Abnormal vascularity in the region of the left atrial appendage was demonstrated by coronary arteriography in 5 patients with mitral stenosis. Subsequently, three of these patients proceeded to operation, and left atrial thrombi were confirmed in all three cases. Neovascularity must be differentiated from congenital fistulae, tumours, and coronary artery disease. Thrombus in the left atrial appendage is difficult to diagnose even with the use of cross-sectional echocardiography and may occasionally be demonstrated by coronary arteriography.

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Ischemic diseases of the bowel. 3. Physiology of the bowel.

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Humans↗

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Vitamin B 12 absorption and the intestinal cell surface.

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Antibodies↗

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Unreliability of radiodilution assays as screening tests for cobalamin (vitamin B12) deficiency.

Recent studies have demonstrated problems with the radiodilution assay method for measuring serum cobalamin (vitamin B12) levels. We have found the standard commercial radiodilution kit assay to be totally ineffective in screening for cobalamin deficiency. In a four-month period, 352 patients were screened in a routine clinical laboratory using this kit. None of the serum samples yielded a result below the given normal range of 200 to 1,100 pg/mL. However, when 42 patients with low-normal serum cobalamin levels (200 to 500 pg/mL) were retested by a combination of a modified radiodilution kit, a human intrinsic factor assay, and a microbiological (Lactobacillus leichmannii) assay, 16 (36%) were identified as having serum cobalamin levels that were abnormally low. The diagnosis of cobalamin deficiency may have been incorrectly dismissed in many patients on the basis of test results obtained with these kits, which are in widespread use.

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