Immunoscintigraphic detection of venous thrombosis of the lower extremities by means of human antifibrin monoclonal antibodies labeled with 111In.

A new monoclonal antibody specific for the beta-chain of human fibrin (C22A) and labeled with 111In has been obtained and successfully used in rabbits and dogs for the in vivo detection of venous thrombosis. Studies in humans are currently ongoing. In order to assess the diagnostic value of 111In-antifibrin for the detection of venous thrombosis of the lower extremities, the authors investigated 25 consecutive patients. Ten patients had clinical and instrumental (contrast phlebography and duplex scanning) evidence of acute deep venous thrombosis (DVT), 3 had a long-standing DVT with relapsing episodes of swelling and pain, 5 had superficial venous thrombosis, and the remaining 7 had no signs of thrombosis at all. Twenty patients were being treated with heparin. All patients received 111In-antifibrin at the dose of 74 MBq IV and were scanned with a large field of view gamma camera coupled with a high-energy, parallel-hole collimator at 30 minutes and three, six, and twenty-four hours postinjection. Only the persistence of an abnormal uptake at twenty-four hours confirmed by two observers at visual inspection was considered as positive. A positive result was obtained in 9 of 10 DVT patients (90% sensitivity) and in all SVT patients. The single DVT patient with a negative 111In-antifibrin test had the longest interval between scintigraphy and onset of symptoms (fifty-five days). Thus, the age of thrombi represented a substantial limitation for the test. A false-positive result was obtained in a single SVT patient, in whom also a deep involvement, unconfirmed by phlebography, was suspected (91.6% specificity).(ABSTRACT TRUNCATED AT 250 WORDS)

[Cost-benefit of upper digestive endoscopy. Frequency of early gastric cancer and negative endoscopy in relation to indications]. / Costi-benefici dell'endoscopia digestiva superiore. Frequenza degli early gastric cancers e delle endoscopie negative in rapporto alle indicazioni.

The increasing demand for upper gastrointestinal endoscopies (184% from 1974 to 1985) led to a review of cases in an attempt to improve the cost-benefit ratio of this diagnostic procedure (E.G.C.). Two parameters were evaluated: the frequency of early gastric cancers and, on the other hand, the incidence of negative endoscopic findings with respect to indications. The increase in the number of endoscopies performed was not matched by an increased frequency of E.G.C. diagnosed: 8.9% in 1974-1979 and 7.5% in 1980-1985 with an E.G.C./endoscopy ratio of 1:218 and 1:415 respectively; in the second period the diagnostic accuracy of endoscopy was enhanced from 42.8% to 100%. The overall frequency of negative endoscopic findings on 500 patients undergoing endoscopy in 1985, was 40.4%. The greatest number of negative findings was observed in patients with non-ulcerous dyspepsia under 50 years of age and in those with ulcerous dyspepsia with prior duodenal ulcer; on the other hand, a significant prevalence of cancerous and precancerous lesions was observed in patients over 50 with non-ulcerous dyspepsia. The results of this study suggest that patients over 50 years with non-ulcerous dyspepsia should receive early endoscopic investigation, in those under 50 an initial therapeutic approach appears reasonable. In the patients with prior duodenal ulcer endoscopy is of limited value for the assessment of response to therapy.

[Biliary peritonitis]. / Le peritoniti biliari.

The Authors contribute to the definition of the diagnosis and treatment of biliary peritonitis (PB) by showing 12 cases of it. They appraise the etiopathogenetic aspects of this pathology, point out the peculiarities of its precocious radiological and echographic picture, and emphasize its high mortality in patients not subjected to adequate emergency therapy.