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Diagnosis of mycotic abdominal aortic aneurysm using 67-gallium citrate.

Mycotic aneurysms of the abdominal aorta are uncommon, but potentially lethal problems. Clinical subtleties may suggest their presence, but in the past, definitive diagnosis has been dependent on surgical exploration or autopsy findings. A case is presented in which 67-gallium citrate abdominal scanning localized the site of sepsis in an abdominal aortic aneurysm and allowed for prompt and successful surgical therapy. This noninvasive technique is recommended as a adjunct in the diagnosis of mycotic abdominal aortic aneurysms.

Aged↗

Comparison of the Anger tomographic scanner and the 15-in. scintillation camera for gallium imaging.

The Anger longitudinal emission multiplane tomoscanner and a 15-in. Anger camera with multipeak spectroscopic capability were compared in a series of 51 patients. The tomoscanner was preferred in 49%, the camera in 12%, and 39% were equivalent. The tomoscanner preference is statistically significant (p less than .025). These data support the conclusion that the Anger multiplane tomographic scanner is the instrument of choice for gallium-67 imaging.

Gallium↗

Alteration of gallium-67 distribution in tumor-bearing mice following treatment with methotrexate: concise communication.

The effect of methotrexate (MTX) treatment upon Ga-67 distribution was investigated. Tumor bearing mice were injected with Ga-67 citrate at varying time intervals following MTX treatment administered either as a single dose or in multiple doses. Altered Ga-67 distribution was observed following MTX therapy, the general pattern showing decreased levels in blood and increased uptake in bone. MTX therapy decreased Ga-67 uptake in liver, tumor, and muscle. The effects of MTX are related to the dose and time interval between the administrations of MTX and Ga-67. The serum of MTX-treated mice had lower unsaturated iron-binding capacities and higher levels of unbound Ga-67. Serum iron and iron binding in rats determined 20 hr after MTX therapy showed significantly higher levels of serum iron and lower levels of Ga-67 in blood, and the percent transferrin saturation was approximately 95%. These observations suggest that MTX inhibition of erythropoiesis elevates serum iron levels and decreases the availability of gallium-binding sites in serum, resulting in altered Ga-67 tissue distribution.

Animals↗

Thymic gallium-67 localization in pediatric patients on chemotherapy: concise communication.

Localization of Ga-67 in the thymus has been reported to occur in children. In our control group of 87 patients, 15% of children under 5 yr and 11% of children over 5 yr demonstrated thymic localization. In contrast, in our study group of seven children with acute lymphocytic leukemia or malignant lymphoma, lymphocytic diffuse, treated on a modified non-Hodgkin's lymphoma protocol, Sloan-Kettering LSA2-L2, thymic localization occurred during treatment in five of the seven. We conclude that increased thymic gallium localization in children under chemotherapy for a known malignancy may reflect increased activity of thymic medullary epithelial cells and regeneration of thymic lymphocytes during recovery form involution induced by certain chemotherapeutic agents.

Adolescent↗

The gallium scan: problems and misuse in examination of patients with suspected infection.

Gallium citrate Ga 67 (67Ga) has been used for almost ten years as a means of detecting inflammatory lesions in febrile patients. We have reviewed 80 cases from Milwaukee County General Hospital (1977 through 1979) in which 67Ga scanning was performed to detect inflammatory lesions in patients by suspected infection. Fifty scans also were available for review by the nuclear medicine staff. We found the sensitivity of 67Ga scans at our institution to be 90%, but specificity to be only 64%. In five (6%) of the cases, 67Ga scanning was the most important means of establishing a diagnosis. Of the 50 scans available for review, only 26 scans (52%) were interpreted in the same way as the original reading. Twenty-two (27%) of all scans in retrospect should not have been ordered, either because of the fever was gone and the patient's condition was improving or the diagnosis was already made. We conclude that 67Ga scans can be useful to detect inflammatory lesions but that they are frequently used inappropriately by physicians at our hospital, they are difficult to interpret, and the specificity is lower than the sensitivity.

Diagnostic Errors↗

The influence of zinc status on the anti-Lewis lung tumour activity of cisplatin and gallium.

Treatment of C57/BL mice with either cisplatin or gallium nitrate inhibited the growth and metastasis of the Lewis lung tumour and these anti-tumour agents also lowered the zinc levels of some tissues. Nutritional zinc deficiency or the deficiency arising from treatment with the chelating agent, penicillamine, also restricted tumour growth. Although the anti-tumour activity of cisplatin was enhanced in zinc-deficient mice, many of these animals died before sacrifice 14 days after tumour inoculation. The results indicate that zinc status could have considerable bearing on the therapeutic index of the mental-containing anti-cancer drugs.

Animals↗

Combined use of ultrasonography and gallium scanning in the diagnosis of pelvic pathology.

Ultrasonography and gallium-67 citrate scanning are two relatively new noninvasive diagnostic aids that have proved useful in the evaluation of neoplastic and inflammatory processes. These two procedures have a complementary role rather than a competitive one in the diagnosis of infections and tumors. Both procedures can be used with mutual benefit and, as a consequence, improved accuracy in clinical diagnosis may be obtained. We consider this approach to be of value in the modern evaluation of patients with inflammatory and neoplastic pelvic processes, offering new possibilities for noninvasive diagnosis and management.

Cystadenocarcinoma↗

[Clinical usefulness of 67 gallium scintigraphy in malignant lymphoma].

The results of 67-gallium scanning in 644 patients with histological confirmation of diagnosis are presented. 67-Ga uptake was recorded in 93.3% of 312 malignant and in 85.8% of 332 benign conditions. In 89.4% 67-Ga was successful in distinguishing between malignant and benign disorders. In 58 of 62 lesions due to malignant lymphoma 67-Ga uptake was seen. 67-Ga scanning is an indispensable tool for early diagnosis of hepatoma (n = 80) and an important non-invasive staging procedure for lymphoma patients which complements exploratory laparotomy.

Diagnosis, Differential↗

Phase I-II clinical trial of gallium nitrate (NSC-15200).

Gallium nitrate (NSC-15200), a group IIIa metal salt, was evaluated in a phase I-II clinical trial, In phase I trial, exploring bolus administration of the drug at 3-week intervals, dose-limiting renal toxicity was observed at doses exceeding 700 mg/m2. Hematological toxicity was minimal. Ototoxicity was observed in one patient. A phase-II trial was initiated evaluating the drug at 700 mg/m2 given at 2- and 3-week intervals. Antitumor responses were observed in one patient with soft-tissuesarcoma and in two patients with small cell carcinoma of the lung. In two of these responders, pretreatment 67Ga scan was positive. Further clinical trials with the drug appear indicated, utilizing the every 2 week schedule. Pretreatment hydration combined with osmotic diuresis may ameliorate potential nephrotoxicity.

Adult↗

Gallium arsenide-induced increase in serum corticosterone is not responsible for suppression of the IgM antibody response.

Previous investigations demonstrated gallium arsenide (GaAs) to be an immunosuppressive agent that alters the function of all cell types involved in the generation of a primary antibody response. In those studies, GaAs was administered as a particulate compound that remained in the lung at least 14 days after exposure. The extended presence of the particulate in the lung may induce a stress response that leads to the release of endogenous corticosteroids. In addition, some of the observed immunomodulatory effects of GaAs were similar to immunological alterations reported to be induced by corticosteroids. The present studies were designed to determine whether suppression of the immunoglobulin (Ig) M antibody-forming calls (AFC) response by GaAs was a result of a GaAs-induced increase in serum corticosterone. GaAs (50-200 mg/kg) significantly decreased the weights of both the thymus and spleen and the cellularity of the spleen. In addition, there was a GaAs-induced decrease in the CD4+/CD8+ thymocyte subpopulations and a concomitant increase in CD4+ and CD8+ cells. Within the spleen, there were no alterations in the percentages of CD4, CD8 or Ig-positive cells. However, when expressed as an absolute cell number, there was a 50% decrease in the numbers of CD4+ and CD8+ cells in the spleen. GaAs also dose-dependently suppressed (50-75%) the IgM AFC response. The GaAs-induced changes in cell populations and immune organ weights were correlated with an increase (6- to 10-fold) in serum corticosterone levels. The treatment of mice with the glucocorticoid antagonist mifepristone (also called RU 486) blocked the observed alterations in splenic and thymic cell populations induced by GaAs.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

[The role of gallium-67 citrate scintigraphy in Crohn's disease].

We investigated the usefulness of gallium scintigraphy and its importance in the choice of a treatment method for Crohn's disease. The subjects for the study were 30 patients diagnosed as Crohn's disease. After intravenous injections of 67Ga-citrate 111 MBq, planar and SPECT images were taken at 48 and 72 hrs. The overall positive rate was 42.1%, and among the positive cases, 78.6% required surgical treatment. On the other hand, surgical treatment was only performed in 18.8% of the negative cases, which was significantly low percentage. However, since 75% of the cases, in whom surgical treatment was performed, showed preoperative positive 67Ga results, positive cases detected by 67Ga scintigraphy were considered to be high-risk cases requiring surgical treatment.

Adolescent↗

[Gallium sulfate and skin allografts in the mouse].

Survival of skin allografts in mice are prolonged when these animals are injected subcutaneously with gallium sulfate before and after the grafting. The average survival is then 17, 2 days whereas it is 12,5 days for controls. For mice treated with an immunodepressive drug such as cortisone acetate average survival is 13,4 days; it is 17 days when cortisone has been added to the metallic salt.

Animals↗

Gallium and bleomycin scans in the clinical staging of testis tumor.

Twenty-one patients with testicular tumors had gallium scans prior to retroperitoneal lymph node dissection. Eleven of 14 patients found to have nodal involvement had positive scans, and 2 of 7 patients with negative nodes had false positive scans. Bleomycin scans were positive in 4 of 5 patients with nodal metastases. While these scans provide a simple, non-invasive and occasionally useful technique for the clinical staging of testis neoplasms, they do not, in our experience, significantly supplement other staging procedures.

Bleomycin↗

Differential effects of gallium nitrate on T lymphocyte and endothelial cell activation.

The immunosuppressive agents used clinically to prevent allograft rejection exert their effects by interfering with antigen-dependent T cell activation, endothelial cell function, or both. Gallium nitrate (GN) is immunosuppressive both in vitro and in vivo, and has potential for clinical use in transplant recipients. Therefore, we analyzed the influence of GN on gonadal vein endothelial cell (GVEC) and T cell activation. GVEC were stimulated with IFN gamma or TNF alpha in the presence or absence of GN, and tested for changes in levels of MHC class I, MHC class II, vascular cell adhesion molecule-1, and intercellular adhesion molecule-1 expression. GN did not interfere with the baseline or cytokine-enhanced expression of these molecules. Rather, it increased the expression of intercellular adhesion molecule-1 on GVEC, and this effect was further augmented in the presence of IFN gamma. In contrast, GN inhibited T cell proliferation stimulated by allogeneic GVEC or allogeneic monocytes in a dose-dependent manner. In transwell experiments, GN blocked the induction of MHC class II expression on isolated GVEC caused by alloactivated T cells, but not by recombinant IFN gamma. This suggests that GN can interfere indirectly with inflammatory responses of endothelial cells by interfering with local T cell activation and lymphokine production. Once lymphokines are produced, GN does not interfere with their effects on endothelial cells. GN is thought to act through transferrin receptors, but GVEC, unlike T cells, do not increase their expression of transferrin receptors, after stimulation with cytokines. This may explain their relative lack of sensitivity to GN. In general, GN appears to stimulate endothelial cells but suppress T cells. This paradoxic effect suggests that therapy with GN may enhance T cell-independent inflammatory responses, such as cellular infiltration and repair of tissue damage, while suppressing T cell-dependent responses, such as T cell-mediated tissue destruction and allograft rejection.

Antineoplastic Agents↗

Gallium arsenide selectively inhibits T cell proliferation and alters expression of CD25 (IL-2R/p55).

Exposure (24 hr) to a single intratracheal administration of gallium arsenide (GaAs; 200 mg/kg) has been shown to suppress antibody production as well as other T cell-mediated immunological functions. GaAs has also been shown to exert toxic effects on events occurring early in the antibody-forming cell response which may include lymphocyte activation and proliferation. Studies were undertaken to determine whether GaAs exposure resulted in the inability of T and B lymphocytes to proliferate in response to an antigenic stimulus. During the first 24 hr after in vitro immunization with sheep red blood cells, GaAs-exposed splenocytes were suppressed 51% in their ability to proliferate compared to the vehicle (0.05% Tween 80 in saline; VH) control. There was no significant difference in absolute numbers of cluster designation (CD)8+ cells between VH- and GaAs-exposed cultures. There was, however, a 50% decrease in CD4+ cells evaluated 24 hr after immunization with sheep red blood cells which persisted for the 5-day culture period. T and B cells were isolated and analyzed for proliferative capacity in response to various mitogenic stimuli. Isolated B cells exhibited no difference between VH- and GaAs-exposed cells in proliferative capacity to either lipopolysaccharide or anti-immunoglobulin plus interleukin-4. However, isolated T cells exposed to GaAs were significantly suppressed in their ability to proliferate to concanavalin A, phytohemagglutinin and anti-CD3 epsilon plus interleukin-2 when compared to VH. In addition, expression of CD25, leukocyte function antigen-1 and intercellular adhesion molecule-1 in GaAs-exposed mice were significantly below VH (36, 18 and 18%, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

The role of gallium-67-citrate in the detection of phenytoin-induced pneumonitis.

A patient with a history of cardiac transplant presented with a fever of undetermined etiology. The patient had been on multiple medications, including phenytoin, which can occasionally cause allergic or hypersensitivity pneumonitis. A chest x-ray and CT scan of the chest revealed no active disease. A 67Ga study was obtained after intravenous administration of 377.4 MBq (10.2 mCi) of 67Ga-citrate. The images showed diffuse intense lung uptake bilaterally. Bronchoscopic biopsy revealed hypersensitivity pneumonitis. Phenytoin was withdrawn and corticosteroid was started in therapeutic doses. A follow-up gallium study obtained 25 days after the baseline demonstrated marked improvement in the lungs with concurrent clinical recovery. This case illustrates the usefulness of 67Ga in the detection of drug-induced pneumonitis and in the follow-up of response to therapy.

Alveolitis, Extrinsic Allergic↗

Acute effects of gallium chloride on ventricular function and metabolism of the Langendorff perfused rat heart.

The effects of two concentrations of GaCl3 (1.79 microM and 7.17 microM) were studied on isolated perfused paced rat hearts. All hearts were submitted to an equilibration period of 20 minutes under normal conditions of oxygenation (95% O2, 5% CO2) and with 11 mM glucose in Krebs-Henseleit buffer. At the end of the perfusion (80 min) tissue Ga contents were 98.0 +/- 13.8 and 200.2 +/- 28.5 nM/g of wet weight for the lower and the higher Ga concentrations respectively. Left ventricular developed pressure (LVdp) as well as +LVdp/dt and -LVdp/dt were similar in control and Ga-treated groups during the 60 minutes following the equilibration period. At the same time mean coronary flow and oxygen consumption were lower (p < 0.05) in hearts perfused with 7.17 microM Ga than in the control group. Lactate production did not differ in the control and Ga-treated groups. Mean creatine kinase release was lower (p < 0.05) in the 7.17 microM Ga-treated group than in the 1.79 microM Ga-treated and control groups. Intratissular malondialdehyde as well as glycogen and ATP concentrations did not differ in all groups at the end of the experiment. Gallium chloride partially prevented the unavoidable oedema resulting from using saline Krebs-Henseleit solution. In conclusion, acute GaCl3 administration improves the functionality of the Langendorff-heart model.

Animals↗

Reversal of gallium arsenide-induced suppression of the antibody response by a mixed disulfide metabolite of meso-2,3-dimercaptosuccinic acid.

Meso-2,3-dimercaptosuccinic acid (DMSA) has been demonstrated to be an effective chelator of lead, mercury and arsenic in humans and in rodent experiments. Studies involving cadmium exposure have typically shown DMSA to be less effective than 2,3-dimercapto-1-propanesulfonic acid, and this is possibly due to an inability of DMSA to cross cell membranes and bind intracellularly-bound metal ions. The present studies were designed to determine whether in vitro addition of DMSA could effectively reverse arsenic-induced immunosuppression in splenocytes exposed in vivo to gallium arsenide (GaAs; 200 mg/kg, intratracheally). In those investigations, DMSA (25-100 microM) was incapable of reversing suppression of the in vitro-generated antibody response induced by in vivo exposure to GaAs. Addition of the recently synthesized 2:1 mixed disulfide (L-cysteine-DMSA) metabolite of DMSA (0.1-100 microM) to cultures of splenocytes exposed in vitro to GaAs (50 microM) dose-dependently reversed GaAs-induced suppression of the antibody-forming cell response with no effect on the vehicle (complete media) response or on cell viability, indicating that the metabolite retained binding capacity. Unlike DMSA, however, addition of the 2:1 mixed disulfide metabolite to splenocyte cultures exposed in vivo to vehicle (0.05% Tween 80 in saline) or GaAs dose-dependently partially reversed GaAs-induced suppression. The reversal of suppression could not be attributed to cleavage of L-cysteine from the 2:1 mixed disulfide metabolite, as addition of equimolar concentrations of L-cysteine or L-cystine (0.2-200 microM) to in vitro generated antibody cultures of splenocytes exposed in vivo to vehicle or GaAs had no effect on the GaAs-induced suppression.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗