Diagnostic accuracy of high-resolution MRI using a microscopy coil for patients with presumed DCIS following mammography screening

PURPOSE: To prospectively evaluate the accuracy of high-resolution (HR)-MRI as a secondary examination in women with abnormal calcifications detected on mammography. MATERIALS AND METHODS: We used a 4.7-cm microscopy coil to acquire HR-MRI signal data. We examined 52 women with breast lesions preoperatively using HR-MRI and vacuum-assisted core needle biopsy. The lesions were suspicious of malignancy, classified as category 3-5 on mammography (Breast Imaging Reporting and Data System [BI-RADS]), and without a palpable mass. All visualized suspicious lesions were correlated with histological findings. We compared the HR-MRI and pathological findings and calculated the sensitivity, specificity, and accuracy. RESULTS: We compared the breast HR-MRI results with the gold standard of pathological results for studies of malignancy (DCIS and invasive cancer), and found a sensitivity of 88.5%, specificity of 92.3%, and accuracy of 90.4%. The positive predictive value (PPV) was 92%, and the negative predictive value (NPV) was 88.9%. When breast MRI was compared with pathological results for studies that diagnosed DCIS only, the results revealed a sensitivity of 88.6%, specificity of 88.2%, accuracy of 88.5%, PPV of 93.9%, and NPV of 78.9%. CONCLUSION: HR-MRI using a microscopy coil is a useful, reliable, safe, and minimally invasive procedure that is a good choice for secondary assessment of abnormal calcification in the breast.     

Preface and comments : multi-functions of orexin in physiological and pathological conditions--state of the art

Recent advances in searching endogenous peptide ligands for multiple orphan receptors led to the identification of the new peptides, orexin-A and -B in the hypothalamus. Their function was initially considered to be associated with food consumption. However, these peptides have revealed their multiple functions in physiological and pathological conditions, such as sleep-wake control, the hypothalamic-pituitary-adrenal axis, pain modulation and so on. In the present reviews, I focused on the role of orexin on the norepinephrine and acetylcholine arousal system during anesthesia, the autonomic/endocrine regulation and pain pathways. These state-of-the-art reviews might contribute to the discoveries of the new functions of orexins in the anesthetic fields.     

Left ventricular-right atrial communication resulting from infective endocarditis

We report a rare case of acquired left ventricular-right atrial communication resulting from infective endocarditis. A 57-year-old male with aortic regurgitation due to infective endocarditis was referred to our hospital because of severe congestive heart failure. Preoperative transthoracic echocardiography showed aortic, mitral and tricuspid severe regurgitations. Intraoperative transesophageal echocardiography revealed left ventricular-right atrial shunt. The fistula was located at the atrioventricular membranous septum. The communication site from the left view was below the commissure between the right coronary cusp and non-coronary cusp, and from the right view was just above the tricuspid annulus of the septal leaflet. The fistula was closed directly with mattress suture and aortic valve replacement and both mitral and tricuspid ring annuloplasty were carried out simultaneously. The postoperative course was uneventful. It is important to inspect shunts carefully in echocardiography of infective endocarditis with massive regurgitations.     

Microsomal prostaglandin E synthase protein levels correlate with prognosis in colorectal cancer patients

The aim of this study is to investigate the expression of three prostaglandin E synthase (PGES) isomers in colorectal cancer (CRC) tissue and to evaluate their relationship to clinicopathological factors and patient prognosis. Microsomal PGES (mPGES)-1, mPGES-2, cytosolic PGES (cPGES) and cyclooxygenase (COX)-2 protein expression were analyzed by real-time polymerase chain reaction and Western blot. The localization of each PGES and COX-2 protein was examined by immunohistochemistry in 155 surgical resections and correlated to clinicopathological factors and patient prognosis. mPGES-1 mRNA and protein levels were significantly higher in CRC than in paired normal tissues. mPGES-1 immunoreactivity localized in cancer cells in 43% of cases. mPGES-2 immunoreactivity was significantly more pronounced in cancer cells than in adjacent normal epithelium in 36% of cases. cPGES immunoreactivity was homogeneous in cancer cells and thus determined constitutive. mPGES-1 and mPGES-2 correlated with significantly worse prognosis in stage I–III patients. These results indicate that mPGES-1 and mPGES-2 may each play a role in CRC progression.     

Severe Pneumonia with Leptotrichia sp. Detected Predominantly in Bronchoalveolar Lavage Fluid by Use of 16S rRNA Gene Sequencing Analysis

We present the first case of severe pneumonia possibly caused by Leptotrichia species with oral bacteria. This was found in a healthy but elderly subject whose bronchoalveolar lavage fluid was analyzed by 16S rRNA gene sequencing analysis. The combination of this method and microscopic observation provided useful information for diagnosis and treatment.     

The cellular niche of Listeria monocytogenes infection changes rapidly in the spleen

The spleen is an important organ for the host response to systemic bacterial infections. Many cell types and cell surface receptors have been shown to play role in the capture and control of bacteria, yet these are often studied individually and a coherent picture has yet to emerge of how various phagocytes collaborate to control bacterial infection. We analyzed the cellular distribution of Listeria monocytogenes (LM) in situ during the early phase of infection. Using an immunohistochemistry approach, five distinct phagocyte populations contained LM after i.v. challenge and accounted for roughly all bacterial signal in tissue sections. Our analysis showed that LM was initially captured by a wide range of phagocytes in the marginal zone, where the growth of LM appeared to be controlled. The cellular distribution of LM within phagocyte populations changed rapidly during the first few hours, decreasing in marginal zone macrophages and transiently increasing in CD11c⁺ DC. After 4–6 h LM was transported to the periarteriolar lymphoid sheath where the infective foci developed and LM grew exponentially.     

A case of colon cancer with long-term survival treated by resection of recurrence on the rectum and chemotherapy for lung metastasis

A 69-year-old male was operated on sigmoidectomy for sigmoid colon cancer (SS, N2, H0, P0, M0, stage IIIb) 7 years ago. Two years later, he was diagnosed for rectal cancer and bilateral lung metastases by TBLB. We performed Mile's operation, and the rectal focus was pathologically diagnosed with a recurrence of sigmoid colon cancer. After surgery, chemotherapy with FOLFOX was started for bilateral lung metastases, resulting in CR during the 22 months. But bilateral lung metastases were exacerbated, and then we administered several other chemotherapies. Five years have passed since chemotherapy started, although the focuses tended to progress. Right now, he has been a chemotherapy outpatient for last 5 years.