White blood cell differential counts in severely leukopenic samples: a comparative analysis of different solutions available in modern laboratory hematology

BACKGROUND: We evaluated the efficacy of white blood cell (WBC) differential counts in severely leukopenic samples by the Hematoflow method and by automated hematology analyzers and compared the results with manual counts. METHODS: EDTA-anticoagulated blood samples (175 samples) with WBC counts of 40-990/microL were selected. Hematoflow differential counts were performed in duplicates employing flow cytometry using the CytoDiff reagent and analysis software. Differential counts were also performed using the DxH 800 (Beckman Coulter) and XE-2100 (Sysmex) automated hematology analyzers. The sum of the manual counts by a hematology technician and a resident were used as the manual counts. RESULTS: The total analysis time and hands-on time required by the Hematoflow method were shorter than those required by manual counting. Hematoflow counts were reproducible, showed a good correlation with automated analyzers, and also showed strong correlation with manual counts (r > 0.8) in neutrophils, lymphocytes, and monocytes. None of the cases containing less than 4% blasts as analyzed by the Hematoflow method had blasts in the manual counts, but 8 cases of 21 cases (38.1%) with over 4% blasts by Hematoflow had blasts in manual counts. CONCLUSION: Hematoflow counts of severely leukopenic samples were reproducible and showed a good correlation with manual counts in terms of neutrophil, lymphocyte, and monocyte counts. The Hematoflow method also detected the presence of blasts. Manual slide review is recommended when over 4% blasts are found by Hematoflow.

Positive predictive value of additional synchronous breast lesions in whole-breast ultrasonography at the diagnosis of breast cancer: clinical and imaging factors

PURPOSE: To evaluate the positive predictive value (PPV) of bilateral whole-breast ultrasonography (BWBU) for detection of synchronous breast lesions on initial diagnosis of breast cancer and evaluate factors affecting the PPV of BWBU according to varying clinicoimaging factors. METHODS: A total of 75 patients who had synchronous lesions with pathologic confirmation at the initial diagnosis of breast cancer during January 2007 and December 2007 were included. The clinical factors of the patients were evaluated. One observer retrospectively reviewed the imaging studies of the index breast cancer lesion and the synchronous lesion. The PPV for additional biopsy was calculated for BWBU and various clinical and imaging factors affecting the PPV for BWBU were evaluated. RESULTS: The overall PPV for additional biopsy was 25.7% (18 of 70). The PPV for synchronous lesions detected both on mammography and BWBU, and detected only on BWBU, was 76.9% (10 of 13) and 14.3% (7 of 49), respectively. There was no clinical factor affecting the PPV for BWBU. Among the imaging factors, ipsilateral location of the synchronous lesion to the index lesion (P=0.06) showed a marginal statistically significant correlation with malignancy in the synchronous breast lesion. A mass with calcification on mammography presentation (P<0.01), presence of calcification among the ultrasonography findings (P<0.01), and high Breast Imaging Reporting and Data System final assessment (P<0.01) were imaging factors that were associated with malignancy in the additional synchronous lesion. CONCLUSION: BWBU can detect additional synchronous malignancy at the diagnosis of breast cancer with a relatively high PPV, especially when mammography findings are correlated with ultrasonographic findings.

Glioma Grading Capability: Comparisons among Parameters from Dynamic Contrast-Enhanced MRI and ADC Value on DWI

OBJECTIVE: Permeability parameters from dynamic contrast-enhanced MRI (DCE-MRI) and apparent diffusion coefficient (ADC) value on diffusion-weighted imaging (DWI) can be quantitative physiologic metrics for gliomas. The transfer constant (Ktrans) has shown efficacy in grading gliomas. Volume fraction of extravascular extracellular space (ve) has been underutilized to grade gliomas. The purpose of this study was to evaluate ve in its ability to grade gliomas and to assess the correlation with other permeability parameters and ADC values. MATERIALS AND METHODS: A total of 33 patients diagnosed with pathologically-confirmed gliomas were examined by 3 T MRI including DCE-MRI and ADC map. A region of interest analyses for permeability parameters from DCE-MRI and ADC were performed on the enhancing solid portion of the tumors. Permeability parameters form DCE-MRI and ADC between low- and high-grade gliomas; the diagnostic performances of presumptive metrics and correlation among those metrics were statistically analyzed. RESULTS: High-grade gliomas showed higher Ktrans (0.050 vs. 0.010 in median value, p = 0.002) and higher ve (0.170 vs. 0.015 in median value, p = 0.001) than low-grade gliomas. Receiver operating characteristic curve analysis showed significance in both Ktrans and ve for glioma grading. However, there was no significant difference in diagnostic performance between Ktrans and ve. ADC value did not correlate with any of the permeability parameters from DCE-MRI. CONCLUSION: Extravascular extracellular space (ve) appears to be comparable with transfer constant (Ktrans) in differentiating high-grade gliomas from low-grade gliomas. ADC value does not show correlation with any permeability parameters from DCE-MRI.

Determination of Optimal Imaging Mode for Ultrasonographic Detection of Subdermal Contraceptive Rods: Comparison of Spatial Compound, Conventional, and Tissue Harmonic Imaging Methods

OBJECTIVE: To determine which mode of ultrasonography (US), among the conventional, spatial compound, and tissue-harmonic methods, exhibits the best performance for the detection of Implanon(R) with respect to generation of posterior acoustic shadowing (PAS). MATERIALS AND METHODS: A total of 21 patients, referred for localization of impalpable Implanon(R), underwent US, using the three modes with default settings (i.e., wide focal zone). Representative transverse images of the rods, according to each mode for all patients, were obtained. The resulting 63 images were reviewed by four observers. The observers provided a confidence score for the presence of PAS, using a five-point scale ranging from 1 (definitely absent) to 5 (definitely present), with scores of 4 or 5 for PAS being considered as detection. The average scores of PAS, obtained from the three different modes for each observer, were compared using one-way repeated measure ANOVA. The detection rates were compared using a weighted least square method. RESULTS: Statistically, the tissue harmonic mode was significantly superior to the other two modes, when comparing the average scores of PAS for all observers (p < 0.00-1). The detection rate was also highest for the tissue harmonic mode (p < 0.001). CONCLUSION: Tissue harmonic mode in uS appears to be the most suitable in detecting subdermal contraceptive implant rods.

Medullary Thyroid Carcinoma Presenting as a Predominantly Cystic Mass on Ultrasonography: A Case Report

Most medullary thyroid carcinomas show suspicious malignant features such as hypoechogenicity, a spiculated margin and/or intranodular calcifications, which are well known features of papillary carcinoma. We report here on a case of medullary carcinoma that was seen as a predominantly cystic thyroid mass on ultrasonography. This type of case is not common in the literature and we discuss the way to diagnose a medullary thyroid carcinoma.

Effect of regular oral health care on aggressive periodontitis using Watanabe's tooth brushing method: case report / 대한구강보건학회지

OBJECTIVES: The purpose of this study was to evaluate the effect of regular oral health care using Watanabe's tooth brushing method on aggressive periodontitis. METHODS: A 14-year-old female visited our clinic with the chief complaint of gingival swelling and teeth mobility in 2008. The present illness on the day of visit was gingivitis with swelling and redness on marginal gingiva, root exposure due to the attachment loss and gingival recession and the degree 3 mobility of #26, 36, 46 with no systemic disease and familial tendency. The panoramic radiograph showed the severe vertical and horizontal alveolar bone loss in the first molars. For the treatment, preventive care including tooth brushing instruction and professional tooth brushing using Watanabe's method and periodontal treatment using scaling and root planing, plaque control and antibiotics prescription were performed from the July, 2008 to September, 2012. RESULTS: The patient could maintain all of her teeth without extraction except for one molar during the treatment period and symptoms of gingivitis decreased all over the oral region. But dental plaque level was not decreased. CONCLUSIONS: The regular oral health care with professional toothbrushing by Watanabe's method was effective in relieving the gingival inflammation of patients with aggressive periodontitis.

Delayed Cerebral Metastases from Completely Resected Cardiac Myxoma: Case Report and Review of Literature

Cardiac myxoma is the most common benign tumor of the heart. However, low incidence of recurrence and metastasis has been reported. A 49-year-old female patient was admitted in the hospital due to sudden onset of left side weakness. Magnetic resonance imaging (MRI) of brain showed multifocal areas of diffusion restriction on diffusion weighted images. Echocardiography was performed to evaluate the cause of embolic brain infarction and cardiac myxoma was found in the left atrium. The patient underwent complete excision of the mass. One year later, the patient was readmitted with symptoms of dysarthria. Brain MRI showed newly developed multiple hemorrhagic metastatic lesions. The patient underwent radiotherapy of the metastatic lesions. Although rare, cardiac myxoma can cause delayed metastasis. We report a rare case of delayed multiple cerebral metastases from the completely resected cardiac myxoma.

Diffuse Interstitial Infiltrative Lung Metastasis of Malignant Melanoma: a Case Report

A diffuse interstitial infiltrative pattern of lung metastasis in a patient with malignant melanoma is rare and can be confused with benign conditions such as pulmonary edema or drug-induced pneumonitis. We experienced a case of diffuse interstitial infiltrative lung metastasis in malignant melanoma in a 37-year-old man. This case was confirmed by a transbronchial lung biopsy. We herein describe the findings on CT and positron emission tomography scan.

A Simplified Technique of Percutaneous Hepatic Artery Port-Catheter Insertion for the Treatment of Advanced Hepatocellular Carcinoma with Portal Vein Invasion

OBJECTIVE: We assessed the outcomes of a simplified technique for the percutaneous placement of a hepatic artery port-catheter system for chemotherapy infusion in advanced hepatocellular carcinoma with portal vein invasion. MATERIALS AND METHODS: From February 2003 to February 2008, percutaneous hepatic artery port-catheter insertion was performed in 122 patients who had hepatocellular carcinoma with portal vein invasion. The arterial access route was the common femoral artery. The tip of the catheter was wedged into the right gastroepiploic artery without an additional fixation device. A side hole was positioned at the distal common hepatic artery to allow the delivery of chemotherapeutic agents into the hepatic arteries. Coil embolization was performed only to redistribute to the hepatic arteries or to prevent the inadvertent delivery of chemotherapeutic agents into extrahepatic arteries. The port chamber was created at either the supra-inguinal or infra-inguinal region. RESULTS: Technical success was achieved in all patients. Proper positioning of the side hole was checked before each scheduled chemotherapy session by port angiography. Catheter-related complications occurred in 19 patients (16%). Revision was achieved in 15 of 18 patients (83%). CONCLUSION: This simplified method demonstrates excellent technical feasibility, an acceptable range of complications, and is hence recommended for the management of advanced hepatocellular carcinoma with portal vein thrombosis.

The Effect of Particulate Matter 10 from Asian Dust on the Production of Reactive Oxygen Species, TGF-beta, NF-kappaB, PDGF-alpha and Fibronectin in MRC-5 Fibroblast Cells / 결핵및호흡기질환

BACKGROUND: Dust clouds blown by the wind from the arid deserts of Mongolia and Northeast China are known as Asian dust storms. Ambient particulate matter with a diameter <10 micrometer (PM(10)) is associated with the exacerbation of respiratory diseases and increased mortality of heart and lung disease patients. The fibrotic effects of PM(10) of Asian dust to pulmonary fibroblast cells are unknown. This study examined the production of reactive oxygen species (ROS), TGF-beta, NF-kappaB, PDGF-alpha and Fibronectin in fibroblasts exposed to Asian dust particles. METHODS: Air samples were collected using a high volume air sampler (Sibata model HV500F) with an air flow of 500 L/min for at least 6 hours. The MRC-5 cells were exposed to 0, 50 and 100 microgram/mL of PM(10) for 24 hours. ROS was detected by measuring the level of oxidized DCF using FACS. TGF-beta, NF-kappaB, PDGF-alpha and fibronectin were detected by western blotting. RESULTS: There was no increase in the ROS, TGF-beta and PDGF-alpha levels in the MRC-5 cells exposed to PM(10). The NF-kappaB level was higher in the MRC-5 cells exposed to 50 and 100 microgram/mL of PM(10) for 24 hours. The fibronectin level in the MRC-5 cells after 24 hours incubation with 50 microgram/mL PM(10) was significantly higher than the control group (PM(10) 50 microgram/mL 113.27+/-8.65 of control, p=0.005). CONCLUSION: PM(10) from Asian dust increases the activation of NF-kappaB and fibronectin expression in MRC-5 fibroblast cells.