S. H. Saverymuttu

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.

Assessment of Disease Activity in Ulcerative Colitis Using Indium-111-Labelled Leukocyte Faecal Excretion

A new method of assessing disease activity in ulcerative colitis has been developed utilizing indium-111-labelled granulocytes. Faecal 111In excretion after intravenous administration of labelled granulocytes ranged from 1.1% to 45% of the injected dose in patients with ulcerative colitis, showing significant differences between mild, moderate, and severely active groups. There was a significant correlation between faecal 111In excretion and a clinical index based on the Crohns disease activity index (r = 0.79, p less than 0.001) and the erythrocyte sedimentation rate (r = 0.73, p less than 0.001). Quantitative faecal 111In-labelled granulocyte excretion is an objective and specific method of assessing disease activity in ulcerative colitis.

Granulocyte migration in ulcerative colitis

Abstract. Although histologically relapses in ulcerative colitis are characterized by an intense granulocyte infiltrate, there is evidence both from in vitro function tests and skin window migration studies in vivo that there is defective granulocyte function in ulcerative colitis. We have recently developed a method for non invasively monitoring granulocyte migration to sites of inflammation using indium‐111‐labelled granulocytes, and have used this technique in fifteen patients with ulcerative colitis. In all fifteen cases there was rapid migration of indium‐111‐labelled granulocytes to inflamed bowel within 10 min of return of the labelled cells. This study provides no support for a significant granulocyte migration defect in ulcerative colitis.

111Indium leukocyte scanning in small-bowel Crohn's disease

Twelve patients with Crohns disease of the small bowel were evaluated by111indium leukocyte scanning of the abdomen. There was localization of the labelled cells in the areas of active Crohns disease and the findings were in complete agreement with the extent of abnormalities demonstrated on barium examination of the small intestine. The value of this technique in the assessment of Crohns disease and as an adjunct to the conventional small bowel series is discussed.

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.

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.

Comparison of fecal granulocyte excretion in ulcerative colitis and Crohn's colitis

Impaired granulocyte migration has been suggested to be present in Crohns disease on the basis ofin vitro granulocyte function tests andin vivo skin window studies. This idea is supported by the impression histologically that the acute inflammatory infiltrate in diseased bowel is less in Crohns disease than ulcerative colitis. We have developed a method of quantitating the acute inflammatory infiltrate in inflamed bowel by measuring fecal indium-111 granulocyte excretion and have compared this assessment in patients with ulcerative colitis and Crohns colitis matched for disease activity. For equivalent disease groups in ulcerative colitis and Crohns colitis, there was no significant difference between fecal granulocyte excretion. These findings provide no support for the contention that there is a reduced granulocyte infiltration in Crohns disease.Impaired granulocyte migration has been suggested to be present in Crohns disease on the basis ofin vitro granulocyte function tests andin vivo skin window studies. This idea is supported by the impression histologically that the acute inflammatory infiltrate in diseased bowel is less in Crohns disease than ulcerative colitis. We have developed a method of quantitating the acute inflammatory infiltrate in inflamed bowel by measuring fecal indium-111 granulocyte excretion and have compared this assessment in patients with ulcerative colitis and Crohns colitis matched for disease activity. For equivalent disease groups in ulcerative colitis and Crohns colitis, there was no significant difference between fecal granulocyte excretion. These findings provide no support for the contention that there is a reduced granulocyte infiltration in Crohns disease.

Indium-111-labeled autologous leukocyte scanning in gastrointestinal graft versus host disease (GVHD)

The technique of scanning with indium-111 autologous leukocytes has been used to assess gastrointestinal graft-versus-host disease (GVHD) following allogenic marrow transplantation. In patients with active disease, abdominal scans showed extensive abnormal localization in the bowel, while in those whose disease was quiescent after responding to treatment, scans showed localized ileocecal involvement. Rectal histology showed excellent agreement with scanning in the diagnosis of GVHD, but in three of six cases with active disease underestimated disease severity. Indium-111 leukocyte scanning is a useful noninvasive technique for the diagnosis and assessment of gut GVHD.