Rate Of Abnormal Findings Research Articles

Comparing clinical measures of near point of convergence and accommodation from the lateral canthus and browline in a paediatric and adolescent population.

Clinicians measure the near point of convergence (NPC) and the amplitude of accommodation (AA) from the spectacle plane, the bridge of the nose or the lateral canthus when assessing visual function. These values are compared to standard clinical criteria to diagnose vergence and accommodation deficits, despite varying reference points. This prospective study explored measuring relative to the spectacle plane and from the lateral canthus for NPC and monocular AA, and the resulting clinical implications of diagnosing visual deficits. Participants were seen by a single clinician for an eye examination. NPC was measured from the forehead and the lateral canthus of the right eye. Monocular AA was measured from the brow and the lateral canthus. Differences between measurements were analysed using non-parametric statistical tests including Wilcoxon Signed Rank, as well as linear regression and a linear mixed effects model to adjust for inter-eye correlation and repeated measures. Chi-square tests were used to assess differences in rates of abnormal findings. Data were collected from 70 participants (53% female, median age 13 [11-15] years). On average, measuring NPC from the lateral canthus yielded a value 1.8 cm higher than measuring from the forehead. Measuring AA from the lateral canthus resulted in an average difference of 1.5 cm compared to measuring from the brow. A total of 39% and 76% of subjects failed NPC compared to clinical norms when measured from the forehead or the lateral canthus, respectively, while 7% and 40% failed AA when measured from the brow or the lateral canthus, respectively. With the variable anatomy of the eye, it is imperative to account for the measurement point when assessing visual function. Measuring from the lateral canthus greatly increased the failure rates for NPC and AA compared with measuring from the forehead and brow, respectively.

1063 Prenatal Exome in low-risk pregnancies and apparently normal fetuses – the rate of abnormal findings

1063 Prenatal Exome in low-risk pregnancies and apparently normal fetuses – the rate of abnormal findings

The Impact of COVID-19 Pandemic on Clinical Findings in Medical Imaging Exams: An Observational Study in a Nationwide Israeli Health Organization.

The outbreak of the COVID-19 pandemic had a major effect on consumption of healthcare services. Changes in the use of routine diagnostic exams, increased incidences of post-acute COVID-19 syndrome (PCS), and other pandemic-related factors, may have influenced detected clinical conditions. The study aimed to analyze the impact of COVID-19 on the use of outpatient medical imaging services and clinical findings therein, specifically focusing on the time period after the launch of the Israeli COVID-19 vaccination campaign. In addition, the study tested whether the observed gains in abnormal findings may be linked to PCS or COVID-19 vaccination. Our dataset included 572,480 ambulatory medical imaging patients in a national health organization, from January 1, 2019 to August 31, 2021. We compared different measures of medical imaging utilization and clinical findings therein, before and after the surge of the pandemic, to identify significant changes. We also inspected the changes in the rate of abnormal findings during the pandemic after adjusting for changes in medical imaging utilization. Finally, for imaging classes that showed increased rates of abnormal findings, we measured the causal associations between COVID-19 infection, hospitalization (indicative of COVID-19 complications), and vaccination and future risk for abnormal finding. To allow adjustment for a multitude of confounding factors, we used causal inference methodologies. After the initial drop in the utilization of routine medical imaging due to the first COVID-19 wave, the number of these exams has increased, but with lower proportions of older patients, patients with comorbidities, women, and vaccine-hesitant patients. Furthermore, we observed significant gains in the rate of abnormal findings, specifically in musculoskeletal magnetic resonance (MR-MSK) and brain computed tomography (CT-brain) exams. These results also persisted after adjusting for the changes in medical imaging utilization. Demonstrated causal associations included: COVID-19 infection increasing the risk for an abnormal finding in a CT-brain exams (odds ratio [OR] of 1.4, with 95% confidence interval [CI] 1.1 to 1.7); and COVID-19-related hospitalization increasing the risk for abnormal findings in an MR-MSK exam (OR 3.1, 95% CI 1.9 to 5.3). COVID-19 impacted the use of ambulatory imaging exams, with greater avoidance among patients at higher risk for COVID-19 complications: older patients, patients with comorbidities, and non-vaccinated patients. Causal analysis results imply that PCS may have contributed to the observed gains in abnormal findings in MR-MSK and CT-brain exams, respectively.

The utility of cardiopulmonary exercise testing in athletes and physically active individuals with or without persistent symptoms after COVID-19.

Cardiopulmonary exercise testing (CPET) may capture potential impacts of COVID-19 during exercise. We described CPET data on athletes and physically active individuals with or without cardiorespiratory persistent symptoms. Participants' assessment included medical history and physical examination, cardiac troponin T, resting electrocardiogram, spirometry and CPET. Persistent symptoms were defined as fatigue, dyspnea, chest pain, dizziness, tachycardia, and exertional intolerance persisting >2 months after COVID-19 diagnosis. A total of 46 participants were included; sixteen (34.8%) were asymptomatic and thirty participants (65.2%) reported persistent symptoms, with fatigue and dyspnea being the most reported ones (43.5 and 28.1%). There were a higher proportion of symptomatic participants with abnormal data for slope of pulmonary ventilation to carbon dioxide production (VE/VCO2 slope; p<0.001), end-tidal carbon dioxide pressure at rest (PETCO2 rest; p=0.007), PETCO2 max (p=0.009), and dysfunctional breathing (p=0.023) vs. asymptomatic ones. Rates of abnormalities in other CPET variables were comparable between asymptomatic and symptomatic participants. When assessing only elite and highly trained athletes, differences in the rate of abnormal findings between asymptomatic and symptomatic participants were no longer statistically significant, except for expiratory air flow-to-percent of tidal volume ratio (EFL/VT) (more frequent among asymptomatic participants) and dysfunctional breathing (p=0.008). A considerable proportion of consecutive athletes and physically active individuals presented with abnormalities on CPET after COVID-19, even those who had had no persistent cardiorespiratory symptomatology. However, the lack of control parameters (e.g., pre-infection data) or reference values for athletic populations preclude stablishing the causality between COVID-19 infection and CPET abnormalities as well as the clinical significance of these findings.

Rate of head ultrasound abnormalities at one month in very premature and extremely premature infants with normal initial screening ultrasound

BackgroundPremature infants are at risk for multiple types of intracranial injury with potentially significant long-term neurological impact. The number of screening head ultrasounds needed to detect such injuries remains controversial.ObjectiveTo determine the rate of abnormal findings on routine follow-up head ultrasound (US) performed in infants born at ≤ 32 weeks’ gestational age (GA) after initial normal screening US.Materials and methodsA retrospective study was performed on infants born at ≤ 32 weeks’ GA with a head US at 3–5 weeks following a normal US at 3–10 days at a tertiary care pediatric hospital from 2014 to 2020. Exclusion criteria included significant congenital anomalies, such as congenital cardiac defects necessitating surgery, congenital diaphragmatic hernia or spinal dysraphism, and clinical indications for US other than routine screening, such as sepsis, other risk factors for intracranial injury besides prematurity, or clinical neurological abnormalities. Ultrasounds were classified as normal or abnormal based on original radiology reports. Images from initial examinations with abnormal follow-up were reviewed.ResultsThirty-three (14.2%) of 233 infants had 34 total abnormal findings on follow-up head US after normal initial US. Twenty-seven infants had grade 1 germinal matrix hemorrhage, and four had grade 2 intraventricular hemorrhage. Two had periventricular echogenicity and one had a focus of cerebellar echogenicity that resolved and was determined to be artifactual.ConclusionWhen initial screening head ultrasounds in premature infants are normal, follow-up screening ultrasounds are typically also normal. Abnormal findings are usually limited to grade 1 germinal matrix hemorrhage.

Helicobacter pylori Prevalence in Laparoscopic Sleeve Gastrectomy Specimen.

Introduction Laparoscopic sleeve gastrectomy (LSG) has become a common surgical procedure. The value of routine histopathologic examination of the LSG specimens remains, however, a controversial issue. Helicobacter pylori was the most prevalent finding in several previous studies, but the overall results were dissimilar. We aim to assess the prevalence of Helicobacter pylori and other histopathologic findings in LSG specimens and the effect of increasing the number of sections for histology, from LSG specimens, on the rates of abnormal findings. Methods We retrospectively reviewed the histopathologic data of all patients who had undergone LSG, in a tertiary care center, over a 4-year period (n = 481). Patient characteristics and histopathologic findings were recorded and analyzed. Results Inactive chronic gastritis was the most common histopathologic finding (62.16%) followed by Helicobacter pylori gastritis (35.34%). Intestinal metaplasia was identified in 1.66% of the cases. There was no diagnosis of malignancy. Increasing the number of sections submitted for histopathologic examination resulted in a significantly higher rate of H. pylori gastritis detection. Conclusion Routine histopathologic examination of LSG specimens may detect H. pylori in a significant proportion of patients, and increasing the number of sections for histology from LSG specimens improves the rate of detection of this bacterium and identifies individuals who may benefit from treatment.

A Comparison of Ordering Pattern of Laboratory Send-Out Tests Between Naturopathic Doctors and General Practitioners in a Pediatric Population

Abstract Objectives Naturopathy is defined as the practice of medicine for the treatment of human diseases with natural agents. It also emphasizes prevention and promotion of health through the self-healing process of the body. Even without any illness or symptoms, naturopathic doctors (NDs) often advocate for and use unique lab tests to make clinical judgments. Tests that are performed outside of the ordering institution, send-out tests, are at increased risk of ordering the wrong or unnecessary test and misinterpreting test results. Here we evaluate the laboratory send-out tests that were ordered by NDs and general practitioners (GPs) at a tertiary pediatric care center to identify opportunities for improved laboratory stewardship. Methods We performed a retrospective analysis from Seattle Children’s laboratory send-out tests, which were ordered between January 1, 2018, and December 31, 2018. We compared the tests ordered by NDs with general practitioners in our practice, by grouping the following provider specialties: adolescent medicine, family medicine, or pediatrics. All the requests were reviewed and categorized by test type: heavy metal, allergen, infectious disease, hormone and vitamin, hematology and immunology, toxicology, oncology, genetics, and others. Ordering frequency and abnormal rate from each category were analyzed. The abnormal rate was defined as percentage of abnormal results divided by total number of ordered tests. Results During the 12-month period, there were 20,312 send-out tests; 1,028 (5.1%) of them were ordered by 83 NDs for 329 patients, and 3,862 (19.0%) of them were ordered by 462 GPs for 2,139 patients. The most frequently ordered tests by NDs were heavy metal screens (506 tests, 49.2% of total), allergen panels (31.7%), and infectious disease tests (7.0%). The corresponding abnormal rates were 8.5%, 0.9%, and 8.3%, respectively, with an overall abnormal rate of 6.6%. For GPs, the most frequently ordered tests were hormone and vitamin analyses (1,346 tests, 34.9% of total), hematology and immunology tests (22.5%), and heavy metal screens (10.8%). The corresponding abnormal rates were 18.1%, 35.9%, and 18.8% and overall abnormal rate was 17.8%. Conclusion We observed different ordering patterns between GPs and NDs, with rates of abnormal findings significantly higher from the tests ordered by GPs. These data suggest some of the tests ordered by NDs have low positive predictive value or clinical significance and could be potentially mis- or overutilized. Understanding the patterns and the variety of testing from different providers can help target interventions to improve laboratory stewardship in this area.

Long-term events after physician-referred initial tests by myocardial perfusion imaging or computed tomography coronary angiography in patients with suspected coronary artery disease.

The effects of initial tests on long-term events have been unknown. In this observational retrospective study, we analyzed the effects of initial noninvasive tests by myocardial perfusion imaging (MPI) and computed tomography angiography (CTA) on long-term major adverse cardiac events (MACEs) among patients with suspected coronary artery disease during a median follow-up of 8.1 years (interquartile range: 7.7-8.9). Sex difference in the rate of abnormal findings on initial tests was observed in both the MPI (female vs. male: 32.6 vs. 55.5%; P<0.0001) and CTA groups (30.6 vs. 47.9%; P<0.0001). Early revascularization in the MPI was significantly lower than that in the CTA (16 vs. 23%; P=0.0005). A total of 109 MACEs (39 of 1830 patients during the original follow-up period and 70 of 616 patients during the extended follow-up period) occurred: 77 MACEs (6.4%) in the MPI group and 32 (5.1%) in the CTA group (adjusted hazard ratio for MPI: 0.78; 95% confidence interval: 0.50-1.23; P=0.29). In the total cohort, the risk-adjusted MACE rate in the females was ∼50% of the males. The long-term MACE rates did not differ between physician-referred initial tests of MPI and CTA despite a higher frequency of early revascularization in the CTA group. In this extended cohort, female sex was associated with a lower rate of positive findings and a lower MACE rate compared with the male sex.

Pathologic findings in reduction mammoplasty specimens: a surrogate for the population prevalence of breast cancer and high-risk lesions

Mammoplasty removes random samples of breast tissue from asymptomatic women providing a unique method for evaluating background prevalence of breast pathology in normal population. Our goal was to identify the rate of atypical breast lesions and cancers in women of various ages in the largest mammoplasty cohort reported to date. We analyzed pathologic reports from patients undergoing bilateral mammoplasty, using natural language processing algorithm, verified by human review. Patients with a prior history of breast cancer or atypia were excluded. A total of 4775 patients were deemed eligible. Median age was 40 (range 13-86) and was higher in patients with any incidental finding compared to patients with normal reports (52 vs. 39 years, p = 0.0001). Pathological findings were detected in 7.06% (337) of procedures. Benign high-risk lesions were found in 299 patients (6.26%). Invasive carcinoma and ductal carcinoma in situ were detected in 15 (0.31%) and 23 (0.48%) patients, respectively. The rate of atypias and cancers increased with age. The overall rate of abnormal findings in asymptomatic patients undergoing mammoplasty was 7.06%, increasing with age. As these results are based on random sample of breast tissue, they likely underestimate the prevalence of abnormal findings in asymptomatic women.

Dynamic changes in Japan\u2019s prevalence of abnormal findings in cervical cytology depending on birth year

Japan’s governmental recommendation of HPV vaccine has now been suspended for more than 4 years. In and before 2013, the targets of 20-year-old cervical cancer screening were females born in and before 1993, i.e., those who could not have received HPV vaccination because it was not yet publicly introduced. The targets during 2014–2019 are, or will be, those born in 1994–1999, i.e., those who came of age during a period with the highest HPV immunization rate. We analyzed the statistical data for each birth year, for the cumulative HPV vaccination rates achieved as of age 16, and for the corresponding results of cervical cancer screening at age 20. The rate of abnormal findings in cervical cytology increased slightly from 3.68% in 2010 (birth year: 1990) to 4.35% in 2013 (birth year: 1993); however, it dynamically dropped to 2.99% in 2014 (birth year: 1994) and 3.03% in 2015 (birth year: 1995). In total, the rate of abnormal findings in cervical cytology was 3.96% in 2010–2013, but significantly dropped to 3.01% in 2014–2015 (p = 0.014). This is the first description of dynamic changes occurring in the abnormal rate of cervical cancer screening as a result of positive changes in national HPV vaccination rates.

Sonography in Hypotension and Cardiac Arrest (SHoC): Rates of Abnormal Findings in Undifferentiated Hypotension and During Cardiac Arrest as a Basis for Consensus on a Hierarchical Point of Care Ultrasound Protocol.

IntroductionPoint of care ultrasound (PoCUS) has become an established tool in the initial management of patients with undifferentiated hypotension. Current established protocols (RUSH and ACES) were developed by expert user opinion, rather than objective, prospective data. PoCUS also provides invaluable information during resuscitation efforts in cardiac arrest by determining presence/absence of cardiac activity and identifying reversible causes such as pericardial tamponade. There is no agreed guideline on how to safely and effectively incorporate PoCUS into the advanced cardiac life support (ACLS) algorithm. We wished to report disease incidence as a basis to develop a hierarchical approach to PoCUS in hypotension and during cardiac arrest.MethodsWe summarized the recorded incidence of PoCUS findings from the initial cohort during the interim analysis of two prospective studies. We propose that this will form the basis for developing a modified Delphi approach incorporating this data to obtain the input of a panel of international experts associated with five professional organizations led by the International Federation of Emergency Medicine (IFEM). The modified Delphi tool will be developed to reach an international consensus on how to integrate PoCUS for hypotensive emergency department patients as well as into cardiac arrest algorithms.ResultsRates of abnormal PoCUS findings from 151 patients with undifferentiated hypotension included left ventricular dynamic changes (43%), IVC abnormalities (27%), pericardial effusion (16%), and pleural fluid (8%). Abdominal pathology was rare (fluid 5%, AAA 2%). During cardiac arrest there were no pericardial effusions, however abnormalities of ventricular contraction (45%) and valvular motion (39%) were common among the 43 patients included.ConclusionsA prospectively collected disease incidence-based hierarchy of scanning can be developed based on the reported findings. This will inform an international consensus process towards the development of proposed SHoC protocols for hypotension and cardiac arrest, comprised of the stepwise clinical-indication based approach of Core, Supplementary, and Additional PoCUS views. We hope that such a protocol would be structured in a way that enables the clinician to only perform views that are clinically indicated, which limits exposure to the frequent incidental positive findings that accompany the current “one size fits all” standard protocols.

Early Detection of Thyroid Gland Disorders for Students in the Faculty of Applied Medical Sciences

In this study 70 male students were participated to determine the thyroid disorder through ultrasonography. Thyroid scan was done in 70 students prospectively with no indicative of thyroid disease (age of 19 - 23 yrs). Thyroid scan for students who participated the study took place in the department of Faculty of Applied Medical Sciences, King Abdulaziz University by using an IU 22 Philips ultrasound machine with a 5 - 12 MHz linear transducer. Among the total number of the subjects, 26% was found with abnormal ultrasound findings, 17% of them with cystic nodule, while solid and mixed nodule represented 4% for each. The high rate of abnormal findings of thyroid gland in the study suggested that screening using ultrasound scan was useful in detecting early thyroid disorders.

Computed Tomographic Scan Findings in Head Injury from a Tertiary Health Facility in South-East Nigeria

Background: Computed tomographic (CT) scan is the ultimate neuro-imaging standard for full evaluation of head injured patients. It guarantees a definitive diagnosis and guides specific treatment. Objective: This study is aimed at examining the CT scan findings in head injury patients managed in a teaching hospital in South-East Nigeria and correlating these with similar studies reported from other centers. Patients & Methods: It is a 3-year retrospective study of the CT scans of head injury patients that presented in our Unit from 1st April 2007 to 31st March 2010. Data was sourced from the Department of Medical records, Radiologists’ reports and Neurosurgery unit records. Only cases of head injury that had CT scanning were included in this study. Data was collated and analyzed with SPSS 13.0. Results: There were 737 cases of head injury within the study period, representing 25.5% of all neurosurgical patients managed under our service in that period. Only 26.6% of these 737 patients did cranio-cerebral computed tomography. Nine of these patients constituting 4.6% had normal CT results. The commonest abnormal findings included: intracranial hemorrhage/hematoma (n-92, 21.3%), cerebral edema (n-85, 19.7%), skull fracture (n-82, 19%), and cerebral contusion (n-76, 17.6%). Conclusion: Intracranial hemorrhage is the most common craniocerebral computed tomographic finding in head injury cases seen in our centre. Computed tomographic scan remains invaluable in the assessment and treatment of some patients with head injuries, considering the high rate of abnormal findings.

Effect of the order of test diets on the accuracy and safety of swallowing studies.

ObjectiveTo assess whether the order of test diets influences the results of swallowing studies with regard to their accuracy and safety.MethodsSubjects with suspected dysphagia underwent a videofluoroscopic swallowing study (VFSS) and/or a fiberoptic endoscopic evaluation of swallowing (FEES) and repeated the study on the same day or within a week. The order of test diets comprised of two different sets: trial 1 with the fluid first and trial 2 with the semi-solid food first. Main outcome measurements were the modified penetration-aspiration scale (mPAS) and the pharyngeal residue severity scale (PRSS) for the vallecula and the pyriform sinus.ResultsSixty-six patients (44 men and 22 women, aged 65.0±15.0 years) were enrolled in this study. Forty-three subjects were evaluated with VFSS only and 23 with both VFSS and FEES. As a result of the swallowing studies, there was no significant difference in each chosen diet sequence regarding mPAS and PRSS. Furthermore, there was no difference regarding the duration of studies, rate of premature study termination, rate of abnormal findings in post-study chest X-ray, and rate of fever or pneumonia post-study.ConclusionThe accuracy and safety of the swallowing studies do not rely on the order of test diets.

Utility Of Pre-Chemotherapy Echocardiograms

Anthracycline-based chemotherapy is widely used in a variety of regimens for Hodgkin's Lymphoma (HL) and Non-Hodgkin's Lymphoma (NHL). Unfortunately this agent is associated with cardiotoxicity, especially in larger cumulative doses. Doxorubicin cardiotoxicity is characterized by a dose-dependent decline in mitochondrial oxidative phosphorylation. Reactive oxygen species, generated by the interaction of doxorubicin with iron, can then damage the myocytes causing myofibrillar loss, cytoplasmic vacuolization, and apoptosis.Current NCCN guidelines for HL and NHL state that left ventricle function is recommended in patients who will receive such chemotherapy. Subsequent evaluations are recommended at a cumulative dose of doxorubicin of at least 300 mg/m² and periodically thereafter during the course of therapy. Despite these recommendations, there is little literature about the usefulness of this approach, the rate of abnormal findings, and whether routine testing changes management.A list of patients with HL or NHL treated with anthracycline-based chemotherapy from the University of Nebraska Medical Center from August 2004-May 2012 was obtained from our Lymphoma Registry.Baseline characteristics of age, disease diagnosis, gender, and prior history of cardiac diagnosis were collected. Prior cardiac diagnosis specified as patients with a past history of atrial fibrillation/flutter, supraventricular tachycardia, heart block requiring pacemaker implantation, coronary artery disease, valvular disease, pulmonary hypertension, or cardiomyopathy.Charts were reviewed for pre-chemotherapy evaluation of left ventricular function and the method of evaluation (echocardiogram, nuclear, cardiac MRI were included). Additionally, post treatment evaluation of cardiac function was evaluated for any change.The individual therapy for each patient was reviewed to determine if findings from the cardiac evaluation modified treatment regimens.A left ventricular function less than 50% was considered abnormal. Echocardiogram findings of moderate to severe valvular disease, diastolic dysfunction (grade 1-3), and moderate or severe pulmonary hypertension (moderate = pulmonary artery systolic pressure of 45-60, severe = pulmonary artery systolic pressure of > 60) were collected.We identified 309 patients from the UNMC lymphoma database. Of these 219 (71%) had an echocardiogram performed prior to therapy and documented in the patient record. Their mean age was 54.2 years of age with 53% of them being male and 47% female.188 of the 219 (86%) had no prior cardiac diagnosis as defined previously. From this group 22 of the 188 (10%) had a pre-chemotherapy echocardiogram that demonstrated one of the following: moderate-severe valvular disease, diastolic dysfunction, moderate-severe pulmonary hypertension or abnormal EF (<50%). However, none of these findings altered the chemotherapy regimen for the 22 patients.31 of the 219 patients with echocardiograms carried a prior cardiac diagnosis. 4 of the 31 had an alteration in their chemotherapy regimen as a result. Post therapy echocardiograms showed no change in cardiac function.5 of the 219 patients were diagnosed with adriamycin induced cardiomyopathy following treatment. All 5 patients had no prior cardiac history and pre-chemotherapy echocardiograms were normal.These finding suggest that current methods of evaluating cardiac function prior to chemotherapy and risk stratifying patients are inadequate and do not alter patient outcomes. Disclosures:No relevant conflicts of interest to declare.

Microscopic Hair Changes Associated with Hair Coloring, Hair Waving and Hair Ironing in Iranian Women

Although, of no vital value, hair plays a significant role in expressing any person's psychosocial status. Many cosmetic and styling methods are available for hair. This study aimed to examine the microscopic changes in women with hair coloring, hair waving, or hair ironing in comparison with normal controls. In a cross-sectional study, 154 Iranian women were recruited and categorized in 4 groups: controls (n = 35) who had not dyed, waved or ironed their hair within the last 6 months; dyed-hair group (n = 49) who had dyed their hair using standard chemical hair colors at least three times within the last 6 months; waved-hair group (n = 35) who had frizzled their hair within the last 6 months and ironed-hair group (n = 35) who had ironed their hair at least 3 times a weak using a temperature more than 30 degrees C within the last 6 months. Hair samples of all four groups were examined microscopically, and the results were compared with the controls. The rate of abnormal findings was 17.1% in the controls, 53.1% in the dyed-hair group, 45.7% in the waved-hair group, and 54.3% in the ironed-hair group. Abnormal findings were significantly more frequent in the last three groups comparing with the controls (p < 0.05). Trichorrhexis was 17.1, 34.7, 40 and 11.4%; kinking was 0, 2, 2.9 and 25.7%; pseudo pili-annulati was 0, 6.1, 0 and 17.1%; trichonodosis was 0, 6.1, 0 and 0%; tracheoschises was 0, 2, 2.9 and 0% and trichoptilosis was 0, 2, 0 and 0% in the mentioned groups, respectively. Based on the results of the present study, hair coloring, waving and ironing all can induce abnormalities in the hair in comparison with the hairs of nonusers.

Abstract P3-02-07: Rates of Cancer Detection and Abnormal Results among Clients Recruited for Mammography through Outreach and Education Supported by the Avon Breast Health Outreach Program

Abstract Background: The Avon Breast Health Outreach Program (BHOP) supports community-based organizations and safety-net providers in conducting outreach and education to recruit underserved, low-income and uninsured women for breast cancer screening mammography. Funded organizations report mammography outcomes as part of routine program monitoring. NCI Breast Cancer Consortium data for 2009 reported a cancer detection rate of 3.92 per 1,000 for screening mammograms and 33.21 per 1,000 for diagnostic mammograms. In CY2009, CDC's National Breast and Cervical Cancer Early Detection Program (NBCCEDP) reported 14 percent of mammograms had abnormal results requiring further investigation, with an overall cancer detection rate of 10.2 per 1,000 mammograms. Objective: To describe reported breast cancer detection rates and rates of abnormal mammography findings among Avon BHOP-funded programs. Methods: We reviewed routinely reported program outcomes data for 98 organizations funded continuously through the Avon BHOP for a three-year period from 2009 to 2011. Data for 17,839 mammograms were available in aggregate by year by grantee agency including the number of mammograms reported, number with a preliminary abnormal finding, and number of confirmed cancer diagnoses. Results: Agencies reported an average of 981 mammogram outcomes per year over 3 years (range 108 to 5,946 by agency). The average agency-specific rate of abnormal findings across 3 years was 13.2% (median 11.2%; range 0.49% to 51.0%). The average agency-specific cancer detection rate was 8.1 per 1,000 (median 6.4 per 1,000; range zero to 31.7 per 1,000). 28 organizations had 3-year average cancer detection rates in excess of 10 per 1,000, and 6 had rates exceeding 20 per 1,000. Large fluctuations in the proportion of mammogram outcomes reported as abnormal by a given agency year-over-year were common. Conclusion: Avon BHOP agencies reported overall abnormal and cancer detection rates similar to those of the NBCCEDP, but higher than the general population. Fluctuations in year-over-year rates were common, and may indicate changes in the way program data were reported over time, changes in screening practices (e.g. new clinical providers or new equipment), and/or differences in breast cancer risk among clients recruited for screening over time. High rates of abnormal screening results could indicate delays in obtaining results from follow-up diagnostic testing, problems with the calibration of equipment, or other quality issues. Discussion: Grantees with unusually high or low rates of abnormal or cancer outcomes or significant year-over-year rate fluctuations would benefit from technical assistance to identify and explain the underlying causes of these trends. Ensuring that all clients recruited for breast cancer screening receive high quality mammography services – including accurate imaging and reliable interpretation by experienced radiologists – is critical to minimize client anxiety and to ensure that screening results in improved health outcomes. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-02-07.

711: Adverse perinatal outcomes in euploid pregnancies with double-positive first trimester prenatal screening for Trisomy 18 and 21

were selected for testing because they are not easily detectable by karyotype, their cumulative frequency is substantial, and they are not usually associated with abnormal ultrasound (US) findings. STUDY DESIGN: Clinical prenatal samples (n 80) were referred to our laboratory for testing with this assay using specimens derived from amniotic fluid and chorionic villi. All samples tested were also karyotyped. Indications for study included AMA (30/80), AMA with a positive family history (4/80), AMA with an abnormal maternal serum screen (MSS) (13/80), abnormal fetal US findings with AMA, family history, and/or abnormal MSS (12/80), abnormal fetal US findings only (11/80), family history alone (2/80), abnormal MSS alone (6/80) and anxiety non-AMA (2/80). RESULTS: For our first 80 prospective specimens, the assay detected abnormalities in 7 cases: 2 Tri-18, 3 Tri-21, 1 each of deletion 1p36 and 5p15. One case with a normal result had 69,XXX by karyotyping. One case with an ambiguous result due to maternal cell contamination had 45,X in 18/19 cells by karyotyping. The mean turnaround time was 1.85 days. Overall, our detection rate of abnormal findings utilizing this assay and karyotyping is 12.5% and a 2.5% detection rate for microdeletions that would have been missed by karyotyping. CONCLUSION: Our results suggest that this new rapid assay, which is designed to avoid detection of results of unclear clinical significance, is a viable alternative to the FISH aneuploidy screening and microarray testing in low-risk pregnancies.

Musculoskeletal trauma in paediatric practice: the experience from Marseille

Imaging technology has progressed dramatically in the last 30 years. Flat panel high-resolution imaging, ultra-thin computed tomography (CT) sections with twoand threedimensional reformatting, and high-contrast and -resolution magnetic resonance imaging (MRI) with dedicated coils have changed our confidence in the exploration of bone trauma. CT and MRI have definitively increased our diagnostic abilities, particularly in children following polytrauma. However, polytrauma only accounts for a minority of trauma cases admitted to an emergency department. This presentation will instead focus on the daily reality. In a previous study performed over a 24-week period, we performed radiography in 3,128 anatomical locations in children admitted following trauma. Only 22% of the radiographic examinations were considered abnormal. In descending order, the hand and fingers, ankle, wrist, knee, elbow, foot and toes, and forearm were the most frequently examined locations. The rate of abnormal findings was 25.7% for the hand and fingers, 9.0% for the ankle, 42.5% for the wrist, 9.5% for the knee, 33.3% for the elbow, 18.3% for the foot and 43.2% for the forearm. When only the direct observation of a fracture was taken into account, these rates decreased for the ankle and knee to 2.6% and 1.9%, respectively. Over the past ten years, these two joints in particular have been the focus of our attention. Despite convincing data on the validity of the Ottawa Ankle Rules, referrals for ankle radiographs remain numerous. Our main explanation for this is the rotation in the emergency department of trainee doctors with various professional experiences and the fear of medicolegal proceedings. We have tried unsuccessfully in several projects to curtail these referrals. We have also investigated the underlying abnormality in swollen ankles when there was suspicion of sprain. Interestingly, in a series of 102 post-trauma MRI scans of ankles without radiographic fractures, we found only two ruptures of the lateral ligament in children with an open physis. Even more interesting, none of these had a classical Salter-Harris type I fracture of the distal fibula, which we believe is overdiagnosed. Two osteochondral avulsion fractures of the distal fibula, and microfractures of the foot were missed on radiographs. MRI has also been reported to be of high interest to modify the Salter-Harris classification of ankle fractures diagnosed on radiographs. However, our experience does not suggest this. In a series of 29 fractures, one patient was misclassified as Salter-Harris type III. MRI modified this classification to a Salter-Harris type III/Ogden type VI, but none of our patients had their therapeutic management changed following MRI. The point is that MRI of the ankle may show numerous abnormalities that are without clinical relevance. A delayed clinical examination, after three to four days’ immobilisation, may also obviate numerous unnecessary imaging procedures. Ultrasounds may have a place in imaging after this period of short immobilization to detect the rare case of rupture of the talofibular and calcaneofibular ligaments. However, expectancy is not suggested in knee trauma, where radiographs underestimate the severity of injury. CT or, even better, MRI must be performed as soon as a SalterHarris fracture is seen radiographically, or when there is Disclaimer Dr. Philippe Petit has no financial interests, investigational or off-label uses to disclose.

Findings at endoscopic retrograde cholangiopancreatography after endoscopic treatment of postcholecystectomy bile leaks

Although the endoscopic management of bile leaks after cholecystectomy (CCY) is well established, the yield of a routine endoscopic retrograde cholangiogram (ERC) with a bile duct sweep at the time of stent removal is unclear. This study aimed to describe the prevalence of abnormal findings at follow-up ERC to determine whether upper endoscopy with stent removal and without cholangiography would suffice. A retrospective cohort analysis of all patients referred for initial and follow-up ERC with post-CCY bile leak was performed. The rate of abnormal findings was measured including choledocholithiasis, biliary strictures, and persistent bile leaks at follow-up ERC. Secondarily, the study sought to define the clinical characteristics of patients who demonstrated stones or sludge at follow-up assessment. Between January, 2003 and April, 2008, 105 patients underwent initial and follow-up ERC. After a mean interval of 6.9 +/- 2.7 weeks between endoscopies, 29 (27.6%) of the 105 patients demonstrated one or more abnormalities including persistent bile leak (n = 8), common bile duct (CBD) stones (n = 12), and CBD sludge alone (n = 9). In the subgroup analysis of the patients who underwent a balloon sweep at initial and follow-up ERC, the prevalence of CBD stones or sludge at the follow-up ERC was 17.6%. Besides stones during the initial ERC, no significant clinical predictors of CBD stones were found at follow-up ERC including surgical approach, interval between endoscopies, and location of bile leak. After endoscopic treatment of a bile leak, the prevalence of abnormalities at follow-up ERC is significant. A repeat cholangiogram with a balloon sweep is preferred at the time of stent removal.