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IN BIOLOGY AND MEDICINE HELD AT THE UNIVERSITY QF PUERTO RICO SCHOOL OF MEDICINE 11). t h e School of Medicine 1)ivision of International Affairs I'nitcti States Atomic Eiicrgy Commissiori
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It Is a diz tinc t ,>lozscre t o introduti ilr. Roberto &:s6 who is -ctu?.lly is tnc 2ioneer ofthe use of radioisotopes in this Island. I*. Chaimnn: Iu vlt to thank you for your kind words. I know they are und ese ncd but I know they were very well meant t o be. It is desirable that in a symposium dealing with the health proki cm peculiar to the atmic era, both, the benefits as well as the known and predict & l e bsd effects of irradiation, ke presented object iv ely.In our present z tic n we will denonstrate sone of the benz fits uhich hnve been derived fr crat mic nuclear medicine and we would like to stress oc exp erie nx with the use of radioisotopes applied to rcedicine here in Fuerto F.ico. The first center tc utilize radioactive isotopes in this Island uz s created in 1952 ir. the Foundation of Clinical Resezrch under the dbnamic lsadershi; of 5r.22r.h ;.:. SuErez and with the disinterested cooperation of O r . h ; 1 d a r Cobzs, Prcfcssor of Physics of the University or Pucrto Rico, Radio i gdi w xs used first for research purposes. Howwzr, itms soon realized that its diacr.ostic value had been est z blis h - ed solid y.In as m ch as this ~ 2 st h e only local organization autkorized Ly the United Stztes Atczic Zncrcy Corxission t o use radioisotopes i n tlic. islaa, t1.e stron; Cen?lsrd for this kind of service forced, a rapid .acve'lopmcnt ir. the use oi rz dio i odi,xin the a iq nos is and treztrnsnt of h ~ t ~k ico est z kli shed.its rai io isotope center in 1957, the Foundation uptQ\cs m : ally ami hac treated XGTE tim 100 cases of hyperthyroidism. Likcwise we can refer to tf.s lise of Chroniun 51 with which we label let red Slood cells for c cq are t iv,studies of blood volunie changes and as kavc also becone extrczcl:; cor?ion. Phos?horus 3: and Cobalt 60 are tm of the other isotopes uscd i n our Center butin more lin it ed conditions. 2 y the tin ctf,ESc bol of ik di cine of tnc! University of Finally it should be mentioned that 1 -muld like to givc i n nore detail OUT experiences vith the use o f Iocine 131. 'de hzve uscd rzdioiodine in the f om of sodium iodide solution, administered orally with the idea of measuring thyroid gland function or to. destroy tis sze of this glad when we have indications
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administration of a known oral dosa!.lc has been the determination which we have used alrrast exclusively for Ziagnostic purposes. king the first tkree years of operation of tPis laboratory, we used as a radioboratory, of Chicago, a M uhose sensibility for I 131 vas around lo0 counts per minute per microccrie, at a distance of 20 cm. of the source and i n 2n en v iron m nt whose background activity MS h0 counts permi - 25 microcuries. hhen we were & leto procure the direction zl counter w'ith the sensitivity of more than 300 counts per minute per microcurie a t 30 mm. distance fron Vie source, in a radioactive background of approximztely 100 counts per nimte,we were able to lover the diagnostic dosq er to about 5ni cro curios without affecting the results. This is the technique which we have followed since 1955. This obliged u s t o use diagnostic dosages which approximated Rzdioiodino tk Ler q y hzs Doen limited to cases of hyperthyroidism, t o de,F,erate cz rd ions cula r diseases of coronary origin or intractable conzestion with nox.21 functioning of the thyroid gland and t o cases of t hyr oidc ance r met as t 2s is. kost of the work achieved has been in the treat rent of hyperthy- -r oic isn. until now we ha\?e treated127 cases of thyroid wer function in s. of these pati cnt s vent ir zed i at ely tc New York, Venezuela, Santo Doming c and Smta Cruz, z f tert ke initial closes and r e only have some information by mil. has of i or gc tt in z L!.C Coctor ukcn he feels better. this reasonir.; ish sed on the fact that all patients showed clinical r+.cover; antin so cz CZSES the total absence of synptons before going away fror, us. !isvc com let eir for.Tztim 3; t:, the present time, The res c lts of 1-131 therapy in this condition have been mea- L &boct 24individuals discontinued their em lu ation 0l.u r q crt is lii zi ted to cover those cases of whom we From a total of 92 cases, 80% were women, 76 had diffuse .goiter, dular enlxceriient, 70 in ci vieu als actually did not prcsent objective &?le iw rove zen t from both points of view, 1 case had received little h e l p and another, decidedly, we do not believe C&-I be improved. pati z nts who are norrnzl at present took between 2 months and 2 years, , with an average of 6 n0nt.b t o ia3rove and they required from 3to 20.3 microcuries for i pro vi ny, with an average of8 mc, Tlle patient who demonstrated very little recovery reccived 15.6 mc. during the and probably will be presented in a special medical report, . inum dose administered a t one time has been 6.3 mc. and t h e minimum dose The patient who did not improve with 1-131, received 39 - 46 patients hzd been treated before with anti thyroid drugs. Five
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had been operated before thc radioiodine therapy. Thc partial thyroidectomies had Leen practiced between 9 nonLhs and 6 ;Tars before the radi ation the r q j. Three patients had received radioiodine treatment bcf o r e coming t o our Center and had relagsec: between 9 months and 24 monks after the or is in al treatment, . A study of our patients ' ages reveal that 13 were i n the third decade of their lives, 2h inthe fourth, 35 in the fifth,9in the sixth, demonstrated relapse between 8 and 12 months after one dose of 3 EC., 5.2 mc. divided i n tw cioses a t two months intervals. All four, however, recovered with subsequent treat nz nt, There were three patients that A fourth person relapsed 6 months after administering Seven patients developcd hmothyroidism. used in these patients ha5 varied from & t o 10 mc. manifestations developed 3 n0nt.k to2 years after the last thera?eutic & see Four of the seven patients needed tcm po ruy substitution therapy uith thjroici extract,for pcriods from 3to6 months. three continued requiring treat nen t two, ei;nt and 10 months after the onset of synptoms. Six patients with co rom ry insufficiency and chronic passive congestion, intractable to conventional thera?y, were referred to our Cli - nic for t.hc destruction of the thyroid gland uith radioiodine. All of them showed normal thyroid function. They received 20 mc. individuzlIjr, administered i n jusc one dose. congestive failure and ano*,her om of acute pulmonary edema. ' - ? ne patients whose coronary circulation at y c sent is coq at i ble with a relatively productive life. maintenance thyroid doscs. Two of them died subsequently of Actually a l l of them receive smll Only one case ofn ? l i ; mnt Chyroid has been considered worth of The slmd of a12 year old boy with f olli cula rradioiodine thera7y. car c in or a showed peat affinity for iodide preoperatively, both i n the original lesion of the neck as well as inthe metastases present in the was given to t h e neck. orally and this was repeated i n June of 1954, for a total dose of 80 mc, At present the patient is 18 years old and under maintenance thyroid therapy, He does not show clinical evidence of disease and the radiographic studies of the lungs does not show any abnormality. Nevertheless,the radioiodine vtaP.e shows uptake in diffuse areas of the thorax totalling 12% of the dose given. A total thyroidectomy yas performed and external radiotheraFy I n Dehenber 1953 he was given LO mc. of 1-131 With our present dose of 5 mc per patient for dias no stic uptake studies, we can calculate that the th poids of the normal.' individual will receive approximately 10 rads, the one ui th mer thyroid is m, 25 rads, and those u i t h hypothyroidism, about 3 rads. 'tR cm equally
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total za di ation dosaGe. tion in2 thyroid .;land, trez ted with 2 U mc. of 1-131, probably receive a redi ation dose in their glands of about 100,000 rads and abtal bodjr exaosurc of a h * Jt1Cto 20 rads. Our patient with pulmonary metastasis possibly has rec.:ivcd aboiit 1?oc),OOO rads inhis pulnomry metastasis and the total radiation of his body can be calculated between k 0 and 80 Thercfcre the pro5a3le injury cadsed to patients treated with raI dioiodi1:e can be sumcd u? i n tf,e follosrins manner: Inthc cases of iii q no stic study - no injury. Inthz cases of the r q y for rner thy roi a is rn - temporary dryness of thc r?ol;th; te For ary tn ro at pain; temporary o r permanent hypotb To id isn in i.5,: of the cases; no possibility of' Genetic chulges; absence of sterility. and possible c;metic chenges. 3. I n the cases of th poi dab la tion bec aue of cardiac cm ditions - k. In nur only case 91 rnetastatic car cino m of the thyroids - real Tt,e possible in jx iz s to th,e persons i n contxct with the patients receivirls radioiodine i n our Center can be sm,ed in the following manner, assu.in ctf z t 3CC r x per week as maxim permissible occupational never receive the rai xm pri a is sib le radiation dosage. have received radiotnerspy f o r hyperthyroidism. thyroid cancer treat zd because the patient was hospitalized ' fora week sub seq u mt ly to the ingestion of each therapeutic dose. personnel having contact with said patient was instructed and supervised on how to mint a in adequate distance and how to give ' nursing care tc the patient with a minimum of close exposure time, In this case, this patient ' s urine vos not collected but uas voided directly in the toilet, uhich was flushed many times for dilution of the radioactivity. During the therapy periods of this patient,there MS no other patient under treat nen tri th internal radiation in the hospital. The psrsont i n contact with patients taking diagnostic doses The sane aFl1es to the personnel i n contact with patients uho The same conclus'ion is reached for t h e case of radiotherapy of
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Cr->l has been used to label red cells and in this way estimating its disappearance from the peripheral blOOil, thus giving us a measurement of ay thro cyte life span. Likewise, t-2 have used dilution techni-es t o determine blood volumcs. ,cula ting blood, 66% of the original dose is eliminated m d 33% is retai ned by the liver, The effective median period in this organ is 1 2 days. We assume, besides, t h a t Chromium-51 is eliminated when it Goes out of the liver. On the basis of these premises, the physical calcula tion re vez ls that it is p ossi hle to administer a t least 300 UC. of Cr-51 labelled erythrocytes before exceeding the permissible radiation dosage for any tissue, The potential danger to individuals in contact with the recipient of marked red cells in our Center is considered zero. lie use a dose of 50 uc, t o label We have assurrcd that when the Cr-51 goes out of the c ir - Ninety five healthy Puerto Ricans of both sacs and varied v eights hire used ina study t o determine the average survival time of red bl md cells in Puerto Ricms. Norrals uere established ui th which t o conpare the var i2tions occurring i n cases of massive hemorrhage prior to, during and after the shock-state has been corrected. Util i zina the Chror-im 51 labelling technique, we have investigated the life span of erp hro cyte s in various conditions after e stab li - shing the norm1var iz ti cns for this technique i n normal subjects without any evidence of clinical or hematolosic pathology, Erythrocytes of all patients with fr2nk hemoljtic aneniz showed ciirinished lifes pn when studied in the circulation of the same person. h'hen e ry thro q tes fro a individuals with hemolltic processes due t o intrinsic defects of there i cells were injected into normal corrpatible ' ec ip i ents,the lifes px of the defective cells uas found t o be very mIysis was extra co qu salar, the life span of the patients ' eq thro - cytes, al thou a dirninishcd i?. the patients ! circulation,was found t o be nom21 when inject cd into a nornal individual, On the cantrzry, if the cause o f the exaggerated heIn this respect, i t should be mentioned that we worked xith Dr. Ram6n Suke zina study of the, incidence of abnormal henoslobins in the Fuerto Ricvl populaticn and.besides corroborating the proportion i n uhich the henoslobins S and C exist, we found that the erythrocytes of affected individuals shoving homozygosity, showed a very short life varied inversely proportional to the quantity of abnormal he m slob in present in the individuals exhibiting heterozysous combinaticns with hemoglobin A, being normal o r almost nornal, inthe cases where the adult hemoglobin constituted 6G of the combination, Identical results were observed in the patients with heterozygoIn this way the life of the red blood cells Fifteen patient sui th hypersplenism showed erythrocytes vi t h less than normal survival, The relation 'between radioactivity measured
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externally ui thE sc in till z tion touter i n the spl s nic ' and he p z tic reSims 2~ hours after their j ect ion :-fCr-51 labelled cells, has been inter pre ted as a v?.lid index of spl eni c red blood cell sequestration. Thc erytl-xccytes of four patients with ' tropical sprue in a state of herratolosic relf;se ex hi kited shortened life span. ing t o see how i n t,vo oi these patients the results returned to noma1 z ft era de pate treat nen t It up interest - is frequently znecic. !.le knew that his indolent general metabolism produccci as …