Evaluation of Cuprimine® and Syprine® for decorporation of radioisotopes of cesium, cobalt, iridium and strontium

Cuprimine® and Syprine® are therapeutics approved by the USFDA to treat copper overload in Wilson Disease (a genetic defect in copper transport) by chelation and accelerated excretion of internally-deposited copper. These oral therapeutics are based on the respective active ingredients D-penicillamine (DPA) and N,N'-bis (2-aminoethyl) -1,2-ethanediamine dihydrochloride (Trien). Cuprimine is considered the primary treatment, although physicians are increasingly turning to Syprine as a first-line therapy. Both drugs exhibit oral systemic activity and low toxicity; their biological effects and safety are established. Previous in vivo studies using a rodent animal model established the decorporation potential of Cuprimine and Syprine for (60)Co and (210)Po. Currently these studies are being expanded to evaluate the in vivo decorporation efficacy of these drugs for several additional radionuclides. In this report, results of this investigation are discussed using the radionuclides (137)Cs, (60)Co, (192)Ir and (85)Sr. Short-term 48-h pilot studies were undertaken to evaluate DPA and Trien for their in vivo decorporation potential using male Wistar-Han rats. In these studies, a radionuclide solution was administered to the animals by intravenous (IV) injection, followed by a single IV dose of either DPA or Trien. Control animals received the radionuclide alone. Results show effective decorporation of (60)Co by DPA within the time frame evaluated. DPA and Trien were also modestly effective in decorporation of (137)Cs and (85)Sr, respectively. The study did not find DPA or Trien effective for decorporation of (192)Ir. Based on these encouraging findings, further studies to evaluate the dose-response profiles and timing of the chelator administration post exposure to radionuclides are warranted.

Assessing the therapeutic and toxicological effects of cesium chloride following administration to nude mice bearing PC-3 or LNCaP prostate cancer xenografts

PURPOSE

The purpose of this study was to assess the therapeutic and toxicological effects of cesium chloride (CsCl) administration in mice bearing prostate cancer tumors.

METHODS

Three CsCl dose titration studies were completed in tumor-bearing and non-tumor-bearing athymic nude mice. All mice were administered either vehicle (controls), 150, 300, 600, 800, 1,000, or 1,200 mg/kg of CsCl once daily by oral gavage for 30 consecutive days. Body mass was measured daily, food and water consumption were measured every 2 days, and tumor volume was measured twice weekly. Histopathological analysis was conducted on tissues collected from each of the studies. Serum AST/ALT and creatinine were also measured.

RESULTS

Administration of 800-1,200 mg/kg CsCl reduced PC-3 tumor growth but had no effect on LNCaP tumors. Administration of 800-1,200 mg/kg CsCl also resulted in increased water consumption, bladder crystal development, and higher prevalence of cardiac fibrin clots. An observed loss in body mass was dependent on the xenograft type and concentration of CsCl administered. CsCl did not affect serum AST/ALT and creatinine levels.

CONCLUSIONS

CsCl may have a therapeutic effect against prostate cancer, but one cannot overlook the acute toxicities also described.

Isolation and characterization of I(Kr) in cardiac myocytes by Cs+ permeation

Isolation of the rapidly activating delayed rectifier potassium current (I(Kr)) from other cardiac currents has been a difficult task for quantitative study of this current. The present study was designed to separate I(Kr) using Cs+ in cardiac myocytes. Cs+ have been known to block a variety of K+ channels, including many of those involved in the cardiac action potential such as inward rectifier potassium current I(K1) and the transient outward potassium current I(to). However, under isotonic Cs+ conditions (135 mM Cs+), a significant membrane current was recorded in isolated rabbit ventricular myocytes. This current displayed the voltage-dependent onset of and recovery from inactivation that are characteristic to I(Kr). Consistently, the current was selectively inhibited by the specific I(Kr) blockers. The biophysical and pharmacological properties of the Cs+-carried human ether-a-go-go-related gene (hERG) current were very similar to those of the Cs+-carried I(Kr) in ventricular myocytes. The primary sequence of the selectivity filter in hERG was in part responsible for the Cs+ permeability, which was lost when the sequence was changed from GFG to GYG, characteristic of other, Cs+-impermeable K+ channels. Thus the unique high Cs+ permeability in I(Kr) channels provides an effective way to isolate I(Kr) current. Although the biophysical and pharmacological properties of the Cs+-carried I(Kr) are different from those of the K+-carried I(Kr), such an assay enables I(Kr) current to be recorded at a level that is large enough and sufficiently robust to evaluate any I(Kr) alterations in native tissues in response to physiological or pathological changes. It is particularly useful for exploring the role of reduction of I(Kr) in arrhythmias associated with heart failure and long QT syndrome due to the reduced hERG channel membrane expression.

Blood and tissue concentration of cesium after exposure to cesium chloride: a report of two cases

CONTEXT

Complementary alternative medicine therapies based on the use of cesium chloride preparations for the treatment of cancer and radiation poisoning, have generated therapeutic interest; but oral or intravenous administration of cesium chloride (CsCl) to cancer patients as an alternative mode of cancer therapy have not been approved by the US Food and Drug Administration (FDA).

OBJECTIVE

Cesium (Cs) levels from human tissue were measured to determine exposure to an alternative medical treatment. Cesium levels are reported from two patients who were administered cesium chloride in conjunction with aloe vera as part of an alternative cancer treatment.

DESIGN

The samples were analyzed by graphite furnace atomic absorption spectrometry with Zeeman background correction. As a reference, Cs was also determined in brain, liver, kidney, and whole blood from control case materials retrieved from the National Tissue Repository of the Armed Forces Institute of Pathology.

RESULTS

High levels of cesium were found in brain, liver, kidney, bile, gastric content, and whole blood collected at autopsy as compared to reference levels. The administration of cesium chloride resulted in blood levels a factor of 1100 higher than normal. The highest Cs concentrations were found in the liver (1029 microg/g, dry wt), followed by the kidney (815 microg/g, dry wt) and brain (219 microg/g, dry wt).

CONCLUSION

The high accumulation in the liver suggests that hepatotoxicity from Cs might be an initial presenting symptom in Cs-poisoning cases. This is the first report describing two cases with high Cs levels in human tissues.

Functional expression of the hyperpolarization-activated, non-selective cation current I(f) in immortalized HL-1 cardiomyocytes

HL-1 cells are adult mouse atrial myocytes induced to proliferate indefinitely by SV40 large T antigen. These cells beat spontaneously when confluent and express several adult cardiac cell markers including the outward delayed rectifier K(+) channel. Here, we examined the presence of a hyperpolarization-activated I(f) current in HL-1 cells using the whole-cell patch-clamp technique on isolated cells enzymatically dissociated from the culture at confluence. Cell membrane capacitance (C(m)) ranged from 5 to 53 pF. I(f) was detected in about 30% of the cells and its occurrence was independent of the stage of the culture. I(f) maximal slope conductance was 89.7 +/- 0.4 pS pF(-1) (n = 10). I(f) current in HL-1 cells showed typical characteristics of native cardiac I(f) current: activation threshold between -50 and -60 mV, half-maximal activation potential of -83.1 +/- 0.7 mV (n = 50), reversal potential at -20.8 +/- 1.5 mV (n = 10), time-dependent activation by hyperpolarization and blockade by 4 mM Cs(+). In half of the cells tested, activation of adenylyl cyclase by the forskolin analogue L858051 (20 microM) induced both an approximately 6 mV positive shift of the half-activation potential and an approximately 37 % increase in the fully activated I(f) current. RT-PCR analysis of the hyperpolarization-activated, cyclic nucleotide-gated channels (HCN) expressed in HL-1 cells demonstrated major contributions of HCN1 and HCN2 channel isoforms to I(f) current. Cytosolic Ca(2+) oscillations in spontaneously beating HL-1 cells were measured in Fluo-3 AM-loaded cells using a fast-scanning confocal microscope. The oscillation frequency ranged from 1.3 to 5 Hz and the spontaneous activity was stopped in the presence of 4 mM Cs(+). Action potentials from HL-1 cells had a triangular shape, with an overshoot at +15 mV and a maximal diastolic potential of -69 mV, i.e. more negative than the threshold potential for I(f) activation. In conclusion, HL-1 cells display a hyperpolarization-activated I(f) current which might contribute to the spontaneous contractile activity of these cells.

Effects of low chronic doses of ionizing radiation on antioxidant enzymes and G6PDH activities in Stipa capillata (Poaceae)

Stipa capillata (Poaceae) seeds were harvested from a control area (displaying a gamma dose rate of 0.23 micro Sv h(-1)) (C plants) and from two contaminated areas (5.4 and 25 micro Sv h(-1)) on the Semipalatinsk nuclear test site (SNTS) in Kazakhstan. The plants were grown for 124 d in a greenhouse under controlled conditions and exposed to three different treatments: (0) control; (E) external gamma irradiation delivered by a sealed 137Cs source with a dose rate of 66 micro Sv h(-1); (E+I) E treatment combined with internal beta irradiation due to contamination by 134Cs and 85Sr via root uptake from the soil. The root uptake led to a contamination of 100 Bq g(-1) for 85Sr and 5 Bq g(-1) for 134Cs (of plant dry weight) as measured at harvest. The activity of SOD, APX, GR, POD, CAT, G6PDH, and MDHAR enzymes was measured in leaves. Under (0) treatment, all enzymes showed similar activities, except POD, which had higher activity in plants originating from contaminated areas. Treatment (E) induced an enhancement of POD, CAT, GR, SOD, and G6PDH activities in plants originating from contaminated areas. Only control plants showed any stimulation of APX activity. Treatment (E+I) had no significant effect on APX, GR, CAT, and POD activities, but MDHAR activity was significantly reduced while SOD and G6PDH activities were significantly increased. The increase occurred in plants from all origins for SOD, with a greater magnitude as a function of their origin, and it occurred only in plants from the more contaminated populations for G6PDH. This suggests that exposure to a low dose rate of ionizing radiation for almost a half century in the original environment of Stipa has led to natural selection of the most adapted genotypes characterized by an efficient induction of anti-oxidant enzyme activities, especially SOD and G6PDH, involved in plant protection against reactive oxygen species.

Induction of micronuclei in mouse polychromatic erythrocytes by the administration of non-radioactive CsCl by the oral and intraperitoneal route

In the present study, we describe the effects of the concentration and route of administration of non-radioactive cesium chloride (CsCl) in inducing micronuclei in mouse bone marrow polychromatic erythrocytes (PCEs). When the dose of 500mg/kg body weight was administered perorally (p.o.), no significant incidence of micronuclei was detected. However, when the same dose was administered intraperitoneally (i.p.), a significant induction of micronuclei in PCEs was observed compared to control. At the dose of 1000mg/kg, both routes were efficient, with no significant difference in micronucleus frequencies. We conclude that both the p.o. and i.p. routes are efficient in inducing micronuclei, with the i.p. route being more efficient when lower CsCl doses are used.

Estimation of dietary 232Th, 238U, cesium, and strontium intakes in Vietnamese people from different geographical regions

Diet samples were collected to estimate dietary intakes of 232Th, 238U, cesium, and strontium for Vietnamese adults using duplicate portion studies and market basket studies. Average concentrations of 232Th, 238U, cesium, and strontium in diet samples were 4.0 ng/g-dry, 2.5 ng/g-dry, 41 ng/g-dry, and 4.5 ng/g-dry, respectively. Daily intakes per person for 232Th, 238U, cesium, and strontium were estimated to be 0.99 microg, 0.66 microg, 10 microg, and 1.2 mg, respectively. Daily intakes of 232Th, 238U, and cesium differed statistically between northern and southern of Vietnam, depending on geological conditions and food habits. However, intakes of the four nuclides were similar to the global averages.

Polymorphic ventricular tachycardia in a woman taking cesium chloride

A 47-year-old patient presented with syncope and recurrent episodes of polymorphic ventricular tachycardia. She had evidence of prolonged QT interval by ECG and had been taking cesium as a dietary supplement. Correction of the hypokalemia and discontinuation of the cesium resulted in normalization of the QT interval during follow-up with no further recurrence of ventricular arrhythmias. The use of this drug is potentially hazardous as it may induce fatal ventricular arrhythmias.

Cellular basis of ventricular arrhythmias and abnormal automaticity in heart failure

The high incidence of sudden death in heart failure may reflect an increased propensity to abnormal repolarization and long Q-T interval-related arrhythmias. If so, cells from failing hearts would logically be expected to exhibit a heightened susceptibility to early afterdepolarizations (EAD). We found that midmyocardial ventricular cells isolated from dogs with pacing-induced heart failure exhibited an increased action potential duration and many more EAD than cells from nonpaced controls; this was the case both under basal conditions (P < 0.01) and after lowering external K(+) concentration ([K(+)](o)) to 2 mM and exposing cells to cesium (3 mM; P < 0.05). An unexpected finding was the occurrence of spontaneous depolarizations (SD, >5 mV) from the resting potential that were not coupled to prior action potentials. These SD were observed in 20% of failing cells (n = 5 of 25) under basal ionic conditions but in none of the normal cells (n = 0 of 27, P < 0.05). The net inward current that underlies SD is not triggered by Ca(2+) oscillations and thus differs fundamentally from the currents that underlie delayed afterdepolarizations. We conclude that cardiomyopathic canine ventricular cells are intrinsically predisposed to EAD and SD. Because EAD have been linked to the pathogenesis of torsade de pointes, our results support the hypothesis that sudden death in heart failure often arises from abnormalities of repolarization. The frequent occurrence of SD points to a novel cellular mechanism for abnormal automaticity in heart failure.

Elucidating the mechanism of cesium-induced sustained monomorphic ventricular tachycardia in rabbits

The mechanisms of sustained ventricular tachycardia (VT) induced by large cumulative dose of cesium chloride (Cs) remains unclear. Seven anesthetized rabbits were intravenously injected with Cs (1 mmol/kg) 3 times at 20-min intervals. The surface ECG and monophasic action potential of the left ventricular endocardium were simultaneously recorded. In another 12 rabbits, transmembrane action potentials of right ventricular muscles were recorded with glass microelectrodes. In experiments in vivo, sustained monomorphic VT was induced after the third injection of Cs, whereas the early afterdepolarization (EAD)-related nonsustained polymorphic VT was induced after the second injection. Overdrive pacing during the sustained VT resulted in postdrive acceleration. The pacing and recovery cycle lengths showed an inverse relation. In experiments in vitro, preparations were superfused with Tyrode's solution containing 7.5 mM Cs. Cs initially induced EADs. Additional exposure to Cs depolarized the membrane potential, which consequently attained threshold, producing spontaneous activities. Further exposure resulted in an induction of sustained rhythms that were accelerated by overdrive pacing. Our results indicate that the sustained rhythms at low membrane potential induced by a long exposure to Cs in vitro may underlie an electrophysiologic mechanism for the sustained VT induced after large cumulative dose of Cs in vivo.

Chromosome aberrations in Syrian hamsters following very low radiation doses in vivo

This paper addresses a report of a large increase (approximately 6- to 11-fold) in chromosome aberrations in lymphocytes of persons in Salzburg attributed to their exposure to fallout from the Chernobyl cloud. Their additional exposure, approximately 0.3 mGy in 1 year, comprised about a 30% increase in their normal background radiation dose. The report has attracted considerable attention because, if correct, it seriously challenges assumptions of linearity in the low-dose response for chromosomal damage and, by implication, the linear, no-threshold hypothesis for risk of induced cancer. An experiment has been carried out with Syrian hamsters treated with caesium-137 to produce a range of doses comparable with those calculated for the persons in Salzburg. No significant elevation in lymphocyte aberration yields was found in the hamsters, thus arguing against the conclusions of the Salzburg study.

Hepatic neoplasms from internally deposited 144CeCl3

Fifty-five dogs were exposed by inhalation to graded activity levels of 144CeCl3, a relatively soluble form of the beta-emitting radionuclide. A large portion of the 144Ce translocated from lung to liver and skeleton. Significant radiation doses were delivered to the respiratory tract, liver, and skeleton; however, the liver received the greatest cumulative absorbed dose. Liver tumors were the most frequently observed neoplasms in these exposed dogs and included 7 primary hepatic hemangiosarcomas, 1 cholangiocarcinoma, 1 hepatocellular carcinoma, 1 fibrosarcoma, 4 biliary cystadenomas, and 1 fibroma. The dose to the liver in these dogs ranged from 11 to 250 Gy with a median of 57 Gy. Autoradiographs showed a relative uniform distribution of beta dose to the liver. All the malignant tumors and 1 cystadenoma were primary causes of death. The morphologic features of the hemangiosarcomas and associated hepatic lesions were similar to those described for hemangiosarcomas induced in people exposed to Thorotrast. Biliary cystadenomas were associated with degenerative lesions in the liver but not with other neoplasms in the liver. These results indicate that the liver is an important target organ for effects from internally deposited 144Ce.

The use of an in vitro technique to predict the absorption of dietary radiocaesium by sheep

The validity of an in vitro extraction technique to predict the availability for absorption of radiocaesium in the sheep gut has been assessed. The technique (a 2-h extraction with caesium chloride) was found to be valid for sources with a low availability for transfer across the gut, but inappropriate for ionic radiocaesium or radiocaesium incorporated internally within herbage. For such radiocaesium sources, which have a high in vitro availability, no correlation was found between in vitro extraction and true absorption measurements. A true absorption value of 0.80 is recommended for these sources, although values for individual sheep in the range 0.60 to 1.00 should be expected.

Biological effects of 137CsCl injected in beagle dogs

The toxicity of intravenously administered 137CsCl in the beagle dog was investigated as part of a program to evaluate the biological effects of internally deposited fission-product radionuclides. The intravenous route of exposure was chosen for simplicity and accuracy because it was known that after intravenous injection, inhalation or ingestion, internally deposited 137CsCl is rapidly absorbed and distributed throughout the body, exposing the whole body to beta-particle and gamma radiations. Fifty-four dogs were injected intravenously with 137Cs to provide one group of six dogs with mean initial body burdens of 141 MBq 137Cs/kg body mass and four groups of 12 dogs each with mean initial body burdens of 104, 72, 52 and 36 MBq 137Cs/kg. Twelve dogs were injected with isotonic saline as study controls. Because the number of study control dogs was small, data from an additional 49 control dogs from other studies at the Inhalation Toxicology Research Institute that were performed over a similar span of years were also used. There was a significant, dose-dependent decrease in survival of the 137Cs-injected dogs. Eleven 137Cs-injected dogs, including all six in the highest initial body burden group, died within 81 days after injection, primarily due to hematopoietic cell damage resulting in severe pancytopenia. An additional 25 dogs had transient hematological dyscrasia but survived for long times. All 137Cs-injected male dogs had marked damage to the germinal epithelium of the testicular seminiferous tubules with azoospermia in the long-term survivors. Benign and malignant neoplasms occurred in a variety of organs in 137Cs-injected dogs, rather than in a single target organ. When individual organs were considered, the incidence of malignant neoplasms was increased in the liver and in the nasal cavity and paranasal sinuses of the 137Cs-injected dogs. There was a 137Cs treatment effect in the incidence of malignant neoplasms (P < 0.001) in male dogs but no 137Cs-related treatment effect in female dogs. However, when malignant mammary neoplasms were excluded from the analysis, there was no gender difference, and there was a dose-related response (P < 0.001) in both males and females for the incidence of malignant neoplasms.

133Cs relaxation times in rat tissues

133Cs relaxation-time studies of tissues from rats into which cesium has been incorporated by dietary loading have been carried out in vivo and in vitro. Whereas tissue T1 values are on the order of seconds, T2 values are as low as a few tens of milliseconds. 133Cs tissue relaxation times are analogous to those of 39K in the same tissues, but are more readily measured because of the greater sensitivity of 133Cs compared with 39K. T1 and T2 data of excised tissue at two resonance frequencies (65.60 and 39.37 MHz) and temperatures (302 and 278K) have been analyzed in terms of a general description of spin-7/2 relaxation. The results are consistent with most of the cesium ions being in a free state, undergoing fast exchange with bound ions having long correlation times located in one or more intracellular compartments.

Modification of cesium toxicity by calcium in mammalian system

The interaction between cesium chloride CsCl and calcium chloride CaCl2 was observed in bone marrow chromosomes of mice. The two salts were administered orally to laboratory bred Swiss albino mice in vivo singly or one followed by the other, or both simultaneously. CsCl induced chromosomal aberrations in frequencies directly proportional to the dose administered. The frequency of aberrations was reduced significantly when the two chemicals were administered simultaneously or when CaCl2 was given 2 h before CsCl. Thus, CaCl2 is able to protect against the cytotoxicity of CsCl.

Clastogenic effects of cesium chloride on mouse bone marrow cells in vivo

Clastogenic effects of cesium chloride (CsCl) on mouse bone marrow cells in vivo following oral administration were studied after 24 h. The incidence of chromosome aberrations increased linearly with increasing concentrations of the chemical from 1/20th to 1/5th of the LD50. The frequency of cell division was also enhanced by the lower doses but higher doses were mitostatic. This report is the first on the clastogenicity of cesium on animals.

A comparison of remote afterloading and manually inserted caesium in the treatment of carcinoma of cervix

Between 1982 and 1985, 240 patients with carcinoma of cervix were treated by radical radiotherapy, 140 using the selectron at the Royal Beatson Memorial Hospital (RBMH) and 100 with conventional caesium at the Western Infirmary. To allow for the increased dose rate to point A (1.2-1.4 Gy/h) during selectron treatment the overall intracavity dose was reduced by a mean value of 25%. Local recurrence rates were similar: 15% (selectron) against 14% (conventional). Three-year survival with local control was somewhat worse in the selectron group (77% against 81%) mainly because of an increased frequency of metastatic disease with local control (19.3% against 12.0%. The use of remote afterloading has not increased late morbidity (15.7% selectron, 15.0% conventional). The introduction of the selectron has brought about a marked reduction in staff radiation exposure. At the RBMH the mean recorded dose to nurses fell from 19 mSv in 1981 to 2.4 mSv in 1985.

Can the MAP technique be applied to study triggered activities of the heart? Intracellular evidence in vivo

Monophasic action potential (MAP) recording with contact electrode has been applied to study triggered activities of the heart. Intracellular evidence in vivo, however, of the MAP technique is lacking. In the present study, transmembrane action potential (TAP) recorded with floating glass microelectrode was compared with MAP in 18 cat hearts in vivo. The results were as follows. 1) In control conditions, the MAP duration at 50 and 90% repolarization was similar to that of TAP without any significant difference. 2) 10 sec after CsCl (0.5 mM/kg, i.v.), early afterdepolarization (EAD) appeared in the middle-late period of phase 3 both in the MAP and TAP; 30 sec after CsCl, the amplitude of MAP-EAD was 3.4 +/- 1.3 mV and that of TAP-EAD was 25.6 +/- 9.3 mV. Delayed afterdepolarization (DAD) was also induced by CsCl in phase 4 of the MAP and TAP simultaneously. The amplitude of MAP-DAD was 3.3 +/- 0.6 mV and that of TAP-DAD was 13.0 +/- 5.3 mV. 3) Triggered arrhythmias, including premature ventricular beat and tachycardia, induced by CsCl repeated injection were observed in the MAP and TAP recording synchronously. The present study not only provides an intracellular and direct evidence in vivo but also suggests that the contact electrode MAP technique could be applied to study triggered activities of the heart in vivo.

Stage I carcinoma of the endometrium: a 5-year experience utilizing preoperative cesium

A treatment protocol for the management of stage I endometrial carcinoma utilizing preoperative cesium is evaluated. One hundred and twelve consecutive patients were treated according to this protocol over a 5-year period. Based on this experience and a literature review a new protocol is recommended. The significant changes include primary surgery without preoperative cesium, primary treatment based on grade without regard to uterine size, modified radical hysterectomy for G3 tumors, pelvic radiotherapy for clear cell carcinoma confined to the pelvis regardless of depth of invasion, cytoxan, adriamycin, and cis-platinum for papillary serous tumors, and postoperative vaginal cuff cesium for G2 and G3 tumors not requiring pelvic radiotherapy.

Squamous carcinoma of the vagina: treatment, complications, and long-term follow-up

Seventy-five cases of primary squamous cell carcinoma of the vagina treated at the University of Pennsylvania are reviewed with long-term follow-up presented. These comprised 2.5% of all female genital malignancies treated during 1958 to 1980 inclusive. Patients treated during that time with non-squamous cell cancers have been excluded. Patients are analyzed with regard to stage, therapy, complications, and survival. Sixty-five percent of patients were stage I or II. Five-year survival for the entire group was 45%. Patients treated with radical surgery other than exenteration did well, with 7 of 8 surviving 5 years. Serious treatment complications were mostly related to radiation therapy and primarily involved the bowel and bladder. Three patients died of complications. Recurrence carried a grave prognosis as 30 of 33 patients with recurrence died of disease. Most recurrences were diagnosed within the first year following treatment. Patients with advanced disease were more likely to have distant recurrences. Although radiation therapy is generally the treatment of choice, radical surgery can yield excellent results when used in carefully selected patients. With meticulous attention to radiation dosage and technique it is hoped that treatment morbidity can be reduced. Optimal treatment of advanced disease may require some form of adjuvant systemic therapy.

Effect of oral intake of cesium chloride: a single case report

The author volunteered to experience on himself the effect of short-term, i.e., 36 consecutive days, oral administration of cesium chloride. Cesium chloride was given 6 g per day into two equally divided doses. The drug was dissolved in 8 ounces fluid and consumed immediately after the morning and evening meals which were diet-restricted to wheat bran and certain grain products, to attain approximately 1% potassium intake, for the initial 3 weeks. Bread products were discontinued and yogurt and cottage cheese products were reinstituted for the two week period that followed prior to reinstituting of the preceding food regimens. There was an initial general feeling of well-being and heightened sense perception. A gradual decrease in appetite was noted initially before it was stabilized at a later date. Discontinuation of rich bread meals resulted in pre-nausea sensation which was followed by diarrhea 48 hr later. The institution of high potassium nutrition decreased the feeling of nausea and abolished diarrhea. A "tingling" sensation in the lip and cheek regions was experienced 15 min subsequent the cesium chloride dosage compared to same sensation occurring at moderate intensity in hands and feet at end of the experiment. No adverse effects of CsCl were noted in performance of mathematical analyses or in driving skill. It is concluded that CsCl is devoid from toxicity provided adequate diet and supplements are administered.

Effect of alkali metals on chlorpromazine toxicity in the mouse

The effect of short-term injection of chlorpromazine alone or combined with either LiCl or CsCl (1 mEq/kg/day) in organ toxicity was studied in the albino male mouse. Chlorpromazine was administered by gradual dose build-up regimens from 5 mg/kg to 50 mg/kg which was attained over a 40-day period followed by abrupt drug withdrawal for a subsequent 25-day observation period. Histological evaluation of 10 tissues selected indicates that the liver was the target organ. The Li-treatment resulted in variable liver lobular size with loss of cell definition and the kidney showed focal lymphatic aggregates related to vascular channel. Chlorpromazine-treated mice displayed variation in liver nuclei size and in cell structure definition. Combined injection of LiCl with the phenothiazine drug resulted in alteration in size of liver nuclei with a slight midlobular distribution. Minimal changes in lobular liver cells were noted subsequent to the Cs-treatment. This is compared to some dilation of liver central veins and few variations in hepatocyte size after combined injection of CsCl with chlorpromazine. There was a reduction in body weight of animals treated with the LiCl and chlorpromazine combination compared to that of mice receiving the chlorpromazine alone or in combination with CsCl. A rebound in body weight loss occurred during drug withdrawal in mice pretreated with chlorpromazine alone or combined with CsCl but not in mice coadministered LiCl with chlorpromazine. Mortality score indicates a profound lethal effect during administration of LiCl with the high dosage of the chlorpromazine used which was persistent during drug withdrawal.(ABSTRACT TRUNCATED AT 250 WORDS)

Elimination of 137-Cs and 59-Fe and its relationship to metabolic rates of wild small rodents

Elimination of 137-Cs and 59-Fe by three species of wild rodents was measured in laboratory and field experiments to determine whether excretion rates of these nuclides are influenced directly by general metabolic (CO-2 production) rates. Sigmodon hispidus and Peromyscus leucopus were used in both field and laboratory experiments, and Reithrodontomys humulis was investigated only in the laboratory. Final-component biological half-lives (Tb) of 59-Fe for Sigmodon averaged 108 days in winter, 144 days in spring, and means ranged from 176 to 242 days under various laboratory conditions (ambient temperature, cold-exposure, irradiation, and chemical metabolic inhibition); for Peromyscus, values were 50 days in winter 47 days in spring, and 289 days (at ambient temperature only) in the laboratory; for Reithrodontomys mean values ranged from 121 to 178 days at different laboratory treatment levels. Biological half-lives of final-component 137-Cs elimination for Sigmodon averaged 7.5 days in winter, 7.9 days in spring, and means ranged from 7.7 to 8.6 days at the different treatment levels in the laboratory. Laboratory mean values for Reithrodontomys ranged from 3.5 to 3.9 days. For Peromyscus, Tb values averaged 3.4 days in winter, 3.6 days in spring, and 3.5 days in the laboratory. The data suggested that elimination of 59-Fe is influenced by metabolic rates of rodents in the field, but laboratory experiments were unable to demonstrate any predictable relationship. Neither did the rate of final-component 137-Cs loss from rodents appear to be influenced by metabolic rate in the laboratory or in the field. However, final-component Y-axis intercept values of 137-Cs exhibited a linear correlation with metabolic rates, and equations were derived from these intercept values to predict metabolism in the field for two species: for Sigmodon, Daily Average CO-2 Production (ml/hr/g, STP) [5.24-0.9172 (log-ea)] [0.886]; and for Reithrodontomys, = [12.51-1.80 (log-ea)] [0.886].