J. P. Lavender

The kinetics of 111Indium distribution following injection of 111Indium labelled autologous granulocytes in man

Summary. The kinetics of human autologous granulocytes, separated and labelled with 111In without isolation from plasma, have been studied in subjects with and without sepsis with the aim of identifying the fate and sites of destruction of granulocytes in man.

Imaging of bone infection with labelled white blood cells role of contemporaneous bone marrow imaging

The uptake of white blood cells (WBC) into normal bone marrow may lead to difficulty in detecting bone infection. Twenty-one patients in whom the WBC scan was equivocal or positive underwent a technetium 99m colloid scan to show the distribution of bone marrow. Six patients had a positive WBC scan, and in five of them a discordant colloid scan confirmed infection. However, in one the colloid scan was concordant, indicating that the WBC activity was not due to infection but the result of normal bone marrow uptake. Fifteen patients had an equivocal WBC scan. In 14, infection was excluded by a concordant scan, and 1 patient with a discordant scan was lost to follow-up. We conclude that the combination of a WBC scan and a colloid scan is an effective method to distinguish infection from normal bone marrow activity and, in particular, reduces the number of incorrect diagnoses of infection.

Indium labelled leucocyte scanning in pyrexia of unknown origin

Pyrexia of unknown origin (PUO), the commonest cause of which is occult infection, represents a difficult diagnostic problem. Radiolabelled white cell scanning provides a non-invasive and potentially useful diagnostic tool in this condition, but its efficacy remains controversial. In a retrospective study, we analysed 30 111In white cell scans, performed between 1983 and 1988 in 25 patients with PUO, strictly defined as a fever of at least 3 weeks duration reaching 38.3 degrees C on more than three occasions and investigated in hospital for a minimum of 7 days. Eleven studies were on post-operative patients who, although developing fever within 1 week of surgery, satisfied the above criteria. Overall, the diagnostic sensitivity and specificity were 55% and 74% respectively, with an overall accuracy of 67%. This improved to 91% in the post-operative patients compared to an accuracy of 52% in spontaneous PUO. Accuracy did not correlate with duration of symptoms, leucocytosis or index of clinical suspicion. In conclusion, although 111In white cell scanning is not particularly useful for the investigation of spontaneous PUO, it does have a role in post-operative PUO.

Indium-111 tropolonate leucocyte scanning in the detection of intra-abdominal abscesses

Indium-111 leucocyte scanning is established as an accurate method for localising intra-abdominal abscesses. With the currently available cell labelling techniques there is a variable and significant delay in localisation of abscesses which is a major disadvantage in comparison with ultrasound or computed tomography. We have examined the speed and accuracy of localisation of leucocytes labelled in plasma with a new chelating agent, indium-111 tropolonate, in 90 patients with suspected intra-abdominal abscess. In 50 patients a comparison with ultrasound was made. Nineteen patients had abscesses. The sensitivity and specificity of labelled leucocytes were 95% and 99%, respectively. Comparative results for ultrasound were 60% and 83%. In nine out of 10 patients with abscesses scanned sequentially from 40 min after return of the labelled cells, activity corresponding to the abscess was already visible on the 40 min scan. These results demonstrate that indium-111 plasma labelled leucocyte scanning is both rapid and an accurate method of detecting abscesses.

Mercury-induced renal vascular shut-down: observations in experimental acute renal failure.

Abstract. Mercuric chloride introduced into the systemic circulation or directly into the renal artery in dogs leads to an immediate and lasting fall in renal blood flow. On arteriography severe cortical ischaemia is seen. These findings were studied in 32 animals. Renal vascular shut‐down induced by mercuric chloride appears concentration dependent, and is not mediated by glomerular filtration. It is possible to protect the kidney from shut‐down by an infusion of hyperosmolar mannitol given before mercuric chloride. This suggests that the ‘no‐reflow phenomenon’, already documented in the ischaemic kidney and brain, has a counterpart in mercury induced acute renal failure. Endothelial cell swelling may be an important primary vascular disorder underlying many acute renal failure states.

Sequential imaging of post-operative thrombus using the In-111-labelled platelet-specific monoclonal antibody P256

Eleven patients undergoing total hip replacement were studied by radioimmunoscintigraph for development of postoperative thrombus. Images were obtained using the 111In-labelled Fab fragment of a monoclonal antibody (P256) directed against human platelets. Six patients showed focal accumulation of radioactivity in the lower limbs. Three of these had contrast venograms that were all positive for thrombus. Two of these six patients showed evidence of pulmonary localization of P256-Fab and this correlated with positive ventilation/perfusion scintigraphy in one of the patients. Sequential imaging with 111In-P256 Fab not only established a diagnosis of deep venous thrombus but also provided useful information regarding its natural history.

Detection of protein-losing enteropathy by 111In-transferrin scanning

Abstract111In-Transferrin scanning was used to detect protein-losing enteropathy due to intestinal lymphangectasia. The advantages of this technique over conventional methods are discussed.

A comparison of indium-111-oxine and indium-111-acetylacetone labelled leucocytes in the diagnosis of inflammatory disease.

Abstract 111In leucocyte scanning in a series of 132 patients has shown this technique to be a reliable and accurate means of diagnosing sepsis. Labelling with 111In oxine and with 111In acetylacetone gave similar values of sensitivity and specificity, and higher than those of ultrasound.

Polytome-encephalography in the investigation of pituitary tumours.

Thirty-seven patients suffering from various types of pituitary tumours have been examined by pneumoencephalography combined with tomography using the Philips polytome. The technique described uses careful premedication by phenoperidine and haloperidol. Circular tomography in sagittal and coronal planes showed suprasellar anatomy in 39 out of 40 examinations. Fourteen patients had suprasellar extensions of tumour and three patients showed intrasellar air. The importance of accurate anatomical assessment of pituitary tumours is discussed. Suprasellar extension could not be predicted from the shape of the sella. Suprasellar extension may exist in the absence of visual field defects.

Preservation of Normal Cortical Vasculature in Ischaemic Renal Failure in the Dog

Ischaemic renal failure in the dog was studied by clamping one renal artery for 2 hr in 18 animals. Total renal blood flow was measured for 3 hr after this and only reduced by about 30%. Fine detail renal angiography showed a normal cortical perfusion pattern. Urine flow rates and creatinine clearances from these kidneys, however, were found to be grossly impaired over this period. Seven days later the angiogram of the oliguric kidney remained normal. Two-hour unilateral renal ischaemia in the dog leads to a form of acute renal failure with a striking disparity between glomerular perfusion and clearance, arguing agains a primary circulatory defect.