Background-Recent trials have shown that intracoronary infusion of bone marrow cells (BMCs) improves functional recovery after acute myocardial infarction. However, whether this treatment is effective in heart failure as a consequence of remodeling after organized infarcts remains unclear. In this randomized trial, we assessed the hypothesis that direct intramyocardial injection of autologous mononuclear bone marrow cells during coronary artery bypass graft (CABG) could improve global and regional left ventricular ejection fraction (LVEF) at 4-month follow-up. Methods and Results-Twenty patients (age 64.8Ϯ8.7; 17 male, 3 female) with a postinfarction nonviable scar, as assessed by thallium (Tl) scintigraphy and cardiac magnetic resonance imaging (MRI), scheduled for elective CABG, were included. They were randomized to a control group (n ϭ10, CABG only) or a BMC group (CABG and injection of 60.10 6 Ϯ31.10 6 BMC). Primary end points were global LVEF change and wall thickening changes in the infarct area from baseline to 4-month follow-up, as measured by MRI. Changes in metabolic activity were measured by Tl scintigraphy and expressed as a score with a range from 0 to 4, corresponding to percent of maximal myocardial Tl uptake (4 indicates Ͻ50%, nonviable scar; 3, 50% to 60%; 2, 60% to 70%; 1, 70% to 80%; 0Ͼ80%). Global LVEF at baseline was 39.5Ϯ5.5% in controls and 42.9Ϯ10.3% in the BMC group (Pϭ0.38). At 4 months, LVEF had increased to 43.1Ϯ10.9% in the control group and to 48.9Ϯ9.5% in the BMC group (Pϭ0.23). Systolic thickening had improved from Ϫ0.6Ϯ1.3 mm at baseline to 1.8Ϯ2.6 mm at 4 months in the cell-implanted scars, whereas nontreated scars remained largely akinetic (Ϫ0.5Ϯ2.0 mm at baseline compared with 0.4Ϯ1.7 mm at 4 months, Pϭ0.007 control versus BMC-treated group at 4 months). Defect score decreased from 4 to 3.3Ϯ0.9 in the BMC group and to 3.7Ϯ0.4 in the control group (Pϭ0.18). Conclusions-At 4 months, there was no significant difference in global LVEF between both groups, but a recovery of regional contractile function in previously nonviable scar was observed in the BMC group.

24 children with symptomatic urinary tract infection (UTI) underwent systematically ultrasound studies (US) and 99mTc-DMSA renal scans. Among the 15 patients considered as acute pyelonephritis (APN) on clinical grounds, the scan was abnormal in 12 cases, in contrast with only 1 abnormal scan in the clinical subgroup of the lower UTI. Among the 10 abnormal scans that were repeated later on, 6 did completely normalize. US showed only once a parenchymal appearance suggestive for APN. Our findings suggest that the DMSA scan has to be considered at present as the most sensitive imaging technique for the detection of APN.

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