Eicosapentaenoic Acid and Prevalence of Cardiovascular Disease in Hemodialysis Patients

Eicosapentaenoic acid (EPA)/arachidonic acid (AA) ratio showed inverse associations with cardiovascular disease (CVD) in general population. However, this has not been examined enough in dialysis patients. We cross‐sectionally investigated the relationship between EPA/AA ratio and prevalence of CVD in 321 chronic hemodialysis patients (64 ± 11 years old; 110 women; dialysis vintage 10 ± 8 years) in an urban area of Tokyo. CVD was defined as a composite of ischemic heart disease, ischemic stroke and hemorrhagic stroke. The frequency of dietary fish intake was also examined. Logistic regression was used to quantify the association of EPA/AA ratio with CVD. EPA/AA ratio was 0.31 ± 0.19 and 154 patients (48%) consumed fish once or less weekly. One hundred and thirty patients (41%) had CVD, including 65 with ischemic heart disease, 70 with ischemic stroke, and 20 with hemorrhagic stroke. Age (odds ratio [OR], 1.04; P = 0.01), hypertension (OR, 2.25; P = 0.002), and dialysis vintage (OR, 1.04; P = 0.02) were associated with CVD; however, EPA/AA was not after adjustment for other risk factors. A similar relationship was observed between fish intake and CVD prevalence. We did not find any significant association between EPA/AA ratio and prevalence of CVD, although traditional risk factors such as age, hypertension and dialysis vintage were associated with CVD. These results might have been influenced by the fact that only a small proportion of our patients showed a high EPA/AA ratio.     

Multicentric granulocytic sarcoma of the breast: mammographic, sonographic, and MR findings

A rare case of granulocytic sarcoma (GS) of the bilateral breasts after complete remission of acute myelogenous leukemia is reported. Mammogram showed multiple irregular high-density masses, and sonogram demonstrated multiple irregular low-echoic masses with a posterior shadow in the bilateral mammary glands. Contrast-enhanced MR images showed multiple irregular enhancing masses. None of those findings were pathognomonic of GS. However, MR image was useful to evaluate the response of the chemotherapy and detect the nonpalpable relapse tumor and determine the introduction of the radiation therapy early.     

Diagnosis of ectopic pregnancy with MRI: efficacy of T2*-weighted imaging.

PURPOSE: To assess MRI in diagnosing ectopic pregnancy (EP), emphasizing T(2)*-weighted imaging (WI) efficacy. METHODS AND MATERIALS: This is a prospective study of 24 female patients (16 to 41 years, average 29.9) clinically suspected of EP from April 1999 to June 2001. Eighteen had minimal vaginal bleeding and slight abdominal pain. All had positive pregnancy tests, and sonography showed no intrauterine pregnancy despite estimated gestational age of embryos and/or high concentrations of human chorionic gonadotrophin. MRI was performed with a 1.5T imager (Siemens, Vision VB33A) with a body-array coil. T(2)-WI (HASTE), T(1)-WI (2D FLASH), and T(2)*-WI (2D FLASH) were obtained without contrast. T(2)-WI was routinely obtained in 3 directions. T(2)*-WI orientation was determined based on the T(2)-WI. One of 4 radiologists with experience interpreting abdominal MR images interpreted images based on transvaginal ultrasonography (TVUS) and laboratory results. Abnormal adnexal mass with remarkable low signal area on T(2)*-WI was diagnosed as EP. RESULTS: We diagnosed 19 cases as EP. Tubectomy in eighteen and abdominal total hysterectomy in one confirmed diagnosis. In one undergoing diagnostic laparoscopy, EP was denied. In 5 cases diagnosed negative based on the above criterion, no mass was detected in three, and no area of low signal was recognized on T(2)*-WI in the masses in two. EP was denied in four of five, and in one of the five, who underwent tubectomy, EP without bleeding was diagnosed. All EP were tubal pregnancies at final diagnosis, 19 were ampullar pregnancies and one, interstitial. Using MRI to diagnose EP, with T(2)*-WI as a key diagnostic factor, sensitivity was 95%, specificity 100%, and accuracy 96%. CONCLUSIONS: MRI using T(2)*-WI is a sensitive, specific, and accurate method to evaluate EP. T(2)*-WI is highly accurate for detecting and diagnosing EP because of its sensitivity to fresh hematoma.     

A cost-effectiveness comparisons of adult spinal deformity surgery in the United States and Japan

Purpose

Information about the cost-effectiveness of surgical procedures for adult spinal deformity (ASD) is critical for providing appropriate treatments for these patients. The purposes of this study were to compare the direct cost and cost-effectiveness of surgery for ASD in the United States (US) and Japan (JP).

Methods

Retrospective analysis of 76 US and 76 JP patients receiving surgery for ASD with ≥2-year follow-up was identified. Data analysis included preoperative and postoperative demographic, radiographic, health-related quality of life (HRQOL), and direct cost for surgery. An incremental cost-effectiveness ratio (ICER) was determined using cost/quality-adjusted life years (QALY). The cost/QALY was calculated from the 2-year cost and HRQOL data.

Results

JP exhibited worse baseline spinopelvic alignment than the US (pelvic incidence and lumbar lordosis: 35.4° vs 22.7°, p < 0.01). The US had more three-column osteotomies (50 vs 16%), and shorter hospital stay (7.9 vs 22.7 days) (p < 0.05). The US demonstrated worse postoperative ODI (41.3 vs. 33.9%) and greater revision surgery rate (40 vs 10%) (p < 0.05). Due to the high initial cost and revision frequency, the US had greater total cost ($92,133 vs. $49,647) and cost/QALY ($511,840 vs. $225,668) at 2-year follow-up (p < 0.05).

Conclusion

Retrospective analysis comparing the direct costs and cost-effectiveness of ASD surgery in the US vs JP demonstrated that the total direct costs and cost/QALY were substantially higher in the US than JP. Variations in patient cohort, healthcare costs, revision frequencies, and HRQOL improvement influenced the cost/QALY differential between these countries.

     

Loss of apical vertebral derotation in adolescent idiopathic scoliosis: 2-year follow-up using multi-planar reconstruction computed tomography

Purpose

The objective of this study was to evaluate 2 years post-surgical loss of three-dimensional correction in adolescent idiopathic scoliosis (AIS) patients using multi-planar reconstruction computed tomography (CT).

Methods

Twenty-seven AIS patients treated by segmental pedicle screw (PS) constructs were included in this study. Correction in the axial plane was evaluated using the “relative apical vertebral rotation angle” (rAVR), defined as the difference between the axial rotation angles of the upper instrumented vertebra and the apical vertebra on reconstructed axial CT images. The Cobb angle of the main curve and apical vertebral translation was measured to evaluate the coronal correction. Thoracic kyphosis was also measured for the evaluation of sagittal profile. Measurements were performed before surgery, and 1 week and 2 years after surgery. The relationships between the correction losses and skeletal maturity, and variety of spinal constructs were also evaluated.

Results

The mean preoperative Cobb angle of the major curve was 59.1° ± 11.2° before and 13.0° ± 7.2° immediately after surgery. Two years later, the mean Cobb angle had increased significantly, to 15.5° ± 7.8°, with a mean correction loss of 2.5° ± 1.5° (p < 0.001). The mean preoperative rAVR of 28.5° ± 8.4° was corrected to 15.8° ± 7.8° after surgery. It had increased significantly to 18.5 ± 8.4 by 2 years after surgery, with a mean correction loss of 2.7° ± 1.0° (p < 0.001). The mean correction losses for both the Cobb angle and rAVR were significantly greater in the skeletally immature patients. The significant correlations were recognized between the correction losses and the proportion of multi-axial screws, and the materials of constructs.

Conclusions

Statistically significant loss of correction in the Cobb angle and apical vertebral axial rotation angle (AVR) were recognized 2 years after surgery using PS constructs. The correction losses, especially AVR, were more evident in the skeletally immature patients, and in patients treated with more multi-axial screws and with titanium constructs rather than with stainless constructs.     

Familial occurrence of moya-moya disease: report of three Japanese families

Three Japanese families with moya-moya disease in six patients are presented. These six patients were among 49 cases of confirmed moya-moya disease in our experience, and the familial incidence was more than 12%. A relatively high familial incidence (7%) was found in the total Japanese series emphasising the important hereditary components in the pathogenesis of the disease.     

Hepatoid carcinoma of the ovary: a report of three cases admixed with a common surface epithelial carcinoma.

Hepatoid carcinoma of the ovary is an ovarian carcinoma that has phenotypic properties in common with hepatocellular carcinomas. However, the extent of the tumor cells' similarity to and their difference from hepatocytes is largely unknown. In addition, the precursor cell of origin for hepatoid carcinoma of the ovary has not been identified. Three cases of alpha-fetoprotein-producing hepatoid carcinoma of the ovary that were admixed with an adenocarcinoma of common surface epithelial type are reported. The hepatoid carcinomas had a trabecular architecture with canaliculi detected by polyclonal (but not monoclonal) anticarcinoembryonic antigen antibodies. A hepatic phenotype in the hepatoid tumor cells was further supported by the production of albumin mRNA by in situ hybridization. The adenocarcinomas in the three cases were mucinous (Case 1), serous (Case 2), and endometrioid (Case 3), respectively. The cytokeratin (CK) profile in both the hepatoid and adenocarcinomatous components was CK18+/CK19+/CK20+/-, whereas normal and neoplastic hepatocytes were CK18+/CK19-/CK20-. Although this study supports a hepatic phenotype in ovarian hepatoid carcinoma, the CK profile of hepatoid carcinoma differs from that of normal and neoplastic hepatocytes but resembles that of the associated common epithelial adenocarcinoma. These findings suggest that hepatoid carcinoma of the ovary is probably derived from carcinomas of surface epithelial origin by a process of neometaplasia or transdifferentiation.