS

To perform TTT, diode laser energy at 810 nm was used with a beam diameter of 1.5 to 4.5 mm for a 1-minute exposure. All 12 patients had choroidal melanoma. Six had had insufficient response to ruthenium 106 (106Ru) brachytherapy. Three patients with tumors more than 5 mm in height were treated simultaneously with 106Ru and TTT. Three patients with juxtapapillary or macular tumors were treated by TTT only.

RESULTS

All but one tumor exhibited a reduction of tumor height in a follow-up period of 3 to 14 months. Side effects were minimal. Severe visual loss occurred in two patients due to radiation retinopathy, in two patients whose foveas were included in the TTT area, and in one patient resulting from a serous retinal detachment that extended over the posterior pole.

CONCLUSIONS

Treatment with TTT may be useful as a complementary modality to brachytherapy. A longer follow-up period is required for final evaluation.

Radiation effects on the optic nerve observed after brachytherapy of choroidal melanomas with 106Ru/106Rh plaques

From 1966 to 1990 a total of 93 juxtapapillary choroidal melanomas were treated using 106Ru/106Rh plaques with a notch for the optic nerve. The choroidal melanoma was controlled after brachytherapy in 79 cases (85%). Fourteen eyes (15%) had to be enucleated because of tumor regrowth. Eye and optic nerve phantoms were fabricated, loaded with small-volume thermoluminescent dosimeters, treated with active plaques, and the radiation dose determined at the optic disc and along the optic nerve. The median dose within the anterior optic nerve was 51.2 Gy (range 10.3-60.5 Gy). The probability of developing complete radiation optic neuropathy (RON) was 23% and 53% at 5 and 10 years, respectively. The probability of developing partial RON was 66% at 5 years and 82% at 10 years. The probability of retaining visual acuity better than 0.5 was 38% at 5 years and 26% at 10 years. No dose-response relationship could be established from the ophthalmological, morphological and functional findings. Eyes following plaque irradiation with 50 Gy or more in the center of the optic nerve experienced significant radiation optic neuropathy, other eyes did not.

A ruthenium-103 red dot blot assay specific for nanogram quantities of sulfated glycosaminoglycans

Ruthenium-103 red has been used previously to detect nanogram quantities of glycosaminoglycans after they have been separated by electrophoresis on cellulose diacetate. We have applied the critical electrolyte principle to the binding of this dye to polyanions. This eliminates interaction with nucleic acids and hyaluronan. After samples are digested with chondroitinase ABC the method allows the measurement of chondroitin sulfates and heparan sulfates at the 2-ng level in dot blots of tissue extracts.

Quantitative measurements of collateral arterial blood flow in nonarterialized rat liver grafts

The early development of arterial blood flow in the grafted liver after orthotopic liver transplantation in the rat without reconstruction of the hepatic artery was studied. Arterial liver blood flow was measured on day 21 after transplantation with NEN-TRAC microspheres (size 15.5 +/- 0.1 microns) and labelled with 103Ru. The arterial liver blood flow in the grafted liver was 0.778 +/- 0.247 ml/min per gram for transplanted rats after 21 days. One day after transplantation, the blood flow was only 0.006 +/- 0.002 ml/min per gram. The results of this study demonstrate that there was no arterial blood flow on day 1 after transplantation, as expected, but that there was a high arterial blood flow in the transplanted liver by day 21. This was also supported by the angiographic findings. The early development of arterial blood flow via collaterals may account for the excellent results that we and others have attained in orthotopic liver transplantation without rearterialization in the rat.

Decreased blood flow to rat bone marrow, bone, spleen, and liver in acute leukemia

An acute promyelocytic leukemia in the rat (BNML) has been used in model studies on pathogenesis and therapy of human acute myeloid leukemia. The blood supply to bone marrow during BNML development has hitherto not been examined, even though in general, blood flow to hematopoietic tissues might affect drug treatment and marrow transplantation regimes. We measured the perfusion of various organs during the course of the disease in untreated rats and in rats given one injection of cyclophosphamide treatment. Organ perfusion was measured with radioactive microspheres. Blood flow per gram tissue to the bone marrow, bone, spleen, and liver declined gradually during the leukemic progression, thus paralleling the growth of leukemic deposits. Cyclophosphamide treatment retarded, but did not reverse, the decreasing perfusion of these tissues.

Plaque radiotherapy in the management of retinoblastoma. Use as a primary and secondary treatment

BACKGROUND

Radioactive episcleral plaque brachytherapy is a treatment method for selected retinoblastomas. The authors have used this technique since 1976 as both a primary and a secondary treatment method after other methods failed to achieve tumor control.

METHODS

A review of the records of 400 consecutive children with retinoblastoma showed that solitary plaque radiotherapy was used as a method of management in 103 cases. The authors' overall experience was evaluated, and the results between primary and secondary plaque therapies were compared in these 103 cases.

RESULTS

Of the 103 tumors, the mean basal diameter was 7 mm, and the mean thickness was 4 mm. Overlying vitreous seeds were clinically apparent in 50 cases (48%). The mean proximity of the tumor margin to the optic disc margin was 6 mm and to the foveola was 6 mm. The mean follow-up period was 40 months. In 89 cases (86%), the tumor was controlled by one plaque application, whereas in 13 cases (13%), tumor recurrence after initial tumor shrinkage necessitated subsequent treatment. Final visual outcome was good in 63 cases (62%), poor in 30 (29%), enucleation in 9 (9%), and unknown in 1 case. The poor vision was due to foveal retinoblastoma (with or without amblyopia) in 25 cases (83%). Eight of the nine enucleated eyes were treated initially with external beam radiotherapy then later with plaque radiotherapy. In 31 cases (30%), plaque radiotherapy was used as a primary treatment to the tumor, while in 72 cases (70%), it was a secondary form of management after failure of other methods to control the tumor. Statistical analysis showed that tumors treated with plaque radiotherapy as a primary measure were more likely to be larger in in base (P = 0.01) and thickness (P = 0.01) than secondary treated tumors. The secondary treated retinoblastomas were more likely to have vitreous seeds (P = 0.02) than the primary treated tumors. The rate of tumor control and patient survival was similar between the two groups.

CONCLUSION

Plaque radiotherapy is very effective in treating selected retinoblastomas with a high rate of tumor control and patient survival. It can be used successfully as a primary or a secondary treatment for tumors that have not been adequately controlled by other therapeutic methods.

The relationship between inert gas wash-out and radioactive tracer microspheres in measurement of bone blood flow: effect of decreased arterial supply and venous congestion on bone blood flow in an animal model

Several methods have been employed in the study of bone perfusion. We used a method of determining inert gas wash-out by mass spectrometry in the study of blood flow rates in pigs. The method was validated by comparison of the result obtained with inert gas wash-out to that with measurement by microspheres. Furthermore, the effect of decreased inlet flow and venous congestion on the bone perfusion data was tested. The undisturbed bone blood flow was not significantly different when measured with wash-out of inert gas (7 +/- 0.7 ml/min/100 g) or with microspheres (9 +/- 2.9 ml/min/100 g), and the methods were correlated. Perfusion was reduced significantly, to 20% of the original value, after arterial occlusion. The changes in wash-out curves and accumulation of radioactive tracer provided substantial evidence for impaired intraosseous circulation following venous obstruction also. In conclusion, the study showed that this method of determining inert gas wash-out is feasible for studies of local perfusion rates in bone. The flow rates obtained by wash-out correlated well with the results of microsphere studies. In this animal model, both methods detected a fivefold reduction in flow rate after clamping of the arterial inflow. Obstruction of the venous outflow also impaired blood flow and lowered the cellular supply.

Studies of epidermal lipids using electron microscopy

Ruthenium tetroxide fixation has permitted the electron microscopic visualization of intercellular lipid lamellae in thin sections of stratum corneum. This development complements prior freeze-fracture studies of lipid lamellae and has advanced our knowledge about the ultrastructure of epidermal lipids in several ways. We have demonstrated a continuous lipid envelope that surrounds each differentiated stratum corneum cell and the presence of lipid lamellae throughout the entire stratum corneum of three mammalian species, including humans. Wherever lamellae are seen, they are present in multiples of one, two, or more pairs of bilayers, consistent with their formation from fused, flattened lipid vesicles. A unique pattern of lipid monolayers intervening between each pair of bilayers, based on sharing lipid chains between bilayers, has been proposed. In regions where there are no intercellular lamellae between corneocytes, intervening monolayers are in contact with adjacent lipid envelopes that might be involved in stratum corneum cohesion. However, limitations to the ruthenium technique must be overcome before changes in lamellar patterns can be accurately attributed to, or correlated with, changes in permeability brought about by experimental procedures or in diseased states.

Quantitative color Doppler imaging in untreated and irradiated choroidal melanoma

Histological data indicate the importance of tumor vascularization as a determinant of the biological behavior and the response to radiotherapy in choroidal melanoma. Duplex ultrasound and color Doppler imaging, the combination of B-mode ultrasound and pulse-waved Doppler analysis, were used to measure quantitatively neovascular blood flow in 31 patients with choroidal melanoma. Follow-up studies (20 patients) were performed to investigate the change of tumor blood flow in choroidal melanomas after radiotherapy. Blood flow was detected in 30 out of 31 melanomas (size 3.1-17.8 mm) within the tumor and at the tumor base with a mean peak systolic frequency of 1.0 kHz (range 0.3-2.7 kHz), a mean end diastolic frequency of 0.3 kHz (range 0.1-1.0 kHz), and a mean frequency of 0.7 kHz (range 0.2-1.3 kHz). Two and six months after 106Ru/106Rh beta-ray application, 19 patients showed a significant decrease in peak systolic frequency. This occurred with and in advance of the decrease in the tumor size. In one patient, a rising maximum systolic frequency after radiotherapy marked a recurrent tumor growth. Results indicate that the quantitative measurement of tumor blood flow by duplex ultrasound and color Doppler imaging may be a new diagnostic modality for monitoring the effectiveness of radiotherapy in choroidal melanoma.

The use of a new radiopharmaceutical, 97Ru-DISIDA, and of 99Tcm-sulphur colloid for the simultaneous evaluation of duodenogastric reflux and gastric emptying

There is no consensus or a uniform technique for measuring gastric emptying and numerous modalities have been reported. We report here the results obtained using a modification of the published techniques for the simultaneous measurement of duodenogastric reflux and gastric emptying utilizing simultaneously the recently developed radiopharmaceutical 97Ru-DISIDA, intravenously, and the oral administration of 99Tcm-sulphur colloid incorporated in a 'solid' test meal.

Urinary bladder blood flow. I. Comparison of clearance of locally injected 99mtechnetium pertechnate and radioactive microsphere technique in dogs

The blood flow of the dog urinary bladder measured by radioactive microsphere technique was compared to the clearance of locally injected 99mTechnetium pertechnate (99mTc) in the bladder wall. In semilogarithmic plots the 99mTc washout curves showed a multiexponential course. From the initial slopes (median 5.7 min) the bladder blood flow was calculated to be only 30-62% of the results obtained from the radioactive microsphere technique (blood flow in the muscular layer 21.7-44.8 ml/100 g/min). These lower values imply that the rate of removal of the hydrophilic tracer 99mTc at these flow rates is limited by the capillary diffusion capacity. The multiexponential curves reflect recirculation and excretion of 99mTc by the kidneys with accumulation of 99mTc in the bladder. It is concluded, that clearance studies of locally injected 99mTc in the bladder wall are unable to evaluate bladder blood flow.

Prone position reverses gravitational distribution of perfusion in dog lungs with oleic acid-induced injury

Although oxygenation improves in patients with the adult respiratory distress syndrome and in animals with oleic acid- (OA) induced acute lung injury when they are turned from the supine to the prone position, the mechanism(s) by which this improvement occurs is not known. Several groups have speculated that this improvement results from preferential edema accumulation in the dorsal lung regions and redistribution of perfusion away from these regions when the patients are turned to the prone position. We used radiolabeled microspheres to measure the regional distribution of perfusion (Qr) to the dorsal, mid, and ventral lungs of eight dogs in vivo in the supine and prone positions, before and after inducing acute lung injury with OA, and correlated the Qr observed after injury with the degree of regional extravascular lung water (EVLWr). Before OA, Qr increased along the gravitational gradient when the animals were supine but was more uniformly distributed when they were prone. After OA, Qr again followed a gravitational gradient when the animals were supine but was preferentially distributed to the nondependent regions when they were prone. EVLWr was similar in all regions, regardless of whether OA was injected when the animals were supine or prone. The gravitational Qr gradient is markedly reduced in the prone position, both before and after lung injury. The prone position-induced improvement in oxygenation is not the result of redistribution of Qr away from areas in which edema preferentially develops.

Splanchnic and systemic hemodynamics in mice using a radioactive microsphere technique

Mice are commonly used for the study of human disease processes. However, techniques for measuring systemic and hepatic blood flow in mice have not been developed. We attempted the conventional technique of radiolabeled microsphere injection into the left ventricle, but difficulties were encountered, including unsuspected ventricular perforation and outflow obstruction in 68% of the animals. We therefore evaluated whether an injection into the carotid artery close to the aortic arch can fulfill the criteria (approximately or greater than 300 microspheres in femoral blood or tissues, adequate mixing of microspheres with blood, and no significant alteration of blood pressure during microsphere injection) required for accurate measurement of systemic and regional hemodynamics. Carotid artery injection resulted in adequate mixing and number of microspheres in tissues in 78 and 91% of the animals, respectively. Portal venous inflow was 1.8 +/- 0.3 ml.min-1.g liver tissue-1 and renal blood flow was 5.1 +/- 0.75 ml.min-1.g tissue-1. Compared per unit weight, these values are quite similar to those reported in rats. Cardiac output was 12.1 +/- 1.2 ml/min and cardiac index was 462 +/- 47 ml.min-1.kg body wt-1. The reliability of cardiac output determination is improved if whole body radioactivity is taken into account. Five of 22 animals had to be excluded because of either a low number of microspheres in tissues or inadequate mixing of microspheres with blood (shown by asymmetrical distribution of microspheres between left and right kidney). With modifications, the radioactive microsphere technique can be adapted to the hemodynamic study of mice.

Theoretical considerations in the estimation of rumen fractional outflow rate from various sampling sites in the digestive tract

The digesta markers 103ruthenium phenanthroline (Ru-P) and 51Cr-EDTA were continuously infused into the rumen of young lambs offered clover hay ad lib. indoors or grazing pure species swards of either lucerne (Medicago sativa), white clover (Trifolium repens), ryegrass (Lolium perenne) or prairie grass (Bromus catharticus). Following the cessation of infusion the fractional outflow rate (FOR) of markers from the rumen was estimated from the rate of decline of marker concentration in rumen and abomasal digesta (Expt 1), abomasal digesta and faeces (Expt 2) and duodenal digesta and faeces (Expt 3). Estimates of FOR from the rumen were similar when based on rumen and abomasal sampling but estimates from abomasal and duodenal sampling were significantly higher than those from faeces. A simulation of a two-compartment model with variable FOR was performed to calculate faecal excretion curves following continuous marker infusion or the administration of a single marker dose into the rumen. Analysis of the descending portion of these theoretical faecal excretion curves yielded values of FOR from the rumen which differed from the values entered in the equations. The magnitude of the difference depended on the ratio of the values of FOR from the caecum and rumen entered in the equation. This suggested that the experimental variation observed in these young lambs was caused by the high FOR from the rumen in relation to the FOR from the caecum-large intestine.

Comparison between measurements of maternal placental blood flow with dynamic placental scintigraphy and radioactive microspheres

Two methods for measurements of maternal placental blood flow were compared, dynamic placental scintigraphy using 113mIndium and the radioactive microsphere distribution technique which was the reference method. These methods were both used before and after the blood flow was altered by a noradrenaline infusion in pregnant monkeys (Macaca fascicularis). The change of the blood flow values obtained by the two methods were compared. A statistically significant correlation between the two methods was found (r = 0.90, p less than 0.01). It is concluded that dynamic placental scintigraphy can be used as a technique for clinical measurements of relative changes of the maternal placental blood flow.

A new cholescintigraphic agent: ruthenium-97-DISIDA

These are the first human experiments with 97Ru-DISIDA, a potentially new alternative to 131I-rose bengal where delayed imaging is indicated. 97Ru has a convenient half life. A DISIDA labeling kit was utilized to prepare the radiotracer for 17 patients (age 6 weeks-84 years). The cholescintigraphic data correlated well with other imaging procedures and with clinical findings. Dosimetric calculations were carried out and were compared with the radiation burden associated with the use of 99mTc-DISIDA and 131I-rose bengal.

Evaluation of nonradioactive, colored microspheres for measurement of regional myocardial blood flow in dogs

Measurement of regional myocardial blood flow (RMBF) is crucial in experimental studies of myocardial ischemia and reperfusion in dogs. The standard measurement technique uses radioactive microspheres; however, not all institutions are able to dispose of radioactive waste and therefore cannot make use of this method. We tested a new, nonradioactive microsphere, labeled with colors instead of nuclides. Simultaneous blood flow measurements with two nuclide-labeled and two colored microspheres were performed after coronary occlusion in dogs. Both techniques show a within-method correlation of r greater than 0.98. Duplicate variability for paired RMBF values in 80 samples was 8.7 +/- 0.1% when computed with radioactive microspheres and 13.2 +/- 1.8% when computed with colored microspheres. There was a good correlation in the measurement of RMBF between the radioactive- and colored-microsphere methods (r = 0.98). The best-fitting linear regression line was expressed by the formula: Colored-microsphere RMBF = 1.11 (radioactive-microsphere RMBF)-0.02. When measured by colored microspheres, RMBF was approximately 8% higher than when computed with radioactive microspheres for blood flow values of 0-2 ml/min/g. When blood flow was increased pharmacologically to levels of 2-7.5 ml/min/g, colored microspheres yielded blood flow values 39% higher than the values computed by radioactive microspheres. We conclude that the nonradioactive, colored-microsphere method correlates with the radioactive technique, but at high flows, it yields values greater than those obtained with radioactive microspheres.

[Ferrocene, ruthenocene and rhodocene analogs in haloperidol synthesis and organ distribution after labeling with 103Ru and 103mRh]

Ferrocene-Haloperidol was synthesized by N-alkylation of 4-(4'-chlorophenyl)- 4-hydroxypiperidine with 1-ferrocenyl-4-chlor-butan-1-on. By heating the ferrocene-haloperidol with 103RuCl3 the 103Ru-labelled ruthenocene-haloperidol was obtained. This compound showed a high affinity for lung but not for brain in rats and mice. The decay of the 103Ru labelled compound results in the formation of the 103mRh labelled rhodocene-haloperidol, which is rapidly oxidized by air to the corresponding rhodocinium-haloperidol. This compound can be separated by extraction and TLC.

Distribution of 103Ru-chloride in tumor-bearing animals and the mechanism for accumulation in tumor and liver

Tumor uptake rates of 103Ru-chloride were smaller than those for 67Ga-citrate. In three tumors and liver, 103Ru in the mitochondrial fraction containing lysosome increased with time after the administration of 103Ru-chloride. The concentration of 103Ru was more dominant in connective tissue (especially inflammatory tissue) than in viable tumor tissue or in necrotic tissue. Quite large amounts of 103Ru in the tumor and liver were bound to the acid mucopolysaccharide whose molecular masses exceeded 40,000. Behavior of this nuclide was essentially similar to that of 67Ga.