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PubMed2006

Thallium poisoning presenting as paresthesias, paresis, psychosis and pain in abdomen.

Due to involvement of multiple systems, thallium poisoning is notorious for complexity and seriousness as symptoms of toxicity are non-specific and diverse. Alopecia and painful neuropathy are its cardinal features, others being gastrointestinal disturbances, encephalopathy, tachycardia, ataxia, hepatorenal and cardiac damage etc. We report a case of thallium poisoning who presented initially with gastrointestinal symptoms and later developed neurological features (peripheral neuropathy and delirium). Various diagnoses were entertained in this case and thallium poisoning was suspected only after he developed alopecia and neuropsychosis. He made a significant recovery by conservative management in spite of delay in diagnosis. We conclude that a high level of suspicion should be kept for thallium poisoning, especially in patients with painful, peripheral neuropathy and gastrointestinal symptoms which appear earlier than alopecia, since prognosis is more rewarding with early diagnosis, leading to complete recovery.

Abdominal Pain↗
PubMed1991

[Thallium-201 myocardial scintigraphy after intravenous infusion of adenosine triphosphate disodium: a preliminary study in the diagnosis of coronary artery disease].

The feasibility and safety of thallium-201 myocardial scintigraphy after the intravenous infusion of adenosine triphosphate disodium (ATP) (Adetphos, Kowa) were studied in eight patients with angina pectoris and/or old myocardial infarction. Coronary arteriography (CAG) was performed by the conventional method in all patients. ATP was infused for 5 min and thallium was injected at 3 min after the start of ATP infusion. ATP was given at 0.12 mg/min/kg in two patients (group A), 0.16 mg/min/kg in three patients (group B), 0.20 mg/min/kg in one patient (group C) and 0.28 mg/min/kg in two patients (group D). SPECT images were obtained at 10 min and 180 min after thallium injection. No significant hemodynamic changes were observed in group A and B. Severe hypotension was observed in group C and one member of group D. Chest pain was experienced by one patient in group A, two in group B, one in group C, and both of the two in group D. ST depression on the electrocardiogram (ECG) was documented in one patient each of groups B and C. In one group D patient, the study was discontinued because of complete atrioventricular block persistent for 5 beats. The correlation between thallium imaging and CAG was unclear in group A, reasonable in groups B and C, and obscure in group D because of side effects. None of the patients who developed side effects of ATP were administered sublingual nitroglycerin or intravenous aminophylline. Their symptoms or ECG changes improved spontaneously within 2 min and disappeared within 5 min after termination of infusion. In conclusion, the optimal ATP regimen for this purpose was considered to be a 5 min infusion at 0.16 mg/kg/min and this method was found to be feasible and safe.

Adenosine Triphosphate↗
PubMed1991

[Clinical implications of diffuse slow washout of thallium-201 in exercise stress myocardial SPECT].

Clinical implications of diffuse slow washout of thallium-201 (DSWO) in exercise-redistribution myocardial SPECT were studied. Thallium-201 washout rate was calculated by Bull's-eye method. DSWO was defined as having abnormal thallium-201 washout rate (less than 30% per 3 hours) in more than two thirds of each coronary artery (CA) area. OF 974 patients whose exercise heart rate exceeded 120/min, 51 (5.2%) showed DSWO and coronary angiography was performed in 43. Twenty-three patients (53%) showed triple vessel disease (3VD), 8 (19%) showed single or double vessel disease (1VD/2VD) and 12 (28%) showed normal CA. Patients with normal CA consisted of 6 patients with hypertrophic cardiomyopathy (HCM), 5 with hypertension (HT) and one with electrocardiographic abnormality only. The causes of DSWO were assessed from the history of effort angina (EA) and congestive heart failure (CHF), delayed fill-in of the perfusion defect and the ratio of lung to heart thallium-201 activity (L/M) at exercise as an indicator of the left ventricular (LV) function. High prevalence of EA (74%), high incidence of scintigraphic delayed fill-in (83%) and normal L/M suggested diffuse LV ischemia as the cause of DSWO in 3VD. On the other hand in patients with 1VD/2VD, LV dysfunction at exercise was considered as the cause of DSWO because of low prevalence of EA (13%) and scintigraphic delayed fill-in (13%) (p less than 0.01, p less than 0.005 each vs 3VD), and high L/M (p less than 0.001 vs 3VD) and high prevalence of CHF (38%, NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Dipyridamole-thallium imaging: minimum dose requirements.

A total of 372 consecutive dipyridamole-thallium studies were reviewed to determine if a relationship existed between the dose of dipyridamole administered and the likelihood that thallium images would show reversible defects. Men who received a dose of less than 31 mg were less likely to have thallium redistribution (P = 0.0001). Until the ideal study involving repeat testing with incremental dipyridamole doses on different days is carried out, the authors recommend that a minimal dose of 31 mg be administered for dipyridamole-thallium imaging.

Coronary Vessels↗
PubMed1991

[Prognostic stratification of non complicated acute myocardial infarct. Usefulness of the dipyridamole test with ecg-echo-thallium 201].

84 patients (pts) with recent first uncomplicated myocardial infarction underwent during the early post-infarction period, dipyridamole (D) test (EKG-ECHO-THALLIUM) and coronary arteriography in order to verify its feasibility, safety and usefulness in the detection of residual jeopardized but viable myocardium and in the diagnosis of multivessel disease. 69 pts performed a pre-discharge exercise test. During the execution of D test no major side effect occurred. The D-Echo was positive for residual ischemia in 41 pts (48.8%), the D-Thallium in 49 pts (58.3%) and the exercise test in 30 pts (43.5%). Both the imaging techniques allow the recognition of viable myocardium within the infarct zone (homozonal positivity) or outside the infarct zone (heterozonal positivity). The sensibility and specificity for multivessel disease are, respectively: with D-echo 50% and 100%; with D-thallium 60% and 100%; with exercise test 48% and 63%. D test has better diagnostic accuracy than exercise test in detecting multivessel disease; in particular we emphasized the excellent specificity of D-echo and D-thallium test. Poliparametric approach with D-test and exercise test gives a better stratification of the ischemic post-infarction risk.

Adult↗
PubMedDate not supplied

Thallium scintigraphy in human transplants: a way to detect myocardial damage.

An original index has been derived from thallium images to detect histopathologic changes in heart transplant patients. One hundred eighty-four static and end-diastolic images with thallium were recorded 5 minutes after injection in the left anterior oblique projection. Twenty patients and 14 healthy volunteers were studied. The epicardial and endocardial borders were determined, and the difference of these values was considered the myocardial area. The results in heart transplants were compared with the results of endomyocardial biopsies (N = 142). A significant decrease (p less than 0.01) was found in the index of the myocardial area between normal biopsy results and mild and moderate rejection. Differences were not detected between studies performed in several postoperative periods in the absence of rejection. The results in healthy volunteers prove that the index does not change between studies performed at different times in the same subject, although the value obtained from the end-diastolic image was more constant. On the basis of these results, it is possible to suggest that the decrease in the myocardial area during rejection is the result of a fall of thallium uptake by the myocardium. Capillary endothelial hyperplasia, perivascular infiltration, and myocytolysis can justify these changes, although the presence of other histologic findings, such as intramyocardial edema, could influence the value of this index. We conclude that the uptake of thallium decreases during acute rejection episodes; the results obtained from the images, in this work, are an expression of this event.

Adult↗
PubMed1991

[The usefulness of thallium-201 scintigraphy in the diagnosis of coronary disease].

Stress thallium scintigraphy was performed in 60 patients with chest pain of uncertain origin. Myocardial ischemia was identified in 91% of the 47 patients who had angiographically significant coronary artery stenoses. Sensitivity of thallium scintigraphy was highest in patients with stenosis in the left descending coronary artery (LAD); 91% of the patients had abnormal thallium as compared with 67% of the patients with normal LAD but significant stenoses in the circumflex artery and/or the right coronary artery. Perfusion defects in the circumflex in only 50% of the patients with multiple vessel disease. We conclude that stress thallium scintigraphy is a useful diagnostic procedure in patients with chest pain of uncertain origin and identifies the patients to be selected for coronary artery angiography.

Adult↗
PubMedDate not supplied

Neurotoxicity of thallium: biochemical and morphological study of organic lesions.

A biochemical study of experimental thallium intoxication in newborn rats and its morphological consequences upon the brain of developing animals was undertaken. The thallium content was analyzed in the following encephalic regions: hippocampus, hypothalamus, mesencephalon, cerebellum, and cortex. One day after application of the toxic substance, a homogeneous distribution of the metal in the brain was found. Thallium concentrations in the mentioned regions were twice as high as those found in an adult rat, at the same dosage, 20 newborn Wistar rats were used for the histopathological study. 5 remained as witnesses, the rest received a single injection of thallium of .07 ml. of a solution with a concentration of .32 mg/Kg. 3 rats were sacrificed at 24, 48 and 72 hours; 3 at 7 days and 3 at 51 days. The brain , sciatic and crural nerves were fixated in 10% formaldehyde for 15 days. Cuts in paraffin and frozen sections measuring between 5 and 7 microns were taken from the fragments of different areas. These were stained with aniline methods (Masson, Gallego and H-E) and silver-gold impregnation as modified by Río-Hortega.

Animals↗
PubMedDate not supplied

[Comparison between myocardial perfusion scintigraphy with thallium-201 and technetium-99m-Sestamibi (methoxy isobutyl isonitrile) for the detection of coronary atherosclerotic disease].

99mTc-SESTAMIBI is a new myocardial perfusion agent used in the detection of atherosclerotic coronary artery disease. In the present study, myocardial scintiscanning (on treadmill) with 99mTc-SESTAMIBI and 201-Thallium were compared, and both were compared with coronary angiography. Some 130 consecutive patients were evaluated within an interval of a few weeks with scintiscans of both 99mTc-SESTAMIBI and 201-Thallium: 82 of them were also examined by coronary angiography. Segmental analysis of the two series of scans revealed some correlation in 89.2% of the segments, while correlation of the final diagnosis showed agreement in 92% of cases. Compared to coronary angiography, sensitivity in the detection of CAD was found to be 75.8% for 201-Thallium and 72.5% for 99mTc-SESTAMIBI. The authors conclude that 99mTc-SESTAMIBI is a promising myocardial perfusion agent which displays an excellent correlation with 201-Thallium.

Adult↗
PubMed1990

[Detection of restenosis after successful percutaneous transluminal coronary angioplasty (PTCA)--usefulness of exercise thallium scintigraphy].

We studied the efficacy of stress thallium scan in detecting restenosis after primary successful PTCA. There were 21 patients with angina pectoris and 16 patients with previous myocardial infarction. The sensitivity and the specificity of stress thallium scan in detecting restenosis were superior to those of stress electrocardiography or chest pain complained in follow-up period. In multi-vessel disease, we could assess the vessel developing restenosis more easily than stress electrocardiography. Initial thallium %UPTAKE RATIO was significantly improved after PTCA but redecreased in patients developing restenosis. In patients showing residual redistribution despite of not developing restenosis, we could judge vessel patency by gradually improving initial %UPTAKE RATIO after PTCA. Thus, stress thallium scan proved to be useful in detecting restenosis after PTCA.

Aged↗
PubMed1990

Management of patients with thyroid carcinoma: application of thallium-201 scintigraphy and magnetic resonance imaging.

Thyroid carcinoma has the ability to concentrate radioiodine, an attribute that can be used both for detection of thyroid cells and for treatment. Unfortunately, however, radioiodine uptake is not observed in all patients and a radioiodine scan requires that the patient be rendered hypothyroid for 4-6 wk. In the present study, we analyzed the utility of thallium-201 scanning and the usefulness of magnetic resonance imaging (MRI) in the detection of thyroid cancer. Nineteen patients with thyroid cancer had a total of 24 radioiodine scans, 33 thallium scans, and 10 MRI examinations. Of the 19 patients in the study, 17 had differentiated thyroid carcinoma. In these 17 cases, all paired studies were concordant for the presence (n = 7) or absence (n = 10) of disease. However, in one case (Patient 10), the 201Tl studies showed far more extensive disease than was observed on the 131I scan. Thyroid cancer was also detected on seven MRI studies. In summary, thallium and MRI scans are adjunctive techniques to radioiodine scanning that can either confirm the presence of neck bed activity, residual disease or metastatic cancer and may delineate tumor deposits not detected by radioiodine scanning. Thallium may be capable of detecting tumor deposits even while a patient remains euthyroid.

Adenocarcinoma↗
PubMed1990

Thallium-201 scintigraphy in bone sarcoma: comparison with gallium-67 and technetium-MDP in the evaluation of chemotherapeutic response.

This study attempts to characterize thallium-201 (201TI) uptake in patients with bone and soft-tissue sarcoma and to compare these findings with gallium-67 (67Ga) and bone scintigraphy with emphasis on evaluating tumor viability before and after chemotherapy. Thirty-eight patients with surgically-proven sarcomas were evaluated. All patients had gallium and thallium studies. Nineteen patients underwent pre- and post-chemotherapy thallium and evaluation. Seven patients also had technetium-99m-MDP (99mTc-MDP) bone scintigraphy comparisons. Pathologic changes pre- and postchemotherapy were graded on the basis of %tumor necrosis as defined histologically. Scintigraphic comparisons demonstrated a high degree of correlation with 201TI and poor correlation with 99mTc-MDP. Thallium-201 was superior to 99mTc-MDP and 67Ga in predicting tumor response to chemotherapy as determined by %tumor necrosis determined histologically. Gallium was superior to Tc-MDP in predicting response to chemotherapy. However, both 67Ga and 99mTc-MDP appear to be affected by factors other than tumor activity.

Adolescent↗
PubMed1990

Beta-methyl-15-P-[123I] iodophenyl-pentadecanoic acid and thallium-201 in the assessment of myocardial perfusion defects.

The purpose of this investigation was to examine the ability of beta-methyl-15-P-[123I]-iodophenyl-pentadecanoic acid (beta 123IPPA) and thallium-201 to assess the ischemic risk zone associated with myocardial infarction. The hearts of mongrel dogs were infarcted by ligating the left anterior descending coronary artery and at 6 h post infarction injected with thallium-201 (2 mCi; scanning time 30 mins) followed by beta 123IPPA (3 to 5 mCi; scanning time 30 mins). Scintigraphic assessment of the perfusion defect yielded perfusion defect size (percentage of whole slice), which was then compared to the defect when assessed by tetrazolium staining. Myocardial ratios were calculated to assess differences in localization between tracers. Any differences noted may affect identification of the area at risk following acute myocardial infarction. A slice-by-slice comparison of perfusion defect size for scintigraphic methods and histochemical method showed no significant difference between beta 123IPPA and thallium-201. The mean ratio for myocardial defect size expressed as beta 123IPPA/thallium-201 was 1.03 +/- 1.29. Enzymatic analysis demonstrated significant increases in creatine kinase (160.33 +/- 46.44 to 5030.6 +/- 2238 U) and creatine kinase-MB% (31.85 +/- 15.11 to 82.99 +/- 8.14%) post infarction (P less than 0.05 in both cases). Elevated ST segments were also seen in all dogs post infarction. It can be concluded that the combined use of beta 123IPPA and thallium-201 does not allow the identification of the ischemic risk zone (percentage area at risk) often associated with myocardial perfusion defects. Problems continue to exist with image resolution and border demarcation.

Animals↗
PubMed1990

Detecting asymptomatic coronary artery disease using routine exercise testing and exercise thallium scintigraphy in patients with atherosclerotic vascular disease.

ECG-monitored exercise testing has been proposed as a relatively inexpensive and effective means of screening for asymptomatic coronary artery disease in patients presenting for peripheral vascular surgery. Despite the fact that exercise thallium scintigraphy is also dependent on the patient's ability to exercise, using this test in conjunction with ECG-monitored exercise testing may enhance sensitivity and specificity of non-invasive evaluation. Thirty-two patients were subjected to ECG-monitored exercise testing, exercise thallium scintigraphy and coronary angiography. The sensitivity of ECG-monitored exercise testing for detecting coronary artery disease was calculated at 81.8% and the specificity at 87.5%, while the figures for exercise thallium scintigraphy were 73.1% and 33.3% respectively. Using these two methods in combination yielded a predictive accuracy of 90.6%. The only advantage of exercise thallium scintigraphy over exercise ECG appears to be in patients in whom the latter test could not be interpreted or was non-diagnostic.

Adult↗
PubMed1978

[Disorder of porphyrin metabolism in thallium intoxication (author's transl)].

A 19-year old male ingested in suicidal attempt 750 mg of thallium. He developed the characteristic symptoms of thallium intoxication. During the acute phase the urinary excretion of porphyrins and porphyrin precursors was largely increased. The percentage distribution of the individual metabolites of heme synthesis revealed a preponderance of kopro- and uroporphyrin. This constellation (kopro- greater than uro- greater than tricarboxylic porphyrin) differs appreciably from that one in lead intoxication. The observation of increased urinary excretion of porphyrins and their precursors in a possibly particular spectrum in thallium intoxication is of special interest for differential-diagnostic reasoning. In each case of a toxic disorder of porphyrin metabolism thallium intoxication ought to be considered a possible cause.

Adrenergic beta-Antagonists↗
PubMed1989

[Clinical significance of exercise induced ST segment depression after successful percutaneous transluminal coronary angioplasty--assessment by thallium-201 SPECT].

To evaluate the clinical significance of ST segment depression during repeated Treadmill exercise after successful PTCA, Thallium-201 SPECT was performed. The Thallium-201 SPECT was performed before, one week after and 3-6 months after PTCA. All thirty-five patients had one vessel disease and positive Thallium-201 exercise test. During follow-up period for 3-6 months, 11 of 35 patients had persistent ST segment depression. Restenosis of dilated coronary lesion was demonstrated in 6 of 11 patients. In another 3 of 35 patients, exercise induced ST segment depression was disappeared during follow-up Treadmill exercise. In 14 patients with persistent or transient ST segment depression after PTCA, Thallium-201 SPECT demonstrated transient ischemia in 5 of 6 patients with restenosis. In other 8 patients without restenosis, SPECT images did not demonstrate myocardial ischemia and coronary arteriographic findings could not verify side branch stenosis or intimal dissection which might cause myocardial ischemia. The etiology of ST segment depression after successful PTCA in one vessel disease is not produced by exercise induced myocardial ischemia but still unknown mechanisms may be present.

Adult↗
PubMed1988

[Disorders of myocardial perfusion in Kawasaki syndrome: noninvasive detection by 201 thallium tomography].

Myocardial infarction and stenotic coronary lesions are serious late complications in children with Kawasaki disease. For the noninvasive assessment of myocardial perfusion, dipyridamole-redistribution thallium-201 emission computed tomography (ECT) was performed in seven children (aged from 2 8/12 to 8 7/12 years) 3 to 20 months after the acute stage of the disease. In all patients, coronary aneurysms had been demonstrated by cross-sectional echocardiography. The scintigrams of six children showed no significant regional reduction of myocardial thallium-201 uptake. These children had remained asymptomatic since the acute stage of Kawasaki disease. Persistent and transient thallium-201 defects were present in one child with documented myocardial infarction. For this patient, obstructions of corresponding coronary vessels were confirmed by contrast angiography. It is suggested that thallium-201 ECT with dipyridamole-induced vasodilatation may be used as a safe alternative to invasive coronary angiography for detection of ischemia and follow-up investigations in patients with Kawasaki disease.

Child↗
PubMed1988

Right ventricular thallium-201 visualization in hypertrophic cardiomyopathy.

Fifty-six patients with hypertrophic cardiomyopathy who had echocardiography and cardiac catheterization were studied. Eleven (18%) of 56 patients had right ventricular (RV) thallium-201 visualization at resting scan. RV thallium-201 visualization was observed in the apex or lower half of the RV free wall, which was quite different from that with RV pressure or volume overload. There was no significant correlation between RV thallium-201 visualization and interventricular septal thickness or haemodynamic data. RV systolic pressure and RV dimension were within normal limits whether RV visualization was observed or not. Thus, an abnormal increase of RV mass in hypertrophic cardiomyopathy may lead to RV thallium-201 visualization without RV pressure or volume overload.

Adult↗