On-call abdominal ultrasonography:the rate of negative examinations and incidentalomas in a European tertiary care center

OBJECTIVES: To determine the proportions of abdominal US examinations during on-call hours that are negative and that contain an incidentaloma, and to explore temporal changes and determinants. METHODS: This study included 1615 US examinations that were done during on-call hours at a tertiary care center between 2005 and 2017. RESULTS: The total proportion of negative US examinations was 49.2% (795/1615). The total proportion of US examinations with an incidentaloma was 8.0% (130/1615). There were no significant temporal changes in either one of these proportions. The likelihood of a negative US examination was significantly higher when requested by anesthesiology [odds ratio (OR) 2.609, P = 0.011], or when the indication for US was focused on gallbladder and biliary ducts (OR 1.556, P = 0.007), transplant (OR 2.371, P = 0.005), trauma (OR 3.274, P < 0.001), or urolithiasis/postrenal obstruction (OR 3.366, P < 0.001). In contrast, US examinations were significantly less likely to be negative when requested by urology (OR 0.423, P = 0.014), or when the indication for US was acute oncology (OR 0.207, P = 0.045) or appendicitis (OR 0.260, P < 0.001). The likelihood of an incidentaloma on US was significantly higher in older patients (OR 1.020 per year of age increase, P < 0.001) or when the liver was evaluated with US (OR 3.522, P < 0.001). DISCUSSION: Nearly 50% of abdominal US examinations during on-call hours are negative, and 8% reveal an incidentaloma. Requesting specialty and indication for US affect the likelihood of a negative examination, and higher patient age and liver evaluations increase the chance of detecting an incidentaloma in this setting. These data may potentially be used to improve clinical reasoning and restrain overutilization of imaging

Detection of clonal mast cell disease in wasp venom allergic patients with normal tryptase

Background: Clonal mast cell disease (CMD) is an underlying aggravating condition in wasp venom allergy (WVA) which requires a different treatment strategy. CMD is increasingly recognized in patients with normal basal serum tryptase (bsT). However, methods to identify at risk patients have not yet been assessed in large cohorts of WVA patients with normal bsT. Methods: This retrospective study evaluated the reliability of the REMA score in detecting CMD in a cohort of grade IV WVA patients with normal bsT and assessed the added value of other clinical parameters, KIT D816V mutation analysis in peripheral blood (PB) and the diagnosis of hereditary alpha tryptasemia (HAT). All patients had a conclusive bone marrow evaluation that demonstrated or excluded underlying CMD. Results: In total 35 CMD and 96 non-CMD patients were included. REMA score had a sensitivity of 72% (95% CI 56%-88%) and specificity of 79% (95% CI 70%-87%) in this cohort. Loss of consciousness during systemic reaction and bsT between 6.3 and 11.4 ng/ml were additional parameters independently associated with CMD. Sensitivity of KIT in PB was relatively low, 56% (95% CI 36%-75%), but had added value as screening method in patients with a low REMA score due to 100% specificity. Conclusion: The REMA score is a relatively reliable method to detect patients at risk of CMD among WVA patients with normal bsT. KIT mutation analysis in PB could serve as additional screening method in patients with low REMA scores

Xenotransplantation of Human Cardiomyocyte Progenitor Cells Does Not Improve Cardiac Function in a Porcine Model of Chronic Ischemic Heart Failure. Results from a Randomized, Blinded, Placebo Controlled Trial

BACKGROUND: Recently cardiomyocyte progenitor cells (CMPCs) were successfully isolated from fetal and adult human hearts. Direct intramyocardial injection of human CMPCs (hCMPCs) in experimental mouse models of acute myocardial infarction significantly improved cardiac function compared to controls. AIM: Here, our aim was to investigate whether xenotransplantation via intracoronary infusion of fetal hCMPCs in a pig model of chronic myocardial infarction is safe and efficacious, in view of translation purposes. METHODS & RESULTS: We performed a randomized, blinded, placebo controlled trial. Four weeks after ischemia/reperfusion injury by 90 minutes of percutaneous left anterior descending artery occlusion, pigs (n = 16, 68.5 ± 5.4 kg) received intracoronary infusion of 10 million fetal hCMPCs or placebo. All animals were immunosuppressed by cyclosporin (CsA). Four weeks after infusion, endpoint analysis by MRI displayed no difference in left ventricular ejection fraction, left ventricular end diastolic and left ventricular end systolic volumes between both groups. Serial pressure volume (PV-)loop and echocardiography showed no differences in functional parameters between groups at any timepoint. Infarct size at follow-up, measured by late gadolinium enhancement MRI showed no difference between groups. Intracoronary pressure and flow measurements showed no signs of coronary obstruction 30 minutes after cell infusion. No premature death occurred in cell treated animals. CONCLUSION: Xenotransplantation via intracoronary infusion of hCMPCs is feasible and safe, but not associated with improved left ventricular performance and infarct size compared to placebo in a porcine model of chronic myocardial infarction

Vascular density.

<p>Respresentative picutures of Lectin staining of the borderzone of a CMCP treated animals (A) and a placebo animal (B)</p

Fibrosis.

<p>Representative picture of a picrosirius red stained borderzone slide (A. bright field, B. polarized light) and a higher magnification of a picrosirius red stained slides isolated from the infarct area (C,D), borderzone (E,F) and remote area (G,H) of the left ventricle (bright field C,E,G, polarized light (D,F,H).</p

Functional outcome measurements by PV loop.

<p>Mean and SD for PVloop parameters. EDV End diastolic volume, ESV End systolic volume, EF Left ventricular ejection fraction, ESPVR End systolic pressures volume relationship, EDPVR end diastolic pressure volume relationship. Placebo n = 8, cell n = 7 for ESV, EDV and EF, n = 6 per group for ESPVR, EDPVR and V0.</p

QPCR.

<p>A. QPCR shows presence of genomic pig DNA (Gapdh) in all pig tissues treated with CMPC or placebo and absence of pig DNA in the sample containing human CMPCs (Human) and the negative control (Neg) containing H2O used for PCR. B. Human genomic DNA (HLA-DMA) was detected in the sample containing human CMPCs (Human), but was absent in all the pig tissues (CMPC and Placebo) and the negative control (Neg) containing H2O used for PCR</p

Functional measurements by echocardiography.

<p>Mean and SD, n = 8 per group. FAS Fractional area shortening, FS Fractional shortening, sWT Septal wall thickening at the level of the apex.</p

Infarct size.

<p>Representative pictures of TTC stained heart slice and LGE image of the same animal. Mean (±SD) infarct size of CMPC and placebo animals were 14.6 ± 2,5% and 13.8 ± 3.9% of the left ventricle based on TTC staining and 17.5 ± 3.8 and 18.0 ± 4.5 based on LGE imaging.</p

Functional measurements by MRI of cell- and placebo treated animals at follow up.

<p>Individual data and mean with SD, n = 8 per group. EF Left ventricular ejection fraction, EDV End diastolic volume, ESV End systolic volume.</p