Utility of an upright-type 11-gauge stereotactic vacuum-assisted biopsy device （Mammotome@） for the diagnosis of breast microcalcifications

Objective： The aim of this study was to evaluate the utility of an upright-type 11-gauge stereotactic vacuum-assisted biopsy device （Mammotome@） for the diagnosis of breast microcalcifications Methods： Between May 2001 and October 2005, 154 biopsies in 152 patients with microcalcifications were performed using the upright-type 11-gauge stereotactic vacuum-assisted biopsy device. Patients in whom this biopsy was diagnosed as carcinoma or a borderline lesion, had a subsequent surgical excision of the lesion. Histopathological and radiological features of the two specimens were then compared with each other. Results： Microcalcification was identified on specimen mammograms and microscopic slides in 97.4% of cases. Of 154 Mammotome biopsies 98 （63.6%） were benign, 51 （33.1%） were malignant, 3 （1.9%） showed atypical hyperplasia, and 2 （1.3%） were indeterminate, respectively. Of the 48 cases that received surgical excision, 6 of 36 ductal carcinomas in situ （16.7%） upstaged to invasive ductal carcinoma and 1 of 2 atypical ductal hyperplasias was upstaged to ductal carcinoma in situ. The positive predictive value of the 11-gauge Mammotome for the diagnosis of invasion in breast cancer was 100%. Linear calcification and pleomorphic calcification linear/segmental distribution was reliable indications of malignancy. The mean follow-up time of the benign lesions was 22 months, and without evidence of lesion growth. Complications included vasovagal reactions （6.3%）, bleeding （0.6%） and hematoma （2.6%）. Conclusion： The upright stereotactic 11-gauge Mammotome procedure is an effective and reliable method for the diagnosis of breast microcalcifications. It has minimal side effects. For lesions diagnosed as ADH or DCIS with the 11-gauge Mammotome, subsequent surgical excision should be performed.     

Cervical myelopathy due to OPLL: clinical evaluation by MRI and intraoperative spinal sonography

BACKGROUND: Concerning the relationship between morphology and clinical outcome, there have been many reports using computed tomography/myelography but not so many using axial magnetic resonance imaging (MRI) of the spinal cord. This is the first report to correlate axial cord image, intensity changes in MRI, and cord expansion pattern using intraoperative ultrasonography. OBJECTIVE: The objectives were to correlate MRI studies, axial cord images/expansion, and changes in MRI intensity to see if there is a direct prognostic significance to these changes and to determine whether preoperative axial MRI images of the spinal cord predict recovery from compressive myelopathy. METHODS: Posterior cervical decompressions with laminoplasty were performed in 44 patients with cervical myelopathy due to ossification of the posterior longitudinal ligament. On T2-weighted MR images, the cross-sectional shape of the cord at the level of maximal compression was categorized as boomerang, teardrop, or triangle. Additionally, with use of intraoperative ultrasonography, the expansion pattern of the cord that occurred intraoperatively was contrasted with that seen on postoperative MR images. RESULTS: Clinical recovery rates were the worst for those with triangular, intermediate for those with boomerang, and the best for those with teardrop shape. Preoperative low T1 and high T2 signals were found in most cases with triangular cord configurations. Triangular cord configurations showed the least expansion among the three categorized spinal cords. CONCLUSION: Patients with triangular deformity of the cord have atrophy as confirmed on MR studies where there is a low T1 and high T2 signal in the cord. Poor postoperative clinical recovery correlates with the lack of postoperative cord expansion on either MR or ultrasound evaluations. Those with either teardrop or boomerang deformities demonstrate a relatively good recovery rate.     

Effects of bile-acid-binding resin (colestimide) on blood glucose and visceral fat in Japanese patients with type 2 diabetes mellitus and hypercholesterolemia: an open-label, randomized, case-control, crossover study

ObjectiveThe objective was to examine the effects of colestimide on blood glucose, visceral fat, adipocytokines, and bile acid conjugate fractions in Japanese patients.MethodsThis study was an open-label, randomized, case–control, crossover study of colestimide 3 g/day in 40 Japanese patients with type 2 diabetes mellitus (T2D) and hypercholesterolemia. Patients were assigned to the colestimide group in which pravastatin and colestimide were administered orally and to the statin group in which pravastatin alone was administered orally. The principal outcome measures were serum lipid levels, fasting plasma glucose level in the early morning, hemoglobin A1c (HbA_1c), visceral fat area (VFA), and serum 1,5-anhydroglucitol (1,5-AG) level.ResultsSerum low-density lipoprotein cholesterol levels significantly decreased from 113±38 mg/dl at baseline to 90±20 mg/dl (P=.009) at week 12 of colestimide administration. HbA_1c significantly decreased from 7.4%±0.9% at baseline to 6.9%±0.9% (P=.001) at week 12 of colestimide administration. Serum 1,5-AG levels increased from 9.4±10.1 μg/ml to 12.4±9.5 μg/ml (P=.05) at week 12 of colestimide administration. The statin group showed no significant changes in lipids and 1,5-AG. However, ΔVFA was inversely correlated with Δcholic acid, and multivariate analysis revealed that ΔVFA was a significant explanatory variable.ConclusionsColestimide holds promise not only for the treatment of hypercholesterolemia but also for the possible improvement of T2D and visceral fat obesity.     

Online reporting system for transfusion-related adverse events to enhance recipient haemovigilance in Japan: A pilot study

BackgroundA surveillance system for transfusion-related adverse reactions and infectious diseases in Japan was started at a national level in 1993, but current reporting of events in recipients is performed on a voluntary basis. A reporting system which can collect information on all transfusion-related events in recipients is required in Japan.MethodsWe have developed an online reporting system for transfusion-related events and performed a pilot study in 12 hospitals from 2007 to 2010.ResultsThe overall incidence of adverse events per transfusion bag was 1.47%. Platelet concentrates gave rise to statistically more adverse events (4.16%) than red blood cells (0.66%) and fresh-frozen plasma (0.93%). In addition, we found that the incidence of adverse events varied between hospitals according to their size and patient characteristics.ConclusionThis online reporting system is useful for collection and analysis of actual adverse events in recipients of blood transfusions and may contribute to enhancement of the existing surveillance system for recipients in Japan.     

hKAP1.6 and hKAP1.7, two novel human high sulfur keratin-associated proteins are expressed in the hair follicle cortex

Hair fiber differentiation involves the expression of both hair keratin intermediate filament proteins and their associated proteins, termed keratin-associated proteins. In this study, cDNA clones encoding two novel keratin-associated proteins were isolated from human hair follicle mRNA. The predicted amino acid sequence derived from these clones revealed that these proteins represent members of the human keratin-associated protein 1 family. They show strong sequence homology to two previously described keratin-associated protein 1 family members hKAP1.1 A and hKAP1.1B. We have called these new proteins hKAP1.6 and hKAP1.7, respectively. RNA in situ hybridization studies of human anagen hair follicles using a conserved probe for these four keratin-associated protein 1 members demonstrated the expression of this group in the differentiated portions of the hair cortex.     

Changes in Expression of Connexin 32, Bile Canaliculus-Like Structures,and Localization of Alkaline Phosphatase in Primary Cultures of Fetal Rat Hepatocytes

We devised an experimental design in primary cultures of fetal rat hepatocytes for studying hepatocyte differentiation over a short period. In the present study, hepatocytes were first cultured for 3 days in dexamethasone-supplemented medium and then for an additional 3 days in dexamethasone- or epidermal growth factor-supplemented medium. In hepatocytes cultured continuously in dexamethasone-supplemented medium, the expression of connexin 32 increased and bile canaliculus-like structures and localization of alkaline phosphatase in the plasma membrane around bile canaliculus-like structures were maintained. Few cells incorporated bromodeoxyuridine. On the other hand, in most of the hepatocytes cultured in epidermal growth factor-supplemented medium, the expression of connexin 32 was minimally recognized, bile canaliculus-like structures were shortened or eliminated, and alkaline phosphatase was localized as numerous fine spots throughout the cytoplasm. More than 20% of all hepatocytes incorporated bromodeoxyuridine.The present study suggests that in hepatocytes, there is a close relationship among connexin 32 expression, the maintenance of bile canaliculus-like structures, and the localization of alkaline phosphatase to the plasma membrane around the bile canaliculus-like structures, and this indicates that the present experimental model is useful for studying hepatocyte differentiation over a short period.