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PubMed1986

The effect of eating on thallium myocardial imaging.

To determine if eating between initial and delayed thallium images alters the appearance of the delayed thallium scan, a prospective study was performed; 184 subjects sent for routine thallium imaging were randomized into two groups, those who ate a meal high in carbohydrates between initial and delayed thallium myocardial images (n = 106), and those who fasted (n = 78). The 201Tl images were interpreted in blinded fashion for global myocardial and pulmonary clearance of 201Tl myocardial defects. The eating group had a significantly lower incidence of transient myocardial defects compared to the noneating group (7 percent vs 18 percent, respectively; p less than 0.05). The time between initial and delayed images and the incidence of exercise-induced ischemic ST-segment depression or pathologic Q waves on the electrocardiogram were not significantly different between the two groups. These data suggest that eating a high-carbohydrate meal between initial and delayed 201Tl images causes increased 201Tl myocardial clearance rates and may alter 201Tl myocardial redistribution over time.

Adult↗
PubMed2004

Contractile reserve, thallium-201 reverse redistribution and mismatch between perfusion and metabolism in reperfused infarct-related myocardium with delayed and incomplete functional recovery.

We investigated simultaneously the correlations between dobutamine-induced contractile reserve (CC), thallium-201 reverse redistribution (RR) and a mismatch between perfusion and metabolism (MM) to the magnitude of functional recovery. In 32 patients with coronary angioplasty early after infarction, echocardiography was performed at low-dose dobutamine stress within 1 week and at resting state at 1 month. Thallium-201/iodine-123 beta-methyl-iodophenyl pentadecanoic acid (BMIPP) dual-isotope single photon emission tomography was performed at 1 month. Wall motion and the uptake of each tracer were scored as 0 to 2 in the infarct-related segments, and CC, RR, and MM were evaluated in the infarct-related segments. In 71 akinetic or dyskinetic segments before reperfusion, the initial thallium-201 uptake and initial BMIPP uptake scores and the 4 hour redistribution thallium-201 uptake scores were less severe in the group with complete functional recovery (group A), followed by the group with incomplete recovery (group B) and then the group with no recovery (group C) (each P < 0.0001). CC was the greatest in group A, followed by group B, and then group C (76.2% in 16/21, 60% in 15/25, 36% in 9/25, P = 0.0212). RR and MM were greater in group B (52% in 13 and 64% in 16) than in groups A and C (19% in 4 and 8% in 2, 33.3% in 7 and 24% in 6, P = 0.0013 and P = 0.0113). The intensity of functional damage reflects perfusion and metabolism, but the delayed and incomplete functional recovery after reperfusion may be closely related to RR, MM, and CC.

Aged↗
PubMed1994

Thallium poisoning from maliciously contaminated food.

Four young adults presented two days after one of them had received marzipan balls packaged in a box from an expensive candy manufacturer. Two ate one candy ball, while two others shared a third. The next day, variable gastrointestinal symptoms developed. On the third day, two patients developed painful paresthesiae of the hands and feet, an early but nonspecific clinical marker of thallium poisoning. A tentative diagnosis of thallium poisoning was made based on symptoms, and treatment was initiated. The remaining candies were radiographed. Metallic densities in the candies supported the diagnosis, and atomic absorption spectroscopy was used to quantitate thallium content. Each candy contained a potentially fatal dose. Five to seven days later, hypertension and tachycardia developed in the two patients who had ingested an entire candy. All patients developed alopecia but recovered without overt neurologic or other sequelae. While the diagnosis of thallium poisoning is often delayed until alopecia develops, an early diagnosis favors an effective treatment strategy.

Adult↗
PubMed1995

Thallium poisoning presenting with abdominal colic, paresthesia, and irritability.

A case of acute thallium poisoning presenting with sudden abdominal pain, paraesthesiae and irritability is described. The peripheral nervous system was later affected along with loss of hair and the development of streaks (Mee's lines) on the nails of the hands and feet. The diagnosis was established by thallium assays of blood and urine. Thallium was undetectable in the blood by day 70. The manifestations cleared in six months with symptomatic treatment only. We review the characteristics and differential diagnosis of thallium poisoning and stress the importance of a high index of clinical suspicion.

Adult↗
PubMed1997

Treatment of severe thallium intoxication.

CASE REPORT: We report a successfully treated case of severe thallium intoxication. In spite of very high serum thallium (5,240 micrograms/L), symptomatology was minor and recovery complete. Prussian Blue was administered, diuresis was enhanced by intravenous fluids and a prolonged hemodialysis was started early. High blood flows (300 mL/min) and intravenous potassium chloride supplements, to mobilize thallium from the tissues, resulted in good clearances (96 to 150 mL/min). In order to prevent the well known complications, we recommend aggressive treatment of severe thallium intoxication.

Adult↗
PubMed2001

Thallium-201 myocardial imaging at rest in male orienteers and other endurance athletes.

During the period 1979 to 1992, 16 sudden unexpected cardiac deaths were known to have occurred in young Swedish orienteers. Autopsy indicated myocarditis to be the most frequent finding, most often combined with extensive myocardial fibrosis. The aim of the present investigation was to explore whether young male orienteers show a higher frequency than other young elite endurance athletes (controls) in the occurrence of Thallium-201 myocardial perfusion defects at rest, suggestive of fibrosis evoked by myocarditis. Thallium-201 perfusion abnormalities at rest were more frequently found in the controls than in the orienteers (26% vs. 12%, p=0.03). Uneven Tl-201 perfusion was associated with left ventricular mass (r=0.32, r=0.24, p<0.01, p=0.02) and body weight (r=0.30, r=0.31, p<0.01, p=0.03) in orienteers and controls, respectively. Echocardiographic left ventricular wall motion abnormalities were found in 11 athletes (9 orienteers and 2 controls) but only two displayed an abnormal Thallium-201 perfusion scan at rest. Perfusion abnormalities at rest did not occur more frequently in the orienteers but were commonly found in both groups of apparently healthy athletes making it futile to discern abnormals from normals. Thallium-201 perfusion aberrations were not associated with left ventricular wall motion abnormalities obtained by echocardiography.

Adult↗
PubMedDate not supplied

[Chronic thallium intoxication in five German pointers of one litter].

The difficulty of diagnosis and therapy of chronic thallium intoxication is described in five German Pointers with the same skin disease. The detection of thallium in cases of skin lesions like the cutaneous erythema with oedema and crusts or in chronic cases with multifocal alopecia is difficult. The first diagnostic information was gathered in this case from the high thallium level in the urine. The thallium concentration in the hair is subject to great variations, even in physiologic conditions. The trichogramme showed in this case pathognomonic changes like adhesion of the hair follicles. Differential diagnosis for this symmetric alopezia without pruritus are hormonal disturbances or, in puppies, the generalized form of demodicosis. The five affected dogs were treated with Fe III-Hexacyanoferrat. The clinical appearance of the skin improved slowly during a period of 1-2 months.

Animals↗
PubMed2000

Comparison between exercise whole body thallium imaging and ankle-brachial index in the detection of peripheral arterial disease.

BACKGROUND: Exercise whole body thallium imaging and rest/exercise ankle-brachial index can provide evidence of peripheral artery disease at the stage of intermittent claudication. The aim of this study was to compare both methods in the detection of asymptomatic peripheral artery disease. METHODS EXPERIMENTAL DESIGN: prospective non-randomised study. SETTING AND PATIENTS: general community, private practice, ambulatory patients referred in a Nuclear Medicine Department for exercise myocardial scintigraphy. Intermittent claudication was present in 8% of the whole study population. Coronary artery disease and diabetes were respectively present in 70% and 16% of the same population. MEASURES: rest/exercise ankle-brachial index and exercise whole body thallium imaging were measured in 105 patients (76 men and 29 women, mean age +/- 1 SD= 61 +/- 10 year) who performed a near-maximal or maximal treadmill test. Normal values of regional blood supply and indices of asymmetry at different levels of legs were determined in 14 patients with a very low probability of peripheral artery disease. RESULTS: The probability of peripheral artery disease was very high in 19 patients (group 1), because of abnormal rest and/or exercise ankle-brachial index, whereas in the 86 remaining patients, the index at rest and exercise was quite normal (group 2).With respect to rest and/or exercise ankle-brachial index, the sensitivity, specificity, positive and predictive negative value of exercise scintigraphy abnormalities were respectively 89%, 62%, 34% and 96%. The false positive scan group differed from the true positive group only by sex and redistribution of thallium 201. The proportion of diabetic patients was the same (15%) in both groups. CONCLUSIONS: Exercise whole body thallium imaging might contribute without additional cost to the detection, functional evaluation and/or risk stratification of peripheral artery disease in patients who perform exercise myocardial scintigraphy.

Adult↗
PubMed2002

Thallium scintigraphy for the prognosis of idiopathic dilated cardiomyopathy.

OBJECTIVES: This study evaluated the significance of perfusion defects demonstrated by thallium-201 and age in the prognosis of patients with idiopathic dilated cardiomyopathy. METHODS: Seventy-four dilated cardiomyopathy patients underwent thallium scintigraphy as well as clinical and hemodynamic examination. RESULTS: Abnormal perfusion defects were present in 23 of 38 patients aged < 60 years (61%) and in 26 of 36 elderly patients aged > or = 60 years (72%; NS). Univariate analysis showed that such perfusion defects were a significant predictor of cardiac death only in patients aged < 60 years (p = 0.015). Stepwise discriminant analysis also revealed that perfusion defects were a significant predictor in patients aged < 60 years (Wilks' lambda 0.499, chi-square test 20.2, p = 0.003). Perfusion defects were not more important than the history of syncope or stroke in elderly dilated cardiomyopathy patients. Twenty-one patients died of disease-related causes during 58 +/- 43 months. The five-year survival rate was better in patients aged < 60 years without than in those with perfusion defects (100% vs 58.4%, respectively), but not affected in patients aged > or = 60 years (66.7% vs 62.2%). CONCLUSIONS: Thallium scintigraphy is valuable for the prognosis of patients with dilated cardiomyopathy aged < 60 years who are usually candidates for heart transplantation. Absence of thallium perfusion defects may indicate good long-term prognosis.

Cardiomyopathy, Dilated↗
PubMed2002

[Relationship between risk factors for coronary artery disease and thallium-201 myocardial scintigraphy].

OBJECTIVE: To investigate the relation of 5 major risk factors (hypertension, diabetes, hyperlipidemia, overweight, smoking) of coronary artery disease (CAD) to the findings from thallium-201 single photon emission computed tomography. METHODS: Exercise 201TI myocardial scintigraphy was performed in 346 patients with clinically suspected CAD, who were divided into no risk, low risk, moderate risk, and high risk groups, based on CAD risk scores. RESULTS: The rate of thallium-201 perfusion abnormalities in no risk, low risk, moderate risk, and high risk groups were 48.1%, 70.6%, 89% and 100%, respectively, showing significant difference between them (X2=49.6, P=0.000 1). In patients with CAD risk factors, significant relation was found between the risk scores and semiquantitative scores, lung-to-heart ratios or segment abnormalities (0.133 r 0.450, 0.000 1 P 0.031). CONCLUSION: A close relation between CAD risk factors and thallium-201 myocardial scintigraphy is found. Routine thallium-201 myocardial scintigraphy should be performed in patients clinically suspected of coronary artery disease with CAD risk factors, especially those with moderate to high risk factors.

Adult↗
PubMed2003

Thallium-201 myocardial scintigraphy in patients with Wolff-Parkinson-White syndrome.

Wolff-Parkinson-White syndrome (WPW) is known to cause abnormal rest electrocardiogram and stress test. Thallium-201 myocardial scintigraphy has been particularly indicated for the noninvasive evaluation of coronary artery disease in these patients. The study group consisted of 11 WPW patients with abnormal ST-segment depression at rest electrocardiogram and/or stress test, with the absence of signs or symptoms of coronary artery disease. All the patients underwent exercise thallium-201 imaging associated with stress test by bicycle ergometer: 7 of them had ST-segment depression, but without other signs or symptoms of coronary artery disease. Transient and moderate myocardial perfusion defects were found in 5 of 11 patients. Perfusion defects in patients with WPW could derive from dyssynergy of ventricular activation, which could modify myocardial perfusion scintigraphy despite the absence of angiographic coronary stenosis. Previous reports and our data concluded that transient perfusion defects during exercise thallium-201 testing in WPW patients without cardiovascular disease may be observed. Thus, thallium-201 myocardial scintigraphy could present some limitations as a helpful adjunctive method for assessment of coronary artery disease in WPW patients.

Adult↗
PubMed1992

Prognostic value of electrocardiographic stress testing compared to thallium scintigraphy.

The highly sensitive and specific thallium scintigraphy is compared to loading electrocardiography with regard to the two crucial parameters: loaded angina pectoris (AP) and horizontal or descendant depression of ST segment of 1.5 mm and deeper (ST). Effectiveness of loading ecg test was determined quantitatively in terms of sensitivity, specificity, prognostic value and test accuracy. Those criteria of positivity of the loading test showed that sensitivity was higher for AP than for ST (73% and 63%, resp.), but specificity was higher for ST (100%) than for AP (79%). The result of thallium test was estimated according to AP occurrence with 80% probability for positive prognosis and 70% probability for negative prognosis; with ST, probability of positive prognosis was 100% and that of negative prognosis was 69%. Test accuracy is 75% for AP and 79% for ST. The 100% probability of positivity of thallium scintigraphy in ST depressions of 1.5 mm and deeper discredits indication of this method in this cases. In the absence of ST depressions, the origin of typical pain during the loading ECG enhances probability of positivity of thallium scintigraphy more than twofold (53 vs. 21%).

Adult↗
PubMed1992

Reverse redistribution on exercise thallium scintigraphy: relationship to coronary patency and ventricular function after myocardial infarction.

OBJECTIVE: To define prevalence, pathophysiology and relation to thrombolytic therapy of reverse redistribution (appearance of a new, or worsening of an existing, scintigraphic defect on 4 h delayed images compared with the stress thallium image). DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Referral centre. PATIENTS: Sixty-three patients with acute myocardial infarction. INTERVENTIONS: Tomographic exercise thallium scintigraphy, radionuclide angiography, and quantitative coronary angiography. MAIN RESULTS: Tomographic exercise thallium scintigraphy performed at day 10 revealed fixed defects in 15 patients, reversible defects in 22 patients and reverse redistribution in 26 patients; no difference in treatment assignment (tissue plasminogen activator versus placebo) was found among the three groups. Left ventricular function was similar in patients with fixed or reversible defects and reverse redistribution; global ejection fraction was 48 +/- 14, 51 +/- 10 and 48 +/- 5%, respectively, and regional infarct ejection fraction was 36 +/- 15, 40 +/- 13 and 37 +/- 18%, respectively. However, nitroglycerin administration resulted in a significantly greater improvement in regional ejection fraction in reverse redistribution patients (5 +/- 4%) than that in patients with fixed defect (2 +/- 5%, P < 0.05) or reversible defects (3 +/- 5%, P < 0.05). The infarct-related artery had a greater cross-sectional area in reverse redistribution patients (1.5 +/- 1.42 mm2) compared with those with reversible defects (0.50 +/- 0.26 mm2, P < 0.05), but was similar to fixed defect patients (1.04 +/- 0.88). CONCLUSIONS: Reverse redistribution on tomographic thallium scintigraphy is a frequent phenomenon (occurring in 40% of patients following acute myocardial infarction) and is independent of thrombolytic therapy. Patients with reverse redistribution have a more widely patent infarct-related artery and similar ventricular function, but significantly greater functional improvement following nitroglycerin administration compared with those with reversible or fixed defects. These data suggest myocardial salvage within the infarct zone in some patients with reverse redistribution.

Animals↗
PubMed2004

The value and throughput of rest Thallium-201/stress Technetium -99m sestamibi dual-isotope myocardial SPECT.

Myocardial perfusion scintigraphy is an established method in cardiology for the diagnosis and evaluation of coronary artery disease (CAD). Thallium-201 and Tc-99m sestamibi myocardial perfusion imaging has been widely accepted as non-invasive diagnostic procedure for detection of CAD, risk stratification and myocardial viability assessment. But, standard Tl-201 redistribution and same day or 2-day rest/stress Tc-99m sestamibi protocols are time-consuming. Hence, the dual isotope rest thallium-201/stress technetium-99m sestamibi gated single-photon emission tomography protocol has gained increasing popularity for these applications. Combining the use of thallium-201 with technetium-99m agents permits optimal image resolution and simultaneous assessment of viability. Dual-isotope imaging may be separate or simultaneous acquisition set-up. The more rapid completion of these studies is appreciated as an advantage by patients, technologists, interpreting and referring physicians, nurses and hospital management. Simultaneous imaging has the potential advantages of precise pixel registration and artifacts, if present, are identical in both thallium and sestamibi, and require only one set of imaging. Also, there are some disadvantages of spillover of activity from the Tc-99m to the Tl-201 window. Fortunately, despite this problem it can be overcome. Separate acquisition dual isotope also has some disadvantages. Difference in defect resolution in attenuation and scatter between T-201 and Tc-99m sestamibi potentially results in interpretation problems. But, studies about cost-effectiveness of dual isotope imaging showed that some selective elimination of the rest studies may decrease the cost of the nuclear procedures and should be considered in the current care health system.

Coronary Artery Disease↗
PubMedDate not supplied

Determination of thallium in potassium chloride and electrolyte replenishers by electrothermal atomic absorption spectrometry.

Thallium in potassium chloride and electrolyte replenishers was determined by electrothermal atomic absorption spectrometry (ETAAS) with direct injection of a resin suspension. Thallium(III) was extracted on fine particles of a cellulose nitrate resin (CNR) from dilute HCl (pH 1.6) in the presence of ammonium pyrrolidine-1-carbodithioate. The CNR particles were collected on a membrane filter by filtration under suction, suspended in 1.0 mL 10mM HNO3, and then delivered directly to ETAAS as the suspension. The effects of chloride ions were thoroughly investigated. The results showed that the addition of 0.5mM NaCl to the suspension (10mM HNO3) was recommended, after CNR and a membrane filter holding the CNR were washed thoroughly with 0.025M HCl, to eliminate interference from chloride ions. No chemical modifier was required. Extraction from the solution containing up to 2M chloride ion was allowable. The proposed method gave a concentration factor of 50 for a 50 mL sample volume. The detection limit (3sigma, n = 5) was 1 ng (20 pg/mL). The relative standard deviation was 4.9% (n = 5) at 30 ng level of thallium. The content of thallium in potassium chloride was 15.7-32.8 ng/g, and in electrolyte replenishers was 0.18-4.16 ng/mL.

Calibration↗
PubMed2004

The role of microorganisms in dispersion of thallium compounds in the environment.

Thallium is a highly toxic element and very rarely studied in the context of environmental hazards connected with zinc and non-ferrous metal industry. Microorganisms naturally existing in post-flotation and smelt wastes can participate in thallium release from waste deposits and can contribute to its dispersion in the environment. Twenty-one isolates were obtained from wastes of a non-ferrous smelter in Southern Poland characterised by high heavy metal contamination. Ten isolates showed high activity in thallium leaching from wastes (post-flotation and smelt wastes) as well as from pure thallous sulphide. Additionally, cadmium and lead were bioleached from wastes. The isolated bacteria indicated thallium resistance at a concentration up to 100 mg/l and some of them were able to survive in good condition at a concentration of up to 4 g/l. The same bacteria were isolated from rivers and wastewater in this region. A preliminary characterisation of isolates was performed. It was shown that some petroleum products i.e. asphalt-base crude occasionally used for waste immobilisation at the edge of pond or flotation surfactants partially stopped the activity of sulphide oxidising bacteria.

Culture Media↗
PubMed1992

Dipyridamole-thallium scintigraphy predicts perioperative and long-term survival after major vascular surgery.

The purpose of this study was to evaluate the ability of dipyridamole-thallium scintigraphy to predict perioperative and late cardiac events after peripheral vascular operations. A total of 262 patients had dipyridamole-thallium scintigraphy before 87 infrainguinal reconstructions, 108 abdominal aortic aneurysm operations, and 67 aortobifemoral bypass grafts that were placed for occlusive disease. Follow-up extended to 5 years (mean, 31.1 months). Logistic regression analysis selected dipyridamole-thallium scintigraphy redistribution as the best predictor of perioperative events. Fixed defects were not predictive. A Cox proportional hazards model for a variety of clinical risk factors and scan parameters identified fixed defects and a history of congestive heart failure as the strongest predictors of late cardiac events. The presence of greater than 1 or 2 fixed segments were the best predictors in patients with an abnormal scan; redistribution did not predict late events. The risk of combined perioperative or late cardiac events was 29% for infrainguinal, 19% for abdominal aortic aneurysm, and 7.5% for aortobifemoral operations. Life-table analysis showed that after a cluster of perioperative events that occurred primarily in patients with dipyridamole-thallium scintigraphy redistribution, most of the late cardiac morbidity and deaths occurred in patients with fixed defects.

Aged↗
PubMed2005

[Consequences of thallium poisoning in adolescent].

INTRODUCTION: Thallium poisoning appears very rare in developmental age and its consequences are quite different. The aim of this study was to characterised the course of thallium poisoning in adolescent and especially electroneurophysiological consequences of it. PATIENT AND METHODS: In a 15 year old boy with sensory-motor polyneuropathy thallium poisoning was recognised in the third week duration of the symptoms. Hemodialysis and hemodiaperfusion were used in the therapy. Data of the repeated electroneurographic and videoEEG examinations were collected. RESULTS: First electroneurographic data showed axonal motor polyneuropathy. Control after 1 year presented the largest form of the motor-sensory polyneuropathy. On videoEEG tape rejestered in the 5th month of clinical symptoms of poisoning, present were tonic seizures (although EEG pattern was flat with short low voltage theta activity). After next the 3 months of encephalopathy and phenobarbital therapy, voltage of the EEG pattern was slightly higher without any background and seizure activity. CONCLUSIONS: Thallium poisoning may result with catastrophic clinical consequences of polyneuropathy and encephalopathy. Electroneurographic and electroencephalographic changes 1 year after indicate that clinical consequences of the poisoning are un-remediable.

Adolescent↗