In this retrospective study, we evaluated the association between the detection of five types of atypical cells in urine sediments and cytodiagnosis results in our hospital. We identified 876 urine sediment specimens with attached comments concerning the detection of atypical cells. Moreover, 348 of 876 cases whose cytological findings were available were included in this study and classified as the benign group (class I–IIIa cytology reports, 109 cases, 28.8%) and the malignant group (class IIIb–IV cytology reports, 239 cases, 63.2%). Thirty cases with class III cytology reports without a or b were excluded from this study. The validity of the atypical comments on the reports was examined. The occurrence ratios of comments about atypical cells in the benign group were as follows: 40.4% included notes about cell clusters, 58.7% about high N/C ratios, 4.6% about nuclear irregularity, 10.1% about hyperchromasia, and 18.3% about recommendations for further analysis. Comments in the malignant group included detection of cell clusters (23.8%), high N/C ratios (82.8%), nuclear irregularity (12.6%), hyperchromasia (29.3%), and recommendations for further analysis (43.9%). The following were the positive predictive values for the malignant group: 56.4%, presence of cell clusters; 75.6%, high N/C ratios; 85.7%, nuclear irregularity; 86.4%, hyperchromasia; and 84.0%, recommended for further analysis. Conclusively, the presence of multiple comments within a single patient case was associated with an increased positive predictive value in the malignant group, confirming that the identification of the five types of atypical cells is a useful screening technique in malignant urogenital diseases.

Background: We established a measurement method for phospholipase-D activity in red blood cells as a pre-investigation for the establishment of a measurement method for phosphatidylethanol (PEth), an alcohol-intake marker, since PLD is related to the generation of PEth. Methods: The present method we developed consists of two reactions (main reaction and removal reaction). First, endogenous choline is removed by choline oxidase (COD) and catalase. Then, the main reaction is started. PLD in blood cells hydrolyzes phosphatidyl choline included in the reagent to phosphatidic acid and choline. Afterward, COD acts on choline and produces H₂O₂. With this H₂O₂, the color reagent changed the color of the reaction mixture. We can detect the PLD activity by this color change. Results: The mean within-run imprecision of three different blood samples was 11.2–12.1% (coefficient of variation). The reaction rate showed a linear relationship with PLD activity up to 120 U/L. The recovery percentages were 94.4% (100 U/L of PLD) and 84.0% (50 U/L of PLD). The comparison of PLD activity between the healthy control group and the patient groups showed the following: the anemia group showed a lower PLD activity, and the obstructive jaundice group showed a higher PLD activity (p < 0.05). The mean PLD activity divided by the hemoglobin concentration was higher in the anemia group than in the healthy control group. This result indicates that the hemoglobin concentration affects the PLD activity. Conclusions: We established a measurement method for PLD activity in red blood cells. By this method, we can determine the PLD activity; however, the quality of precision is not good. We are planning to clarify the relationship between the PLD activity and the generating ability of PEth.

We tested the usefulness of the biochemical assay with VITROS XT7600 (VITROS), which can operate without water supply even in a disaster. VITROS was used as the study instrument and LABOSPECT008 (008) as the control instrument. The assay reagent was VITROS Microslide (VITROS dry), a VITROS-specific reagent, and the 008 reagent was replaced by a VITROS bottle and used in the open channel (VITROS wet). The 008-specific reagents (008 wet) were used as the control reagents. The main biochemical analytes were examined in this study. We evaluated the within-run and between-day precisions and the correlation between assays. All 26 VITROS dry assays showed good within-run and between-day precisions with a coefficient of variation of less than 5%. The within-run precision of the 19 VITROS wet items was also good with a coefficient of variation of less than 5%. The VITROS dry method and the 008 wet method were correlated in 20 of the 26 items. The correlation coefficient (r) was greater than 0.990. The correlation coefficient between the VITROS wet method and the 008 wet method was determined from the r for the 19 items evaluated. The r of the VITROS dry method was greater than 0.9945. In the VITROS dry method, the levels of albumin and amylase differed from those of the 008 wet method in some cases, the cause of which was considered to be the differences in the principles of measurement and reaction substrates. These results suggest that VITROS is useful not only in disasters but also in routine tests.

Our diagnostic center for sonography holds an echocardiographic conference once a week with cardiologists and sonographers (echocardiographic team). However, since April 2020, owing to the spread of COVID-19 infection, we have refrained from holding conferences to prevent the spread of infection. We developed the question format used in the conference and created clinical case questions on the World Wide Web (Web). We delivered a Web-based joint educational program named “FUJITA Echocardiography Webinar” for our hospital and affiliated hospitals on the Web using information technology (IT). Unlike conventional conferences, web seminars or webinars can be attended at any time and place, and the number of participants has increased. Without holding a conference, we were able to provide a fulfilling educational environment not only to our hospital but also to affiliated hospitals. By quantifying the correct answer rate, we were able to clarify the degree of understanding for each disease. For the question with the lowest correct answer rate, it was confirmed that its correct answer rate was significantly improved by distributing the educational program. Another advantage was that the description of free comments clarified the problems and led to improvements. In the future, it is expected that the educational environment on the Web using IT will become more diverse. We believe that it will be possible to collaborate not only with affiliated hospitals but also with regional medical facilities in education and quality control. Furthermore, we believe that the program we developed can be used for recurrent education through collaboration with universities.

Antibody detection reagents for the novel coronavirus SARS-CoV-2 can be classified into two types: those that detect antibodies to the spike protein S1 domain (S) and/or the nucleocapsid protein (N) of SARS-CoV-2. In this study, we evaluated the reactivity of the HISCL^TM SARS-CoV-2 antibody reagent in three cases of COVID-19. In case 1, IgM antibodies were detected when using the HISCL^TM SARS-CoV-2 S-IgM reagent from the time of admission to the hospital (day X). In case 2, SARS-CoV-2 antibodies were detected when using the HISCL SARS-CoV-2 S-IgM, N-IgM, and N-IgG reagents from the X + 1st day, and IgG antibodies were detected from the X + 2nd day when using the HISCL^TM SARS-CoV-2 S-IgG reagent . In case 3, positive results were obtained from X + 12th day for the HISCL^TM SARS-CoV-2 S-IgM and S-IgG reagents. These results suggest that among the HISCL^TM SARS-CoV-2 reagents, the S-targeting antibody reagent could detect SARS-CoV-2 antibodies earlier than the N-targeting antibody reagent.

Low-density lipoprotein cholesterol (LDL-C) is used for risk assessment of various arteriosclerotic diseases. In recent years, Martin’s formula, which is an improvement over the Friedewald equation, has been reported. We compared the homogenous method with LDL-C estimated using the Friedewald equation and Martin’s formula. Correlation analysis with the homogeneous method in healthy subjects showed that the Friedewald equation (Y = 0.956X + 9.690, r = 0.9183, Sy·x = 11.54) and Martin’s formula (Y = 1.019X + 2.425, r = 0.9757, Sy·x = 6.23) were obtained, and Martin’s formula showed a better correlation. When the correlation between the homogeneous method and the estimation formula for triglyceride (TG) level was analyzed, the regression equation for TG levels and LDL-C residuals estimated by the homogeneous method, and the Friedewald equation [Y = −0.0652X + 8.571 (TG < 400), Y = −0.0848X + 26.332 (TG ≥ 400)] and Martin’s formula [Y = 0.0059X + 1.3641 (TG < 400) and Y = −0.027X + 33.872 (TG ≥ 400)] were obtained. These results suggest that Martin’s formula is highly accurate and convenient, approximating the homogenous method, and is a better estimation method than the Friedewald equation.

Antimicrobial susceptibility tests of positive blood cultures are required for the timely treatment of patients with appropriate antibacterial drugs. Antimicrobial susceptibility tests using a single colony typically take three days to complete. Thus, we compared the antimicrobial susceptibility test results of a rapid method using microcolonies obtained after 2 to 4 hours of subculture with those of the standard method using a single colony. The target species were Escherichia coli and Klebsiella pneumoniae. The concordance rate was calculated for E. coli (225 samples) and K. pneumoniae (79 samples). The MIC 1 agreements of the rapid method and standard method were 97.3–100.0% for E. coli and 96.2–100.0% for K. pneumoniae, the category complete agreements were 81.8–100.0% for E. coli and 78.5–100.0% for K. pneumoniae, the major error rates were 0–0.4% for E. coli and 0–2.5% for K. pneumoniae, and the very major error rates were 0–0.4% for E. coli and 0–1.3% for K. pneumoniae. Thus, these findings suggest that the results of the antimicrobial susceptibility test performed using microcolonies formed in the early stage of subculture are reliable and can be reported quickly.

We compared the performance of two glucose analyzers on the basis of the glucose oxidase immobilized enzyme membrane electrode method for both plasma and whole blood measurements. Regarding their accuracy, both analyzers showed good accuracy, and within-run and between-day reproducibilities were also confirmed to have good precision. A high correlation was confirmed for plasma and whole blood samples analyzed with the current equipment and other measurement methods. In whole blood measurement, samples with a high hematocrit showed greater fluctuations of glucose levels, and it was confirmed that the hematocrit greatly affected the whole blood measurement. However, changing the routine work to whole blood measurement eliminates the need for centrifugation, which can lead to more efficient measurement operations and a shorter TAT. As a result, it is conceivable that efficiency could lead to clinical contribution. There are various samples used for blood glucose examination, such as arterial blood, venous blood, plasma, serum, whole blood, and there are multiple methods, and we considered that the measurement accuracy could be ensured by understanding and using the characteristics of samples and methods.

We study the adhesion between a specimen and a glass slide and try to prevent the detachment of intra-operatively obtained frozen HE specimens of the mammary margin. First, we used tissue paraffin sections and the remaining cytology material to study specimen adhesion to a coated glass slide. As a result, we found that to achieve adhesion of specimens that can withstand staining, the paraffin tissue sections must be wetted with water, and both paraffin tissue sections and cytology specimens required adequate water diffusion through drying and dehydration from the adhesion surface to a coated glass slide. Next, we examined the prevention of detachment of intra-operatively obtained frozen HE specimens of the mammary margin, and found that, compared with wet fixation, dry fixation significantly prevented specimen detachment (p < 0.001). Therefore, the choice of the fixation method for specimen preparation was important. In practice, after spray fixation, which is one of the cytological specimen fixation methods, specimen detachment is prevented by drying the specimen, and it was possible to prepare intra-operatively obtained frozen HE specimens of the mammary margin with good staining.

To introduce the Staphylococcus aureus (MRSA) surveillance culture test in our hospital, we compared the characteristics of different MRSA screening media: Methicillin-resistant MDRS-K agar medium (MDRS-K), X-MRSA agar medium (X-MRSA), Chromagar MRSA screen medium (Kanto Chrom) and CHROMagar MRSA II (MRSA II). In the evaluation using 11 preserved S. aureus strains, small colonies of three variant MRSA strains were detected only in X-MRSA and Kanto Chrom, and a culture time of 48 h was required for these three variant strains to become positive. Aerobic-culture-delayed MRSA was detected only in Kanto Chrom and MRSA II after 48 h of culture. Cefoxitin-sensitive MRSA was negative in all media up to 48 h of culture. In the evaluation using patient samples, the sensitivity/specificity/positive predictive values/negative predictive values (%) of MDRS-K, X-MRSA, Kanto chrom and MRSA II after 48 h of culture were 100.0/80.0/42.9/100.0, 100.0/94.9/75.0/100.0, 100.0/89.7/60.0/100.0 and 93.3/95.9/77.8/98.9, respectively. We detected colonies of contaminating bacteria at 48 h of culture, and some of these contaminants were observed to form MRSA-like colonies at 48 h. On the basis of these results, we propose that the surveillance culture test using these screening media needs to continue for up to 48 h. It is possible to judge the presence of MRSA only by the color of its colonies on the screening medium at 24 h. Our study may lead to the establishment of a low-cost, high-accuracy and quick surveillance culture test.

Group B streptococci (GBS) are the most common causative pathogen of neonatal meningitis and sepsis through vertical transmission. The current CDC guidelines for the prevention of perinatal GBS (“Prevention of Perinatal Group B Streptococcal Disease-Revised Guidelines from CDC, 2010”) recommends screening of all pregnant women for GBS colonization at 35–37 weeks’ gestation using enrichment cultures. We compared the enrichment medium for GBS used at six centers and discuss their usefulness. In addition, a direct latex agglutination test was introduced to identify non-hemolytic GBS that may be missed by usual procedures, and thus the GBS detection was performed using three methods: one direct culture and two enrichment cultures (subculture and direct latex agglutination). In a comparison between the direct and enrichment culture methods using the enrichment culture at five of the six centers, we found a 1.0- to 2.0-fold increase in the positivity rate of GBS with an average of 1.4-fold. An additional study was conducted at our hospital for one year, but the number increased 1.6-fold, which however was not significantly different from those from other centers. The results of the subculture and direct latex agglutination methods did not deviate from the GBS identification results in all centers, suggesting that the subculture method can be omitted. The enrichment culture method has a higher rate of detection of infection and seems to be useful in improving the accuracy of perinatal GBS screening.

We evaluated the IFCC-based reagent kit L-type Wako ALP·IFCC and the reactivity of samples under the on-board state. The within-run precision obtained was 0.6%. The dilution linearity and the lower limit of detection were 990 and 5.4 U/L, respectively. The reagent stability in the analysis laboratory and the serum (liver and intestine) ALP activities decreased by 7.9–8.2% after 30 days, but QAP troll IX and IIX were stable (< 3.2%). The correlation coefficient (r) between the IFCC-based reagent and the JSCC-based reagent was 0.997, and the ALP activities determined using the IFCC-based reagent were 37% of the ALP activities determined using the JSCC-based reagent. The basal performance of the IFCC-based reagent is satisfactory and it could be used for measurement with high sensitivity.

To support the transition from the JSCC recommended method of measuring lactate dehydrogenase (LD) and alkaline phosphatase (ALP) to IFCC reference methods, we evaluated the performance of two reagents, Vitros Slides LDHI (LDHI) and Vitros Slide ALKP (ALKP). We obtained good results in terms of repeatability and onboard stability with both reagents. LDHI and ALKP showed linearity up to 510 U/L and 837 U/L, respectively. Regarding the effects of interfering substances such as unconjugated bilirubin, conjugated bilirubin, chyle and ascorbic acid, neither reagents demonstrated any interference effects. Regarding the addition of hemolytic hemoglobin, LDHI levels increased in a concentration-dependent manner, whereas ALKP levels decreased. These IFCC reagents showed good correlation with the JSCC method, and ALKP levels were about 1/3 of reported values. Although the correlations with the IFCC standard method were confirmed, some of the samples showed discrepant results. Such results could be caused by a difference in the ratio of isozymes contained in some samples. The results of this study demonstrated that these reagents, LDHI and ALKP, are compatible with the IFCC method and have sufficient performance for clinical use, which enabled our laboratory to shift quickly to the IFCC method. Correlation studies suggest that the reactivity between these reagents and the standard IFCC wet reagents may differ by depending on the ratio of isozymes contained in samples. Therefore, it is necessary to understand the limitations and characteristics of each reagent and to provide relevant information to the clinical department if needed.

We evaluated a multiplex real-time polymerase chain reaction (PCR) system of the Xpert C. difficile PCR assay (Xpert CD, Beckman Coulter) that detects tcdB of Clostridioides difficile directly from the stool. Loose stool specimens (n = 250) were analyzed by toxigenic culture (TC), Xpert CD, and C. DIFF QUIK CHEK COMPLETE (COMPLETE, Abbott). Given that the results of TC are correct, the sensitivities for toxin were 100% and 17.6% for Xpert CD and COMPLETE, respectively. Seven of the 250 samples showed discordant results among the three methods. The reasons considered were as follows: the levels of toxin were below the detection limit of COMPLETE for two cases, false negative in the TC for four cases, and one CDI case detected only by Xpert CD probably because it is not affected by the viability of the bacterium. These results suggest that Xpert CD is superior to TC. However, considering that false positive/negative results can be obtained in any of these methods, it is important that the diagnosis of CDI requires the evaluation of both clinical symptoms and test results. Replacing TC with Xpert CD may reduce unnecessary infection control owing to its short turnaround time. In conclusion, Xpert CD can be a choice for the accurate and rapid diagnosis of CDI.

Purpose: Cancer genomic medicine is a personalized therapeutic approach that enables the optimal treatment of individuals based on tumor-profiling multiplex gene panel tests. The Hyogo Cancer Center launched a cancer genomic medicine outpatient clinic in June 2018. Here, we show that medical technologists evaluate and prepare specimens for tumor-profiling multiplex gene panel tests and work as cancer genome medical coordinators at this clinic. Methods: The quality and quantity of DNA extracted from the target specimens were measured. The amount of DNA to be submitted for each tumor-profiling multiplex gene panel test was calculated from the size of the specimen, and the appropriate number of sliced specimens were prepared. We also interviewed patients and explained about tumor-profiling multiplex gene panel tests and secondary findings. Results: Gene profiling data were successfully obtained in 94.9% of the patients. The patient interviews enabled us to confirm the patients’ will and whether their statuses match insurance coverage or not. We obtained the consent of 94.2% of the patients interviewed in advance. Conclusions: In providing cancer genomic medicine, medical technologists are expected to play a role as cancer genome medical coordinators, not only by conducting tests and sample management, but also by conducting patient interviews.

To ensure that the precision and standardization of general biochemical test items are of a high level, streamlining the quality control work is one of the challenges for future clinical laboratory work. Our hospital constructed a system for creating internal and external quality control ledgers. From the database, it was possible to improve work efficiency by detecting the possibility of optimizing internal quality control operations and corrective cases requiring external quality control. Making the quality control work more efficient by systematizing it and utilizing a database is considered useful, which would be helpful for the construction of future clinical laboratory work management systems.

Measurement of proteinuria is vital for diagnosing renal disease and determining severity. The urine dipstick test is the most widely used screening method. However, the proteinuria interpretation is affected by urine specific gravity (SG). We collected the medical records of patients (aged < 19 years) from January 2014 to December 2019 at our hospital. This study included 508 patients whose protein levels measured by the dipstick test, urinary protein-to-creatinine ratio (Up/Ucr), and SG were determined concomitantly. These patients were stratified according to their protein levels measured by the dipstick test (5 groups) and SG (4 groups). The percentages of pathological proteins determined using Up/Ucr were calculated for all 5 × 4 cells. Normal Up/Ucr ratios were defined as less than 0.5 for younger than 2 years and less than 0.2 for older than 2 years. In the group whose dipstick test was negative and SG was ≤ 1.010, 25/106 (23.6%) of the patients were considered as having pathological proteins. In children, the urine SG is often low since their kidneys are premature. Hence, the combination of dipstick test results and SG is considered to be more important for children than for adults. Adding SG to urine protein screening should decrease the underestimation of proteinuria.

Amid the ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (COVID-19) pandemic, control and preventive measures against SARS-CoV-2 infection are required to be implemented in medical institutes. In our hospital, a screening approach to detect COVID-19 patients using rapid immunochromatographic tests has been implemented to reduce the risk of infection among the hospital staff and prevent nosocomial infections. Here, we report the outcomes of the screening tests and significance of engaging professional medical technologists licensed by the Japanese government in the triage of patients with scheduled surgery by performing finger-prick blood sampling and evaluating the test results. A total of 325 patients were admitted to the hospital to undergo scheduled surgery under general anesthesia between May 11 and June 17, 2020. Antibodies against SARS-CoV-2 were detected in 16 patients (4.9%) using the immunochromatographic tests. The antibodies identified were IgM and IgG in 14 and 2 patients, respectively. All patients identified to be positive using antibody tests were then subjected to the nasopharyngeal swab examination; however, none of the patients were identified to be positive for SARS-CoV-2 RNA using polymerase chain reaction (PCR) or loop-mediated isothermal amplification (LAMP) assays. Consequently, all surgeries were performed as scheduled, except for five that were postponed for other reasons, and the occurrence of COVID-19 was not reported among patients admitted to our hospital. Our data suggest that antibody testing using rapid immunochromatography could be considered an alternative to the cost- and time-consuming PCR or LAMP assays for screening COVID-19 patients. Furthermore, medical technologists may provide crucial professional clinical laboratory skills as members of the COVID-19 task force.

Our hospital provides flu vaccinations to all employees with no charge. We surveyed all employees who contracted the flu and took a sick leave. On the basis of that survey, we analyzed the morbidities of the 2017–18 (first) and 2018–19 (second) flu seasons. The vaccination coverages for the first and second seasons were 97% (674/696) and 96% (663/693), whereas the disease prevalences were 8.5% (59/696) and 9.5% (66/693), respectively. In both flu seasons, more than 30% of the employees who contracted the flu had no typical symptoms of the flu, such as temperature over 38°C or muscle and joint pain. The percentages of the infected employees who were working on the day before or on the day when they were diagnosed with the flu were 68% (40/59) and 67% (44/66) for the first and second flu seasons, respectively. Among the employees, 47% (28/59) and 33% (22/66) were diagnosed at our hospital outpatient department, and among those, 50% (14/28) and 41% (9/22) had come to the hospital solely for a checkup. From our results, vaccination may be effective in reducing the severity of symptoms. This reduction may be the reason why some employees continued to work despite having some symptoms. To avoid nosocomial infection, we will continue to conduct this survey every flu season and will also ensure that all employees know that even if their symptoms appear to be those of the common cold because the vaccination reduces the severity of flu symptoms, they should consult their family doctors for the flu test, not our hospital.

The rapid detection of methicillin-resistant Staphylococcus aureus (MRSA) is important. In this study, a rapid detection method using MRSA-LA with culture fluid from positive blood culture bottles (direct method) was compared with an antimicrobial susceptibility test and real-time PCR assay. Thirty-seven blood culture isolates that were identified as S. aureus were used. Results showed that 11 isolates were determined to be MRSA and 26 were found to be methicillin-susceptible S. aureus (MSSA) by the antimicrobial susceptibility test. On the other hand, twelve isolates were determined to be MRSA by the direct method and PCR assay. In other words, one bottle with a mixture of MSSA and methicillin-resistant Staphylococcus epidermidis (MRSE) was determined to have MRSA. In conclusion, the detectability of MRSA from blood culture by this method was satisfactory.

The anti-SARS-CoV-2 antibody test is recognized as reliable for the diagnosis of the novel coronavirus infectious disease (COVID-19). Various measurement reagents have been developed, but the characteristics of these reagents have not been sufficiently compared. The aim of this study was to evaluate the characteristics of four reagents used to analyze serum anti-SARS-CoV-2 antibody. The 37 employees of our hospital who had underwent SARS-CoV-2 PCR tests with suspicion of COVID-19 or for having close contacts with confirmed COVID-19 cases were included in this study. Serum samples were obtained and the anti-SARS-CoV-2 antibody was analyzed using the four reagents: Elecsys Anti-SARS-CoV-2 (RUO) (Roche Diagnostics Co., Ltd), ARCHITECT SARS-CoV-2 IgG (Abbott Japan GK), and the two commercial lateral flow immunoassay (LFIA) kits to analyze IgM and IgG, manufactured by Kurabo Co., Ltd. and Artron Laboratories Inc., respectively. The within-run and between-day reproducibilities of all four reagents were excellent. Regarding the dilution test, Elecsys Anti-SARS-CoV-2 (RUO), which measured the total amount of IgM and IgG, had the highest detection sensitivity among the four reagents. However, freezing and thawing of the samples caused unstable results of tests using the LFIA kits. Thus, it is necessary to understand the characterists of a reagent before choosing and using it for the anti-SARS-CoV-2 antibody test.

We performed smears, used two different culture methods (blood culture bottles and agar plates), and studied the isolated bacteria from 55 peritoneal dialysis (PD) effluent samples collected from patients diagnosed with PD-related peritonitis from April 2013 to December 2019. The percentage of gram-positive staining in the smears was 27.2% (15 cases), and the percentage of positive cultures was 81.8% (45 cases), and 58.1% (32 cases) for blood culture bottles, and agar plates, respectively. Thirty-one gram-positive, 23 gram-negative, and 1 fungal strains were isolated. Of note, PD effluent samples were collected by nurses prior to May 2017 (n=43), and by clinical laboratory technicians (n=12) thereafter. Thus, we examined the difference in the percentage of positive cultures before and after this change. The percentage of positive cultures in samples collected by nurses and clinical laboratory technicians were 76.7% (33 cases) and 100% (12 cases), respectively, for blood culture bottles, and 58.1% (25 cases) and 58.3% (7 cases), respectively, for agar plates. These results indicate that the collection of PD effluent samples by clinical laboratory technicians and the use of blood culture bottles improved the detection of microorganisms. Importantly, the identification of the infectious agent is not only important for the selection of appropriate antibacterial drugs but also for the investigation of the route of infection and the education of patients, e.g. revision of the back exchange procedures, and improvement of the home environment and daily life habits.

Intraoperative spinal cord monitoring has been considered useful in preventing the development of C5 palsy, a complication of cervical spondylosis, but it is still under debate. Here, we report the case of a 59-year-old male patient in whom an abnormal free-run EMG waveform was observed to improve during intervertebral foramen magnification. The patient’s chief complaint was numbness and difficulty in raising his right upper limb. He underwent intervertebral foramen enlargement and vertebroplasty, during which intraoperative spinal cord monitoring was performed. During the enlargement of right foramen magnification, there were abnormalities in the free-run EMG waveforms in the deltoid, biceps, and triceps muscles, suggesting nerve root damage, which improved as decompression progressed. There were no abnormalities in the Tc-MEP and SEP waveforms, and there was no postoperative paralysis. Although free-run EMG abnormalities are useful for detecting nerve root disorders, it is important to use direct nerve stimulation to improve the accuracy of the differentiation. When observing free-run EMG abnormalities, it is important to pay attention to the amplitude and frequency of the abnormality as well as the duration of the abnormality in the time series.

A male patient in his 70s presenting with type 2B von Willebrand disease (VWD2B) visited the hematology department of our hospital. He was admitted to the department because of severe anemia and tarry stool. His blood test at the time of hospitalization revealed severe anemia and thrombocytopenia, and large platelet aggregates were observed in the peripheral blood smear. During the treatment course, the platelet aggregates disappeared as the number of platelets increased. The thrombocytopenia and platelet aggregates were found to be correlated. VWD2B may have platelet aggregation and is caused by a mutation in exon 28. Confirmation of platelet aggregation that correlates with thrombocytopenia with a bleeding risk factor is important in the diagnosis of VWD2B.

The patient was a 70-year-old female who presented with atrial fibrillation and atrial flutter in our hospital for catheter ablation. During Cavo tricuspid isthmus (CTI) ablation using radiofrequency, her electrocardiogram showed signs of bradycardia, and we therefore commenced cardiac atrium pacing using an electrode catheter placed in the coronary sinus (CS). Following CTI ablation, a cryoballoon (CB) catheter was introduced into the left atrium and CB was applied from left-sided pulmonary veins (PVs) to right-sided PVs. The patient’s electrocardiogram still showed signs of bradycardia during CB applications on right-sided PVs, and we therefore commenced simultaneous cardiac atrium pacing from the CS and the phrenic nerve via the superior vena cava at 50 beats per minute. The results of all compound motor action potential (CMAP) amplitude tests showed no overlapping QRS waves. Thus, this case suggests that the simultaneous pacing of the cardiac atrium and phrenic nerve can provide effective phrenic nerve monitoring when using compound motor action potentials.

Prostatic adenocarcinoma (PA) cells are rarely detected in urine and pleural effusion cytology specimens. Because of the difficulty in cytological identification of PA cells in cytological specimens, immunohistochemical staining of cell block (CB) preparations is useful for the cytological diagnosis of PA. We report a case of PA diagnosed in the urine and pleural effusion cytology specimens. A 70-year-old man visited our hospital for further assessment of an elevated serum prostatic specific antigen (PSA) level pointed out during a health checkup. Core needle biopsy specimens of the prostate showed adenocarcinoma with obvious nucleoli that formed crowded small glands or fused glands lacking a layer of basal cells. Since metastasis of the prostatic cancer to pelvic lymph nodes and direct invasion into the seminal vesicle were suspected on the basis of magnetic resonance imaging findings, prostatectomy was not performed and hormone therapy was started. Seven years after the initial diagnosis of PA, microscopic hematuria was observed in a laboratory test. Urinary cytology specimens showed adenocarcinoma cells having eccentrically located nuclei with obvious nucleoli either in scattering cells or in cell clusters. The adenocarcinoma cells were immunohistochemically positive for PSA in CB specimens. These findings were consistent with PA. After nine months, computed tomography revealed bilateral pleural effusion. In the pleural effusion cytology, adenocarcinoma cells having the atypical nuclei containing obvious nucleoli formed ball-like clusters. CB specimens of pleural effusion showed adenocarcinoma cells positive for PSA, confirming the diagnosis of pleural metastasis of the PA. The PSA immunohistochemical staining in CB preparations is useful for the confirmation of PA diagnosis based on urinary and pleural effusion cytological findings.

The patient was a man in his 60s, who visited the hospital because of respiratory distress that had continued for three days. A plain chest X-ray showed infiltrative shadows in both lungs, and he was admitted to the hospital with a diagnosis of heart failure. After admission, transthoracic echocardiography (TTE) was performed to evaluate cardiac function. TTE showed diffuse thickening of the left ventricular wall and increased left atrial pressure. The pulmonary valve had a ventral deviation toward the outflow tract during diastole. Regurgitation from the pulmonary valve was mild, but it jets from both ends of the leaflet. Observation with a short-axis image revealed that there were two leaflets, which were suspected to be a bicuspid pulmonary valve. When the previously obtained chest contrast CT images were reconstructed and evaluated, it was confirmed to be a bicuspid pulmonary valve, as shown by TTE. Pulmonary bicuspid valves are rare, and they are often anatomically difficult to evaluate by TTE. In this case, the bicuspid pulmonary valve could be detected by TTE by observing the morphology of the valve by capturing the deviation of the valve belly toward the outflow tract side and the deviation of the regurgitation jet. Furthermore, it was considered that the acoustic window could be secured owing to pericardial effusion among others, which was a factor in identifying the bicuspid pulmonary valve.