To evaluate the dual-isotope Schilling test for the diagnosis of pernicious anemia or malabsorption syndrome, 65 studies were selected for clinical correlation. Criteria for pernicious anemia included mean corpuscular volume greater than 100 cu micrometer, serum B12 greater than 100 ng/l, megaloblastic marrow, achlorhydria, reticulocytes greater than 5% on B12 therapy, atrophic gastritis, and elevated serum antibodies to parietal cells or intrinsic factor. Criteria for malabsorption syndrome included: decreased serum B12, folate, and carotene; increased fecal fat; abnormal D-xylose absorption; abnormal radiographic and biopsy findings. 58Co-cyanocobalamin and 57Co-cyanocobalamin bound to intrinsic factor were given orally to fasting patients; 1 mg of nonradioactive B12 was injected intramuscularly within two hours. Aliquots of 24-hour urine samples were counted. If the excretion of 58Co was less than 7% and the 57Co/58Co ratio was greater than 1.7, the test indicated pernicious anemia; a ratio less than 1.7 indicated malabsorption syndrome. Sensitivity, specificity, and accuracy of the dual-isotope Schilling test were 83%, 98%, and 94% for pernicious anemia, and 67%, 90%, and 86% for malabsorption syndrome, respectively.
Cases are presented in which Tc-99m methylene diphosphonate accumulated in a lung metastasis from well differentiated adenocarcinoma of the colon, and in a hepatic metastasis from oat cell carcinoma of the lung. To our knowledge, this is the first report of Tc-99m phosphonate complexes concentrated in a pulmonary metastasis of colonic caecinoma or in a hepatic metastasis of oat cell lung carcinoma. The exact mechanism for this non-osseous uptake of bone scanning agents is still unknown.
In 82 subjects 82 gastric emptying studies using Tc-99m triethylene tetramine polystyrene resin were retrospectively evaluated. All six patients with diabetic gastroenteropathy (GE) had delayed biologic gastric emptying time (BGET) that responded well to metoclopramide (MP) injection. In 11 diabetics without GE, only two had prolonged BGET with good response to MP. All 11 patients with gastric outlet obstruction also had prolonged BGET, but no significant response to MP was found in 7 studies. Five of 7 patients with active gastric ulcer had delayed BGET. Three of ten patients with previous Billroth I or II operation had accelerated BGET, and 3 of 9 patients with previous vagotomy had delayed BGET with good response to MP. Markedly prolonged BGET with significant response to MP was also observed in 3 patients with disordered gastric motility. Delayed BGET was found in one patient with bile reflux gastritis and in 2 of 6 patients with reflux esophagitis. No prolongation of BGET was observed in 6 symptomatic patients whose radiographic and endoscopic examinations were negative. BGET studies with this agent appear to be reliable and very helpful in the management of patients with gastric symptoms and for obtaining an objective measurement of the response to therapy.
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