Sachio Otsuka

Radioimmunodetection of cancer of gastrointestinal tract and liver metastasis with I-131 anti-CEA and I-131 anti-CA19-9 monoclonal antibody cocktail (IMACIS-1)

We evaluated the intravenous infusion of a cocktail of I-131 anti-CEA and anti-C A19-9 monoclonal antibody F(ab’)2 (IMACIS-1) in patients with gastrointestinal neoplasm and liver metastases in order to assess its efficacy in detecting the presence of cancer. Seven patients with primary or recurrent gastrointestinal cancer in whom liver metastases were also detected were studied. Accumulation of radioactivity in the primary tumor was seen in only one patient. Visualization of the liver metastases was achieved in all patients. Thus detection of liver metastasis was better than in primary or recurrent tumors. While tumor visualization was most often seen in the 3 day image, optimal visualization of the tumor was seen at 5–7 days. There was no correlation between the serum concentration of CEA or CA19-9 and the visualization of tumors. Serum kinetics of I-131IMACIS-1 showed biexponential components with a 1st phase T1/2 of 5.0 hours and 2nd phase T1/2 of 34.7 hours. The mean whole body (I-131) half-life determined from the whole-body scans was 1.95 days. The mean urinary excretion of I-131 in 7 days was 85%. This value agreed closely with total radioactivity retention detected by scanning. This series of studies demonstrated the potential utility of a cocktail of antibodies consisting of an anti-CEA and an anti-CA19-9 monoclonal F(ab’)2.

Magnifying Observation of Ectopic Gastric Mucosa of the Cervical Esophagus

We attempted to investigate the fine mucosal patterns of inlet patches using a transparent‐tip‐hood‐fitted magnifying electronic endoscope (Olympus, GIF‐200Z). The prevalence of inlet patch was 10.1%, 26 out of 257 patients undergoing screening endoscopic examination using a GIF‐200Z. This rate was higher than that of previous reports in Japan, higher in the young group than in the aged group, and higher in males than in females. The mean inlet patch size, measured by the new method using a transparent hood, was 5.2 mm. Large inlet patches, above 8.1 mm, were found more frequently in males than in females. The number of inlet patches in one patient was one in 19 patients and two in seven. The inlet patches were oval and had a smooth margin in 23 (69.7%) cases, and irregular in 10 (30.3%). The oval patches with smooth margins were significantly larger than those with an irregular form. The fine mucosal pattern of inlet patches was mixed with B, BC and C type. Inlet patches with acid production were suggested to be fewer in number than expected, and patients with an inlet patch appear to have minimal, if any, complaints. A transparent‐tip‐hood‐fitted magnifying electronic endoscope was thought to facilitate accurate diagnosis of the inlet patch.

A case of an intra-atrial tumor thrombus from hepatocellular carcinoma (HCC), first indicated by67Ga-citrate scintigraphy

We encountered a very rare case of an intra-atrial tumor thrombus from hepatocellular carcinoma (HCC). Conventional XCT and US gave evidence of HCC. In nuclear medicine studies performed incidentally, the first study with99mTc-phytate liver scintigraphy showed 2 SOLs and evidence of chronic liver disease, and the second study with67Ga-citrate scintigraphy demonstrated 2 hot lesions within the liver parenchyma, and also another unexpected hot area just above the left lobe of the liver, seemingly beyond the diaphragm. When echocardiography was performed, in addition to ECG, because the patient began to complain of dyspnea, an oblong mass lesion was detected within the right atrium. Reexamination with XCT and angiography clearly proved the existence of an intraatrial tumor thrombus. These results indicate the need for routine examination by echocardiography for HCC patients complaining of dyspnea.