Astragalus membranaceus polysaccharides modulate growth, hemato-biochemical indices, hepatic antioxidants, and expression of HSP70 and apoptosis-related genes in Oreochromis niloticus exposed to sub-lethal thallium toxicity

A 60-day experiment was performed to assess the efficacy of dietary Astragalus membranaceus polysaccharides (ASP) in attenuation of sub-lethal thallium (Tl) toxicity in Nile tilapia. Six experimental groups (in triplicates) were designed where a fish group was raised in clean water and fed basal diet and served as control (CONT), two groups were fed the basal diet supplemented with 0.15% and 0.30% ASP (ASPL and ASPH), Tl-intoxicated group exposed to 1/10 of 96-h LC50 (= 41.9 μg/L), and two other groups were fed 0.15% and 0.30% ASP and concomitantly exposed to 41.9 μg Tl/L (ASPL-Tl and ASPH-Tl). At the end of the experiment, fish behavioral responses, clinical signs, survivability, growth, whole-body composition, intestinal digestive enzymes, serum biochemical parameters, hepatic antioxidative biomarkers, and transcription of stress and apoptosis genes were assessed. Results showed that the whole-body composition, intestinal α-amylase and protease enzymes, serum AST and blood urea levels, and hepatic GSH were not significantly different among groups (P > 0.05). The Tl-intoxicated fish group was off food, had darkened skin, showed restlessness and hyperexcitability, and high mortalities. FBW, WG, SGR and FI were significantly decreased alongside increase FCR in the Tl-exposed group. Tl exposure caused significant increases (P < 0.05) in intestinal lipase enzyme and serum indices such as ALT, creatinine, total cholesterol, triglycerides, glucose, and cortisol levels. Moreover, a significant decreases in hepatic CAT and SOD enzyme activities and significant increases in hepatic MDA contents were also noticed (P < 0.05). Furthermore, Tl exposure induced significant upregulation of hepatic HSP70 and apoptosis-related genes (p53 and caspase 3). Interestingly, dietary supplementation with ASP in ASPL-Tl and ASPH-Tl groups modulated the parameters mentioned above but still not reached the CONT values. Altogether, this study suggests that ASP could be beneficial in the modulation of sub-lethal Tl toxicity effects in Nile tilapia. Additionally, we can conclude that using natural feed supplements such as ASP in aquafeed might be necessary for maintaining the overall health performances of Nile tilapia.

Spatial patterns of neuronal activity in rat cerebral cortex during non-rapid eye movement sleep

It is commonly assumed that cortical activity in non-rapid eye movement sleep (NREMS) is spatially homogeneous on the mesoscopic scale. This is partly due to the limited observational scope of common metabolic or imaging methods in sleep. We used the recently developed technique of thallium-autometallography (TlAMG) to visualize mesoscopic patterns of activity in the sleeping cortex with single-cell resolution. We intravenously injected rats with the lipophilic chelate complex thallium diethyldithiocarbamate (TlDDC) during spontaneously occurring periods of NREMS and mapped the patterns of neuronal uptake of the potassium (K+) probe thallium (Tl+). Using this method, we show that cortical activity patterns are not spatially homogeneous during discrete 5-min episodes of NREMS in unrestrained rats-rather, they are complex and spatially diverse. Along with a relative predominance of infragranular layer activation, we find pronounced differences in metabolic activity of neighboring neuronal assemblies, an observation which lends support to the emerging paradigm that sleep is a distributed process with regulation on the local scale.

Effects of exposure to high concentrations of waterborne Tl on K and Tl concentrations in Chironomus riparius larvae

Thallium (Tl) is a non-essential metal which is released into the environment primarily as the result of anthropogenic activities such as fossil fuel burning and smelting of ores. The ionic radius of monovalent Tl⁺ is similar to that of K⁺ and Tl⁺ may thus interfere with K⁺-dependent processes. We determined that the acute (48 h) lethal concentration where 50% of the organisms do not survive (LC₅₀) of Tl for 4th instar Chironomus riparius larvae was 723 μmol L⁻¹. Accumulation of Tl by the whole animal was saturable, with a maximum accumulation (Jmax) of 4637 μmol kg⁻¹ wet mass, and K(D) of 670 μmol Tl l⁻¹. Tl accumulation by the gut appeared saturable at the lowest four Tl concentrations, with a Jmax of 2560 μmol kg⁻¹ wet mass and a K(D) of 54.5 μmol Tl l⁻¹. The saturable accumulation at the gut may be indicative of a limited capacity for intracellular detoxification, such as storage in lysosomes or complexation with metal-binding proteins. Tl accumulation by the hemolymph was found to be linear and Tl concentrations in the hemolymph were ~75% of the exposure concentration at Tl exposures >26.9 μmol L⁻¹. There was not a significant decrease in whole animal, gut or hemolymph K during exposure to waterborne Tl at any of the concentrations tested (up to 1500 μmol L⁻¹). The avoidance of hypokalemia by C. riparius larvae may contribute to survival during acute waterborne exposures to Tl.

Brachial artery flow-mediated dilation and myocardial perfusion in patients with cardiac syndrome X

We assessed the relation between systemic endothelial dysfunction abnormalities (brachial artery flow-mediated dilation) and myocardial perfusion abnormalities (single-photon emission computed tomography) in 41 patients who had cardiac syndrome X. Eighteen patients had normal perfusion scans and 18 had transient perfusion defects. Reverse redistribution was found in 5 patients. Patients who had myocardial perfusion defects had significantly lower flow-mediated dilation values (1.8%) than patients who had normal single-photon emission computed tomograms (3.9%, p = 0.012). Preserved systemic endothelial function appears to rule out the occurrence of transient single-photon emission computed tomographic defects in patients who have cardiac syndrome X.

Radiation-absorbed dose from 201Tl-thallous chloride

Revised radiation dosimetry estimates for 201Tl-thallous chloride have been developed using new data specifically acquired to address the issue of testicular uptake of this agent and through reevaluation of extant data for biodistribution in other organs.

METHODS

Quantitative testicular scintigraphy data of sequestered testes (body-background shielded) were obtained from 28 patients (56 studies) injected with 201Tl-thallous chloride at peak exercise. Previously published data for 15 patients injected at maximal exercise were reanalyzed to obtain updated biodistribution parameters for designated organs. Radiation dose was calculated according to the MIRD schema. Radiation dose to testes as a function of age was determined. Comparisons are made between organ dose estimates derived in this study and those previously published. The dose contributions of possible contaminants (200Tl, 202Tl, 203Pb) have been included. Estimates are provided of the dose component from these contaminants if injected at the time of the maximum recommended 5-d shelf life (as opposed to at the designated calibration time).

RESULTS

The radiation dose per unit administered activity to adult testes calculated in this study of 0.21 mGy/MBq (0.77 rad/mCi) is approximately a factor of 2 less than the value of 0.45 mGy/MBq (1.7 rad/mCi) previously accepted. The revised dose estimates for other organs show less variation from published values. The effective dose determined in this work is approximately 0.16 mSv/MBq (0.60 rem/mCi). Under the assumption of similar biokinetics as for the adult, the testes dose for children increases significantly as age decreases with a value of 7.5 mGy/MBq (28 rad/mCi) for a newborn. Contributions from radiocontaminants that may be encountered in the preparation of 201Tl-thallous chloride are shown to range from a fraction of a percent up to approximately 20% of the total dose for some organs, with the higher values arising from the long half-life contaminant 202Tl after a 5-d shelf life.

CONCLUSION

It is recommended that the dose values determined in this study be used when estimating the radiation dose to the adult testes from intravenous administration of 201Tl-thallous chloride. The potential for increased radiation dose per administered activity to the testes at younger ages should be evaluated before performing procedures on children. The presence of radiocontaminants in the product should be considered when estimating radiation dose and may add a significant contribution to dose dependent on the specific radionuclide and concentration at the time of administration.

Long term retention and excretion of 201Tl in a patient after myocardial perfusion imaging

201Tl is widely used in nuclear medicine to carry out myocardial perfusion imaging (MPI). However, very limited data is available on long-term distribution in the body, excretion and corresponding dose. In this study we performed a 2 month follow-up of a patient who underwent MPI, by urine analysis and in vivo measurements. The biological half-life of thallium was consequently estimated to be 11.6-27 d, which is in partial agreement with previous studies. We also estimated excretion and retention of 200Tl, 201Tl and 202Tl isotopes using the biokinetic parameters from ICRP publication 53 and compared the forecast result with actual measurements. The latter demonstrated a higher urinary excretion and a higher body retention than what was expected. Our results therefore suggest that the long-term retention and consequently the effective dose coefficient for 201Tl considered in ICRP publications 53 and 80 may be slightly underestimated.

Uptake, localization, and dosimetry of 111in and 201tl in human testes

This study concerns the testicular uptake and dosimetry of Auger electron-emitting radionuclides that are used during routine diagnostic nuclear medicine procedures. To consider the possible effects of these radionuclides on spermatogenic cells, a study has been undertaken to obtain in vivo data for quantification of (111)In chloride and (201)Tl chloride uptake into the human testis after intravenous administration. Values have been determined for uptake into the testis as a whole and to the seminiferous tubules where the germ cells are located.

METHODS

Data were obtained from patients with prostate cancer who opted for orchidectomy to effect hormone suppression. Patients were administered intravenously 1.5 MBq of either (111)In chloride or (201)Tl chloride at 24 or 48 h before orchidectomy. Upon removal, the testes were analyzed to assess uptake of radionuclide. Conventional dosimetry has been used to estimate testicular radiation doses using our values of percentage uptake.

RESULTS

Uptake of both (111)In chloride and (201)Tl chloride into the testes was seen at a level above that explained by simple homogeneous distribution of the radionuclide throughout the body; the testes as a whole demonstrated increased uptake by factors of 3.56 and 4.01 compared with nonspecific uptake for (111)In and (201)Tl, respectively, at 24 h after administration. Both radionuclides gained access to the seminiferous tubules.

CONCLUSION

The results obtained indicate that the values of testicular radiation doses quoted by the International Commission on Radiological Protection for (111)In might be too low by a factor of 4, whereas those for (201)Tl might be too high by a factor of 4. No data were obtained for uptake by individual germ cells within the testis and, therefore, no consideration of dosimetry at the cellular level was possible. However, it has been demonstrated that uptake of diagnostic Auger electron-emitting radionuclides by male germ cells within the testis is possible after intravenous administration.

Tl-201 reinjection enhances the detection of myocardial ischemia after acute myocardial infarction

BACKGROUND

Thallium 201 reinjection has been shown to enhance the detection of myocardial ischemia in patients with chronic coronary artery disease. However, limited data are available regarding its value in patients after acute myocardial infarction.

METHODS AND RESULTS

We performed adenosine Tl-201 tomography in 126 patients in stable condition at a mean of 5 +/- 3 days after acute myocardial infarction (MI). After acquisition of redistribution images, patients were reinjected with 1 mCi of Tl-201 and reinjection images were then obtained. The stress, redistribution, and reinjection images were quantified to determine the total perfusion defect size and percent ischemia and scar. The mean age of patients was 54 +/- 10 years. Of the patients, 64% were male, 56% had Q-wave MI, 46% had anterior MI, and 34% received thrombolysis. The percent total defect size was the same on the stress-redistribution and stress-reinjection images (28.3% +/- 19.0%). The reinjection images showed an increase in ischemic defect size (14.7% +/- 13.5% vs 12.8% +/- 12.0%, P =.001) and a decrease in scar defect size (13.6% +/- 13.1% vs 15.5% +/- 13.9%, P =.001) compared with the redistribution images. The enhancement in the detection of myocardial ischemia was seen in both the infarct (P =.001) and noninfarct (P =.01) zones.

CONCLUSIONS

Tl-201 reinjection enhances the detection of myocardial ischemia after acute MI compared with stress-redistribution alone.

Serum caffeine levels after 24-hour abstention: clinical implications on dipyridamole (201)Tl myocardial perfusion imaging

BACKGROUND

Caffeine binds to the A2 receptors and inhibits adenosine's action of vasodilation or dipyridamole-induced vasodilation. Patients scheduled for (201)Tl myocardial perfusion using pharmacologic stress with dipyridamole or adenosine are advised to abstain from caffeine for 24 h before the test. This article reports on the residual serum caffeine levels of 36 patients after 24-h caffeine abstention and the clinical implications on dipyridamole (201)Tl myocardial perfusion imaging.

METHODS AND RESULTS

Heart rate, diastolic blood pressure, and systolic blood pressure were recorded before and after dipyridamole infusion. Sixty-six percent of the patients had detectable plasma caffeine but all values were within the range of 0.1-0.8 mg/L. No statistically significant change in diastolic and systolic blood pressures after dipyridamole infusion has been observed. The mean heart rate was increased by 18% after dipyridamole infusion in patients with zero caffeine, and the heart rate increase was inversely correlated with the serum caffeine levels (r = -0.22) with 81% confidence.

CONCLUSION

A serum caffeine level of 2 mg/L is predicted to be the lower limit for false-negative dipyridamole (201)Tl myocardial perfusion. The increase of heart rate after dipyridamole infusion could be the simple indicator for the serum caffeine level. Rescheduling of the patient study or further adenosine challenge is necessary only if the heart rate increase is <5% after dipyridamole or adenosine infusion.

Unilateral pulmonary edema demonstrated with Tl-201 imaging

Clinical and scintigraphic findings are described in a patient in whom acute right-sided pulmonary edema developed during a treadmill exercise test. The patient's SPECT Tl-201 stress images are reviewed along with the pertinent clinical history. The development of unilateral pulmonary edema during an exercise treadmill test was demonstrated with Tl-201 imaging.

Comparison of glucose-insulin-thallium-201 infusion single photon emission computed tomography (SPECT), stress-redistribution-reinjection thallium-201 SPECT and low dose dobutamine echocardiography for prediction of reversible dysfunction

The usefulness of glucose-insulin-thallium-201 (GI-Tl) infusion single photon emission computed tomography (SPECT) in predicting reversible dysfunction has not been evaluated, so the present study recruited 20 patients with regional ischemic dysfunction for investigation. All patients underwent GI-Tl SPECT, post-stress Tl reinjection imaging and low dose dobutamine echocardiography. The diagnostic accuracy of these 3 techniques in predicting functional recovery was evaluated by receiver operating characteristic (ROC) analysis. In segments with functional recovery, regional Tl activities of GI-Tl SPECT were significantly higher than those of reinjection imaging (p<0.05), although there were no significant differences in segments without recovery. The area under the ROC curve for GI-Tl SPECT (0.75+/-0.06) was greater than that for reinjection imaging (0.68+/-0.07). The optimal cutoff values to identify viable myocardium were considered to be 55% of peak activity for GI-Tl SPECT and 50% for reinjection imaging. At this cutoff point, the sensitivity and specificity for detection of functional recovery were, respectively, 85% and 61% for GI-Tl SPECT, and 73% and 61% for reinjection imaging. Dobutamine echocardiography had the same sensitivity (85%), but lower specificity (48%) than GI-Tl SPECT. Continuous infusion of GI-Tl solution enhances regional Tl uptake compared with conventional post-stress reinjection imaging. This study suggests that GI-Tl SPECT is superior to reinjection imaging and dobutamine echocardiography in predicting functional recovery after ischemic left ventricular dysfunction.

Course of impaired left ventricular function after acute myocardial infarction predicted with planar thallium-201 chloride and F18-fluorodeoxyglucose imaging

Planar reset myocardial thallium-201 chloride (201Tl)/F18-fluorodeoxyglucose (FDG) imaging has been shown to distinguish between viable and non-viable tissue. Twenty-five patients (60 +/- 9 years) with acute myocardial infarction were studied using this technique within 6 +/- 2 days (T1) after infarction and again after 42 +/- 4 days (T6). Serial assessment of wall motion with 2D-echocardiography was performed to determine the predictive value of radionuclide indices for the course of impaired regional left ventricular function. No revascularization procedure was performed. Segmental 201Tl and FDG uptake was evaluated using circumferential profiles. Echocardiographic wall motion was scored as normal, hypokinetic or akinetic. Myocardial segments were considered non-viable if a match between 201Tl and FDG uptake was present, which is a concordant reduction in 201 Tl and FDG uptake (Group A). Myocardial segments were considered viable if: a mismatch was present between 201Tl and FDG uptake which was defined as a segmental FDG uptake exceeding 201Tl uptake by > or = 20% in a segment with reduced 201Tl uptake (Group B); a normal FDG uptake (> or = 75%) was present without a mismatch pattern in a segment with reduced 201Tl uptake (201Tl < 75% of peak activity) (Group C); a normal 201Tl uptake was present in the area of wall motion abnormality (Group D). Corresponding scintigraphic images obtained at T1 and T6 were compared.

RESULTS

51 segments were normokinetic, 37 were hypokinetic and 6 were akinetic at T1. Of the 63 segments with wall motion abnormalities at T1, 18 regions showed a match (FDG-201Tl < 20%) (Group A). Regional function improved in only one (6%) of these segments. In 19 regions a mismatch was present (FDG-201Tl > 20%) (Group B) of which three (16%) showed spontaneous improvement in function (p = NS vs. matched segments), although recovery varied considerably among patients. Regional function in two segments deteriorated. In 14 regions with reduced 201Tl uptake, FDG uptake was normal (Group C) of which five (36%) were improved after 6 weeks (p < 0.05 vs. match; p = NS vs. mismatched segments). Of the 12 segments with normal 201Tl uptake (Group D), seven (58%) showed improvement in function, whereas five (42%) did not show improvement (p < 0.05 vs. match). In addition, all scintigraphically selected viable segments were grouped (Group B + C + D) and compared with the non-viable segments (Group A). The predictive value of a positive viability test for spontaneous functional improvement was 33%. The predictive value of a negative viability test for lack of functional improvement was 94%.

CONCLUSIONS

absence of residual FDG uptake shortly after infarction is associated with irreversible injury, while preservation of metabolic activity identifies segments with variable outcome. Wall motion alone is not a good indicator for the presence of viable tissue. Planar 201Tl/FDG imaging allows early identification of viable but jeopardized tissue and may help select patients who will benefit from aggressive therapy to salvage endangered myocardium.

Renal amino acid transport in immature and adult rats during thallium-induced nephrotoxicity

The effect of Tl2SO4 (Tl, 2 mg/100 g b.wt.) on renal amino acid excretion and plasma amino acid composition was investigated in 10- and 55-day-old rats. Tl decreased glomerular filtration rate only in adult rats. On the other hand, the renal fractional excretion (FE) of amino acids was distinctly higher in adult rats as a sign of lower amino acid reabsorption capacity after Tl. In immature animals FE was increased only for a few amino acids. However, in both age groups Tl administration significantly decreased plasma amino acid concentrations, and was more pronounced in immature rats. The investigation of renal amino acid handling (1) confirms that Tl was more nephrotoxic in 55-day-old animals as demonstrated before using other parameters for nephrotoxicity testing and (2) showed that determination of renal amino acid handling is a suitable marker for nephrotoxicity in adult rats.

Functional and morphological aspects of thallium-induced nephrotoxicity in rats

Until now the effect of thallium (Tl) on renal function has not been investigated systematically. Therefore, the dose (5, 10, 15, 20 mg Tl2SO4/kg body wt., intraperitoneally) and time-dependence of renal damage was investigated in diuresis experiments on conscious rats. Morphology was evaluated after perfusion fixation in situ. Morphologic changes were localized in the thick ascending limb of the loop of Henle, mostly expressed at the 2nd day after Tl administration, which were completely normalized again at the 10th day. Other parameters such as Tl concentration, changes in water content and the activity of Na+/K(+)-ATPase as well as the diuretic effect of furosemide confirmed the Tl effect to be localized in the renal medulla. One single Tl administration is followed by a decrease in glomerular filtration rate (GFR) and urine volume and an increase of proteinuria. Electrolyte excretion was only slightly changed. All changes were reversible within the 10-day investigation period.

Variable portal circulation from inferior mesenteric vein assessed by per-rectal radionuclide administration

The intrahepatic distribution of radioactivity after the per-rectal administration of 201T-chloride and/or 99Tcm-pertechnetate was investigated in 177 studies in 149 patients with no liver disease or diffuse liver disease and compared with that of 99Tcm-stannous (99Tcm-Sn) colloid scintigrams. The patients were classified into two groups: distribution of intrahepatic radioactivity of 201Tl and/or 99Tcm-pertechnetate scintigrams similar to (homogeneous) or different from (heterogeneous) that of 99Tcm-Sn-colloid scintigrams. The heterogeneous group was divided into three subgroups: increased radioactivity of the right lobe (right dominant pattern), increased radioactivity of the left lobe (left dominant pattern) and uneven distribution of radioactivity in both lobes (uneven pattern). Of the 80 patients in whom the studies were performed in the supine position at rest, 14 (17.5%) showed a heterogeneous pattern (8 right dominant, 4 left dominant, 2 uneven) and 66 (82.5%) a homogeneous pattern. In the 97 patients allowed free body movement, 6 (6.2%) showed a heterogeneous (1 right dominant, 5 left dominant) and 91 (93.8%) a homogeneous pattern. A significant difference in the incidence of heterogeneous distribution between the resting and free body movement groups was found (P < 0.05). One patient with a left dominant pattern after free body movement with 201Tl showed a right dominant pattern at rest in the 99Tcm-pertechnetate study. It is concluded that a heterogeneous intrahepatic distribution of inferior mesenteric vein blood is sometimes observed and that the distribution of portal vein blood flow seems to be affected by the patient's positioning and free body movement.

Thallium distribution in organs and brain regions of developing rats

The concentration of thallium in body organs and brain regions was studied in rats as a function of the animals age from newborn to 20-days old. Thallium was analyzed at different times after a single sublethal i.p. injection of the metal (16 mg/kg). The results indicate that the brain is less permeable to thallium in the older animals, suggesting that reduced thallium transport into the brain is related to the establishment of the blood-brain barrier in the rats. Differences between weanling and newborn rats were also found in regard to regional distribution of thallium in the brain as the older animals showed a region-dependent distribution while newborn rats presented an homogeneous content of thallium among all regions.

Dosimetric consequences of radiopharmaceutical infiltrations

RATIONALE AND OBJECTIVES

Little is known about the time-related biologic behavior of radiopharmaceutical misinjections. Such inadvertent tissue infiltration of such injections may not only adversely affect a scheduled test or cause some discomfort, but potentially could produce tissue damage. Radiopharmaceutical infiltrations were assessed in a rat model.

METHODS

Particulate and nonparticulate radiopharmaceuticals were injected subcutaneously or intradermally into an anesthetized shaved rat model. The rate of release of the nine infiltrations per radiopharmaceutical per injection type were measured from computer data acquired with a gamma camera up to 24 hours after administration. These data were used for dosimetry determinations.

RESULTS

When injected subcutaneously, the particulate radiopharmaceutical, technetium 99m (99mTc) albumin microspheres, exhibited essentially no movement, and the soluble agents showed a biexponential release pattern. The rate of release was similar for 99mTc methylene diphosphonate (99mTc MDP) and for 67Ga citrate (67Ga), whereas thallous chloride (201Tl) exhibited the slowest release pattern. The average effective half-lives (T1/2 av-eff) were 78.3 minutes, 76.1 minutes, and 268.4 minutes, respectively. When injected intradermally, the nonparticulates exhibited a triexponential release pattern; MDP showed a more rapid release (T1/2 av-eff, 50 minutes) and 201Tl showed the slowest (T1/2 av-eff, 491.2 minutes). Absorbed doses were calculated using conventional medical internal radiation dose (MIRD) methodology for small unit density spheres. The absorbed dose was greatest for a 201Tl infiltration. A 201Tl infiltrate of 1 mCi per gm of tissue is capable of producing radiation-absorbed doses greater than 500 rads. Additional studies were performed with heat, hyaluronidase, and volume dilution in an attempt to accelerate the rate of release of 201Tl. Local heat application proved to be more efficient than volume change or hyaluronidase application.

CONCLUSION

These data indicate an insignificant skin radiation burden from the majority of nonparticulate infiltrated radiodiagnostic agents. Thallium 201, however, has the potential to produce significant radiation burdens when infiltrated at high specific activity. Actual human infiltration release rates may differ because of variants in blood flow and assumed infiltration volume relative to the animal model.

Cardiac risk in vascular surgery. The oral dipyridamole-thallium stress test

The value of the oral dipyridamole-thallium stress test in identifying patients at high risk of myocardial infarction after vascular procedures has not been documented. We studied prospectively 46 patients who underwent an oral dipyridamole-thallium stress test before undergoing vascular operations. Twenty patients (43%) had a positive test result, defined by a thallium defect with reperfusion, while 26 patients had a negative test result. Myocardial infarctions were documented postoperatively in 5 (25%) of 20 of the group with positive results and 1 (4%) of 26 of the group with negative results. Three of the six myocardial infarctions were clinical; all three were in the group with positive results. No correlation was identified between dipyridamole-thallium stress test results and clinical cardiac history. A positive dipyridamole-thallium stress test result is a more sensitive predictor of postoperative myocardial infarction than ejection fraction or history of coronary artery disease. The oral dipyridamole-thallium stress test is as useful as the intravenous test in this setting.

Acute toxicity testing in the nonlethal dose range: a new approach

A new modification of acute toxicity testing of chemicals in rats is presented. Instead of using death as the principal criterion of toxicity, it is based on a careful, standardized clinical assessment of toxic signs measured in the nonlethal dose range. Test compounds are administered to groups of rats at four dose levels, selected on the basis of pilot experiments. General indices of toxicity, i.e., body weight gain, food and water consumption, and body temperature, are recorded at regular intervals; activity in the home cage is monitored continuously with a newly developed passive infrared device; neurobehavioral dysfunctions are assessed repeatedly with a checklist; and routine hematology is done on the 4th day after administration of the test compounds. All measured signs of toxicity are scored in relation to the control groups so that the absolute magnitude of the score increases as a function of the deviation from the normal conditions of the animals. In order to take into consideration the course of intoxication and the rate of recovery, toxicity scores are added over the duration of the whole experiment. For each variable measured, the resulting total scores are converted into a relative point system, scaling from 0 to 10 points. These points are added to a single "total ToxScore" value for each dose group. A regression line is calculated for these total ToxScore points, and the dose giving 15 total ToxScore points is determined. Based on the results obtained with nine reference substances, a classification system is proposed that is comparable to that based on LD50 values. It is concluded that the proposed test procedure provides much more information on the signs of acute toxicity, the course of the intoxication, the slope of the dose-effect curve, and the rate of recovery than does the standard LD50 test. In addition, the degree of distress and suffering of the animals is reduced.

[Acute pharmacokinetics of the Tl+ ion in the rabbit. 3-compartment model]

New Zealand rabbits were used to determine the acute kinetics of the Tl+ ion (0 to 90 minutes) following intravenous administration of two doses of Tl+ (10 mg.kg-1 and 30 mg.kg-1). The rapid disappearance of Tl+ from the blood may be explained by means of an open parallel tricompartmental mamillary model. The most important pharmacokinetic parameters which changed with the dose were Vdl (0.61 +/- 0.08 1.kg-1 for the low dose and 0.59 +/- 0.10 1.kg-1 for the high dose); ABC0-90 (310 +/- 18 mg.ml-1 min-1 for the low dose and 942 +/- 107 Mg.ml-1 min for the high dose; Kd (0.026 +/- 0.005 min-1 for the low dose and 0.037 +/- 0.010 min-1 for the high dose). The importance of the values of the slopes alpha, rho & gamma found by residual methods are discussed and compared with the results reported by other authors working with other species and different times.

Per rectal thallium scintigraphy for the assessment of portosystemic shunt: an experimental study in the bile duct ligated rats

Bile duct ligated rats (n = 7) have been investigated for 6 months. Two patterns of evolution have been observed: (i) progressive development of cirrhosis and portosystemic shunt (detected by 201Tl per rectal scintigraphy) in three animals, (ii) repermeabilization of the biliary tract in four animals. Despite the small number of animals investigated, the 201Tl per rectal scintigraphy seems to be a good indicator of portosystemic shunt secondary to biliary cirrhosis.

Arrhythmogenic right ventricular dysplasia. Delineation of myopathic site by intracoronary thallium-201

Arrhythmogenic right ventricular dysplasia (ARVD) is characterized by right ventricular (RV) myopathic changes and ventricular tachycardia (VT). Myocardial scintigrams obtained by intracoronary injection of TI-201 chloride were useful in the diagnosis of the location and extent of dysplasia in a 23-year-old man.

The clinical value of 201Tl per rectum scintigraphy in the work-up of patients with alcoholic liver disease

The clinical value of thallium 201 per rectum scintigraphy in the work-up of patients with alcoholic liver disease was evaluated using data obtained in 104 patients. The 25th min ratio of heart to liver activities was used as an index of portal systemic shunting. This ratio was found to be normal in alcoholic patients with normal liver biopsy and also in those presenting only steatosis. It was slightly higher in patients with liver fibrosis and significantly higher values were observed in patients with liver cirrhosis. High values of the ratio were associated with a higher risk of portal systemic encephalopathy and/or gastrointestinal bleeding. The prognostic value of the test was supported by the fact that good correlations were observed between the ratio and widely accepted prognostic scores such as the Child score or the Orrego index. Moreover, high ratios were associated with an increased mortality risk at one year. We conclude that this simple test is interesting in the screening of cirrhotics at risk of encephalopathy, gastrointestinal hemorrhage, or early death.

Arm vein uptake of thallium-201 during exercise: incidence and clinical significance

We prospectively analyzed several clinical and technical variables that might be associated with arm vein uptake of 201Tl during stress thallium scintigraphy in 63 patients. The influence of site (medial antecubital vs. other vein) and technique (with or without a 15-cc saline flush) were examined. Arm vein uptake was not seen after medial antecubital injections except in one case injected through a 24-hr-old indwelling catheter. Arm vein uptake was seen in 24/45 (53%) of cases injected into veins other than the medial antecubital. A saline flush did not reduce the incidence of arm uptake. In patients with normal myocardial studies, those with positive arm uptake had 33% lower net myocardial counts on the postexercise images (p = 0.00008) and 20% lower net myocardial counts on the delayed images (p = 0.04). Myocardial washout of thallium was significantly (p = 0.009) slower in those with arm uptake.

Flavor aversions induced by thallium sulfate: importance of route of administration

Flavor aversions induced by intraperitoneal (IP) and oral (PO) administration of thallium sulfate were compared in a repeated trial, two-bottle preference test. Male Long-Evans rats (N = 6/group) were given 30-min access to a 0.1% saccharin solution followed 20-min later by either IP or PO thallium sulfate (2.5, 5, 10 or 20 mg/kg), vehicle or nothing. Non-treated and vehicle-treated rats consistently preferred the saccharin solution, with relative saccharin intakes ranging from 0.65 to 0.85 over the three choice trials. On the first choice trial, flavor aversions produced by IP-administered thallium sulfate were marginal and occurred only at the highest dosage. In contrast, on the first choice trial, PO-administered thallium sulfate led to pronounced aversions at all but the lowest dosage. Saccharin preferences on the second and third choice trials resembled those obtained on the first choice trial. These results suggest that failure to obtain toxicant-induced flavor aversions may be due in part to the particular route by which the toxicant is administered.

Myocardial thallium-201 kinetics during coronary occlusion and reperfusion: influence of method of reflow and timing of thallium-201 administration

Thallium-201 (201Tl) uptake and redistribution kinetics were examined in an open-chest canine preparation of occlusion and reperfusion. Seven dogs (group I) underwent 3 hr of sustained occlusion and received 1.5 mCi of 201Tl after 40 min of occlusion of the left anterior descending coronary artery (LAD). Group II (n = 18) underwent 60 min of LAD occlusion followed by sudden and total release of the ligature. Group IIa (n = 8) received intravenous 201Tl during occlusion of the LAD, whereas group IIb (n = 10) received intravenous 201Tl at the time of peak reflow. Group III dogs (n = 26) also underwent 60 min of LAD occlusion that was followed by gradual reflow through a residual critical stenosis. Animals in this group also received 201Tl either before (IIIa; n = 16) or after reflow was established (IIIb; n = 10). In group I, the relative 201Tl gradient (nonischemic minus ischemic activity) decreased from 88 +/- 8% (mean +/- SEM) to 59 +/- 6% during 3 hr of coronary occlusion (p = .034). After rapid and total reperfusion (group IIa), this gradient decreased from 71 +/- 6% during occlusion to 26 +/- 5% after reflow (p less than .001). After slow reperfusion through a residual stenosis (group IIIa), the gradient decreased from 81 +/- 5% to 31 +/- 5% (p less than .001) (p = .56 compared with group IIa). In rapidly reperfused dogs receiving intravenous thallium during peak reflow (IIb), initial 201Tl activity in the ischemic zone was 155 +/- 20% of initial normal activity and fell to 93 +/- 13% of normal after 2 hr of reperfusion. Similarly, in dogs reperfused slowly through a critical stenosis (IIIb), which received 201Tl during reflow, 201Tl activity soon after reflow was 94 +/- 4% of initial normal and decreased to 80 +/- 6% at 2 hr of reperfusion (p = .10). Histochemical evidence of necrosis was present in the biopsy region in 80% of the 20 dogs subjected to triphenyl tetrazolium chloride (TTC) staining. Microsphere-determined transmural blood flow was similar in all groups during LAD occlusion and final flows after 2 hr were comparable in all subgroups undergoing reflow. Ischemic zone flow (% normal) was significantly higher at the time of 201Tl administration in groups IIb (192 +/- 25%) and IIIb (110 +/- 5%), which received 201Tl during reflow, than in groups IIa (31 +/- 9%) and IIIa (22 +/- 5%), which received 201Tl during occlusion.(ABSTRACT TRUNCATED AT 400 WORDS)

Evaluation of portal circulation in rats by rectal administration of 201Tl followed by intrasplenic injection of 51Cr-labeled microspheres

The heart-to-liver (H/L) uptake ratio in rats was determined 8 min after the rectal administration of 201Tl. Apart from normal controls, three groups of rats were examined; these were composed of animals with induced (1) acute hepatic damage, (2) liver cirrhosis, and (3) partial portal-vein ligation. After the rectal administration of 201Tl, 51Cr-labeled microspheres were injected into the spleen. The radioactivity of the removed liver, lungs, and heart was determined in a gamma-well scintillation counter, and the radioactivity of 201Tl and the 51Cr-labeled microspheres was separately calculated using simultaneous equations derived from the results of a preliminary experiment. The H/L ratios (201Tl) in the normal controls and the animals with acute hepatic damage were not significantly different; however, there was a positive correlation (P less than 0.01) between the H/L ratio and the shunt index (51Cr microspheres) in three groups, i.e., normal controls, liver cirrhosis, and partial portal-vein ligation.

201Tl per-rectal scintigraphy in primary hepatocellular carcinoma

The results of 201Tl per-rectal scintigraphy in 10 patients with primary hepatocellular carcinoma (HCC) were presented together with the findings from contrast angiography, computed tomography and ultrasonography. 201Tl accumulation within the tumour was seen in seven of ten patients. This accumulation was thought to be due to 201Tl supply not from the portal vein but from the hepatic artery since significantly high heart to liver uptake (H/L) ratio from 0.71 to 1.21 and clear visualization of the heart and kidneys, indicating the presence of abundant portal-to-systemic shunting, were observed. Another three patients showed negative 201Tl accumulation within the tumour and near-normal H/L ratios from 0.32 to 0.47 which indicates little portal-to-systemic shunting. This finding reveals the evidence of the lack of 201Tl supply to the tumour from the portal vein. It seems that HCC does not receive any significant amount of blood flow from the portal system.

Mechanism of thallium extraction in pump perfused canine hearts

Myocardial extraction of Tl has been postulated to depend on the rate of delivery (flow rate) and the metabolic state of tissue (ATPase activity). Experiments were performed to assess the role of these factors. In 22 arrested dog hearts the left anterior descending and circumflex coronary arteries were cannulated and pump perfused with oxygenated blood containing 204Tl. Isotope activity was determined in coronary sinus blood. The myocardial extraction ratio (E) of Tl varied inversely with flow, and the permeability-surface area product (PS) increased with increasing flow rates. These findings indicate that Tl uptake is flow dependent and can be analyzed with Renkin's capillary clearance theory. To assess the role of ATPase in Tl uptake, studies were also performed with blood containing ouabain. After introducing ouabain, coronary sinus blood Tl activity increased, approaching arterial activity, and E fell markedly. It was concluded that myocardial Tl uptake is mediated by ATPase.

Evaluation in dogs of a new double-dose technique for imaging changes in myocardial perfusion

Assessment of myocardial perfusion with thallium immediately before and after an intervention that alters blood flow has been difficult due to presence of residual activity from the first tracer dose at the time of the second imaging. In a canine model we investigated a technique using two separate thallium injections during an intervention and after its reversal. Images were obtained after each injection, and a difference image was obtained by subtracting the first from the second image to correct for tracer persisting from the first injection. Interventions on coronary blood flow included: transient occlusion, subcritical stenosis with dipyridamole infusion, and permanent occlusion. The first images showed defects corresponding to the occlusion or stenosis, while the "difference" images correlated with myocardial perfusion at the time of the second injection. This technique allows rapid evaluation of changes in perfusion in response to interventions, and may find application in several clinical procedures.

Radioactive implant induced x-ray emission technique for noninvasive determination of iodine content in thyroid: experimental study

A new technique, radioactive implant x-ray emission spectrometry to determine the in vivo iodine content of the human thyroid is proposed. The variations of counting rate and effective excitation efficiencies of I K alpha (28.6 keV) with iodine content, thyroid volume and skin-thyroid distance were studied for the 201Tl source to examine the properties of excitation and photon attenuation. As a result, the gland depth and volume could be estimated from the peak ratios of 30.7 keV/167.6 keV and 28.6 keV/167.6 keV. Using a 1 MBq 201Tl implant source, the detectable minimum iodine concentration found was approximately 70 micrograms/g for 2000 s measuring time in the phantom experiment. The effectiveness of the RIXE technique is discussed. It was concluded that the 201Tl RIXE spectrometry might serve to determine the in vivo iodine content of the human thyroid.

A noninvasive method for evaluating portal circulation by administration of Ti-201 per rectum

A new method for evaluating portal systemic circulation by administration of TI-201 per rectum was performed in 13 control subjects and in 65 patients with various liver diseases. In normal controls, the liver was visualized on the 0--5-min image whereas the images of other organs such as the heart, spleen, and lungs were very poor. In patients with liver cirrhosis associated with portal-systemic shunt, and in many other patients with hepatocellular damage, the liver was not so clearly visualized, whereas radioactivity in other organs, especially the heart, became evident. The heart-to-liver uptake ratio at 20 min after administration (H/L ratio) was significantly higher in liver cirrhosis than in normals and patients with chronic hepatitis (p less than 0.001). The patients with esophageal varices showed a significantly higher H/L ratio compared with that in cirrhotic patients without esophageal varices (p less than 0.001). The H/L ratio also showed a significant difference (p less than 0.01) between Stage 1 and Stage 3 esophageal varices. Since there were many other patients with hepatocellular damage who had high H/L ratios similar to those in liver cirrhosis, the effect that hepatocellular damage has on the liver uptake of TI-201 is also considered. Our present data suggest that this noninvasive method seems to be useful in evaluating portal-to-systemic shunting.

Thallium-201 peripheral perfusion scans: feasibility of single-dose, single-day, rest and stress study

The distribution and redistribution kinetics of thallium-201 in the lower extremities were investigated to determine the relationships among the rest, stress, and delayed-stress perfusion studies. The distribution of perfusion when the tracer was administered at rest was compared with that when administered during stress, and the distribution 5--6 hr after the stress injection. The distribution was evaluated qualitatively by scanning and quantitatively by point counting. In nine of 10 subjects without peripheral vascular disease, the 5--6 poststress redistribution pattern was unchanged from the stress pattern and was different from the rest pattern. However, in all patients with peripheral vascular disease, the delayed poststress perfusion distribution had greater similarity to the rest pattern and was substantially different from that noted immediately after stress. Using the time frame of this study, the stress and delayed-stress 201Tl perfusion study of the lower extremities cannot be used to represent true rest perfusion. However, because of the similarity of the delayed-stress to the true rest distribution in abnormals, it may be clinically useful in defining rest and stress alterations.

Partition of thallium-201 in isolated myocardial tissue of rats previously injected at rest or after exercise

The kinetics and distribution of TI-201 in isolated myocardial tissue of rats injected i.v. with this radionuclide are compared at rest and after exercise (2 hr of forced swimming). At 1/2 and 3 hr after injection, a myocardial segment was obtained and subjected to continuous washout with the radioactivity remaining in the tissue recorded each 10 sec for 1 hr. Altogether there were four groups of ten animals each. A three-compartment model (extracellular, main intracellular, and subcellular) was found to describe adequately the kinetics of TI-201. In the groups studied 1/2 hr after TI-201 injection the most dramatic effect of exercise was a translocation of TI-201 into the subcellular compartment. The change was also present but less marked in samples from exercised rats obtained 3 hr after TI-201 injection, which suggests a transition to the resting stage. The findings suggest the possibility of structural subcellular differences in myocardial uptake for TI-201 in clinical images visualized after exercise and at rest.