Diphosphonate bone scan in an unusual case of rhabdomyolysis: a report and literature review.

We describe a patient with bilobar pneumonia and acute renal failure, whose unusual skeletal muscle uptake on technetium methylenediphosphonate bone scan led to the diagnosis of rhabdomyolysis. The clinical and serologic findings were most consistent with Legionnaires' disease. Radioisotope scanning may occasionally be useful in the diagnosis and management of muscle disease, particularly myositis and rhabdomyolysis.

Use of the radiolabeled murine monoclonal antibody, 111In-CYT-103, in the management of colon cancer.

Monoclonal antibodies directed at tumor-associated antigens may be useful adjuncts for the management of patients with colorectal cancer. The murine monoclonal antibody, B72.3, binds Tag-72, a cell-surface antigen, which is expressed by colorectal carcinoma cells. We investigated the benefit of indium-111-labeled B72.3, 111In-CYT-103, in localizing the presence and extent of disease in patients with suspected or biopsy-proven primary colorectal cancer and in patients with apparently localized recurrent colorectal adenocarcinoma. Twenty patients were enrolled in this study. Each patient received 1 mg of B72.3 labeled with 4 to 5 mCi of 111In. Patients then underwent planar and single-photon emission computed tomographic imaging 2 to 5 days after infusion. Fifteen patients underwent surgery 1 to 14 days after scanning. There were 11 true positives, 1 false positive, 2 true negatives, and 1 false negative. The 111In-CYT-103 scan correctly identified the presence or absence of tumor in the 15 patients in whom biopsies were obtained, for an accuracy rate of 87%. Overall, 111In-CYT-103 supplied clinically useful information regarding the extent of disease that was not previously reported by standard techniques in 33% (5 of 15) of patients who underwent surgical exploration. We conclude that 111In-CYT-103 is a promising imaging agent for patients with potentially resectable recurrences and for those patients with a presumed isolated primary tumor requiring preoperative staging.

The application of radionuclide ventriculography to cardiac screening.

Screening asymptomatic individuals for latent coronary disease often requires sequential testing because exercise electrocardiography typically produces more false positive than true positive results in a population with a low prevalence of coronary disease. Cardiac scintigraphy is a technique that may be employed as a confirmatory test in lieu of coronary arteriography to further evaluate the significance of a positive exercise electrocardiogram. Radionuclide ventriculography was employed in 98 asymptomatic individuals who were considered to be at moderate risk of heart disease after risk factor analysis and exercise electrocardiography. Seventeen (17%) patients had an abnormal study and underwent cardiac catheterization. Seven had coronary artery disease, two had cardiomyopathy, and eight were normal. Eighty-one (83%) patients had a normal study. Because the sensitivity of radionuclide ventriculography is 63-80%, it was postulated that 2 to 5 individuals with disease were missed. Thus, from a population with an 11-14% prevalence of disease, two subsets were identified. A large subset in which a prevalence of 2-6% could be estimated was separated from a much smaller one in which a prevalence of approximately 50% was demonstrated.

Delayed hemolytic transfusion reaction caused by anti-P1 antibody.

A 67-year-old white woman received transfusions of a total of 87 units of whole blood and red blood cells during and within 48 hours following a pneumonectomy. Although she had previously received blood transfusions, unexpected antibodies were not detectable by routine screening. On the second postoperative day, she developed fever, hemoglobinemia, hemoglobinuria, and oliguria. However, the direct antiglobulin test and the antibody screen were negative. On the eighth postoperative day, an IgM anti-P1 antibody was detected for the first time. This anti-P1 antibody increased in thermal amplitude from 22 to 37 C, but remained IgM. The circulating transfused P1-positive cells decreased progressively without evidence of bleeding. Testing of the patient's preoperative blood at 15 C found her serum to be weakly reactive with P1 cells, while her own cells were P2. Thus, an anamnestic response to the P1 antigen is the most likely cause of her delayed hemolytic transfusion reaction.