Effects of intravenously infused Fluosol-DA 20% in rats.

Rats were injected with a fractionated 50 ml/kg dose of Fluosol-DA 20% with and without exposure to 100% oxygen. Animals were killed at 24, 43, 92, and 183 days post-treatment and samples taken for hematological, hepatic enzyme, histological, and perfluorochemical analyses. There were no significant differences in hemograms or hepatic enzyme findings between treatment and control groups. Differences in organ weights and histology were a result of perfluorochemical (PFC) accumulation in the tissues of treated animals. All changes were reversible. There were no effects from breathing high oxygen levels in either treatment or control animals.

Perfluorocarbon emulsions in cancer therapy: preliminary observations on presently available formulations.

Perfluorocarbon (PFC) emulsions, due to their favorable oxygen transporting properties, have been proposed as tumor sensitizers for application in both radiotherapy and chemotherapy. While this application is a very promising one it is by no means simple, and presently available formulations are inadequate. Intravenous administration of these emulsions can produce a severe hemodilution which tends to offset the desired effect; these emulsions can alter the pharmacokinetics of simultaneously administered drugs. Unless these variables are taken into account the risk of false negative and false positive results will be excessive. Of more serious concern are the profound disturbances produced by these emulsions in the reticuloendothelial system. Using two of the more popular PFC, Fluosol-DA and DMA/NONANE, we have shown that daily administration of these emulsions can produce 9-fold increases in liver size and 27-fold increases in spleen size. This problem appears to involve the surfactant used in both emulsions, pluronic F-68. It will be necessary to circumvent this problem before further study of their potential application can proceed.

Tissue damage caused by the intramuscular injection of long-acting penicillin.

In order to elucidate whether tissue damage produced on occasion by intramuscular injection of long-acting penicillin is due to accidental intra-arterial injection or vasospasm, two types of experiments were carried out in rabbits. In the first set of experiments, six New Zealand White rabbits were given intra-arterial injections of 0.4 mL of a mixture containing 300,000 U of penicillin G benzathine and 300,000 units of penicillin procaine per milliliter (Bicillin C-R) into the left femoral artery and 0.4 mL of normal saline into the right femoral artery as autocontrol. In a second set of experiments, 0.4 mL of the same penicillin preparation was injected in the space surrounding the left femoral artery in five New Zealand rabbits, and 0.4 mL of normal saline was injected in a similar fashion around the right femoral artery as control. The legs of the rabbits that received the intra-arterial injection of penicillin invariably developed ischemic manifestations. None of the legs of rabbits given intra-arterial injections of normal saline had pathologic manifestations. None of the rabbits that received the periarterial penicillin preparation or normal saline developed abnormalities. These results strongly suggest that the tissue damage produced by penicillin is secondary to the intra-arterial administration of the drug.

Radiation enhancement of lung nodule formation in mice is not potentiated by treatment with a perfluorochemical emulsion and carbogen.

The ability of intravenously-injected mouse mammary tumor cells to form lung tumors is increased by irradiation of the thorax 24 h previously. We examined the effects of treatment with a perfluorochemical emulsion (Fluosol-DA, 20%) plus carbogen before and during irradiation on the radiation-induced enhancement of lung nodule formation. We found no evidence that treatment with Fluosol plus carbogen altered the development of tumor nodules in irradiated mouse lungs.

Red blood cell substitutes and artificial blood.

Artificial substitutes for specific functional portions of blood are being developed. Perfluorocarbons have received the most publicity in recent years, and one, Fluosol-DA, is undergoing clinical trials in the United States. The perfluorocarbon emulsions physically dissolve oxygen, which distinguishes them from the chemical binding that occurs in hemoglobin. Fluosol-DA has been shown to transport oxygen in amounts that are probably clinically useful if the patient inspires an atmosphere with increased oxygen. A large clinical trial from Japan suggests that Fluosol-DA is safe to transfuse, although recent work suggests that Fluosol-DA may produce significant pulmonary reactions that can be prevented by steroid administration. These reactions are probably caused by complement activation by an emulsifying agent in Fluosol-DA. Recent applications of Fluosol-DA include use in a resuscitative fluid, use in occlusive vascular disease, an special applications, such as treatment of carbon monoxide poisoning, which take advantage of the solubility properties of perfluorocarbons.

The aggravating effect of dehydration on pulmonary edema induced by ionic and nonionic contrast media.

High intravenous doses of diatrizoate are known to induce a profound degree of pulmonary edema in the rat. In euhydrated rats, similar doses of iohexol do not induce significantly higher lung weights when compared with nontreated animals. However, for dehydrated rats, intravenous administration of equivalent doses of these agents results in significant pulmonary edema formation with iohexol, and enhanced edema with diatrizoate; the same magnitude of response is not seen in euhydrated rats. These results show that patients susceptible to severe contrast reactions should be well-hydrated and preferably given a nonionic agent when contrast material must be administered.

Effects of contrast media on the conducting system of the heart during coronary angiography. A comparison of Renografin-76 to Hypaque-76.

Electrocardiographic changes induced by ionic contrast media can cause complications during coronary angiography. A conduction delay through various parts of the heart is one factor in the genesis of asystole or ventricular fibrillation. Hypaque-76 (H76) and Renografin-76 (R76) are nearly identical ionic contrast media except that R76 binds more calcium than H76 because of the presence of sodium citrate and EDTA in R76. To determine whether the calcium binding additives in ionic contrast media contribute to the cardiac conduction abnormalities, we examined conduction time through the atrioventricular (AV) nodal tissue (via bipolar His bundle electrograms) and through the distal part of the conduction system (recording the QRS complex from the ECG) during coronary angiography. We injected 10 mL of H76 and R76 in 19 closed chest dogs in a blinded, randomized fashion during coronary angiography. The effects of H76 and R76 on heart rate, AH interval, HV interval, V interval and PR interval, and QRS complex duration were recorded. In 14 nonatrial pacing dogs, compared with H76, R76 produced a greater increase in the AV interval (32.9 +/- 6 milliseconds vs 12.4 +/- 2 milliseconds, P less than .01) and the PR interval (29.6 +/- 6 milliseconds vs 11.9 +/- 4 milliseconds, P less than .02). Additionally, the heart rate decreased 13.9 +/- 3.5 beats/minute from control with R76 compared with a decrease of 4.2 +/- 2.6 beats/minute from control with H76 (P less than .05). There was no significant difference between the prolongation of the HV interval and V interval, or QRS complex duration generated by R76 and H76.(ABSTRACT TRUNCATED AT 250 WORDS)

Contrast media-induced ventricular fibrillation. A comparison of Hypaque-76, Hexabrix, and Omnipaque.

Contrast media occasionally produce ventricular fibrillation during coronary angiography. We compared the fibrillatory propensity of the conventional ionic contrast medium, Hypaque-76 (H76) to the low osmolar ionic dimer Hexabrix (HB) and to the nonionic agent Omnipaque (OM) in 20 open chest anesthetized dogs. Intracoronary injection of 6 mL of contrast medium produced spontaneous ventricular fibrillation in four of ten dogs with H76, compared with two of ten with HB, and zero of ten with OM (P = .07). The induction of two premature beats by programmed stimulation of the myocardium during injection of 4 mL of contrast medium produced ventricular fibrillation in ten of ten dogs with H76, compared with three of ten with HB, and zero of ten with OM (P less than .001). Both H76 and HB produced ventricular fibrillation in ten of ten dogs when three premature beats were induced, compared with two of ten dogs with OM (P less than .001). Four mL H76 produced a 109 +/- 18 msec increase in the QT interval, compared with an 82 +/- 17 msec increase with HB, and a 45 +/- 12 msec increase with OM. We conclude that both low osmolar HB and OM are less fibrillatory than the conventional ionic medium H76, and that the nonionic medium OM is less fibrillatory than the ionic dimer contrast medium HB.

Ultrastructural changes in rat aortic endothelium during contrast media infusion.

A rat model was employed to investigate contrast media (CM) induced ultrastructural changes in the vascular endothelium. Ionic contrast materials such as Renografin-76 (diatrizoate meglumine diatrizoate sodium), MD-76 (diatrizoate meglumine diatrizoate sodium), and Angiovist (meglumine diatrizoate) were injected into the femoral vein of anesthetized male Wistar rats (240-260 g) and allowed to circulate. Control animals were similarly injected with equiosmolar sucrose and physiologic saline. The thorax was opened 15 minutes, 1 hour, and 4 hours postinjection and cardiac perfusion performed using Karnovsky's fixative; the thoracic aorta was then surgically removed, and processed for transmission electron microscopy. All CM produced shrinkage in cell cytoplasm and nuclear structures thereby causing distortions in cell morphology. In control tissues, however, no such ultrastructural damages were noted. Within 15 minutes of CM infusion, electron dense granules were seen on the luminal surface of endothelial cells, in pinocytotic vesicles, as well as in the gap junctions between cells. These observations indicate that contrast media intake occurs via vesicular transport, and through the cell junction.

Contrast media induced pulmonary edema. Comparison of ionic and nonionic agents in an animal model.

High intravenous doses of diatrizoate are known to induce pulmonary edema in the rat. The newer generation of contrast media--nonionics and monovalent dimers--are considered less toxic than diatrizoate. In this study we evaluated the degree of pulmonary edema induced by a high dose (6 g I/kg) of these new agents and found that Ioxaglate produced higher lung weights than Renografin 60 and Iopamidol. Iohexol and Amipaque did not induce a significant degree of edema. The model used in this study demonstrates distinct differences in pulmonary toxicity among these new agents, when given in doses exceedingly higher than given in clinical practice.

Investigation of a new arthrographic contrast agent: Iotrol.

A new nonionic dimer (Iotrol; Schering AG) and diatrizoate meglumine-diatrizoate sodium (Renografin-60; Squibb) were compared as arthrographic agents by injecting these substances into the knees of rabbits. Three experienced arthrographers judged the image quality produced by Iotrol to be superior to that of Renografin-60. Following animal sacrifice, histologic examination of the synovium revealed a significant difference in the inflammatory response evoked by the contrast agents: Iotrol caused less inflammation. In a second group of rabbits, methylprednisolone was subcutaneously injected 24 hours before the arthrographic studies. The methylprednisolone significantly reduced the inflammation in the Renografin-60 subgroup when compared with the nonmedicated counterparts. No significant effect was noted in a like comparison with Iotrol. In addition, the administration of methylprednisolone led to a deterioration of the radiographic images. Based upon our data, we believe Iotrol is superior to Renografin-60 as an arthrographic agent.

Mutagenicity of endodontic sealers.

Four endodontic sealer materials and some of their chemical constituents were subjected to Ames' test for mutagenicity with the Salmonella/microsome assay. Extracts of two zinc oxide-eugenol based materials and of one gutta-percha-zinc oxide-chloroform based sealer were negative in the test. Extracts of a synthetic polymer material, based on epoxy-bis-phenol A, induced mutations in Salmonella typhimurium TA 100 as did extracts of the epoxy-bis-phenol A resin alone. Formaldehyde, an active ingredient from one of the ZnO-based materials, induced mutations in both Salmonella typhimurium TA 98 and TA 100. The mutagenic activity of formaldehyde as well as of the epoxy material was reduced in the presence of rat liver microsomes.

A comparison of the efficacy and toxicity of and intraocular pressure response to viscous solutions in the anterior chamber.

An intraocular-lens abrasion test, vital dye staining, and scanning electron microscopy were used for an in vitro comparison of endothelial protection offered by four viscous solutions of 1% sodium hyaluronate (Healon), 3% sodium hyaluronate (AmVisc), 4% chondroitin sulfate (Viscoat), and 2% methylcellulose. Wide-field specular microscopy with analysis of endothelial cell density and morphologic evaluation, pachymetry, and intraocular pressure measurements were also used to study the toxicity of the viscous solutions in an in vivo cat model with and without anterior chamber washout. All four solutions provided complete endothelial protection from mechanical trauma. Endothelial cell density and morphologic nature were unaffected during the in vivo toxicity study. A mild increase in intraocular inflammation occurred at one and two days after intraocular injection with all four viscous solutions. Intraocular pressure elevations peaked within four hours after instillation of the viscous solutions and were significantly reduced by anterior chamber washout.

Mediastinal fibrin glue: hemostatic effect and tissue response in calves.

There is continued controversy regarding the effectiveness and potential adverse effects of fibrin glue. Thus, we chose to evaluate it in a model of experimental calf aortic valve replacement that has been previously well established. Concentrated fibrinogen and topical thrombin were sprayed to form a thin layer of fibrin glue over the mediastinal tissues of 20 consecutive calves undergoing aortic valve replacement. Chest tube outputs of these animals were compared with those of the preceding 20 consecutive calves undergoing aortic valve replacement without fibrin glue. All procedures were performed by the same surgeon, and no other technical changes were made between the two series. Total postoperative chest tube output (mean +/- standard error) was 553 +/- 50 mL for the calves treated with fibrin glue and 1,155 +/- 103 mL for the control calves (p less than 0.001). On histological examination of mediastinal tissues from 5 treated calves killed 6 weeks after operation, there was no evidence of inflammation, fibrosis, or residual fibrin. To our knowledge, this is the first controlled laboratory study to show that fibrin glue spray is an effective hemostatic agent and that it produces no long-term tissue reaction.

The effect of Gd-dimeglumine on subcutaneous tissues: a study with rats.

Gadopentetate dimeglumine and a saline solution of similar osmolality of 2100 mOs/kg H2O were placed in the paws and in the thigh muscles and subcutaneous tissue of Sprague-Dawley rats weighing 225-250 g. The paws were serially photographed for 4 weeks and the thighs were examined histologically for up to 4 weeks. Gross and histologic reactions to gadopentetate dimeglumine were greater than those to the saline solution, and included tissue sloughs. When risk factors for extravascular extravasation are present, such as infusion sites in the dorsum of the hand or foot, or around the ankle, or when soft tissues are obscured by bandages, caution should be exercised when injecting gadopentetate dimeglumine.

Hypothermia and chloropent anesthesia differentially affect the flash evoked potentials of hooded rats.

Anesthetics and body temperature alterations are both known to alter parameters of sensory-evoked responses. However few studies have quantitatively assessed the contributions of hypothermia to anesthetic-induced changes. Two experiments were performed. In the first, chronically implanted rats were injected with either 0, 0.05, 0.10 or 0.20 ml Chloropent/100 g b.w., while body temperature was maintained. Flash evoked potentials recorded 30 min later showed increased latencies but only minor (not statistically significant) changes in amplitude. In the second experiment the same rats were anesthetized with 0.35 ml Chloropent/100 g b.w. and rectal temperature was systematically varied between 31 degrees C and 37 degrees C. Over the ranges of temperature and anesthetic employed, latencies increased more extensively with hypothermia than with anesthesia. P1N1 amplitude doubled when temperature was lowered to 31C, but P2N2 and N2P3 amplitudes declined over the same temperature range. Anesthetic-induced changes in peak-to-peak amplitude did not reach statistical significance when body temperature was constant. The findings suggest that previously reported alterations in evoked potentials following anesthesia may have been confounded with hypothermia.

Toxicity of venalot (a mixture of coumarin and troxerutin) in the baboon.

Venalot, a mixture of coumarin and troxerutin, in the proportion 1 to 6 respectively, was given orally to baboons at dosages of 0, 100, 300 and 1000 mg/kg/day for 26 weeks. Vomiting, usually within 3 h of administration and considered to be of central origin, in addition to vomiting immediately after dosing, was noted in animals receiving 1000 mg/kg/day. At this level, collapse on several occasions in two animals, one of which died, was also observed. Another animal receiving 1000 mg/kg/day was killed for humane reasons following a period of weight loss, reduced appetite and deterioration in body condition. However, no adverse effect on body weight gain, food or water consumption, ophthalmoscopic or electrocardiographic examinations were noted in any other animals during this study. Increased levels of liver function (serum leucine amino-peptidase (LAP), and serum ornithine carbamyl transferase (OCT) were noted during the dosing period, together with slightly increased liver weights terminally for animals receiving 1000 mg/kg/day; however, as no morphological or ultrastructural changes were noted, these findings were considered to be attributable to hypertrophy.

Prophage induction by 4 antimalaria drugs (daraprim, fansidar, nivaquine and camoquine) and in combination with aflatoxin B1.

The abilities of 4 antimalaria drugs (Daraprim, Fansidar, Nivaquine and Camoquine) on their own and in combination with aflatoxin B1 to induce prophage in tester strains E. coli D21 and D22 were studied. The 4 drugs were found to induce prophage in the tester strains; Daraprim and Fansidar without the need for activation by liver mixed function oxidases (S9 microsomal fraction), while Nivaquine and Camoquine did require activation by this system. Aflatoxin B1 was used as a positive control in all the tests. The combined effects of each of the drugs with aflatoxin B1 were lower than that of the individual drugs acting alone. From these results, it may be concluded that the drugs may, on their own, pose a carcinogenic hazard to the population in the Nigerian environment exposed to them. In addition, the depression of prophage induction observed when the drugs were combined with aflatoxin B1 may be indicative of a common target site of action in the tester strains.

Autologous fibrin tissue adhesive biodegration and systemic effects.

A series of experiments was conducted to investigate the rate of Autologous Fibrin Tissue Adhesive (AFTA) degradation by the fibrinolysis inhibitor, epsilon amino caproic acid (EACA). The duration of AFTA clots in vitro, subcutaneous, and in the middle ear was prolonged for a time interval that was proportional to the concentration of EACA in Component II of the adhesive. No toxic reactions were observed in the middle or inner ear. Systemic pathology (thrombosis or emboli) could not be related to the presence of EACA applied in the middle ear or directly into the blood stream at concentrations (mg/kg body weight) up to 1,500 times that expected to occur during surgery on humans.

Ototoxicity of Vasocidin drops applied to the chinchilla middle ear.

Some widely used ototopical preparations are potentially toxic to the middle and inner ear. Vasocidin Ophthalmic Solution (sulfacetamide sodium and prednisolone sodium phosphate) has been advocated as an alternative agent that may have fewer toxic side effects in the treatment of otorrhea. Vasocidin was introduced into the bullae of nine chinchillas to investigate the effects on the middle and inner ear. The organ of Corti and stria vascularis were found to be entirely normal in 17 of the 18 temporal bones studied. Changes observed in the middle ears at one week included inflammation, hemorrhage, and effusion. Examination of specimens at four weeks revealed resolution of most of the inflammatory changes. The results of this experimental study indicate that Vasocidin causes reversible middle ear inflammation with little or no toxic effect on inner ear structures.