Hepatic flow scintigraphy has been used to evaluate 150 patients with gastrointestinal carcinoma. A normal range has been obtained on a group of 23 healthy volunteers. The flow scintigraphic findings have been correlated with the presence of metastases at the time of primary surgical therapy. The group of patients with livers ostensibly clear of metastases have been followed up over a one-year period. At one year the specificity of the investigation is 72 per cent with a sensitivity of 96 per cent. We conclude that flow scintigraphy is capable of not only detecting established hepatic metastases, but will also identify patients harbouring occult metastatic disease.

Leeds LS9 7TFIt has been shown that ultrasound and static isotope imaging are relatively insensitive for the detection of lesions <2cm diameter (Bryan et al., 1977). CAT scanning, although apparently more sensitive than these 2 methods still appears to have a limitation in detecting small lesions in the liver (Scherer et al., 1978). However, since it has been established that intrahepatic primary or secondary tumours are associated with an increased hepatic arterial blood flow (Breedis & Young, 1953) and time-activity curves generated. The time of the peak of the kidney curve was used to indicate the division between arterial and portal inflow phases of the liver curve. The quality of the bolus injection and its distribution was assessed by examination of the rise time of the kidney curve and studies were rejected if this was greater than 8 sec. After 3-point smoothing of the liver curve the average slopes of the 2 consecutive 8-second sections on either side of the arterial/portal division were calculated. The first slope was taken to represent arterial inflow and the second slope was taken to represent the portal inflow. The hepatic perfusion index (HPI) was expressed as a fraction of the arterial inflow to the total hepatic inflow. Static scans were independently assessed (P.J.R.) as being indicative or non-indicative of the presence of hepatic metastases. The results of the static and dynamic studies were correlated with findings at laparotomy for the presence or absence of hepatic metastases, which where possible were measured. The sites of these metastases were also noted. Figure 1 shows the distribution of HPI values in the positive laparotomy group, in the group of patients with no liver metastases and in the control group. It can be seen that 24/25 patients who were in the laparotomy positive group (96%) had HPI values above the normal range, the upper limit of normal in this series being 0.42. One patient with massive hepatic replacement by tumour had an HPI value of 0.15 but interestingly had a positive static scan. In those patients known to have hepatic involvement, the sensitivity of static scanning was 64%. Nine patients in this group had normal scans, but all had abnormal HPI values. The data for the negative laparotomy group are also shown but no definitive statement can be made until the follow-up

The necropsy findings of a large cell lymphoma involving only the pericardium and myocardium in a 62‐year‐old woman are reported. The initial presenting symptoms were heart failure followed by rapidly progressive heart block. The diagnosis of cardiac lymphoma was suggested by gallium and blood pool isotope studies, and was subsequently confirmed by operative myocardial biopsy. The clinical course was abrupt, and the patient died before therapy was instituted. While primary cardiac lymphoma is an extremely rare condition, experience in this case suggests that noninvasive isotope studies, particularly gallium and blood pool, are helpful in the diagnosis of atypical cardiomyopathy.

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Summary A patient with severe thyrotoxicosis of the apathetic variant in whom vomiting was the prominent presenting symptom is described. An alternative mechanism for thyrotoxic vomiting is postulated.