Monoclonal antibodies in nuclear medicine

Monoclonal antibodies have been a part of biomedical research for nearly a decade, yet a comparable period of time may be required before radiolabeled monoclonal antibodies come into standard practice in the diagnosis and therapy of human disease. Difficulties in identifying appropriate antigens, developing the optimal antibody species, attaching the most effective radiolabel and choosing the best method of administration all confound present investigations. The problems confronting therapeutic applications are, for the most part, an extension of those associated with diagnostic techniques. Still, there is much well-deserved optimism, and progress in all areas of investigation will ultimately come together to resolve most if not all of these problems. It is inevitable that monoclonal antibodies will have significant impact on the practice of nuclear medicine, and presented here is a review of the basic knowledge as well as an update on the current status of radiolabeled monoclonal antibodies in medicine.     

Aetiology of acute diarrhoea in adults.

We have studied 73 adults with acute diarrhoea and identified a micro-organism or toxin likely to be the cause in 58%. In addition to routinely cultured bacteria, Campylobacter coli/jejuni and Clostridium difficile were important pathogens in the community. Patients who developed diarrhoea after antibiotic use had a distinctive clinical syndrome and comprised the third largest group of cases. Clinical, epidemiological, and histological features in an additional group with negative cultures and no antibiotic history suggest that an additional bacterial pathogen remains to be identified as a cause of acute diarrhoea in adults.     

Upper gastrointestinal hemorrhage

Hemorrhage in the upper gastrointestinal tract can be a diagnostic and therapeutic challenge to the physician. Although some advances have been made in patient care, mortality from gastrointestinal bleeding has not decreased during the past 40 years. The initial priorities in the physical examination of the bleeding patient should be a rapid assessment of the hemodynamic status and evaluation of the circulatory state. Once the patient has been hemodynamically stabilized, endoscopy is the best available technique for identifying the bleeding lesion. Potential sources of the bleeding are duodenal ulcers, gastric ulcers, Mallory-Weiss tears, and esophageal varices. The classic indications for surgical intervention are loss of 30% of the estimated blood volume in the first 24 hours, a need for 1,500 ml of transfused blood per 24 hours to maintain stable hemodynamics, hemorrhage to the point of hypotension or shock, and rebleeding during medical therapy.