Ancillary Finding Research Articles

Occult malignancy in ‘unprovoked’ VTE

Purpose The National Institute of Health and Care Excellence (NICE) guidelines state that we should offer all patients diagnosed with unprovoked deep vein thrombosis (DVT) or pulmonary embolism (PE) who are not already known to have cancer, the investigations for occult malignancy. Cross-sectional imaging is one of the modalities used to investigate these patients. We have examined case notes of 92 patients that have been referred for cross sectional imaging post primary venous thromboembolism (VTE) in order to calculate the radiation burden and cancer pick-up rate in our hospital. Methods and materials A single consultant radiologist identified 92 consecutive patients at the protocolling stage. The patient notes and electronic records were analysed for demographic data and subsequently to identify compliance against the NICE guidance. Dose linear product (DLP) was obtained from computerised radiology information system (CRIS) and converted to effective dose based on conversion factors from the American Association of Physicists in Medicine (AAPM) report 96. Rates of pick-up for underlying malignancy as well as other significant non-cancer ancillary findings were recorded. Literature search indicates a 9.4% rate of underlying cancer in primary VTE patients. Results Of patients screened, 1.08% were found to have a new malignancy, 5.4% of patients were known cases. There was an 18% significant ancillary finding rate. Patients received an average dose of 7 milliSieverts (mSv) from radiological investigations. Conclusion The radiation burden associated with non-compliance with guidelines is equivalent to an additional 2.69 years of UK background radiation with a lower than expected pick up rate of underlying malignancy. The National Institute of Health and Care Excellence (NICE) guidelines state that we should offer all patients diagnosed with unprovoked deep vein thrombosis (DVT) or pulmonary embolism (PE) who are not already known to have cancer, the investigations for occult malignancy. Cross-sectional imaging is one of the modalities used to investigate these patients. We have examined case notes of 92 patients that have been referred for cross sectional imaging post primary venous thromboembolism (VTE) in order to calculate the radiation burden and cancer pick-up rate in our hospital. A single consultant radiologist identified 92 consecutive patients at the protocolling stage. The patient notes and electronic records were analysed for demographic data and subsequently to identify compliance against the NICE guidance. Dose linear product (DLP) was obtained from computerised radiology information system (CRIS) and converted to effective dose based on conversion factors from the American Association of Physicists in Medicine (AAPM) report 96. Rates of pick-up for underlying malignancy as well as other significant non-cancer ancillary findings were recorded. Literature search indicates a 9.4% rate of underlying cancer in primary VTE patients. Of patients screened, 1.08% were found to have a new malignancy, 5.4% of patients were known cases. There was an 18% significant ancillary finding rate. Patients received an average dose of 7 milliSieverts (mSv) from radiological investigations. The radiation burden associated with non-compliance with guidelines is equivalent to an additional 2.69 years of UK background radiation with a lower than expected pick up rate of underlying malignancy.

Patellotibial contusions in anterior cruciate ligament tears

Bone contusions are an important ancillary finding of many knee injuries. Not only are they a source of pain, they may suggest a mechanism of injury or a specific derangement of the knee joint. We have encountered a small number of patients being evaluated for anterior cruciate ligament (ACL) tears with unexplained patellar and tibial edema at magnetic resonance (MR) imaging. We present three individuals with contusions of the inferior patella with a corresponding contusion of the anteromedial tibial plateau. Internal derangements in these patients were similar to other individuals with acute ACL tears, however osseous contusions were more widespread. In conclusion, patellotibial contusions are rare and may indicate an injury with forces greater than usually encountered in most ACL tears. A careful search for uncommon associated injuries is prudent in these high-energy knee injuries.

Depression, antidepressant medications, and risk of Clostridium difficileinfection

BackgroundAn ancillary finding in previous research has suggested that the use of antidepressant medications increases the risk of developing Clostridium difficile infection (CDI). Our objective was to evaluate whether depression or the use of anti-depressants altered the risk of developing CDI, using two distinct datasets and study designs.MethodsIn Study 1, we conducted a longitudinal investigation of a nationally representative sample of older Americans (n = 16,781), linking data from biennial interviews to physician and emergency department visits, stays in hospital and skilled nursing facilities, home health visits, and other outpatient visits. In Study 2, we completed a clinical investigation of hospitalized adults who were tested for C. difficile (n = 4047), with cases testing positive and controls testing negative. Antidepressant medication use prior to testing was ascertained.ResultsThe population-based rate of CDI in older Americans was 282.9/100,000 person-years (95% confidence interval (CI)) 226.3 to 339.5) for individuals with depression and 197.1/100,000 person-years for those without depression (95% CI 168.0 to 226.1). The odds of CDI were 36% greater in persons with major depression (95% CI 1.06 to 1.74), 35% greater in individuals with depressive disorders (95% CI 1.05 to 1.73), 54% greater in those who were widowed (95% CI 1.21 to 1.95), and 25% lower in adults who did not live alone (95% CI 0.62 to 0.92). Self-reports of feeling sad or having emotional, nervous or psychiatric problems at baseline were also associated with the later development of CDI. Use of certain antidepressant medications during hospitalization was associated with altered risk of CDI.ConclusionsAdults with depression and who take specific anti-depressants seem to be more likely to develop CDI. Older adults who are widowed or who live alone are also at greater risk of CDI.

The pathophysiology of chagasic megacolon: beyond ICC…

To the editor: Dear Sir, We read with interest the recent article by Adad et al. [1] in which they reported a reduction of the number of interstitial cells of Cajal (ICC) in the colonic myenteric plexus and circular muscle areas of chagasic patients with or without megacolon. This reduction was much more pronounced in patients with megacolon, where it was also accompanied by a significant decrease of enteric neurons [1]. The strength of this study relies in the fact that the authors took into consideration patients without overt megacolon and the cell count was carried out in complete intestinal rings that allowed them to correct the neuron and ICC dispersion due to intestinal dilation and muscular hypertrophy of the megacolon. The findings of ICC decrease were consistent with previous studies in chagasic patients with megacolon [2–4]. However, in our study, we found an increase of one of the three colonic populations of ICC, the intramuscular, and we disagree with the interpretation of Adad et al. that this increase might have been due to an inclusion of mast cells in the count, since these were specifically excluded, as specified in the paper [4]; on the other hand, in our experience the distribution of ICC within the human colon is fairly homogeneous (Bassotti and Villanacci, unpublished observations). More importantly, in their paper Adad et al. did not distinguish between the three well established populations of colonic ICC, i.e., ICC submucous (along the submucosal surface of the circular muscle bundle), ICC myenteric (within the intermuscular space between circular and longitudinal muscle layers, myenteric region, which displays the highest yield of ICC in normal tissue), and ICC intramuscular (within the muscle fibers of the circular and longitudinal muscle layers) [4]. This fact might have led to a decreased cell count due to a different methodologic approach. However, we were pleased that Adad et al. did not limit their approach only to ICC, but included enteric neurons, that were also decreased. This fact, in addition to the significant decrease of enteric glial cells we also found in patients with megacolon and other conditions characterized by constipation [4, 5] strongly suggests that the development of megacolon requires enteric denervation and that an ICC decrease is an ancillary finding to neurogliopathic abnormalities.

Evolution of the chemistry of Fe bearing waters during CO2 degassing

► The effect of CO 2 stripping on the chemistry of Fe bearing waters was investigated. ► Changes in pH, carbonate speciation and Fe(II) oxidation rates were modelled. ► Both net acid and net alkaline waters were investigated. ► Cascades were shown to degass CO 2 more efficiently than mechanical aeration. ► Cascade design did not affect CO 2 stripping efficiency at the flow rates measured. The rates of Fe(II) oxidation and precipitation from groundwater are highly pH dependent. Elevated levels of dissolved CO 2 can depress pH and cause difficulty in removing dissolved Fe and associated metals during treatment of ferruginous water. This paper demonstrates interdependent changes in pH, dissolved inorganic C species, and Fe(II) oxidation rates that occur as a result of the removal (degassing) of CO 2 during aeration of waters discharged from abandoned coal mines. The results of field monitoring of aeration cascades at a treatment facility as well as batchwise aeration experiments conducted using net alkaline and net acidic waters in the UK are combined with geochemical modelling to demonstrate the spatial and temporal evolution of the discharge water chemistry. The aeration cascades removed approximately 67% of the dissolved CO 2 initially present but varying the design did not affect the concentration of Fe(II) leaving the treatment ponds. Continued removal of the residual CO 2 by mechanical aeration increased pH by as much as 2 units and resulted in large increases in the rates of Fe(II) oxidation and precipitation. Effective exsolution of CO 2 led to a reduction in the required lime dose for removal of remaining Fe(II), a very important factor with regard to increasing the sustainability of treatment practices. An important ancillary finding for passive treatment is that varying the design of the cascades had little impact on the rate of CO 2 removal at the flow rates measured.

Hypermetabolic subcutaneous fat in patients on highly active anti-retroviral therapy treatment: Subtle finding with implications

Lipodystrophy (LD) is a serious complication of highly active anti-retroviral therapy, characterized by peripheral fat wasting, central adiposity and metabolic changes. Since the disfiguration caused by LD is permanent, the focus of management is on early detection to arrest progression. We report a case where ancillary finding of increased fluorine-18 fluoro-2-deoxyglucose (F-18 FDG) uptake in the sub-cutaneous fat helped early detection of LD and led to early intervention to arrest progression. Though F-18 FDG positron emission tomography/computed tomography scan is not recommended to diagnose LD, conscious reporting of this finding when present can greatly influence patient management.

Landslide Stability: Role of Rainfall-Induced, Laterally Propagating, Pore-Pressure Waves

The Johnson Creek Landslide is a translational slide in seaward-dipping Miocene siltstone and sandstone (Astoria Formation) and an overlying Quaternary marine terrace deposit. The basal slide plane slopes sub-parallel to the dip of the Miocene rocks, except beneath the back-tilted toe block, where it slopes inland. Rainfall events raise pore-water pressure in the basal shear zone in the form of pulses of water pressure traveling laterally from the headwall graben down the axis of the slide at rates of 1–6 m/hr. Infiltration of meteoric water and vertical pressure transmission through the unsaturated zone has been measured at ∼50 mm/hr. Infiltration and vertical pressure transmission were too slow to directly raise head at the basal shear zone prior to landslide movement. Only at the headwall graben was the saturated zone shallow enough for rainfall events to trigger lateral pulses of water pressure through the saturated zone. When pressure levels in the basal shear zone exceeded thresholds defined in this paper, the slide began slow, creeping movement as an intact block. As pressures exceeded thresholds for movement in more of the slide mass, movement accelerated, and differential displacement between internal slide blocks became more pronounced. Rainfall-induced pore-pressure waves are probably a common landslide trigger wherever effective hydraulic conductivity is high and the saturated zone is located near the surface in some part of a slide. An ancillary finding is apparently greater accuracy of grouted piezometers relative to those in sand packs for measurement of pore pressures at the installed depth.

Visualization of Discrete Sacral Foramina as an Ancillary Sign of Superscan

the purpose of this study was to determine if visualization of discrete sacral foramina on bone scintigraphy can be used as an adjunct criterion supportive of a superscan diagnosis. the Radiology Information System at our institution was queried for all bone scintigraphy reports, during July 1999 to July 2009, containing the words/phrases: normal bone scan, normal bone scintigraphy, superscan, or diffuse osseous metastatic disease. The final study group consisted of 22 normal studies and 8 superscans. All studies were reviewed by 2 nuclear medicine physicians who rated the examinations on a numeric scale of bone-to-soft tissue activity, whether they would classify the study as a superscan (based on previously published criteria), whether sacral foramina were visualized, and, if so, how many? of the 22 normal studies, no distinct sacral foramen was visualized in 17 cases. Of the 8 superscan patients, 1 patient demonstrated 8 foramina, 4 patients demonstrated 4 foramina, 1 patient demonstrated 3 foramina, and 2 patients demonstrated none. There was a statistically significant difference between the normal and superscan groups (P < 0.0017). Based on statistical analysis, it was determined that visualizing at least 3 distinct sacral foramina could be used as an ancillary finding to support the diagnosis of superscan. the ability to clearly visualize at least 3 sacral foramina is a statistically significant finding that may be useful as an ancillary criterion to differentiate normal bone scintigraphy from a superscan.

Test yourself—knee pain after falling

The semimembranosus muscle originates at the posterolateral aspect of the ischial tuberosity. Distally, the semimembranosus tendon divides into five anatomically distinct tendinous branches, each inserting into the posteromedial region of the knee [1]. The insertion sites include the infraglenoid tubercle of the posteromedial tibial plateau, the posterior capsule, the posterior horn of the medial meniscus, and a portion of the capsule deep to the medial collateral ligament [2]. The function of the semimembranosus muscle is flexion and medial rotation of the knee [3]. The anterior cruciate ligament (ACL) attaches proximally to the posteromedial aspect of the lateral femoral condyle and courses anteromedially to insert anterior to the intercondylar eminence [4]. Functionally, the ACL can be divided into an anteromedial bundle and posterolateral bundle, which prevent anterior translation and internal rotation of the tibia, respectively [2, 4]. An avulsion fracture of the semimembranosus insertion site is a rare, but a highly specific, ancillary finding of cruciate ligament injury [2]. Radiographic findings demonstrate an avulsion fracture of the posteromedial tibial plateau, which is mildly superiorly displaced (Fig. 1). Magnetic resonance (MR) imaging of the knee confirms the avulsion of the semimembranosus central tendon at its insertion on the infraglenoid tubercle of the posteromedial tibial plateau (Fig. 2). Additional findings include a complete ACL tear and bone contusions in the lateral aspect of the knee joint (Figs. 3, 4). In a retrospective review of patients with acute knee injury, 100% of patients with abnormalities of the posteromedial tibial plateau of the semimembranosus insertion site had an associated complete ACL tear [2]. These abnormalities included fractures of the posteromedial tibial plateau or bone bruises and avulsions of the semimembranosus tendon insertion site. Some of these patients lacked bone contusions in the lateral compartment of the knee. This, as well as the lack of bone marrow edema in the medial femoral condyle, may help distinguish semimembranous avulsions from other bone marrow contusion patterns of the knee. Prior to this case, only three other studies of avulsion fractures of the semimembranosus insertion site and ACL tear had been described [2, 5, 6]. An avulsion fracture of the posterior medial plateau is not necessarily indicative of ACL injury, however, as a single case of a posterior cruciate ligament tear with semimembranosus avulsion has been reported [7]. The exact mechanism of injury of cruciate ligament tears and semimembranosus avulsion is debated. Cadaveric The case presentation can be found at doi:10.1007/s00256-010-1060-8.

FRET imaging of hemoglobin concentration in Plasmodium falciparum-infected red cells.

BackgroundDuring its intraerythrocytic asexual reproduction cycle Plasmodium falciparum consumes up to 80% of the host cell hemoglobin, in large excess over its metabolic needs. A model of the homeostasis of falciparum-infected red blood cells suggested an explanation based on the need to reduce the colloid-osmotic pressure within the host cell to prevent its premature lysis. Critical for this hypothesis was that the hemoglobin concentration within the host cell be progressively reduced from the trophozoite stage onwards.Methodology/Principal FindingsThe experiments reported here were designed to test this hypothesis by direct measurements of the hemoglobin concentration in live, infected red cells. We developed a novel, non-invasive method to quantify the hemoglobin concentration in single cells, based on Förster resonance energy transfer between hemoglobin molecules and the fluorophore calcein. Fluorescence lifetime imaging allowed the quantitative mapping of the hemoglobin concentration within the cells. The average fluorescence lifetimes of uninfected cohorts was 270±30 ps (mean±SD; N = 45). In the cytoplasm of infected cells the fluorescence lifetime of calcein ranged from 290±20 ps for cells with ring stage parasites to 590±13 ps and 1050±60 ps for cells with young trophozoites and late stage trophozoite/ early schizonts, respectively. This was equivalent to reductions in hemoglobin concentration spanning the range from 7.3 to 2.3 mM, in line with the model predictions. An unexpected ancillary finding was the existence of a microdomain under the host cell membrane with reduced calcein quenching by hemoglobin in cells with mature trophozoite stage parasites.Conclusions/SignificanceThe results support the predictions of the colloid-osmotic hypothesis and provide a better understanding of the homeostasis of malaria-infected red cells. In addition, they revealed the existence of a distinct peripheral microdomain in the host cell with limited access to hemoglobin molecules indicating the concentration of substantial amounts of parasite-exported material.

Analytical study of tensile behaviors of UHMWPE/nano-epoxy bundle composites

Ultra-high molecular polyethylene (UHMWPE) fiber reinforced nano-epoxy and pure epoxy composites in bundle form were prepared and tested for tensile properties. UHMWPE fiber composites are well known for their superior tensile performance, and this work was conducted to assess the effect of adding nanoadditives to the resin and to evaluate possible enhancements or degradations to that attribute. The results showed that tensile tests on various types of UHMWPE fibers/nano-epoxy bundle composites resulted in an increase in modulus of elasticity due to the addition of small amounts of reactive nanofibers (r-GNFs) to epoxy matrix. It was observed that the modulus of elasticity of the composite bundles depended on both volume fractions of the matrix and the weight percent (wt%) of r-GNFs in the matrix. A non-linear relationship was established among them and an optimal modulus was determined by calculation. A three-dimensional surface plot considering these two parameters has been generated which gives an indication of change in modulus of elasticity with respect to volume fraction of matrix and wt% of r-GNFs in the matrix. A Weibull analysis of tensile strengths for the various bundle composites was performed and their Weibull moduli were compared. The results showed that presence of r-GNFs in the composites increased the strength effectively, and 0.3 wt% r-GNFs based composites showed the highest strength. An important ancillary finding is that optimum tensile values are a function not only of the above parameters, but also strongly influenced by the addition of diluents which control the viscosity of the blend.

Circulating regulatory T‐cells: Acute exercise response in elite swimmers

Several authors have found higher rates of allergy and asthma (AA) among elite endurance athletes. The purpose of this study was to characterize the pattern of Regulatory T‐cells (Tregs) and FoxP3+ Tregs at baseline (Pre) and at the end of high‐intensity swim exercise (EE). On the weekend after their last high school swim meet, 22 elite swimmers (12 males, mean age=15.4 years, AA group=12) participated in a swim study. Spirometry was measure before and 10–15 minutes post EE and blood collected Pre and EE. Neither Pre nor EE blood lactate, FEV1, heart rate, or lymphocyte subsets (% of cells or absolute counts, #s) differed between the groups (control vs AA). Controls had lower CD4+CD25+FoxP3 dim cells (% of lymphs) than the AA group (p&lt;0.05), though absolute cell counts did not differ. As shown on Figure 1, the AA group had higher percentages and absolute FoxP3+ cell counts (n.s.) at both Pre and EE. Absolute cell counts increased in both groups during exercise however, the percentages of FoxP3+ cells decreased from Pre to EE. An ancillary finding of this study was that the baseline levels of Tregs and FoxP3+ cells in the elite swimmers appeared to be substantially lower than values previously reported for non‐endurance athletes. This study was funded by USA Swimming and NIH P01 HD048721.

Under Diagnosis and Over Diagnosis of Prostate Cancer

We quantified the rates of over and under diagnosis of prostate cancer in 2 large patient cohorts during the last 15 years. A total of 2,126 men with clinical stage T1c prostate cancer were treated with radical prostatectomy during 1 of the 3 periods 1989 to 1995, 1995 to 2001 and 2001 to 2005. The respective proportions of men with a tumor that met our criteria for over diagnosis (0.5 cm3 or less, confined to the prostate with clear surgical margins and no Gleason pattern 4 or 5) and under diagnosis (nonorgan confined, pathological stage T3 or greater, or positive surgical margins) were examined. The proportion of men with an over diagnosed tumor was 1.3% to 7.1%. The proportion with prostate cancer that was under diagnosed was 25% to 30%. An ancillary finding was that decreasing the prostate specific antigen threshold for biopsy from 4.0 to 2.5 ng/ml in the screened population resulted in a lower rate of under diagnosis from 30% to 26%, a higher rate of over diagnosis from 1.3% to 7.1% and an increase in the 5-year progression-free survival rate from 85% to 92%. Men who were 55 years or younger were significantly more likely to meet our criteria for over diagnosed cancer. Under diagnosis of prostate cancer continues to occur more frequently than over diagnosis. Lowering the prostate specific antigen threshold for recommending biopsy to 2.5 ng/ml resulted in a lower rate of under diagnosis and a higher progression-free survival rate.

Auditory Processing Disorder in Children Diagnosed With Nonverbal Learning Disability

To determine whether children with a nonverbal learning disability (NVLD) have a higher incidence of auditory processing disorder (APD), especially in the tolerance-fading memory type of APD, and what associations could be found between performance on neuropsychological, intellectual, memory, and academic measures and APD. Eighteen children with NVLD ranging in age from 6 to 18 years received a central auditory processing test battery to determine incidence and subtype of APD. Psychological measures for assessment of NVLD included the Wechsler Scales, Wide Range Assessment of Memory and Learning, and Wechsler Individual Achievement Test. Neuropsychological measures included the Category Test, Trails A and B, the Tactual Performance Test, Grooved Pegs, and the Speech Sounds Perception Test. Neuropsychological test scores of the NVLD+APD and NVLD groups were compared using analysis of covariance procedures, with Verbal IQ and Performance IQ as covariates. Sixty-one percent of the children were diagnosed with APD, primarily in the tolerance-fading memory subtype. The group of children with APD and NVLD had significantly lower scores on Verbal IQ, Digit Span, Sentence Memory, Block Design, and Speech Sounds Perception than children without APD. An ancillary finding was that the incidence of attention deficit/hyperactivity disorder was significantly higher in children with NVLD (with and without APD) than in the general population. The results indicate that children with NVLD are at risk for APD and that there are several indicators on neuropsychological assessment suggestive of APD. Collaborative, interdisciplinary evaluation of children with learning disorders is needed in order to provide effective therapeutic interventions.

No ancillary finding is valid to distinguish a primary ovarian hepatoid carcinoma from metastatic hepatocellular carcinoma

Primary ovarian hepatoid carcinomas (POHC) are extremely rare. Especially rare are those with phenotypic properties of hepatocellular carcinoma (HCC) and an absence of clinical evidence of hepatic tumor. We report a case of a POHC with a common microscopic, immunophenotypic, and ultrastructural property of HCC in the absence of a liver mass. It is extremely difficult to differentiate POHC from metastatic HCC using any kinds of ancillary studies, with the exception of clinical identification of a hepatic tumor.

No ancillary finding is valid to distinguish a primary ovarian hepatoid carcinoma from metastatic hepatocellular carcinoma

Primary ovarian hepatoid carcinomas (POHC) are extremely rare. Especially rare are those with phenotypic properties of hepatocellular carcinoma (HCC) and an absence of clinical evidence of hepatic tumor. We report a case of a POHC with a common microscopic, immunophenotypic, and ultrastructural property of HCC in the absence of a liver mass. It is extremely difficult to differentiate POHC from metastatic HCC using any kinds of ancillary studies, with the exception of clinical identification of a hepatic tumor.

Rupture of the gastrocnemius muscle in six foals

Rupture of the gastrocnemius muscle and subsequent disruption of the reciprocal mechanism of the hind limb was diagnosed in 6 foals examined at 7 hours to 3 weeks of age. In 2 foals, the musculoskeletal injury was detected as an ancillary finding to clinical signs of neurologic dysfunction ascribed to hypoxic ischemic insult during delivery, whereas in the other 4 foals, musculoskeletal injury, manifested as inability to rise or stand unsupported, was the chief complaint at admission. Five foals had a history of dystocia and assisted delivery. Common clinical signs were inability to rise, disruption of the reciprocal mechanism, swelling in the caudal aspect of the thigh, instability of the stifle joint, and stifle joint effusion. For mild gastrocnemius injury, exercise restriction via forced recumbency, with minimal or no bandaging, may be sufficient treatment. For more severe disruption of the muscle, limb stabilization via splinting and intensive nursing and monitoring are necessary. Four foals had important concurrent problems, including musculoskeletal deformations (joint contractures), hypoxic ischemic disease, and failure of passive transfer and associated problems (ie, sepsis, polyarthritis, and pneumonia). Moderate to severe gastrocnemius muscle injury is difficult to treat successfully, and the long-term prognosis for athletic function should be regarded as guarded.

Prevalence and Significance of Nonthromboembolic Findings on Chest Computed Tomography Angiography Performed to Rule Out Pulmonary Embolism: A Multicenter Study of 1,025 Emergency Department Patients

To evaluate the hypothesis that computed tomography (CT) angiography often yields a result interpreted as an alternative diagnosis to pulmonary embolism (PE) in emergency department (ED) patients. This was a multicenter, retrospective, and secondary analysis of consecutive patients in three academic emergency departments. ED patients with symptoms suspicious for PE were included. CT angiography was ordered at the discretion of the treating physician; patients were identified by query of the electronic medical record. Board-certified radiologists gave CT readings, which were reviewed by two independent emergency physicians who categorized the non-PE findings into one of four acuity categories: A = requiring specific and immediate intervention, B = requiring specific action on follow-up, C = requiring no action, and D = indeterminate findings. The prevalence of PE among the 1,025 patients studied was 10% (95% CI = 8% to 12%). In the 921 patients without PE, the mean prevalences (ranges between sites) of concordant categorized non-PE findings were: A = 7% (range 3%-11%), B = 10% (7%-13%), C = 17% (10%-20%), D = 4% (0%-8%), and no ancillary finding = 41% (29% to 45%). The most common category A findings included infiltrate or consolidation suggesting pneumonia (81%), aortic aneurysm or dissection (7%), and mass suggesting undiagnosed malignancy (7%). The overall unweighted agreement was 80% (kappa = 0.72) and weighted agreement was 93% (kappa(w) = 0.84). In ED patients with suspected PE, the CT angiogram frequently provides evidence suggesting an important alternative diagnosis to PE. Pulmonary infiltrate suggesting pneumonia was the most common non-PE finding.

Interaction of Factors Related to Lactation Duration

Perceived social support and interpersonal dependency were studied as potential factors associated with lactation duration based upon previous breastfeeding experience. Inexperienced breastfeeding mothers perceived more social support than experienced breastfeeding mothers did. Perceived social support was not significantly correlated with lactation duration. An ancillary finding was that women providing a combination of breast milk and human milk substitutes had significantly lower social self-confidence than did mothers providing breast milk exclusively.

Acute diverticulitis of the cecum and ascending colon: thin-section helical CT findings.

Our objective was to describe thin-section helical CT findings of acute diverticulitis of the cecum and ascending colon in 12 patients. Thin-section helical CT is able to reveal inflamed diverticula in acute diverticulitis of the cecum and ascending colon, which are diagnostic of this disease. Preservation of the enhancing pattern of the colonic wall was the most common helpful ancillary finding.