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For mechanically ventilated patients undergoing surgery, interrupting enteral feeding to prevent pulmonary aspiration is common; however, there are no published preoperative fasting guidelines for these patients, resulting in fasting practices that often vary greatly between hospitals. This retrospective study described fasting practices and surgical outcomes of mechanically ventilated patients across five trauma centres. The primary exposure was hours nil per os before surgery and was stratified into short (

We sought to determine occurrence, predictors, and prognosis of alcohol withdrawal syndrome and delirium tremens in patients with traumatic injury.Retrospective multicenter cohort study.Three U.S. trauma centers.Twenty-eight thousand one hundred one trauma patients admitted from 2010-2014.None.Measures included occurrence of alcohol withdrawal syndrome and delirium tremens, injury characteristics, risk factors for alcohol withdrawal syndrome, clinical outcomes, pharmacologic treatment for alcohol withdrawal syndrome, and Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) scores. Alcohol withdrawal syndrome severity was defined by CIWA-Ar score as minimal (10), moderate (10-20), and severe (20). Alcohol withdrawal syndrome developed in 0.88% (n = 246), including 12% minimal, 36% moderate, and 53% severe. Alcohol withdrawal syndrome progressed to delirium tremens in 11%. Before adjustment, alcohol withdrawal syndrome severity was associated with injury severity, hypokalemia, baseline CIWA-Ar score, and established alcohol withdrawal syndrome risk factors. Logistic regression identified the following predictors of delirium tremens: baseline CIWA-Ar score greater than or equal to 10 (odds ratio, 6.05; p = 0.02) and age greater than or equal to 55 (odds ratio, 3.24; p = 0.03). In patients with severe alcohol withdrawal syndrome, severe head injury also predicted progression to delirium tremens (odds ratio, 6.08; p = 0.01), and hypokalemia was borderline significant (odds ratio, 3.23; p = 0.07). Clinical outcomes of hospital length of stay, ICU length of stay, and alcohol withdrawal syndrome complications differed significantly by alcohol withdrawal syndrome severity and were worse with more severe manifestations of alcohol withdrawal syndrome. Mortality also significantly differed by alcohol withdrawal syndrome severity but was only greater in patients who progressed to delirium tremens (11.1%; p = 0.02); otherwise, there were no differences in mortality by severity (4%, 4%, and 0% by minimal, moderate, and severe alcohol withdrawal syndrome).Trauma patients with alcohol withdrawal syndrome experience a high occurrence of delirium tremens that is associated with significant mortality. These data demonstrate the predictive ability of baseline CIWA-Ar score, age, and severe head injury for developing delirium tremens.

As legless predators, snakes are unique in their ability to immobilize and kill their prey through the process of constriction, and yet how this pressure incapacitates and ultimately kills the prey remains unknown. In this study, we examined the cardiovascular function of anesthetized rats before, during and after being constricted by boas (Boa constrictor) to examine the effect of constriction on the prey's circulatory function. The results demonstrate that within 6 s of being constricted, peripheral arterial blood pressure (PBP) at the femoral artery dropped to 1/2 of baseline values while central venous pressure (CVP) increased 6-fold from baseline during the same time. Electrocardiographic recordings from the anesthetized rat's heart revealed profound bradycardia as heart rate (fH) dropped to nearly half of baseline within 60 s of being constricted, and QRS duration nearly doubled over the same time period. By the end of constriction (mean 6.5±1 min), rat PBP dropped 2.9-fold, fH dropped 3.9-fold, systemic perfusion pressure (SPP=PBP−CVP) dropped 5.7-fold, and 91% of rats (10 of 11) had evidence of cardiac electrical dysfunction. Blood drawn immediately after constriction revealed that, relative to baseline, rats were hyperkalemic (serum potassium levels nearly doubled) and acidotic (blood pH dropped from 7.4 to 7.0). These results are the first to document the physiological response of prey to constriction and support the hypothesis that snake constriction induces rapid prey death due to circulatory arrest.

Sport participation is one hallmark of American childhood and adolescence. Approximately 25 million children and adolescents play competitive sports within schools and 30 to 45 million participate in at least one school or community-based athletic program (NYU Child Study Center, 2010). Young people who participate in sports earn higher grades, manage their time better, make quicker decisions, and experience better professional outcomes when compared with their nonathlete peers (Engle & Gurian, 2004). Because of the mentorship, time spent, and attention given, coaches contribute enormously to the development of student-athletes. Primary and secondary school coaches might have an even greater influence over student-athletes because, in many cases, they are also their teachers. The occurrence of sexual abuse among youths, particularly those in junior high and high school participating in school sports, is a phenomenon that has received very little attention from school social workers and other related service personnel. Despite the reality that millions of children and adolescents participate in sports yearly, there is little written within the research literature on the role of related services personnel on how to protect children and adolescents from sexual abuse at the hands of teachers who serve as coaches, sports administrators, and other school-affiliated authority figures. Similarly, despite the reality that teachers, in every state, are mandated reporters, many are uneasy about making accusations against their colleagues. We know little empirically about the challenge of sexual abuse occurring between authority figures and youths in schools, yet local news outlet throughout the nation do report its occurrence and allegations. This prompts the need for greater research, education, and enhanced awareness on the topic. School social workers should be aware of the signs, symptoms, and procedures for reporting sexual abuse between authority figures in school and youths. Language: en

Blunt: (a) characterized by directness in manner or speech, or (b) a cigar filled with marijuana that has become a popular mode of ingestion among adolescents and young adults. Despite my experienc...

The association between Chance fractures and intra-abdominal injuries is reported to be as high as 89 per cent. Because prior studies were small series or case reports, we conducted a multicenter review to learn the true association between Chance fractures and intra-abdominal injuries as well as diagnostic trends. Trauma registry data, medical records, and radiology reports from 7 trauma centers were used to characterize 79 trauma patients with Chance fractures. Initial methods of abdominal assessment were computed tomography (CT) scan (79%), clinical examination (16%), and diagnostic peritoneal lavage (DPL) (5%). Twenty-six (33%) patients had intraabdominal injuries of which hollow viscus injuries predominated (22%). Twenty patients (25%) underwent laparotomy. The presence of an abdominal wall contusion and automobile restraint use were highly predictive of intra-abdominal injury and the need for laparotomy. The association between a Chance fracture and intra-abdominal injury is not as high as previously reported. CT scan has become the primary modality to assess the abdominal cavity of patients with Chance fractures, whereas the role of DPL has diminished.

RWJ-54428 (MC-02,479) is a new cephalosporin with a high level of activity against gram-positive bacteria. In a broth microdilution susceptibility test against methicillin-resistant Staphylococcus aureus (MRSA), RWJ-54428 was as active as vancomycin, with an MIC at which 90% of isolates are inhibited (MIC 90 ) of 2 μg/ml. For coagulase-negative staphylococci, RWJ-54428 was 32 times more active than imipenem, with an MIC 90 of 2 μg/ml. RWJ-54428 was active against S. aureus, Staphylococcus epidermidis , and Staphylococcus haemolyticus isolates with reduced susceptibility to glycopeptides (RWJ-54428 MIC range, ≤0.0625 to 1 μg/ml). RWJ-54428 was eight times more potent than methicillin and cefotaxime against methicillin-susceptible S. aureus (MIC 90 , 0.5 μg/ml). For ampicillin-susceptible Enterococcus faecalis (including vancomycin-resistant and high-level aminoglycoside-resistant strains), RWJ-54428 had an MIC 90 of 0.125 μg/ml. RWJ-54428 was also active against Enterococcus faecium , including vancomycin-, gentamicin-, and ciprofloxacin-resistant strains. The potency against enterococci correlated with ampicillin susceptibility; RWJ-54428 MICs ranged between ≤0.0625 and 1 μg/ml for ampicillin-susceptible strains and 0.125 and 8 μg/ml for ampicillin-resistant strains. RWJ-54428 was more active than penicillin G and cefotaxime against penicillin-resistant, -intermediate, and -susceptible strains of Streptococcus pneumoniae (MIC 90 s, 0.25, 0.125, and ≤0.0625 μg/ml, respectively). RWJ-54428 was only marginally active against most gram-negative bacteria; however, significant activity was observed against Haemophilus influenzae and Moraxella catarrhalis (MIC 90 s, 0.25 and 0.5 μg/ml, respectively). This survey of the susceptibilities of more than 1,000 multidrug-resistant gram-positive isolates to RWJ-54428 indicates that this new cephalosporin has the potential to be useful in the treatment of infections due to gram-positive bacteria, including strains resistant to currently available antimicrobials.

A systematic approach toward building activity against methicillin-resistant staphylococci into the cephalosporin class of beta-lactam antibiotics is described. Initial work focused on finding the optimal linkage between the cephem nucleus and a biphenyl pharmacophore, which established that a thio linkage afforded potent activity in vitro. Efforts to optimize this activity by altering substitution on the pharmacophore afforded iodophenylthio analog MC-02,002, which although highly potent against MRSA, was also highly bound to serum proteins. Further work to decrease serum protein binding showed that replacement of the iodo substituent by the positively-charged isothiouronium group afforded potent activity and reduced serum binding, but insufficient aqueous solubility. Solubility was enhanced by incorporation of a second positively-charged group into the 7-acyl substituent. Such derivatives (MC-02,171 and MC-02,306) lacked sufficient stability to staphylococcal beta-lactamase enzymes. The second positive charge was incorporated into the cephem 3-substituent in order to utilize the beta-lactamase-stable aminothiazolyl(oximino)acetyl class of 7-substituents. These efforts culminated with the discovery of bis(isothiouroniummethyl)phenylthio analog MC-02,331, whose profile is acceptable with respect to potency against MRSA, serum binding, aqueous solubility, and beta-lactamase stability.

Feline leukemia virus (FeLV) was not detected in Florida pumas (Puma concolor coryi) in almost 20 yr of surveillance; however, the finding of two FeLV antigen-positive pumas during the 2002-2003 capture season led to an investigation of FeLV in the population. Between January 1990 and April 2007, the proportion of pumas testing FeLV antibody positive increased, with antibody-positive pumas concentrated in the northern portion of puma range. Five of 131 (4%) pumas sampled between July 2000 and April 2007 were viremic, with all cases clustered in Okaloacoochee Slough (OKS). Clinical signs and clinical pathology at capture were absent or included lymphadenopathy, moderate-to-severe anemia, and lymphopenia. All viremic pumas died; causes of death were septicemia (n=2), intraspecific aggression (n=2), and anemia/dehydration (n=1). Outcome after FeLV exposure in pumas was similar to that in domestic cats, with evidence of regressive, latent, and persistent infections. Management of the epizootic included vaccination, and as of April 2007, 52 free-ranging pumas had received one or more inoculations. Vaccinations were concentrated in OKS and in a band between OKS and the remainder of the puma population. There have been no new cases since July 2004; however, the potential for reintroduction of the virus remains.

Testicular regrowths were observed in 10 of 21 tom turkeys between 28 and 32 weeks old, which was between 19 and 23 weeks after surgical caponization at 9 weeks of age. Regrowths were not observed in younger caponized toms. Two types of histologic patterns that differed from the normal pattern were observed in these regrowths. The first pattern was observed in seven regrowths and was characterized by a higher density of seminiferous tubules and more interstitial cells. The second pattern was seen in three regrowths and was characterized by extensive intertubular fibrosis, tubular detachment, and an increased number of interstitial cells. No correlation was found between the presence of these regrowths and plasma testosterone levels. The interstitial cell hyperplasia in all regrowths possibly was related to a diminished negative feedback by the endogenous testosterone on the release of luteinizing hormone from the pituitary. The appearance of regrowths at this age probably was related to the onset of normal physiological puberty.

The deafening effect of high intensity noise is well known—from rock music, aircraft, snowmobiles, motorcycles and the shooting of guns. The effects of hospital noise and its interaction with ototoxic drugs are less well known. The subject is of particular importance to pediatricians, because infants in incubators are exposed to substantial noise from the motor, airflow, respirators, slamming of incubator doors and the baby's own crying. Furthermore, animal experimentation1 shows that the ototoxic drug, kanamycin (often given to the premature infant to combat sepsis), can potentiate the effect of noise on hearing loss as much as 100-fold. Whether or not an interaction between noise and potentially ototoxic drugs occurs in man is as yet unknown. MEASUREMENT Noise has frequency and intensity. Frequency is measured in cycles per second, designated hertz (Hz). The young human ear is sensitive to a frequency range of 20 to 20,000 Hz. White noise, the auditory counterpart of white light, has equal energy in each frequency in the audible range. Intensity is measured in decibels on a scale which is linear with respect to audible frequencies. This measurement is designated dB (linear). Since the human ear is more sensitive to the damaging effects of high frequency sound than to low frequency, a better correlate with noise-induced hearing loss can be obtained when low frequencies are filtered out. Filtered sound level, measured on a so-called A-weighted scale, is designated dB(A). Room conversation produces 60 to 70 dB(A), rock music 100 to 120 dB(A) and snowmobiles 105 to 135 dB(A) for the driver.

This study reports the long-term effects of intensive instruction (II) in the cue attendance (CA) or hypothesis generation (HG) on open-exploration behavior. The five dependent measures included: the number of observed details; the number and quality of hypotheses; and the number and diversity of questions. In the original study, Ss receiving either form of II performed significantly better than control Ss on all dependent measures. Both experimental groups performed equally well except for a large number of details observed by the II group. Fifteen months later, Ss II in CA were able to describe more details and ask more questions with greater diversity than the II in HG group or the control Ss. Ss II in HG produced more hypotheses than the control Ss and a higher quality of hypotheses than either the control Ss or the II in CA group.

To summarize—this study shows that the variability of mental ratings in adult neuropsychiatric cases is much greater than the variability found in normal school children, and is considerably greater than that found in the children used in this study. Part of this difference is probably due to the fact that most of the adults had mental disturbances of psychotic degree, while the disturbances in the children were of a different type—namely, behavior problems, and various mild neurotic manifestations. Of all the cases with organic diseases, causing physiological and mental deterioration, the variability was greatest in the adults and there were likewise more adults with organic as well as functional disturbances. This was further emphasized by the brief supplementary study of the 10 cases of general paresis. Age and level of I. Q. were not found to be important factors in variability in this series of cases. In the adult group the women varied more than the men while in the group of children the boys varied...

A case is presented of a patient with Letterer-Siwe disease who manifested features of primary liver disease upon admission. A brief review of the reticuloendothelioses is also given.

Hydrazine (1 · 1 m-mole/kg, i.v.) in adult male rats fasted for 48 hr caused the previously reported prompt elevation of serum free fatty acids (FFA) and depletion of liver glycogen, followed in 12–24 hr by a 10-fold elevation of liver triglyceride. In the liver, total phospholipid and total cholesteryl ester increased slightly for 24 hr, but total free cholesterol remained unchanged. In the serum, phospholipid rose above control levels at 24 and 48 hr. Cholesteryl ester levels, however, fell below control levels at 8–24 hr, then rose at 48 hr, while free cholesterol levels appeared unchanged. In consequence, the esterifled cholesterol of serum in hydrazinized rats fell to a mean of 57 per cent of total serum cholesterol at 12–24 hr. This evidence of liver malfunction occurred during the period when the liver was glutted with triglyceride. Since mean serum triglycerides were normal at 8–12 hr and only twice control levels at 24 hr, the data support the postulate that hydrazine embarrassed the secretion of triglyceride from the liver, possibly by decrease of lipid-binding capacity of lipoproteins.

The Committee on Environmental Hazards has recommended that the American National Standards Institute (ANSI) revise that portion of the American Standard Z66.1/64 pertaining to the lead content of paint downward from the present 1% to "minimum traces" or < 0.06% of the total weight of the contained solid, including pigment, film solids, and driers. This recommendation is based on a study of recently published materials which appeared after the 1% voluntary standard for lead was originally established in 1955 by ANSI. At the same time, in response to the notice in the Federal Register of November 2, 1971 (21 CFR Part 191), the Committee recommended that Federal standards for lead content of paint used on surfaces accessible to young children be reduced to "minimum traces" on < 0.06%, and that paints containing more than this amount of lead be banned as hazardous substances. On review and evaluation of available data in children and adults, an ad hoc committee (B. G. King, Chairman) recently concluded that, for children, the maximum daily permissible intake (DPI) of lead from all sources should not exceed 300 µg Pb/day. If average daily intake is maintained below this level, blood lead concentrations are unlikely to exceed 40 µg Pb/100 gm whole blood. At this level of intake, it is estimated that the amount assimilated by 1- to 3-year-old children could probably be excreted so no net increment in total body lead burden would be anticipated. It is estimated that approximately one half of this 300 µg Pb/day intake would be derived from usual food, water, and air, so intake from all other sources, on the average, should not exceed 150 µg Pb/day.

THE presence of a foreign body in the extrahepatic biliary tract is extremely infrequent judging from the paucity of reports in the medical literature.1 2 3 4 5 6 7 8 9 10 11 Having recently been confronted by the problem of obstructive jaundice developing several years after a wound, we believe that the case, together with its diagnostic and pathogenetic aspects, merits reporting. Previously reported cases are presented in Table 1. Case Report J.D., a 29-year-old man, was admitted to the hospital on December 2, 1953. During combat activity in 1944 he received several gunshot wounds of the right lateral and posterior aspects of the chest. Surgical operation was performed . . .

✓ The clinical results of lyophilized human cadaver dura transplantation in 170 neurosurgical patients show that it is a safe and effective material for dural closure. It is associated with low complication rates and minimal cortical scarring and adhesions. The successful results have been attributed to the minimal foreign body reaction stimulated by freeze-dried tissue. These factors plus its capacity for safe and convenient long-term storage at room temperature make lyophilization the method of choice for preserving dura mater.

AMONG the complications associated with chronic ulcerative colitis has been the development of associated "rheumatoid arthritis." The frequency of occurrence has been estimated at between 5 and 10 ...

Thromboembolism as a complication of ulcerative colitis has received scant attention in the medical literature. In most treatises on the disease either it is not mentioned at all or it receives only passing notice. Between 7% and 30% of patients with ulcerative colitis are said to develop nonpostoperative intravascular thromboses. Usually only the more seriously ill patients are affected. That phlebitis and arterial occlusion may be a serious and, at times, grave occurrence in ulcerative colitis is borne out by the following two cases in both of which autoimmune mechanisms may have played an important role. Report of Cases Case 1. —This 20-year-old white soldier with two years of active military service was in good health until March, 1961, when he noted fatigue, loss of energy, pallor, and increased frequency of bowel movements. Initially, he passed two to six loose stools daily which, at times, contained bright red blood. There

Lead poisoning in childhood is a preventable disease. Virtually all cases occur in children who live in old, deteriorated houses which were built and painted years ago when the use of lead-based paints on housing surfaces was widespread. Eighty-five percent of recognized cases occur in children in the 1- to 3-year age range in which pica (the habit of eating non-food substances) is prevalent. Consequently, the disease results from the interaction between hazardous housing and the child with pica. Early diagnosis of plumbism on clinical grounds alone is exceedingly difficult, and often impossible. Furthermore, by the time the clinical diagnosis is obvious, permanent brain damage which cannot be modified by therapy may already have taken place. Although the true incidence of plumbism is not known, careful surveys have revealed that 10 to 25% of young children who live in deteriorated urban slum housing show evidence of increased absorption of lead and that 2 to 5% show evidence of poisoning. While recent therapeutic advances have reduced the mortality of acute lead encephalopathy, it is now apparent that at least one-third of the survivors of encephalopathy sustain permanent irreversible damage to the brain. Significant reduction in the risk of permanent brain damage, therefore, requires identification of the child with increased body lead burden prior to the onset of poisoning. Fundamentally, both the prevention of adverse health effects due to lead and the treatment of identified cases depend upon the elimination of the housing hazard which lies at the root of the problem.

The Committee on Environmental Health of the Indiana Chapter of the American Academy of Pediatrics sought the assistance of the Academy's Committee on Environmental Hazards regarding a developing health risk to children in Indiana. A cattle feedlot was developed along the shores of a creek which empties into a lake where recreational use included an area specifically designated for swimming. The Environmental Protection Agency estimates that the wastes produced by farm animals in the United States are equivalent to the wastes of 2 billion people, more than half the world population of 3.7 billion people. It has further estimated that more than half of these wastes are produced in feedlots. Feedlots for livestock and poultry are a relatively new industry that has developed since World War II in various parts of the United States. Significant changes are occurring in the increased demand for meats and in the manner of feeding, processing, and marketing livestock. Feedlots are now being established closer to market areas throughout the nation. With the increasing number of animals and the increasing use of feedlots, it is necessary that some wastes management system be required to protect the human population from a number of infectious diseases. Animal wastes from feedlots are more infectious than wastes from grazing farm animals because of naturally occurring epizootics within such confined feeding facilities. Chemical pollution by animal wastes or chemical changes incident to microbiologic or chemical pollution are also a concern. In the interest of our domestic water supply and the safe use of recreational waters, both vital to the health of children, the Committee has approved the following statement

Excerpt It is now well established that all types of porphyria are familial diseases in which the underlying mechanism is an inborn error of pigment metabolism. Patients with the condition often gi...

Excerpt Reports of psittacosis are by no means uncommon in the medical literature of recent years, and further individual case reports might seem superfluous. Recently, a patient was observed, howe...

There has been increasing concern by several groups about the plight of children whose lives are harmed by their housing environment, which results in an increased risk of accidents, infectious diseases, and in particular, lead poisoning. The Committee on Environmental Hazards has also been vitally concerned with these problems, and several of its members have served as expert witnesses in congressional hearings on related bills. However, efforts up to the present have been insufficient to alleviate illnesses which, though ill-defined, are clearly preventable. The Committee on Environmental Hazards recommends that the Academy encourage national and local governments to support, at the economic and law enforcement levels (including health departments), those measures necessary to alleviate the problems of childhood lead poisoning. Deteriorated housing is an essential feature of lead poisoning, and it is related to the increased risk of accidents and the incidence of infectious diseases. Action is needed to urge landlords, by whatever means possible, to improve those housing conditions which are a danger to the health of children. It may be economically unfeasible for landlords of deteriorated housing in inner cities to improve their buildings, and both legislative action and financial commitment from government may be necessary to bring about required action.

Rationale The development of consensus guidelines for interpretation of Prostate-Specific Membrane Antigen (PSMA)-Positron Emission Tomography (PET) is needed to provide more consistent reports in clinical practice. The standardization of PSMA-PET interpretation may also contribute to increasing the data reproducibility within clinical trials. Finally, guidelines in PSMA-PET interpretation are needed to communicate the exact location of findings to referring physicians, to support clinician therapeutic management decisions. Methods A panel of worldwide experts in PSMA-PET was established. Panelists were selected based on their expertise and publication record in the diagnosis or treatment of PCa, in their involvement in clinical guidelines and according to their expertise in the clinical application of radiolabeled PSMA inhibitors. Panelists were actively involved in all stages of a modified, nonanonymous, Delphi consensus process. Results According to the findings obtained by modified Delphi consensus process, panelist recommendations were implemented in a structured report for PSMA-PET. Conclusions The E-PSMA standardized reporting guidelines, a document supported by the European Association of Nuclear Medicine (EANM), provide consensus statements among a panel of experts in PSMA-PET imaging, to develop a structured report for PSMA-PET in prostate cancer and to harmonize diagnostic interpretation criteria.

METHODS: After primary treatment, biochemical relapse (BCR) occurs in a substantial number of patients with prostate cancer (PCa). PET/CT imaging with prostate-specific membrane antigen based tracers (68Ga-PSMA) has shown promising results for BCR patients. However, a standardized image interpretation methodology has yet to be properly agreed. The aim of this study, which was promoted and funded by European Association of Nuclear Medicine (EANM), is to define standardized image interpretation criteria for 68Ga-PSMA PET/CT to detect recurrent PCa lesions in patients treated with primary curative intent therapy (radical prostatectomy or radiotherapy) who presented a biochemical recurrence. In the first phase inter-rater agreement between seven readers from seven international centers was calculated on the reading of 68Ga-PSMA PET/CT images of 49 patients with BCR. Each reader evaluated findings in five different sites of recurrence (local, loco-regional lymph nodes, distant lymph nodes, bone, and other). In the second phase the re-analysis was limited to cases with poor, slight, fair, or moderate agreement [Krippendorff's (K) alpha

In prostate cancer with biochemical failure after therapy, current imaging techniques have a low detection rate at the prostate-specific antigen (PSA) levels at which targeted salvage therapy is effective. (11)C-choline and (18)F-fluoromethylcholine, though widely used, have poor sensitivity at low PSA levels. (68)Ga-PSMA (Glu-NH-CO-NH-Lys-(Ahx)-[(68)Ga-N,N'-bis[2-hydroxy-5-(carboxyethyl)benzyl]ethylenediamine-N,N'-diacetic acid]) has shown promising results in retrospective trials. Our aim was to prospectively compare the detection rates of (68)Ga-PSMA versus (18)F-fluoromethylcholine PET/CT in men who were initially managed with radical prostatectomy, radiation treatment, or both and were being considered for targeted therapy. METHODS: A sample of men with a rising PSA level after treatment, eligible for targeted treatment, was prospectively included. Patients on systemic treatment were excluded. (68)Ga-PSMA, (18)F-fluoromethylcholine PET/CT, and diagnostic CT were performed sequentially on all patients between January and April 2015, and the images were assessed by masked, experienced interpreters. The findings and their impact on management were documented, together with the results of histologic follow-up when feasible. RESULTS: In total, 38 patients were enrolled. Of these, 34 (89%) had undergone radical prostatectomy and 4 (11%) had undergone radiation treatment. Twelve (32%) had undergone salvage radiation treatment after primary radical prostatectomy. The mean PSA level was 1.74 ± 2.54 ng/mL. The scan results were positive in 26 patients (68%) and negative with both tracers in 12 patients (32%). Of the 26 positive scans, 14 (54%) were positive with (68)Ga-PSMA alone, 11 (42%) with both (18)F-fluoromethylcholine and (68)Ga-PSMA, and only 1 (4%) with (18)F-fluoromethylcholine alone. When PSA was below 0.5 ng/mL, the detection rate was 50% for (68)Ga-PSMA versus 12.5% for (18)F-fluoromethylcholine. When PSA was 0.5-2.0 ng/mL, the detection rate was 69% for (68)Ga-PSMA versus 31% for (18)F-fluoromethylcholine, and when PSA was above 2.0, the detection rate was 86% for (68)Ga-PSMA versus 57% for (18)F-fluoromethylcholine. On lesion-based analysis, (68)Ga-PSMA detected more lesions than (18)F-fluoromethylcholine (59 vs. 29, P < 0.001). The tumor-to-background ratio in positive scans was higher for (68)Ga-PSMA than for (18)F-fluoromethylcholine (28.6 for (68)Ga-PSMA vs. 9.4 for (18)F-fluoromethylcholine, P < 0.001). There was a 63% (24/38 patients) management impact, with 54% (13/24 patients) being due to (68)Ga-PSMA imaging alone. Histologic follow-up was available for 9 of 38 patients (24%), and 9 of 9 (68)Ga-PSMA-positive lesions were consistent with prostate cancer ((68)Ga-PSMA was true-positive). The lesion positive on (18)F-fluoromethylcholine imaging and negative on (68)Ga-PSMA imaging was shown at biopsy to be a false-positive (18)F-fluoromethylcholine finding ((68)Ga-PSMA was true-negative). CONCLUSION: In patients with biochemical failure and a low PSA level, (68)Ga-PSMA demonstrated a significantly higher detection rate than (18)F-fluoromethylcholine and a high overall impact on management.