[en] Short communication. 3 tabs

[en] Standard teaching in textbooks and review articles has long been that liquid gastric emptying is less sensitive than solid emptying for detection of gastroparesis. Gastroparesis must be severe for the liquid study to be abnormal. Liquid emptying should be reserved for patients who cannot tolerate solids. This is based on data derived from dual-isotope dual phase solid-liquid studies performed in the past. However, we had noted that some of our referring gastroenterologists order both liquid and solid studies. Our studies consisted of 300 cc of water with 200 μCi Tc-99m DTP A for the liquid study and the standardized solid protocol of Tougas, et al. with Tc-99m SC, performed on separate days. A review of studies performed over a 6 month period revealed that many of these patients had delayed liquid emptying but normal solid emptying (1). Therefore we initiated a prospective study of 40 patients who were scheduled to have sequential liquid and solid studies on the same day. This minimized the potential for preparation variability. The liquid study was performed first with 0.200 μCi In-111 DTP A (1 min frames x 30) in 300 cc of water and immediately followed by the solid study, using 2 mCi Tc-99m SC. We used historical normal values for liquid emptying (2). We found that 23% of patients had delayed solid emptying and 33% had delayed liquid emptying. Of those patients with normal solid emptying, 32% had delayed liquid emptying (3). In a follow-up larger study, we studied 30 normal controls to establish a large data base of normal liquid emptying values. Prior normal data was quite limited. And we investigated 101 new patients. Normal values for clear liquid emptying was determined to be less than 22 minutes (mean ± 3 SD). Of the 101 patients, 16% had delayed solid emptying and 36% had delayed liquid emptying. Of those with normal solid emptying, 32% had delayed liquid emptying. Adding the patients with delayed liquid emptying those with delayed solid emptying nearly doubled the number of abnormal studies (4) From a functional standpoint the stomach has two compartments. The fundus relaxes and accommodates large meals; its tonic pressure is responsible for liquid gastric emptying. The antrum has strong phasic contractions that break down food into small particles that can pass through the pylorus into the duodenum. Gastroenterologists have noted a poor correlation between patient symptoms and the results of gastric emptying studies. We hypothesize that a reason may be that we have only been studied solid emptying and not liquid emptying. We expect that further investigation will lead to therapies that are specific for fundal and antral gastric function. (author)

[en] Following work done by Professor John McAfee and Mathew Thakur at the MRS Cyclotron Unit a method is available for labelling cells with indium-111 which results in a stable intracellular marker. The method uses indium-111-8 hydroxyquinoline (111In oxine) which is a lipoid soluble complex which goes across the cell membrane and results in the deposition of indium into various subcellular structures. It has been applied to various preparations of white cells, platelets and also malignant cells. Autologous granulocytes have been used to identify inflammatory lesions in 35 patients. By similar means autologous lymphocytes can also be labelled and reinfused. Lymphocytes have been shown in animals to circulate from the blood via the lymphatic system and then returning to the blood once more. The same phenomenon can be seen in man using indium labelled lymphocytes. Lymph nodes become visible at between 12 and 18 hours and recirculation of labelled cells can be shown on the blood activity curves. Certain problems arise concerning cell behaviour after labelling which appear due to irradiation of cells rather than chemical toxicity. (author)

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[en] Short communication

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[en] An optimized procedure is described for isolation and high-efficiency radiolabeling of leukocytes using ¹¹¹In-oxine. The chief advantages over conventional methods include virtually no loss of leukocytes during washing and separation steps; a significant reduction in the time required to prepare leukocytes for radiolabeling compared to non-hemolytic preparations; a 28% increase in the average labeling efficiency obtained using ¹¹¹In-oxine; > 95% cell viability as measured by the trypan blue exclusion test; elimination of contaminating red blood cells from the leukocyte pellet prior to labeling; and 80% survivability at 15 min post injection (measured as per cent of blood activity on leukocyte fraction). (author)

[en] Indium-111 scintigraphy is a method proposed for specific diagnosis and localization of focal infection. It has been found that, in general, cancers did not visualize with leukocyte scintigraphy. In this article, a case of positive indium-111 leukocyte scintigrams of a foot metstasis from a mucoepidermoid carcinoma of the lung is reported