Suspicious Radiological Findings Research Articles

Autologous fat grafting to lumpectomy defects: complications, imaging, and biopsy rates

BackgroundAutologous fat grafting is emerging as a promising reconstructive technique after breast conservation therapy (BCT). Recent evidence suggests that autologous fat grafting does not increase the risk of cancer recurrence; however, women may still be subject to unnecessary biopsies secondary to suspicious radiologic findings. The purpose of this study was to assess surgical complications and biopsy rates in these patients. MethodsWe retrospectively reviewed the records of women who underwent autologous fat grafting after BCT at a single institution over a 6-y period. Independent variables included demographic and operative details. Outcome variables included complications, and incidence of palpable masses and/or suspicious breast imaging findings requiring biopsy. Descriptive statistics were generated. ResultsBetween June 2008 and February 2015, 37 women aged 41 to 74 y (mean 54.4 y) underwent a total of 56 fat grafting sessions for correction of contour deformities after BCT. The mean number of fat grafting procedures was 1.5 (range 1-4) per breast. Follow-up ranged from 1 to 99 mo (mean 29.5 mo). Imaging data were available for 31 (83.7%) breasts after autologous fat grafting. Biopsy was recommended in four cases after suspicious imaging findings or palpable masses (10.8%), with benign pathology in all cases. There was one incidence of a local wound infection. No other local or systemic complications were noted. ConclusionsOur study demonstrated a risk of unnecessary biopsies after autologous fat grafting. Complication rates were low, and it appears to be a safe reconstructive option for the correction of contour deformities after BCT.

Pulmonary tuberculosis: An analysis of isolation practices and clinical risk factors in a tertiary hospital

BackgroundInadequate isolation of patients with active pulmonary tuberculosis causes exposure whereas over-cautious isolation generates time and cost inefficiencies. This study aims to ascertain the delays involved in isolating subjects and the importance of risk factors. Methods and materialBetween December 2010 and January 2013, a retrospective analysis of 271 subjects was performed. Information was obtained from discharge letters, radiological and microbiological results. ResultsThe median time taken to isolate subjects was 0 days, and 71.7% were isolated within 1 day. Most subjects (75.3%) had sputum samples obtained after isolation, of which 14.7% were positive. The median time from admission to first sputum sample was 1 day. Smear was negative in 174 subjects (85.3%). Country of birth (high or low risk) did not significantly affect sputum positivity (25.5% vs 19.4%, p=0.52). Suspicious radiological findings were noted in 38.6% subjects, and 32.8% had a suspicious clinical history. Subjects with both clinical and radiological probability had more sputum positivity (46.2%), compared to subjects who had neither (2.7%). ConclusionThere are delays with isolation and diagnosis of subjects with a high probability of tuberculosis. Clinical and radiological probability were more significant in predicting sputum positivity than country of birth.

Risk Stratification in Multinodular Goiter: A Retrospective Review of Sonographic Features, Histopathological Results, and Cancer Risk

PurposeIn the management of thyroid nodules, although the potential for malignancy exists, there is also the potential for overtreatment of subclinical disease. Although the TI-RADS (Thyroid Imaging-Reporting and Data System) system outlines a risk stratification score based on suspicious ultrasound findings, it has not been universally accepted. Many TI-RADS 2 or 3 patients proceed to fine needle aspiration biopsy (FNAB), potentially unnecessarily. The aim of the study was to identify whether lesions within a multinodular goiter (MNG) without suspicious features can be followed with ultrasound rather than biopsied as is recommended for single nodules. MethodsPathology records were retrospectively analysed for proven MNGs over a 5-year period. A total of 293 cases were identified. FNAB, prebiopsy ultrasound images, and reports were identified for each case. Images were reviewed and assessed for sonographically suspicious criteria guided by TI-RADS. Logistic regression was applied to determine if any sonographic features were associated with neoplasia. Odds ratios with 95% confidence intervals were calculated. ResultsOf 293 samples, 14 (4.7%) were neoplastic. Having no suspicious features conferred an average risk of 0.0339 (95% confidence interval: 0.02831-0.04087) of neoplasia. Risk of neoplasm significantly increased by having 1 and >1 suspicious feature (P < .001). Regarding cytological results, of 237 patients with Thy-2 cytology, 159 were followed up and 8 had a neoplasm. ConclusionUltrasound can be used to estimate risk of neoplasia in MNG. In the absence of suspicious radiological findings, follow-up with ultrasound rather than FNAB may be appropriate in patients who have a low clinical suspicion for neoplasia.

Occult Primary with Cervical Secondary-Role of CT Scan and Evaluation Under Anesthesia.

The potential of CT, MRI or both to detect a primary tumor ranges from 9.3 to 23% rising to 60% when suspicious radiological findings direct subsequent endoscopic biopsies (Zhuang et al. in Mol Clin Oncol 2:917-922, 2014). Prospective case Study. To know the sensitivity, specificity accuracy rate and P value of CT scan and upper aero digestive tract endoscopy with palpation of nasopharynx and oropharynx to search the primary site of cancer. 53 patient of occult primary with FNAC proved metastatic squamous cell carcinoma were evaluated to find out the sensitivity, specificity, accuracy rate and P value of imaging study and rigid endoscopic examination of upper aero digestive tract with through palpation of oropharynx, nasopharynx and evaluation under anesthesia (EUA). Punch biopsies were taken from suspicious areas and sent for histopathology examination (HPE). Taking HPE as a gold standard (Ishak et al in Rawal Med J 35:209-213, 2010) sensitivity of both EUA and imaging was found to be 100%, Specificity and diagnostic accuracy of EUA and imaging were 96.77, 83.87, 98.11 and 90.57% respectively. P value was <0.0000001 which is highly significant.

Periodontal Initial Radiological Findings of Genetically Predisposed Finnish Adolescents.

Periodontitis is a multifactorial infectious disease of the supporting tissues of teeth in which bacterial, genetic and lifestyle factors such as smoking have an important role. The aim was to examine if Bleeding On Probing (BOP ≥ 20%) and ≥ 4 mm deep pockets correlated with any suspicion of initial radiological findings of periodontitis and bone loss. We also investigated whether any pro-inflammatory-related candidate Single Nucleotide Polymorphisms (SNPs) were associated with any suspicion of radiological findings. Altogether 47 generally healthy adolescent patients of one birth cohort had given their approval for their saliva samples to be used for DNA analysis. One participant was excluded after discrepant gender check. An oral radiologist analysed right and left bitewing radiographs of 47 patients. Clinical parameters such as BOP ≥ 20%, ≥ 4 mm pockets, Visible Plaque Index of all teeth (VPI%), as well as smoking habits were recorded. DNA was extracted and 71 SNPs from candidate genes for initial periodontitis were genotyped. The association between ≥ 4 mm pockets and BOP ≥ 20% with radiological findings and selected SNPs was modelled using logistic regression. Variants in Toll-Like Receptors 4 (TLR4) gene (rs498670) (OR=5.8, {CI95% 1.6-20.7}, p=0.02, FDR q-value=0.13) and TNFSF11 gene (rs2277438, OR=0.3 {CI95% 0.1-0.9}, p=0.002, FDR q-value=0.56) were associated with any suspicious radiological findings; however the significance vanished after False Discovery Rate analysis (FDR). The association between BOP ≥ 20% and any radiographic signs of periodontitis was found to be statistically significant, OR=1.6, CI 95% 1.0-2.4, p=0.04. Only TLR4 (rs498670) and TNFSF11 (rs2277438) genes were found to have a positive correlation with radiological findings suggestive of initial periodontitis after adjustment for smoking and visible plaque.

Management of men with previous negative prostate biopsy.

Up to 70% of prostate biopsies are negative in men with suspected prostate cancer. Because of inherent limitations in biopsy strategies, a significant proportion of cancers are missed on initial biopsy. Following negative biopsy, men frequently exhibit persistently elevated prostate-specific antigen - raising concerns for missed diagnosis. We highlight the recent updates in the management of negative prostate biopsy. Advances in noninvasive diagnostics are available and assist clinicians in further substratifying risk of prostate cancer. Despite limited data, urinary prostate cancer antigen 3 and transmembrane protease serine 2 appear to have a promising predictive value for patients suspected of prostate cancer. The advent of multiparametricMRI allows the visualization of intermediate and high-grade prostate cancer, particularly in the troublesome anterior prostate. This modality may further provide the potential for magnetic resonance-guided targeted biopsies. Current data suggest that in the presence of suspicious radiological findings, magnetic resonance-guided biopsies have superior sensitivity profiles compared with traditional rebiopsy approaches. In the absence of multiparametricMRI or suspicious findings, traditional saturation biopsies are sufficient. The management of negative biopsies is evolving rapidly with emerging diagnostics to stratify risk of prostate cancer in men with previous negative biopsies. An increasing body of information supports the use of magnetic resonance-guided biopsies.

Cystic Echinococcosis in Childhood: Five-Years of Experience From a Single-Center

To evaluate the clinical data and prognosis of cystic echinococcosis during a 5-year period who were followed by the pediatric clinics. Demographic, clinical, laboratory, and prognosis data of 34 patients with cystic echinococcosis obtained between 2009 to 2014 were retrospectively evaluated. Of these, 10 patients were excluded because of incomplete data or failure to follow up. A total of 24 (12 males and 12 females) children were included the study. The mean ages of patients were 11.17 ± 3.71 (range, 5-17) years. The most common symptoms were abdominal pain (41.7%), cough (16.7%), and fatigue (12.5%). Localization of the parasite in the patients was determined to be as follows: liver (54.2%), lung (33.3%), and intraabdominal (4.2%). Multiorgan involvement was observed in 8.3% of the cases. Indirect hemagglutination test was positive in 13 (54.2%) patients at admission. All patients received treatment with albendazole. Seven patients were treated with puncture-aspiration-injection-re-aspiration (PAIR) (29.2%). Open surgery was performed in six patients (24.2%). One patient was treated with both PAIR and open surgery. Cystic echinococcosis is a serious public health problem in developing countries. Hydatid cyst should be considered in the presence of suspicious radiological and clinical findings in endemic areas.

Pelvic Lymph Node Dissection in Patients Treated for Testis Cancer: The Memorial Sloan Kettering Cancer Center Experience

To describe the pathologic findings and clinical outcome data for patients undergoing pelvic lymph node dissection (PLND) in the course of management of testicular germ cell tumors at Memorial Sloan Kettering Cancer Center (MSKCC). Following institutional review board approval, data on 2186 patients who underwent retroperitoneal lymph node dissection (RPLND) at MSKCC between 1989 and 2011 were retrospectively reviewed. Of these 2186 patients, we analyzed data for 44 patients (2%) who underwent PLND at the time of RPLND. PLND was performed in 14/44 (31%) patients at time of primary RPLND (P-RPLND), and in 21/44(48%) patients at time of postchemotherapy RPLND (PC-RPLND), usually for suspicious radiologic or intraoperative findings, whereas 9/44 (21%) underwent PLND for treatment of relapse. Positive pelvic findings on imaging included pelvic disease ≤5 cm in 17/44 (39%) patients and >5 cm in 11/44 (25%) patients (median size = 4 cm). At the time of PC-RPLND, alpha-fetoprotein and beta human chorionic gonadotropin were elevated in 6/21 (29%) and 4/21 (19%) patients, respectively. Histology revealed teratoma in 15/44 (34%) and viable tumor in 5/44 (11%) patients. At a median follow-up of 46 months, 40/44 (91%) patients were living without disease, 3/44 (7%) were living with disease (1 after PC-RPLND and 2 after relapse), and 1/44 (2%) died of other causes. PLND was performed infrequently in our series of patients who underwent RPLND for testis cancer. Teratoma was the dominant tumor histology in the resected tissue.

Gastrointestinal Infantile Hemangioma: Presentation and Management.

The aim of the present study was to document the clinical presentation, diagnostic studies, and therapy of gastrointestinal infantile hemangiomas. This is a retrospective analysis of children with gastrointestinal hemangiomas culled from our Vascular Anomalies Center database. We detailed the location of visceral and cutaneous tumors, as well as radiologic and procedural methods used for diagnosis and treatment. A total of 9 of the 16 children (14 girls and 2 boys) with hollow visceral hemangiomas also had cutaneous lesions. The most common extravisceral sites were regional facial lesions (n = 6), multifocal lesions (n = 2), and a solitary chest lesion (n = 1). Presenting symptoms were melena and hematochezia in the first 4 months of life (n = 14); several infants required multiple blood transfusions. The most frequent locations were small bowel and mesentery. One-half of the patients (n = 8) were diagnosed by laparotomy; the majority (n = 12) had suspicious radiologic findings. Corticosteroid and/or propranolol were the most common therapies. Melena and hematochezia, sometimes with profound anemia, in the first 4 months of life, suggest the possibility of intestinal infantile hemangioma even in the absence of cutaneous tumor. Intestinal bleeding, particularly in association with a regional facial lesion, should initiate workup: ultrasonography, computed tomography, and magnetic resonance imaging display diagnostic features. First-line treatment is medical management; bowel resection may be necessary, particularly for perforation.

Mammographic and Ultrasonographic Findings of Different Breast Adenosis Lesions.

Aim: To describe imaging features of different breast adenosis lesions.Materials and methods: Mammographic and ultrasonographic findings of patients with different types of adenosis were reviewed retrospectively Tissue samples were obtained either with US-guided core needle biopsy or localization with needle-wire system and surgical excision.Results: Forty-three adenosis lesions were diagnosed in 41 patients: 27 sclerosing adenosis, 13 blunt duct adenosis and 3 microglandular adenosis. Most frequent abnormal findings of sclerosing adenosis were masses with non-circumscribed margins and focal acoustic shadowing without mass configuration (54%) on ultrasonography. Mammography was normal in 54% of sclerosing adenosis, the most common abnormality was architectural distortion (21%). In blunt duct adenosis, usually circumscribed masses (46%) were detected on ultrasonography, clustered punctate microcalcifications (23%) and circumscribed masses (23%) were observed on mammography. All microglandular adenosis lesions were non-circumscribed masses. Premalignant components were detected only with surgical excisional biopsy in three patients that showed suspicious radiological findings and benign pathological result on core biopsy.Conclusion: The adenosis lesions have no pathognomonic characteristics on mammography and ultrasound. Total excision may be considered when suspicious radiological findings are present although core needle biopsy results are benign.

Utility of endoscopic ultrasound-guided transbronchial fine-needle cytology in the diagnosis of sarcoidosis: A Saudi experience

Background:Endoscopic ultrasound-guided transbronchial fine-needle aspiration (EBUS-TFNA) is a minimally invasive technique for diagnosis of mediastinal masses/lesions. Although most studies have reported the utility of EBUS-TFNA in malignancy, its use has been extended to the benign conditions as well.Objective:The present study focused on utility of EBUS in contributing to reach the final diagnosis of sarcoidosis.Design:From May 2010 to December 2013, 19 of 80 patients who underwent EBUS-TFNA at one center for radiologically suspicious lesions for sarcoidosis, and with no definite histological diagnosis, were included in this retrospective study.Results:When the histological diagnosis was taken as the gold standard, the sensitivity of EBUS-TFNA was 84.2% and specificity 100% with the positive predictive value of 100. The combined diagnostic sensitivity of EBUS-TFNA and transbronchial lung biopsy was 100%.Conclusion:EBUS is a valuable, minimally invasive diagnostic modality to support the diagnosis of sarcoidosis in appropriate clinical setting, after conventional work-up – particularly if patients have suspicious radiological findings. This minimally invasive procedure helps in providing a final diagnosis without exposing the patient to the risk of complications from more invasive procedures.

High-grade microscopic hematuria in adult men can predict urothelial malignancy.

Microscopic hematuria in men younger than 40 is a confusing issue to urologists, especially when these men have normal radiological findings. We report our experience in looking for urologic malignancy in this group of patients. We conducted a prospective study for men with vague urological symptoms. We included men under 40 years old, men with microscopic hematuria greater than 25 red blood cells/high power field in 2 properly collected mid-stream urine samples, and men with free urine culture and normal multiphasic computed tomography abdomen and pelvis studies. All patients underwent diagnostic cystoscurethroscopy. If there were no lesions, multiple random biopsies were taken. In cases of apparently normal cystoscopic findings and associated renal colic, uretroscopy was done to the suspected side. Only 20 patients fulfilled our inclusion criteria. The mean age of the patients were 34; 2 patients presented with pain. The other 18 patients were presenting with mild recurrent lower urinary tract symptoms. Cystoscopy showed small papillary low-grade tumour in 3 patients. All random biopsies were free of malignancy. Unilateral uretroscopy for the 2 cases presented with pain detected carcinoma in situ in one of them. Cystoscopy is highly recommended for young adult men, with significant levels of microscopic hematuria, due to the 20% incidence rate of associated urological malignancy. Random bladder biopsies, in the absence of suspicious lesions, have no diagnostic role, and should not be done. Uretroscopy is advised for patients with microscopic hematuria and loin pain, even in the absence of suspicious radiological findings.

Determinants for malignancy in surgically treated adrenal lesions

It is difficult to definitively rule out or establish malignancy pre-operatively in patients with adrenal lesions referred for adrenal surgery. The aim of this study was to identify risk factors for a malignant diagnosis in patients treated with adrenalectomy. Consecutive adrenalectomies at the Department of Surgery, Lund University Hospital between 2000 and 2009 were identified. Pre-operative clinical, radiological and biochemical data, as well as details on the operation and histology, were retrieved from patients' medical records. There were 175 adrenal operations in 172 patients (98 female and 77 male). There were 28 malignancies. Malignant tumours were larger than in benign cases (p = 0.003), had radiological signs of malignancy more often (p = 0.001) and the patients were more likely to have a history of malignancy (p = 0.001). There were no differences regarding age, gender, body mass index or mode of detection (incidental vs. clinical) between patients with benign and malignant diagnoses. A unilateral uptake on fluorine-18 deoxyglucose positron emission tomography was more frequent in malignant cases than in benign; however, this association did not reach statistical significance. Size of adrenal lesion, suspicious radiological findings and history of malignancy were factors associated with malignancy.

Medical and Surgical Evaluation and Treatment of Adrenal Incidentalomas

Adrenal incidentalomas are detected in approximately 4% of patients undergoing high-resolution abdominal imaging studies. The majority of adrenal incidentalomas are benign, but careful evaluation of all patients is warranted to be certain that primary adrenocortical carcinoma and functional adenomas are not missed. The diagnostic approach in patients with adrenal incidentalomas should focus on two main questions: whether the lesion is malignant, and whether it is hormonally active. Radiological evaluation including noncontrast and contrast computed tomography attenuation values expressed in Hounsfield units is the best tool to differentiate between benign and malignant adrenal masses. All adrenal tumors with suspicious radiological findings, most functional tumors, and all tumors more than 4 cm in size that lack characteristic benign imaging features should be surgically excised. All patients should undergo hormonal evaluation for subclinical Cushing's syndrome and pheochromocytoma, and those with hypertension should also be evaluated for hyperaldosteronism. Combined 1-mg dexamethasone suppression test, plasma metanephrines, and aldosterone/plasma renin activity measurements (if hypertensive) are reasonable initial hormonal evaluations. Annual biochemical follow-up of most patients with adrenal incidentalomas, especially if the tumor is more than 3 cm in size, for up to 5 yr may be reasonable. Patients with adrenal masses less than 4 cm in size and a noncontrast attenuation value of more than 10 Hounsfield units should have a repeat computed tomography study in 3-6 months and then yearly for 2 yr. Adrenal tumors with indeterminate radiological features that grow to at least 0.8 cm over 3-12 months may be considered for surgical resection.

A 2-year-old Girl With Fever, Abdominal Pain, and Lung Cavities

A 2-year-old Girl With Fever, Abdominal Pain, and Lung Cavities

Pseudoangiomatous stromal hyperplasia of the breast: A contemporary approach to its clinical and radiologic features and ideal management

Pseudoangiomatous stromal hyperplasia (PASH) is a benign, proliferative lesion of the breast whose clinical relevance, presentation, and optimal treatment remains described incompletely. The purpose of this study is to review the clinical, radiologic, and histopathologic features and appropriate management. Patients diagnosed with PASH were identified from our pathology database between 2000 and 2009. Clinicopathologic data including presentation, diagnosis, imaging, and histology were reviewed. All specimens were confirmed by a single pathologist. We identified PASH in 80 patients. Median follow-up was 3.71 years (range, 0.45-9.42). Age ranged from 12 to 65 (median, 45) and 95% were female. Lesions were palpable in 56% and found on imaging in the remainder. Core biopsy was performed in 65 of 80 patients (81%), which confirmed a diagnosis of PASH in 65%. The other 23 of 65 patients (35%) required operative excision for diagnosis. There was a progression rate of 26% in the observation arm versus 13% in the excision arm. A diagnosis of cancer or carcinoma in situ was seen in 30% at or before the diagnosis of PASH. PASH may present as a mass, radiologic lesion, or incidentally in pathology specimens. It may be associated with cancerous or precancerous lesions. A diagnosis on core biopsy in the absence of suspicious radiologic features may be managed with follow-up and imaging at a 6-month interval. In this series, 35% of patients with PASH had a negative core biopsy. Growth, suspicious radiologic findings, or inconclusive biopsy warrants surgical excision. Close surveillance is necessary given its recurrence rate of 13-26%.

Conjoined lumbosacral nerve roots: current aspects of diagnosis

Conjoined lumbosacral nerve roots (CLNR) are the most common anomalies involving the lumbar nerve structures which can be one of the origins of failed back syndromes. They can cause sciatica even without the presence of a additional compressive impingement (such as disc herniation, spondylolisthesis or lateral recess stenosis), and often congenital lumbosacral spine anomalies (such as bony defects) are present at the "conjoined sheaths". This congenital anomaly has been reported in 14% of cadaver studies, but myelographic or computed tomographic studies have revealed an incidence of approximately 4% only. Diagnostic methods such as magnetic resonance imaging (MRI) are helpful for determination of the exact anatomical relations in this context. We present five typical cases of conjoined nerve roots observed during a 1 year period, equivalent to 6% of our out-patients without a history of surgical treatment on the lumbar spine. In all cases with suspicious radiological findings MRI or lumbar myelography combined with CT and multiplanar reconstructions is recommended.

Concurrent BCG Vaccination

1) In Rio de Janeiro, Brazil, the specific mortality from tuberculosis is higher than 20 per cent in the first year of life of those children who are exposed to tuberculosis contagion immediately after birth. The socio-economic level of a large part of the population and the welfare organizations are not yet adequate to provide facilities to isolate children from tuberculous families in a practical way. 2) The peroral BCG vaccination of children exposed to tuberculosis, in the first 10 days of life and with doses from 60 to 90 milligrams, apparently reduced the specific mortality from tuberculosis in the first year of life to 4.68 per cent. 3) This partial result speaks in favour of the necessity to enforce the BCG vaccination of newborns exposed to tuberculosis, and monthly re-vaccinations with 100 milligrams of BCG, up to the sixth month of life should be carried out when the source of infection still exists. 4) The monthly use of BCG reaching total doses of 190 and 590 milligrams of vaccine, in 61 children ranging from two to six months of age was carried out with good tolerance, and without any ill consequences to the children, both when the weight and the lymphatic system were concerned. 5) Of these 61 children, 34 (Group 1), were in contact at home with an open case of tuberculosis from birth up to 37 months. Twenty-two were exposed to only one source of infection; 11 to two sources; and one to three sources. All of these children lived under unfavourable financial and sanitary conditions. 6) In this vaccinated group, followed from 24 to 36 months by physical examinations, x-ray films, eventual bacteriological examinations and tuberculin tests (Mantoux), no deaths occurred, either from tuberculosis or any other illness. 7) During the observation period, eight children at one time or another showed suspicious radiologic findings of active primary tuberculosis, in coincidence with a hypersensitive allergic reaction to tuberculin, however, without any clinic or bacteriological evidence of disease (on three gastric lavages). Fourteen other children had only strong positive tuberculin reaction and, were considered for this reason as having primary phase tuberculosis, although clinic or radiologic evidence of disease could not be detected. Twelve children showed no clinical or radiological signs of disease and the tuberculin reaction was moderate and of the regressive type, apparently failing to reveal the existence of active primary infection. 8) Twenty-seven children (Group 2), who received from 290 to 590 milligrams of BCG were exposed to sputum negative patients (direct smear or animal inoculation) or to patients without any expectoration. Twenty-one were exposed to one tuberculous person; four to two persons and, two to one closed case during the first days of life and to an open case in the second year of life. 9) Among the children of Group 2, two deaths occurred within the first year of life, but both children had negative x-ray films and were diagnosed before death as having alimentary toxicosis with diarrhea and dysenteric enteritis. Another child (32 months) without any x-ray, allergic, or clinical signs of tuberculosis died from post-measles bronchopneumonia two years after the source case had been considered clinically cured and had negative sputum as demonstrated by two animal inoculations. 10) Of the 24 other children in Group 2, four were healthy up to 36 months, but lack of cooperation on the part of the families later on, made impossible a definite conclusion in regard to their health. Of the 20 other children, one had transitory radiologic evidence of right para-hilar involvement, which was interpreted as active, regressive primary. Nine children had hypersensitive (strong) tuberculin allergy which was considered as a sign of primary infection, although the physical and radiologic findings were normal. Ten did not have any evidence of virulent tuberculous infection. All of these 24 cases were followed from 24 to 37 months. 11) The results obtained with the Concurrent BCG Vaccination, during two years of observation, seem to indicate that in the 61 cases studied (particularly the 34 newborns of Group 1), there was a considerable decrease in the incidence of primary tuberculosis among vaccinated children in contact with tuberculosis in their early life. Moreover, no deaths occurred in this group up to the second year of life and the occurrence of active primary infections was low, recognized only by radioscopy and positive tuberculin reaction. These results represent only the beginning of an investigation which will take into consideration the BCG vaccination in a manner not yet contemplated in human beings.