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Objectives: The aim of this study was to correlate the prostate-specific antigen (PSA) level and Gleason score with staging bone scan result in patients with a new diagnosis of prostate cancer in order to establish the feasibility of implementing the European Association Urology guidelines, which state that a bone scan may not be indicated when PSA ,20 in well-moderately differentiated tumours. Methods: We identified 633 patients retrospectively and 186 patients prospectively with a new diagnosis of prostate cancer undergoing a staging bone scan between March 2005 and January 2010. Patients were excluded if there was no Gleason score available or if the PSA level was checked over 3 months prior to bone scan. Bone scan results were analysed with respect to age, PSA level and Gleason score. In the case of an equivocal result, subsequent imaging was taken into consideration or the initial bone scan was re-reviewed. In persistently equivocal cases, all relevant imaging was assessed by a blinded panel of radiologists to allow a final decision to be made. Results: Of 672 patients aged 39-93 years (median 71 years), who fulfilled the inclusion criteria, 54 (8%) had evidence of bony metastases. PSA level and Gleason score were both independent predictors of bone scan positivity and their predictive value was additive p,0.01. None of the 357 patients with a PSA level of ,20 and a Gleason score of ,8 had a positive bone scan. Conclusion: Staging bone scans in newly diagnosed prostate cancer patients with a PSA level of ,20 and a Gleason score of ,8 can be safely omitted, with these criteria having a negative predictive value of 100% in our series.

PI and RI in the early posttransplantation period correlate with long-term transplant function and can potentially be used as prognostic markers to aid risk stratification for future transplant dysfunction.

Objective: To prospectively derive high-yield criteria for the detection of clinically significant electrolyte abnormalities (CSEAs) in children presenting to the ED. Methods: A prospective, multicenter, observational study was performed at the EDs of 2 urban teaching hospitals, a university medical center, and a children's hospital with a combined census of >275,000 patient visitdyear (100,000 visits for children <13 years old). All children <13 years old who had electrolyte panels obtained were eligible for analysis. A data form containing potential predictor variables for a CSEA was completed by the clinician prior to receipt of electrolyte results. A CSEA was any abnormal electrolyte value that 1 ) stimulated constructive assessment of the patient's condition (monitoring, reevaluation of nonspurious laboratory values, or admission), 2) led to further diagnostic studies, 3) led to a new diagnosis, or 4) affected therapy. x7 recursive partitioning was used to derive a decision rule for ordering electrolytes.Results: Of 7 15 eligible patient visits, 488 (68%) electrolyte panels contained a laboratory abnormality, with 182 ( 2 5 % ) CSEAs. A decision rule requiring 1 of 6 clinical criteria was 100% sensitive (95% CI 98-100%) and 24% specific (95% CI 21-28%) in detecting CSEAs with positive and negative predictive values of 31% (95% CI 28-33%) and 100% (95% CI 97-loo%), respectively. If these criteria had been used to screen patients for whom electrolyte panels were ordered, 128 patients (18%) would not have had electrolyte panels obtained and no CSEAs would have been missed. Conclusion: A set of clinical criteria was derived that may be useful for limiting electrolyte panels ordering in children. This criterion set requires prospective validation in a separate patient population.

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