Sentinel lymph node identification using contrast-enhanced ultrasound in breast cancer: review of the literature.

Before breast cancer surgery, sentinel lymph node (SLN) identification and biopsy using blue dye, radioisotope (RI) with a gamma probe, or a combination of the two are mainly performed. The dye-guided method requires skilled technique to make an incision in the skin and identify SLNs without damaging the lymphatic vessels. In addition, dye-induced anaphylactic shock has been reported. To use the γ-probe-guided method, the facility must be able to handle RI. However, to overcome the drawbacks of these methods, Omoto et al. developed a new identification modality using contrast-enhanced ultrasound with an ultrasound contrast agent (UCA) in 2002. Since then, many basic experiments and clinical studies using various UCA have been reported. In particular, a number of studies in SLN detection using Sonazoid have been reported and are herein reviewed.

Correlation between the 72-hour fatality ratios and out-of-hospital cardiac arrest ratios in patients with extremely high outlier values of 57 laboratory test items: A single-center retrospective inception cohort study.

The association between extremely high outlier values (EHOV) of laboratory test items (LTIs) and short-term prognosis or out-of-hospital cardiac arrest (OHCA) remains unclear. This retrospective study investigated the correlation between 72-hour fatality ratios and OHCA ratios in patients with the top 100 EHOV of 57 LTIs without focusing on the disease group and which test items were predictors of 72-hour fatality. This single-center retrospective inception cohort study enrolled patients aged ≥ 18 years who underwent any combination of laboratory tests at the Saitama Medical Center, Japan between January 1, 2008, and December 31, 2013. The primary outcome was the correlation between the 72-hour fatality ratios and OHCA ratios in patients with the top 100 EHOV for 57 LTIs without focusing on the disease group. The LTIs included hematology, blood chemistry, erythrocyte sedimentation, blood coagulation, and arterial blood gas test results. The secondary outcome was which of the 57 LTIs with the top 100 EHOV were more likely to associate with the 72-hour fatality. We evaluated the correlation between the 72-hour fatality ratios and the OHCA ratios for each laboratory test item using the Passing-Bablok regression method. The 72-hour fatality ratios for the top 100 EHOV of 57 LTIs were significantly positively correlated with the OHCA ratios. The regression coefficient of the regression line was 0.394, and the correlation coefficient (95% confidence interval) was 0.644 (0.458-0.775, P < .001). These 72-hour fatality ratios tended to be lower than the OHCA ratios. The top 100 EHOV of 13 LTIs including total bilirubin, direct bilirubin, C-reactive protein, base excess, bicarbonate ion, creatine kinase, uric acid, partial pressure of oxygen, sodium, chloride, blood urea nitrogen, aspartate aminotransferase, and lactate dehydrogenase had 72-hour fatality ratios that were above the upper limit of the linear confidence region of the regression line, with higher 72-hour fatality ratios than the OHCA ratios. The 72-hour fatality ratios for the top 100 EHOV of 57 LTIs tended to be lower than the OHCA ratios. The top 100 EHOV of these 13 LTIs were found to be more likely to associate with 72-hour fatality than OHCA.

Predicting 72-h mortality in patients with extremely high random plasma glucose levels: A case-controlled cross-sectional study.

ABSTRACT: The risk factors associated with 72-hours mortality in patients with extremely high levels of random plasma glucose (RPG) remain unclear.To explore the risk factors predictive of 72-hours mortality in patients with extremely high RPG under heterogenos pathophysiological conditions.Retrospective, single-center, case-controlled cross-sectional study.University teaching hospital.Adults over age 18 were selected from the medical records of patients at the Saitama Medical Center, Japan, from 2004 to 2013.Extremely high RPG (≥500 mg/dl).Mortality at 72 hours following the RPG test, regardless of hospitalization or in an outpatient setting. Multivariate logistic regression analysis was performed with adjustment for age, sex, body mass index (BMI), and RPG level. The final prediction model was built using the logistic regression model with a higher C-statistic, specificity, and sensitivity.A total of 351 patients with RPG ≥500 mg/dl were identified within the 10-year period. The 72-hours mortality rate was 16/351 (4.6%). The C-statistics of the 72-hours mortality prediction model with serum albumin (ALB) and creatine kinase (CK) was 0.856. The probability of 72-hours mortality was calculated as follows: 1/[1 + exp (-5.142 + 0.901log (CK) -1.087 (ALB) + 0.293 (presence (1) or absence (0) of metastatic solid tumor)]. The sensitivity and specificity of this model was 75.5%.The independent risk factors associated with 72-hours mortality in patients with RPG ≥500 mg/dl are hypoalbuminemia, elevated CK, and presence of a metastatic solid tumour. Further research is needed to understand the mechanisms and possible interventions to prevent mortality associated with extremely high RPG.

Prediction of 72-hour mortality in patients with extremely high serum C-reactive protein levels using a novel weighted average of risk scores.

The risk factors associated with mortality in patients with extremely high serum C-reactive protein (CRP) levels are controversial. In this retrospective single-center cross-sectional study, the clinical and laboratory data of patients with CRP levels ≥40 mg/dL treated in Saitama Medical Center, Japan from 2004 to 2017 were retrieved from medical records. The primary outcome was defined as 72-hour mortality after the final CRP test. Forty-four mortal cases were identified from the 275 enrolled cases. Multivariate logistic regression analysis (MLRA) was performed to explore the parameters relevant for predicting mortality. As an alternative method of prediction, we devised a novel risk predictor, "weighted average of risk scores" (WARS). WARS features the following: (1) selection of candidate risk variables for 72-hour mortality by univariate analyses, (2) determination of C-statistics and cutoff value for each variable in predicting mortality, (3) 0-1 scoring of each risk variable at the cutoff value, and (4) calculation of WARS by weighted addition of the scores with weights assigned according to the C-statistic of each variable. MLRA revealed four risk variables associated with 72-hour mortality-age, albumin, inorganic phosphate, and cardiovascular disease-with a predictability of 0.829 in C-statistics. However, validation by repeated resampling of the 275 records showed that a set of predictive variables selected by MLRA fluctuated occasionally because of the presence of closely associated risk variables and missing data regarding some variables. WARS attained a comparable level of predictability (0.837) by combining the scores for 10 risk variables, including age, albumin, electrolytes, urea, lactate dehydrogenase, and fibrinogen. Several mutually related risk variables are relevant in predicting 72-hour mortality in patients with extremely high CRP levels. Compared to conventional MLRA, WARS exhibited a favorable performance with flexible coverage of many risk variables while allowing for missing data.

A retrospective cross-sectional study for predicting 72-h mortality in patients with serum aspartate aminotransferase levels ≥ 3000 U/L.

Risk factors associated with 72-h mortality in patients with extremely high serum aspartate aminotransferase levels (AST; ≥ 3000 U/L) are unknown. This single-centre, retrospective, case-controlled, cross-sectional study obtained data from medical records of adult patients treated at Saitama Medical Center, Japan, from 2005 to 2019. We conducted a multivariate logistic after adjusting for age, sex, height, weight, body mass index, Brinkman Index, vital signs, biochemical values, updated Charlson Comorbidity Index (CCI) score, CCI components, and underlying causes. A logistic regression model with selected validity risks and higher C-statistic for predicting 72-h mortality was established. During the 15-year period, 428 patients (133 non-survivors and 295 survivors [cases and controls by survival < 72 and ≥ 72 h, respectively]) with AST levels ≥ 3000 U/L were identified. The 72-h mortality rate was 133/428 (31.1%). The model used for predicting 72-h mortality through the assessment of alkaline phosphatase, creatine kinase, serum sodium, potassium, and phosphorus levels had a C-statistic value of 0.852 (sensitivity and specificity, 76.6%). The main independent risk factors associated with 72-h mortality among patients with AST levels ≥ 3000 U/L included higher serum values of alkaline phosphatase, creatine kinase, serum sodium, potassium, and phosphorus.

Rapid Progression of Lung Cancer Following Emergency Caesarean Section Led to Postpartum Acute Respiratory Failure.

Our case patient was a 38-year-old pregnant Japanese woman who underwent emergency Caesarean section because of massive vaginal bleeding due to a low-lying placenta. Immediately after delivery, she presented with rapidly progressive dyspnea. Contrast-enhanced computed tomography revealed bilateral pleural effusion, lung nodules, multiple liver tumors, and multiple osteolytic lesions. Accordingly, epidermal growth factor receptor-mutant advanced lung adenocarcinoma was diagnosed. This report highlights the occurrence of rapid progression of lung cancer following delivery that led to postpartum acute respiratory failure, rather than due to pulmonary thromboembolism associated with the existing deep venous thrombosis of the inferior vena cava.

Vogt-Koyanagi-Harada Disease Associated with Influenza A Virus Infection.

We herein report a case of a 31-year-old Japanese man who simultaneously had a positive influenza A virus antigen test result and Vogt-Koyanagi-Harada disease (VKHD), demonstrated by both diffuse multiple early hyperfluorescent points on fluorescein fundus photography and serous retinal detachments on optical coherence tomography. He had meningitis. It was difficult to determine whether the main cause of meningitis was influenza A or VKHD. After initial treatment with peramivir for influenza A and then methylprednisolone pulse with subsequent corticosteroid therapy for VKHD, his symptoms improved gradually. These findings suggest that influenza A virus infection contributes to the onset or exacerbation of VKHD.

Aortic Intimal Sarcoma Contributes to Atherosclerotic Renovascular Hypertension: An Autopsy Case Report and Review of the Literature.

An autopsy of a 70-year-old man with multiple bone metastases from a malignancy of unknown origin (MUO) and renovascular hypertension revealed an aortic intimal sarcoma (AIS) in the right renal artery accompanied by atherosclerotic changes. AIS appeared as aggregated mutton fat-like translucent particles arising from the intima of the branching portion of the right renal artery and was composed of undifferentiated, fine spindle cells with thicket-like proliferation. AIS was confirmed by immunohistopathology, showing the loss of the lumen lined by CD31-positive endothelium and the expression of CD31, keratin, and vimentin in the viable part of the tumor. In patients with MUO presenting with both bone metastases and an acute or sub-acute onset of renovascular hypertension, AIS in the renal artery may be responsible.

Co-infection with group A Streptococci and Epstein-Barr virus presenting with acute glomerulonephritis and acute left ventricular dysfunction.

Acute pharyngitis is commonly encountered, but a definite etiological diagnosis is difficult. Although co-infection with Group A Streptococci (GAS) and Epstein-Barr virus (EBV) is uncommon, general physicians should consider the possibility of EBV co-infection in patients with GAS pharyngitis who fail to show prompt remission of symptoms following appropriate antibiotic treatment. In this article, we present a rare case of a 16-year-old girl who had co-infection with GAS and EBV. She developed acute glomerulonephritis and left ventricular dysfunction in an overlapping manner. We were able to follow her until she healed, and herein describe the pathogenesis of her systemic and pulmonary edema.