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Machine-read from the scan, so expect some errors. Lines that couldn’t be read are left out.
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IRS TIPU TE of NUCLEAR STUDIES For The Period Ending December 31, 1956 Operating Under Contract AT - 4 0 - I - Gen - 3 3
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A continually expanding series of patients kith carcinoma of thetl ~ pid, Extensive surgical pro-s tu died and treated h5th iochie-l3l, i s being built up. cedures are used i n connection with the 1-131 and special interest hao been taken i n studying the indications for surgery and radioiodine treatment. surgical procedures have been done by Robert Bigelow of Oak Ridge, who is a consultan t to the Iledical Division. stud ed with resichinl areas of functioning thyroid tissue in the neck, after previous radical surgery for carcinoma of the thyroid; i n these instances it is often h if fi cult to determine whether the residual tissue i s normal thyroid or surgery, m y be very difficult to inter prc this to logically, It is also sometimes impossible t o determine whether they are well-differentiated tumor o r residuaJ normal thyroid tissue. The improved scintiscanner has been of considerable help in making this distinction by showing the exact location of the residual radio activity. Studies of the rate of concentration of the iodine in the tissue, and rate of release, have not been very helpful in making a distinction between tumor tissue and ncrrnal thyroid tissue. great assistance when used in surgical explorations af these residual areas of Host of the A considerable number of patients have been Such areas of tissue, surrounded,by scarring from previous The surgical probe counter* has been of There has been accumulation of further autoradiographic and assay infomation on the concentration of radioiodine in the lesions of thyroid carcinoma, Bd correlated with the presence of fol ii cles and colloid. nal radiation to thc thynus o r nasopharynx, o r both, and vho had subsequently developed well - differentiated carcinoma of the thyroid. two cases was a striking transfonnation of the lesions to a clear - cell type after the normal thyroid gland had been removed, and a reversal from the clear - cell picture after the institution of replacement with desiccated thyroid therapy. child has been studied in whom there was an opportunity fora similar transfonnation to be observed, but i n whom this change did not occur t o any significant degree after the r.:moval of the nom1 thyroid tissue ; this child had also received previous external radiatiqn. Studies have continued of two children who had previously received e*rThe unusual. feature of these STUDIES WITH THE SCINTISCANNER Studies with the sc inti scanner have been extended t o include direct comprison of an improved acmer with a more standard model. The improved scanner A CsI (Tl)-Grystal Surgical Scintillation Probe. Ilucleodcs lh, NO. 11, 102-
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C. C. H a r r i s of Oak Ridge E!ational Laboratory. Thcse improvements include a specia1 collimating hcad vith multiple npertures, alarc e sodium iodide crystal, and pdsc - height disc rl m ! ~ etion. The oldcr type of scanner has a simple cylindrical vantages of the new device are imprvmd delineation of the areas of activity and improved sensitivity.In spite of the advantages of the new scintiscanner, however, there is no evidence that any sc inti scanner studies are as valuable i n the study of thJ.roid nodules a s some reports have seemed to indicate ; the scintiscanner has failEd to provide preoperative evidence i n some cases of patients. subseqoently shoxn t o have hypo- and hyperfunctioning nodules. MULTIPLE MYELOMA AND IODINE - 131 '!iThe use of iodine-131 i n the trcatment of multiple qyeloma has been discontinued because it i s believed that no really favorable results were obtained, clinical data correlated ui th his to logic and radiation - distribution data. studies and autoradiograms were prepared from the tissues. of favorable concentration of the isotope in the lesions. A group of patients given this form of treatment are now being analyzed and the eral of these patients xe re autopsied after doses of iodine-131, and radioassay There was no evidence 8 ' STUD lES WITH ROSE BENGAL External counting studies with Rose Bengal in clinical problems have not w been pursued extensively. The limitation on the Rose Bengal method with acter? nal counting over the liver, as a means of studying Uver function, appears to be the imp ossi bj lit y of obtaining truly quantitative data, since a variable and unknown part of the liver is under the sensitive Pres of the counter. The shapeof the curves of uptake and release can be obtained, but the significance of the height of the curve i s very difficult to interpret ; yet,this last seems t o be. one of the most importan& potential values of the test. Even if a coullter could be deviscd to include thk whole liver, the limitation would be the presence of the gall bladder and its unpredictable function. A feu patients havc been studied uith external scaminK of the liver by means of Rose Bengal alone the lines suggested by F ric dell not as astuq of Thc Eledical Division skff has had considerable earlier experience with external scanning of the liver by means of radioactive colloids and is currently intereste d in evaluating the new scanning equipment in this situation. liver function but i n an effort to demonstrate a localized hepatic metastasis, A complete study of Rose Bengal in rats has been performed and a report , 'is i n preparation. Careful autoradiographic studies fail to indic zte any algnif iczn t concentration of the @e i n h'upffer cells of the liver. it i s excreted thro uh the parenchymal cells of the liver, -as has been generally It appears that
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this distribiJtion is distinctly rare. There \.:Ere a fet; areas whcre foci of activity appcared t o be i n K@'- These night rep-esent arcas of ag;:rcFatcs of the labeled dye, but SARCOMAS h \ ETA STIC TO THE LUNGS The study of metastatic sarcomas t o the lungs has been continued and a n effort has been Fade t o re.;oct these slu*,;ically. tal Division interest in various bone-seeking isotopes and the distribution of such isotopes in various sarcomas, particularly in ost.eoEenic sarcoma. with knom primary sarcorzas have been subjected to surgical trez.tnent of pulmom.ry rcetastases then these appear i n an area whcre complete re section is judged than i s being ta':en a t most medical schools, although it i s not iulusual for resect i cn to be advised for rather s typical, exceedingly slo:q-erowing netastases. On the other hand, at tex pts are made a t ORINS tore sect lesions even when they are multiple and are not denonstrated t o be slow i n growth; this progran appears t o be rewarding i n tmns of better palliation. The surzery for it has been performed by George I.Iinor, University of Virginia. Tllis work cmbines with Medim This is a more vigoreus surgical apprcacli t o pulmonaiy metastases STUDIES ON COLLOIDS AND RARE - EARTH ELEMENTS Lutecium-177 and yttrium-90 have been studied as isotopes for intra - cav it ary adri in is tr atl on and, ina small number of patients, for intravenous creased interest has been focused upon possible bio ch m ical damage from the developed rather severe imrtediatc clinical reaction suit hpa in and paralytic ileus, uhich seems t o be an effect of the carrier rather than the radiation. And it appears that the amount of carrier usually used (200 mg) is considerably more tha;l is needed; current studies suggest thata much smaller .mount of carrier can be uscd satis factor il $ . The pos sib rl it y that these rare-earth matedas and related isotopes nay b6 more favorably localized in lymph nodes (based on Gram61 Xyker's work) maltes them of particular interest for continued clinics lt to say how they would conpare with radioactive gold. Both isotopes are given with stable yttrium as a carrier. Patients given the isotopes intra perito ii a ally have sometimes. Pre lh in w results on the control of as cites are not easily The materials seem t o be therapeutically effective, but it i s diffi-. Ina few instances, intravenous use his produced as ip if i cant response i n leulcenic patients and external counting studies have suggested that possibly there is a more favorable localization of yttrium and lutecium inthe spleen in late granulocytic leukemia than there is of colloidal cold-198. One of the inpossibility of a biological estimate of relative cff ect iv c doses as compared with col loir lal cold-7.98.
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D IS TRI BUT I Ot4OF PHOSPHORUS - 3 2 A report is be iq conpleted on the distribution of radioactive phosphorus as studied at autopsy, using radioassay and gross mtt)radiographic techniques. Evaluation of these data emphasizes the very general distribution of phosphorus32 The high concentration i n epiphyses of growing children was n o t fully spprecia ted in earlier studies. Phosphorus teiids t o concentrate i n growing bone area, and radioassays of large bone specimens, containing both growing and non mod ng bone, give average figures cm sidera bly l oxer than those obtained by localized radioassays of growinl; zones. Except for these growing-bme areas, the liver io consistently the organ ’having the highest concentration of radioactive phospho-, I n general, these studies with radioactive phosphorus do not offer encouragement for the use of this isotope, except i n those diseases - that respond to total - boe irradiation ; hoxever, there is some current interest in the use of radioactive phosphorus in certain types of bone rnetastas’es, and the data available here should be of value in interpreting this type of therapeutic use, In addition to the autopsy information, there isa considerable volume of surgical data collected on patients who have been given - tracer amounts of phosphorus-32 prior tore section of neoplasms, t o phosphorus-32 has brought out some rather general concepts concerning the interpreta tion of assay data: It is clear that the gross autoradiograms are of very fundamental value and that it is quite impossible to interpret radioassay data on most isotopes unless the size of sample is very carefully controlled, or uriless autoradiograms are used i n order t o understand the degrees of unevenness of distrlThe study of this information rdafing For some time, the clinical staff of the ORII?S Medical Division has been interested in the possible application of total-body radiation and bone-marrow transplantation to clinicLC situations. availability of bone marrod from living human donors using the posterior iliac aspiration site as suggested by Biennan. row transplantation have peen satis facto - rily worked out and plans are under m y for continuing clinical experiments, particularly involving patients with acute Some evaluation has been made of the Technical details for this type of mar-