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Biomedical subjects

M K Dewanjee

Publications and source records attributed to M K Dewanjee.

At least 37 records · Page 2Linked to original sources

The chemistry of 99mTc-labeled radiopharmaceuticals.

The subject of the chemistry of 99mTc-radiopharmaceuticals consists of a collection of bits and pieces of information without a unifying theme. Since the initial impetus to the field of organ imaging was provided by radiochemists, nuclear chemists, and clinician-investigators, using easily prepared 99mTc-compounds from available off-the-shelf ligands, complete chemical characterization was not carried for the 99mTc-radiopharmaceuticals and their metabolites. The influx of coordination, organic, and analytic chemists and their systematic studies clarified some of the structures of these tracers, and promoted the general synthetic methods of a variety of ligands and the corresponding 99mTc-chelates as well as understanding of the nature of their metabolites. Although major developments for organ-imaging radiopharmaceuticals had been made, future studies will result in the simplified methodology of protein-labeling, fine-tuning of the currently available radiopharmaceuticals for higher organ-extraction, and replacement of expensive 123I-labeled tracers with the corresponding 99mTc-tracers. In general, the Tc-complexes are thermodynamically less stable and kinetically more labile than the corresponding Re-complexes. The well established chemistry of Re-compounds, the similarity of Tc-chemistry to that of Re compounds, and structure-activity relationships of a few classes of 99mTc-labeled compounds, may promote the development of new generation of 99mTc-labeled radiopharmaceuticals.

Animals↗

The kinetics and quantitation of platelet deposition on control (CPC) and heparin-bonded polyurethane angio-catheter (HBPC) with indium-111 labeled platelets in a dog model.

The dynamics of platelet deposition on CPC and HBPC was evaluated with In-111 labeled platelets (In-PLT) with a computerized gamma camera (CGC). Ten non-heparinized dogs (18-25 kg) were catheterized in both femoral arteries with 10 cm of CPC and HBPC (5 Fr., Cordis, Inc.) 24 hours post-injection of 300-420 microcuries of In-PLT, and imaged for 3 hours with gamma camera. The regional platelet deposition on three segments of catheters and puncture site was determined. The catheters were harvested and radioactivity on the catheter segments (proximal: PROX, middle: MID, distal: DIST and puncture site: PS) of both was determined. From the platelet count in blood, radioactivity in blood and segments of catheters, adjacent artery and area of artery and catheter, the platelet-density [X10(3)] (mean +/- S.D.) on catheter and artery were calculated and tabulated: (table; see text) The large standard deviation of retained platelets is due to embolization. The platelet-density and regional counts on catheter segments were lower in the HBPC than CPC. The rate of platelet-deposition was lower in the HBPC than CPC. Most of the thrombi were lost during pullout of the catheter. Both in vivo (dynamic) and in vitro studies were necessary for evaluation of CPC thrombogenicity.

Animals↗

Endotoxin testing with limulus amoebocyte lysate in a radiopharmaceutical containing chelated metallic radionuclides and chelating agents.

The gel formation by endotoxin with limulus amoebocyte lysate (LAL) solution requires the presence of free calcium ions. The chelating agents and radiopharmaceuticals prepared from the chelating agents always reduce the available free calcium levels present in the kits used for the testing of apyrogenicity and thus inhibit gel formation of LAL with E. Coli endotoxin (ET). This inhibition of gel formation could be reversed by the addition of excess free calcium ions or the excessive dilution of radiopharmaceuticals and chelating agents. The tests of positive control (0.2 ml ET units and LAL), inhibition control (0.1 ml sample, 0.1 ml ET and LAL), and negative control (0.1 ml sterile saline and LAL) were carried out with the fresh preparation (0.1 ml) of samples (triplicate), tropolone, ACD anticoagulant, and 99mTc-labeled radiopharmaceuticals. In the Ca-supplemented tests, 0.1 ml of 60 mM sterile calcium chloride solution was added to the test solutions and incubated for 60 min at 37 degrees centigrade. The results of gel formation (+ve and -ve) and normalization of inhibition control tests with Ca-supplement indicate that commercial LAL kits need extra calcium ions for the correct testing of the apyrogenicity of chelate-containing radiopharmaceuticals and chelating agents.

Limulus Test↗

Thrombogenicity of canine free internal mammary artery autografts.

Early patency of free internal mammary artery (IMA) grafts for coronary artery bypass (CAB) is lower than that of in situ IMA grafts, and proximal anastomotic problems have been implicated in the pathogenesis of graft occlusion. To determine whether thrombotic phenomena might account for proximal graft narrowing, we examined platelet and fibrinogen deposition in 23 free IMA grafts in a canine model of CAB. Twelve animals had no antiplatelet therapy and were controls. Eleven animals received dipyridamole, 55 mg p.o. daily, 2 days before and each day after operation; aspirin, 325 mg p.o. daily, was given after CAB. Six of the 12 untreated dogs and 5 of the 11 treated dogs were sacrificed at 1 day after surgery; the remainder of each group was sacrificed on the 14th postoperative day. Platelet and fibrinogen depositions were quantitated by indium-111 tropolone and Iodine-125 labeling, respectively. Grafts were sectioned into five parts: proximal anastomosis (PA), proximal graft (PG), midgraft (MG), distal graft (DG), and distal anastomosis (DA). Platelet deposition was highest at the PA of free IMA grafts, and fibrinogen deposition was high at both anastomoses. Antiplatelet therapy significantly reduced platelet deposition at the PA at 14 days, but not at 1 day; fibrinogen deposition was significantly reduced at the DA at 1 day, and at both the PA and DA at 14 days. The ratio of fibrinogen molecules per platelet was unaffected by antiplatelet therapy, but was observed to increase with time at the DG and DA.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Comparison of polyethylene glycol and chromium-51 chloride as nonabsorbable stool markers in calcium balance studies.

The day-to-day variations in stool calcium content during calcium balance studies are usually corrected for by adjusting for the recovery of an orally administered nonabsorbable stool marker. We describe here a simple method for making this correction using chromium-51 chloride hexahydrate (51Cr) in balance studies. This approach was developed because of difficulties encountered with the more widely used marker, polyethylene glycol (PEG). With one batch of PEG, the stool recovery was only 81% (whereas with 51Cr it was 95%). The reason for this poor recovery was contamination of the PEG 4000 with a high molecular weight species (10-15%, wt/wt). Because others have also reported low PEG recoveries and because we found that the chemical abnormality in the PEG was very difficult to detect, we believe that 51Cr is more reliable and should be the preferred stool marker for the calcium balance studies.

Administration, Oral↗

Effect of platelet inhibitors on platelet and fibrin deposition following transluminal angioplasty of the atherosclerotic rabbit aorta.

Experimental atherosclerosis was induced in a rabbit model by intimal damage of the infrarenal aorta followed by two months cholesterol feeding. The influence of four different antiplatelet drug regimens on acute platelet and fibrin deposition after transluminal angioplasty of the atherosclerotic abdominal aorta was then evaluated. The study group consisted of 32 New Zealand rabbits: 7 controls, 7 treated with prostacyclin (10 mg/kg/min i.v.), 5 treated with low-dose acetylsalicylic acid (2 mg/kg i.v.), 7 treated with acetyl-salicylic acid (5 mg/kg i.v.) and dipyridamole (2 mg/kg i.v.), and 6 treated with low molecular dextran (5 ml/kg). By 2 hours after angioplasty, there was a significant increase of the deposition of platelets (P less than 0.001) as well as fibrin (P less than 0.01) when comparing dilated to non-dilated segments in the control animals. There was no significant difference in the amount of platelets and fibrin deposition among the control and drug treated groups. Thus, in this animal model there appears to be no immediate benefit in using antiplatelet drugs during transluminal angioplasty. Although, this study did not address the potential long-term effects of antiplatelet drug therapy, future evaluation of the clinical benefits of these drugs in conjunction with transluminal angioplasty seems warranted.

Angioplasty, Balloon↗

The search for an 111In labeled agent for the solid component of gastric emptying.

111In-labeled solid meal was prepared by chelation of 111In with Chelex resin bead. The effect of grinding of normal Chelex bead on 111In chelation and retention in solid meal was evaluated in an in vitro system. The Chelex resin beads were ground in a mortar-pestle to form ground Chelex resin beads. Fine particles were removed by resuspension in distilled water and centrifugation (1000 g). One hundred to 150 microCi of 111In chloride was diluted with 0.1 N HCl and mixed with 1 g of Chelex resin beads. Unbound 111In was removed by centrifugation (1000 g). The 111In-labeled Chelex resin beads were mixed with fresh egg and 111In-labeled solid meal was prepared by heating until solid. The meals were digested with HCl-pepsin (1.2 mg/mL of pepsin in 0.1 N HCl) for 4 h in a stirrer-bath (37 degrees C). Aliquots were collected at intervals for determination of 111In loss from 111In-labeled solid meal. These results suggest that 111In Chelex resin beads were retained in solid meals at a higher level than normal Chelex resin beads and other 111In-tracers.

Digestion↗

Labeled polymorphonuclear leukocytes: a comparison of methodology.

Polymorphonuclear neutrophilic granulocytes were separated from anti-coagulated whole blood using three techniques. The methods employed included volex sedimentation (VS), volex sedimentation with hypotonic lysis (VSHL), and Ficoll-Hypaque gradient separation (FH). The cells were labeled with 111In-oxine and 111In-tropolone. Studies were done with both blood from normal human volunteers and with canine blood. From the cell counts and differential, the harvested granulocytes, platelets, and red blood cells per milliliter of whole blood were calculated. Using the granulocyte chemotactic response to E. coli in agarose plates, the ratio of chemotactic migration to random migration (c.m./r.m.) was determined. Survival time for 111In labeled granulocytes were also determined in a canine model. The studies demonstrated that all procedures yielded 100% viability by the Trypan blue exclusion test. Chemotactic migration and leukocyte survival times were similar amongst all techniques. With the VSHL technique, there were significantly fewer red blood cells and platelets in the final preparation approaching the results of FH separation. The results suggest that for a relatively pure granulocyte preparation VSHL is an acceptable alternative to FH.

Animals↗

Indium-111 labeled purified granulocytes in the diagnosis of synthetic vascular graft infection.

Indium-111 labeled leukocytes have been shown to be useful in the diagnosis of synthetic vascular graft infection. To minimize the potential effects of labeled red blood cells and platelets on image interpretation, the authors prepared purified autologous granulocytes (PG) from 84 ml of blood using Volex enhanced gravity sedimentation and Ficoll-Hypaque double density centrifugation. The labeling efficiency of PG with In-111 tropolone was 90 +/- 9% (mean +/- SD). Imaging was performed 18-24 hours following injection of approximately 445 microcuries of In-111 PG in 26 patients with suspected infection of vascular grafts that had been implanted 12 days to 12 years prior to the study. In ten patients with proven graft infection, seven had positive In-111 PG scans. Ten of 11 patients without infection had negative scans. In five patients with clinically equivocal findings, scan results were positive in one, negative in one, and equivocal in three. A false-positive scan occurred in a patient with an uninfected inflammatory pseudoaneurysm of an aortic graft. These results confirm an earlier report that In-111 PG imaging is a useful technique in the diagnosis of synthetic vascular graft infection.

Aged↗

Thrombocytopenia after liver transplantation.

Thrombocytopenia occurs in postoperative liver transplant patients, with platelet counts reaching a nadir on the third postoperative day. Significant bleeding episodes are not uncommon during the first five days postoperatively when platelet counts are low. This thrombocytopenia may be the result of platelet sequestration in the newly grafted liver. The sequestration phenomenon does not appear to be on the basis of antiplatelet antibody activity. Further work defining the time course of this organ sequestration and evaluating the possible release of previously sequestered platelets back into the circulation need to be done. Also, it may be productive to study medications known to inhibit platelet activation (ie, cyclooxygenase inhibitors, prostacyclin, and calcium channel blockers) with the intent of interrupting platelet adhesiveness-sequestration at the time of recirculation of the newly grafted liver.

Hemorrhage↗

Methods of assessment of thrombosis in vivo.

The contributions of platelets and clotting factors in thrombosis on injured vessel and cardiovascular prostheses have been quantified with several tracers. Thrombus formation in vivo could be measured semiquantitatively in animal models and humans with 111In-labeled platelets, 123I- and 131I-labeled fibrinogen, 111In-labeled antibody to the fibrinogen receptor on the platelet membrane and to fibrin. Thrombus localization by imaging was possible for large thrombus in vessel with deep injury of thrombogenic surface in the acute phase. A single layer of adherent platelet could not be imaged, due to the high background radioactivity present in blood. Thrombogenicity of graft was compared with that of contralateral vessel. The dynamic process of platelet deposition could be followed accurately using the in vivo imaging technique. In addition, in vitro quantification permits determination of platelet and fibrin density and of the number of fibrin monomers per platelet in thrombus. The roles of prostacyclin, thromboxane inhibitors, and nonsteroidal antiinflammatory drugs have also been evaluated in animals models and humans. The tracer techniques thus provide invaluable information about platelet-fibrin deposition, its organization and dissolution, and for development of less thrombogenic surfaces for use in cardiovascular prostheses.

Animals↗

Identification of new collagen formation with 125I-labeled antibody in bovine pericardial tissue valves implanted in calves.

Failure of bovine pericardial tissue valve used in young patients may be due to a slow rejection process. Polyclonal anticollagen (Type I) antibody (IgG) was made in rabbits and purified by protein A affinity column. Two milligrams of IgG was labeled with 2 mCi of 125I by the Iodogen method. Free iodide was separated by G-10 column. Affinity of 125I-IgG was checked by radioimmunoassay. Two hundred and fifty microcuries of 125I-IgG was injected in calves immediately after tissue valve implantation, and the calves were killed 4 h post-injection. After harvesting the valve, each of the three leaflets was separated into four zones, and radioactivity in each section was mapped with a gamma counter. The radioactivity in tissue valve section was compared to that of normal aortic valve. The sections of tissue valve retain five to ten times more 125I-IgG than control aortic valve. Iodine-IgG thus provides a sensitive technique for determination of residual antigenicity in tissue valve.

Animals↗

Radiolabeled polyvinyl alcohol particles: a potential agent to monitor embolization procedures.

Polyvinyl alcohol sponge (PVA) is a widely used angiographic embolic agent. The radiolabeling of PVA can accurately identify particle localization and may decrease the possibility of patient morbidity from embolization to distal sites. We incorporated 99mTc sulfur colloid (SC) into PVA by heating. Animal experiments demonstrated the in vivo stability of the 99mTc SC-PVA complex and the efficacy of external imaging. 99mTc SC-PVA biodistribution data and external NaI(T1) scintillation probe counts were performed, to assess anatomic localization. Embolization with this complex was performed in a patient.

Angiography↗

Comparison of three platelet markers for measurement of platelet survival time in healthy volunteers.

We studied mean platelet survival times in healthy volunteers with use of [51Cr]disodium chromate, 111In-oxine (in a solution of acid-citrate-dextrose [ACD] and saline), and 111In-tropolone (in ACD-plasma) as markers. Differences found between the 51Cr and 111In labels probably can be attributed to a variation in localization of the label on the cell and of renal handling of the free label after release. The mean platelet survival time with 51Cr was slightly longer than the survival time with both indium labels and showed a sex difference not seen with 111In-oxine. Protein-bound plasma 51Cr was lower than plasma 111In and remained constant throughout the study. Plasma 111In increased with time. For survival time calculations, no correction for free 51Cr is necessary, but correction should routinely be performed when 111In markers are used. Both 111In markers gave similar results with respect to platelet survival time. The somewhat more elaborate plasma labeling procedure with tropolone shows no measurable advantage over the original 111In-oxine method. 111In-tropolone labeling takes less time and maintains platelets in the physiologic environment of plasma during incubation. Biodistribution studies show no difference between the two 111In markers.

Blood Platelets↗

Deep arterial injury during experimental angioplasty: relation to a positive indium-111-labeled platelet scintigram, quantitative platelet deposition and mural thrombosis.

Although it is not clear why coronary occlusion and restenosis occur after successful coronary angioplasty, factors related to the procedure may influence early and late results. The possible adverse effects of a medial tear documented histologically and produced during balloon angioplasty of the common carotid arteries were studied in 30 fully heparinized (100 U/kg body weight) normal pigs. Scanning electron microscopy showed endothelial denudation and extensive platelet deposition in all dilated arterial segments. Visible macroscopic mural thrombus was present within an hour of the procedure in 29 (91%) of the 32 arteries that had a medial tear documented by histologic study; the tear produced an indium-111-labeled platelet deposition of 116.4 +/- 26.5 X 10(6)/cm2 (mean +/- SE) and total thrombotic occlusion in 2 arteries (4%). None of the 24 arteries without a medial tear had a thrombus, and the mean platelet deposition in that group was 7.0 +/- 0.5 X 10(6)/cm2 (p less than 0.0008). In 12 pigs scanned with a gamma camera, visible thrombus was associated with platelet deposition in excess of 20 X 10(6)/cm2 in 12 arteries, 9 of which had a positive indium-111-labeled platelet scintigram. Thus, arterial angioplasty causes deep arterial injury, which appears to be a major cause of mural thrombosis, heavy platelet deposition, a positive indium-111-labeled platelet scintigram and acute arterial occlusion. A positive indium-111-labeled platelet scintigram was always associated with macroscopic thrombus of at least 20 > 10(6) platelets/cm2 and underlying deep arterial injury.

Angioplasty, Balloon↗

Quantification of regional platelet and calcium deposition on pericardial tissue valve prostheses in calves and effect of hydroxyethylene diphosphonate.

Mitral valves were replaced with 25 mm bovine pericardial tissue valve prostheses (Ionescu-Shiley) in 45 calves (23 controls and 22 treated daily with hydroxyethylene diphosphonate). Before being killed 1, 14, 30, and 90 days later, the calves received In-labeled autologous platelets intravenously. Regional variations in platelet deposition were measured by a new technique. Thrombus was noted early on the flexion zone of the valve; with time it increased on the free edge and central zone. Platelet deposition was initially high on the flexion zone, attachment zone, sewing ring, and perivalvular tissue but decreased with time. Hydroxyethylene diphosphonate treatment tended to decrease platelet deposition in all zones. Calcium content was high in thrombus and increased in all zones with time, in both groups, but the deposition was less in the group treated with hydroxyethylene diphosphonate. Collagenous tissue and adherent thrombus appear to provide nucleation sites for calcification.

Animals↗