Background: Long-standing atrial fibrillation (LSAF) is a risk factor for mitral regurgitation (MR). Conversion to sinus rhythm can be achieved by radiofrequency catheter ablation (RFCA), which is also expected to reduce the severity of MR through reverse remodeling of the left atrium (LA) and the mitral apparatus. However, the severity of MR one year after RFCA is often unpredictable. Methods: To create an appropriate model for the prediction of MR severity one year after successful RFCA, we assessed 50 patients with lone LSAF by transthoracic two-dimensional echocardiography prior to RFCA and one month and one year after RFCA. On the basis of the data obtained from the assessments, three prediction models for MR one year after RFCA were specified and analyzed using multivariate linear regression. Results: A prediction model for MR using variables, such as LA volume index and MR severity in pre-RFCA, and left ventricular ejection fraction, MR severity, and the ratio of the diameter of the anteroposterior annulus to that of the transverse mitral annulus one month after RFCA, best matched the demonstrated MR severity one year after RFCA (sensitivity, 1.00; specificity, 0.795). Excellent relationships between the predicted MR severity and the demonstrated MR severity (r = 0.732) and between changes in the demonstrated MR severity and changes in the predicted MR severity were found.

The coronavirus disease 2019 pandemic has led to the widespread use of molecular diagnostics in many clinical laboratories in Nara Prefecture. Since the results of molecular diagnosis have a significant impact on society as a whole, high accuracy and precision are required. Therefore, the Nara Association of Medical Technologists conducted an external quality assessment (EQA) of the molecular diagnosis of SARS-CoV-2 RNA in July 2021. The EQA samples consisted of three SARS-CoV-2-positive samples and one SARS-CoV-2-negative sample. Two samples with high (sample 1) and low (sample 3) Ct values prepared from patient specimens and commercial SARS-CoV-2-positive control (sample 4) were used as SARS-CoV-2-positive samples, and nuclease-free water (sample 2) was used as a SARS-CoV-2-negative sample. The evaluation was conducted on the basis of qualitative results, and for some reagents, we asked the manufacturer to measure EQA samples and evaluated the results as reference data. Forty tests with 12 different reagents from 26 laboratories were included in this EQA. The correct answers for each sample were as follows: “Sample 1” 62.5% (25/40); “Sample 2” 100% (40/40); “Sample 3” 95.0% (38/40); and “Sample 4” 67.5% (27/40). Since the incorrect results for some reagents were consistent with the manufacturer’s reference data, the detection sensitivity of the reagents and their compatibility with the samples were considered to be the factors. The results of the participating facilities reflected the characteristics of the samples and reagents, indicating the validity of this project. We believe that this EQA will contribute to the continuous maintenance and management of the quality of molecular diagnostics at the participating facilities.

Endothelial dysfunction has been reported to predict future cardiovascular events. Reactive hyperemia index measurement is a noninvasive index of predicting endothelial dysfunction. A reactive hyperemia index of less than 1.67 is usually considered to indicate endothelial dysfunction. However, this value is based on the results of Westerners. In this study, we measured the reactive hyperemia index in 173 patients and then followed them up for 42 ± 11 months. Twenty-two cardiovascular events occurred during the follow-up period. The patients were divided into two groups on the basis of the reactive hyperemia index cutoff value of 1.67, which is commonly used to predict endothelial dysfunction. There was no significant difference in the incidence of coronary risk factors such as hypertension and diabetes as well as cardiovascular events between the two groups. The reactive hyperemia index, which well predicts cardiovascular events and is obtained from the receiver operating characteristic curve, was less than 1.98 in this study. The incidence of cardiovascular events was significantly different between groups divided on the basis of a cutoff value of 1.98. Although a cutoff value of 1.67 has been commonly applied to predict cardiovascular events in Westerners, a higher cutoff value of 1.98 may be appropriate for the Japanese population.

Purpose: Nucleic acid amplification assays for SARS-CoV-2 have been developed rapidly. Our laboratory has been testing for SARS-CoV-2 with Xpert Xpress using nasopharyngeal swab samples. However, the clinical staff requested that saliva samples be tested to prevent secondary infections of the medical staff. Therefore, we introduced GENECUBE^® Model C and GENECUBE^® HQ SARS-CoV-2. We evaluated the heat extraction and magLEAD methods. Methods: ① We prepared a dilution series with AccuPlex and evaluated the results of the two detection methods. ② We added saliva to AccuPlex to prepare a dilution series and examined the effects of the inhibitors on the two methods. ③ We compared the results of the two methods using clinical samples. Results: The LOD of the magLEAD method was 0.25 copies/μL and that of the heat extraction method was 1 copy/μL. From verification ②, the magLEAD method was found to have the same sensitivity as the heat extraction method even when saliva was added, but SARS-CoV-2 could not be detected by the heat extraction method. When verifying the illness days and fluorescence values of 40 clinical samples, the heat extraction method had a significant difference between 1–3 illness days and 4 illness days (p < 0.05). The magLEAD method had no significant difference between them. Conclusion: When using saliva samples, it seems necessary to consider the effects of inhibitors.

Exosomes, which are released by cells in body fluids such as serum and plasma, are nanovesicles containing RNAs and proteins. In recent years, RNAs or proteins within exosomes have attracted considerable attention because they serve as potential diagnostic biomarkers, especially in cancer. In addition, reagents for extracting exosomes from serum and/or plasma have been developed worldwide, but no definite conclusion on their extraction efficiency has been reached. At present, the conventional ultracentrifugation method still remains more reliable than methods using commercial extraction reagents. However, there are many problems associated with ultracentrifugation, such as the need to prepare the equipment and acquire operation skills, making it unsuitable for efficient exosome research and clinical applications. Thus, we are awaiting a reliable method for extracting exosomes using commercially available reagents. In this study, we compared two different commercial kits, ExoRNeasy (QIAGEN), which has been reported to have a high extraction efficiency in the analysis of proteins and mi-RNA, and the newly developed Plasma/Serum Exosome Purification Kit (NORGEN), which has not yet been analyzed elsewhere. An evaluation assay using healthy human plasma was performed by RNA determination and RT-qPCR analysis of the exosome marker CD9. For both RNA quantification and RT-qPCR analysis of CD9, we obtained reliable mRNA extraction results using ExoRNeasy. Thus, we confirmed the reliable extraction of mRNA in exosomes using commercially available reagents. On the basis of these results, we consider that we should proceed with our research on the establishment of novel biomarkers and clinical applications of these kits.

Obesity is a risk factor for many diseases, including diabetes mellitus, the incidence of which has nearly tripled since 1975, and is known to be caused by dietary and other lifestyle-related diseases as well as genetic factors. In this study, to elucidate the effects of genetic factors on individual differences in obesity vulnerability, I focused on four SNPs, including functional polymorphisms of ADRB3 (rs4994), HTR2A (rs6311, rs6313), and NOS1 (rs2682826), and compared the differences in the frequencies of these polymorphisms between nine obese subjects (BMI ≥ 25) and 51 non-obese subjects (BMI < 25) living in a Japanese prefecture. There was no significant difference in the allelic frequency of each SNP between the obese and non-obese groups. In addition, analysis of the combinations of gene polymorphisms showed that they were not associated with the risk of diabetes. Therefore, ADRB3 (rs4994), HTR2A (rs6311, rs6313), and NOS1 (rs2682826) gene SNPs do not appear to be risk factors for obesity.

Recently, the throughput, performance, and usability of automated hematology analyzers have been improved. This time, we had an opportunity to evaluate XR-1000 of the XR-Series Automated Hematology Analyzer newly developed by Sysmex. We evaluated its performance in the detection of immature granulocytes (IGs) and immature platelet fractions (IPFs) as new reportable parameters and the detectability of abnormal cells, in addition to its basic performance evaluation. It showed good performance in terms of repeatability for CBC and good correlation with Sysmex XN-9000, our current analyzer. For DIFF parameters, correlation with microscopy count was also good. Correlation of the IG% with the microscopy count and the Sysmex DI-60 automated digital imaging analyzer and the concordance rate with the microscopy count were also good. Regarding IPF, repeatability and correlation with the XN-9000 were good. In a hemolytic uremic syndrome case, there was an IPF increase that preceded the PLT increase, and the usefulness of IPF as a platelet hemopoiesis marker was indicated. The concordance rate between abnormal flags and microscopy results for blasts, abnormal lymphocytes, and atypical lymphocytes was good. Finally, the visibility of the appearance position of the cell population was improved by the three-dimensional scattergram, which is a new feature displayable in the XR-Series. In conclusion, the XR-Series can rapidly provide clinically useful information and improve operational efficiency.

Fully automated urine sediment analyzers have been commonly used, and this contributes to the automation and optimization of urinalysis. Several types of instrument using digital image analysis or flow cytometry are available. We conducted a comparison study to evaluate the analytical performances of AUTION EYE AI-4510 (hereafter, AI-4510), Atellica UAS800 (hereafter, UAS800), and UF-5000. The focus of this study was on the availability of those devices for holiday/night medical services. We compared the repeatability, correlation, and interference by turbid urine among these three devices by using 561 clinical specimens. All the results of repeatability showed a within ±1 rank variation. We found differences in sensitivity and specificity among the three devices. Although the correlation, which was represented as a ±1 rank match, was almost comparable, UF-5000 showed better correlation with RBC, WBC, and BACT, which are especially important for holiday/night medical services. Regarding the required duration for the measurement of turbid urine specimens, UAS800 showed a constant term, whereas AI-4510 and UF-5000 did not. Since the urinary sedimentation test is a morphological test, there are differences among experiences and individual differences between day and night shift staff. To eliminate these concerns, a urine sediment analyzer is useful. Utilizing the analyzer by taking advantage of it will be helpful to eliminate staff anxiety.

At our hospital, the direct method of antimicrobial susceptibility testing of pathogen-positive blood cultures is performed by the disk diffusion method using the bottle culture medium. However, it is necessary to perform an indirect method to obtain the final result, and this takes several days. Therefore, to shorten the turn around time, we examined an indirect but rapid method (rapid method) for both the identification of causal microorganisms and antimicrobial susceptibility testing directly using the bottle culture medium and the autoanalyser MicroScan WalkAway 96plus (Beckman Coulter). We performed the rapid method using 353 blood culture samples (140 positive for cocci and 213 negative for bacilli) during the period at our hospital, and in parallel, we performed the direct disk diffusion method (disk method) and compared its results with those of the rapid method. About 98.0% were correctly identified by the rapid method. The categorical agreement was 79.2% for the disk method and 94.5% for the rapid method. The rapid method showed better results. The categorical agreement was ≥ 99% for Escherichia coli and ≥ 91% for Klebsiella pneumoniae. Although caution is required depending on the strain and antimicrobial agents, in the case of a single culture, the rapid method can be finished one day earlier than the current system, which is very beneficial in terms of both clinical and diagnostic aspects.

The Japan Society of Clinical Hygiene Technologists proposed “Business Development for Promotion of Team Medicine” to meet the diversifying needs of medical care. This time, we conducted a questionnaire survey to examine how the educational field should be involved in the further development of the future image of medical technologists. We conducted a questionnaire survey using Google Forms with no-name answers and targeted medical technologists and healthcare professionals. 1. Approximately 1/3 of all hospital technologists responded that they were satisfied with their work, and the reasons given by those who were dissatisfied were dissatisfaction with salary and workload. 2. More than half of the hospital technologists were interested in the introduction of artificial intelligence (AI) and its use in test systems and cell morphology identification. 5. The hospital technologists strongly desired to obtain for certifications and academic activities to do in the future. Through this survey, we were able to clarify the current problems that hospital technologists are feeling and facing. In addition, we believe that the roles of educational institutions that are looking toward the future of clinical technologists should include training in research methods and laboratory data processing from the time students are in school. Furthermore, it is important for educational institutions to develop students’ personality, management skills, and communication skills required as medical professionals.

In our hospital, the blood sample collection and injection treatment rooms share the same reception area. However, the current system has a limitation in that while unattended reception is possible for blood sample collection, it cannot be implemented in injection treatment rooms. By updating the electronic medical record system, in addition to solving these problems, we aimed to review the reception method for blood sample collection and in injection treatment rooms, improve patient service, and improve reception efficiency. Therefore, we changed from unmanned reception to manned reception and built the following system. 1. We built an integrated reception system that enables checking different order types on the same screen and accepts them. We also built a comment sending function that conveys patient information to the blood sample collection and injection treatment rooms and a mechanism that links the reception of these rooms. 2. Urinalysis cup labels (specimens, bacteria, pathology) for outpatient urinalysis were put together on one sheet. 3. We developed an integrated progress confirmation system that allows each department and consultation room to manage the progress of patients’ treatment and confirm the whereabouts of patients. This consequently simplified reception processing, enhanced work efficiency, and improved patient service. Additionally, we visualized patient flow lines by providing tools for checking the progress and whereabouts of patients and coordinated the operations of the blood sample collection and injection treatment rooms.

Cryoprecipitates contain high concentrations of coagulation factors such as fibrinogen. Hence, a cryoprecipitate infusion for massive bleeding may reduce blood loss and blood transfusion requirement. We introduced processes for the supply of in-hospital-prepared cryoprecipitates and found changes in transfusion-related clinical parameters in our hospital. In this study, we compared the use and non-use of cryoprecipitates in major and nonmajor cardiovascular surgeries. The parameters compared were the amounts of blood loss, red blood cells (RBC), fresh frozen plasma (FFP), and platelet concentrate administered, the ratio of RBC to FFP (R/F ratio), and the duration of intensive care unit admission. The levels of serum fibrinogen increased after cryoprecipitate infusion. However, the amount of blood loss was greater in use than non-use of cryoprecipitates for both major and nonmajor cardiovascular surgeries. There was no significant differences in RBC and FFP administered for patients use and non-use cryoprecipitates for major cardiovascular surgery. Reducing the requirement of blood products in cardiovascular surgeries requires not only the use of cryoprecipitates but also identifying the cases for which cryoprecipitate infusion is effective as well as changing the minds of the medical staff involved in transfusion therapy.

Clinical laboratory technologists have been dispatched to the Japan International Cooperation Agency’s (JICA) Japan Overseas Cooperation Volunteers program to contribute to the development of clinical laboratories in developing countries. Many of them have experiences that are different from their experiences in Japan. Japan Overseas Cooperation Volunteers have difficulties in achieving results owing to differences in politics, religion, culture, and particular agendas in developing countries. In this study, we investigated the clinical laboratory status and issues in developing countries encountered by Japanese clinical laboratory technologists. The clinical laboratory technologists mainly conducted tests on specimens. Most of the countries received aid from other countries, including Japan; however, issues regarding the ability to continuously purchase reagents after assistance, the establishment of a maintenance system, and the response to failures were identified. The following suggestions were made for JICA and the Japanese Association of Medical Technologists: “opportunity for training in Japan”, “cultivation of Japanese clinical laboratory technologists who can work overseas”, and “providing textbooks on clinical tests in foreign languages”. Furthermore, it was suggested that technology should be provided. Using the survey, we found that it is considered important for Japan to provide “skilled people and material and financial assistance” to developing countries and to continuously share knowledge and technology with them.

Background and purpose: SARS-CoV-2 infection (COVID-19) is difficult to diagnose on the basis of symptoms. By using four virus antigen detection kits of ImunoAce Series and nasopharyngeal samples, we investigated the usefulness of a single-sampling-based qualitative detection of multi-virus antigens (SSD-MVA) including SARS-CoV-2 and four other antigens. Methods: From November 1, 2020 to July 31, 2021, patients who visited the Division for Health Service Promotion in the University of Tokyo and gave consent with a fully filled questionnaire were included in this study. Also obtained was another questionnaire regarding the subsequent 14-day observation period. Results: The SSD-MVA was correctly performed in all 111 patients (80 males; mean age, 30.7 ± 10.8 years), and the questionnaire for the observation period was collected from 94 patients (84.7%). Five patients (4.5%; four males; mean age, 42.6 ± 17.5 years) and 83 patients (74.8%) were diagnosed as having COVID-19 and common cold, respectively. The kit for the SARS-CoV-2 antigen showed three positives in three patients with COVID-19, meaning no false positives, and the SSD-MVA did not show any positives for the other four antigens. Two patients (40%) with COVID-19 likely had a false negative result, while one was diagnosed with SARS-CoV-2 infection 14 days after the SSD-MVA. In four patients with COVID-19, the quantitative antigen test using saliva samples performed on the same day showed a discrepancy with a clarity in the positive line of the qualitative detection kit for SARS-CoV-2. Conclusion: The SSD-MVA including the SARS-CoV-2 antigen is beneficial with 60–75% sensitivity and 100% specificity for SARS-CoV-2. The sensitivity could be improved if the qualitative detection kit were available for saliva samples.

From April 2020, the JSCC method using 2-ethylaminoethanol (EAE) buffer solution has been used to measure alkaline phosphatase (ALP) activity in Japan. It was decided to gradually shift to the IFCC method using a 2-amino-2-methylpropanol (AMP) buffer solution, which is also a commonly used reagent. When our hospital was preparing to switch to the IFCC method, we learned about the training workshop on ALP activity conducted by the Japanese Association of Medical Technologists Kinki Branch and participated in it. Its purpose is “Understand the reagent components of the JSCC method and IFCC method, and be able to prepare them yourself. You can measure and calculate the activity value by yourself. Understand that the activity value differs depending on the ABO blood type.” After preparing the reagents myself for the JSCC and IFCC methods during the practical training workshop, ALP activity was measured using type A, type B, type O, and type AB blood samples collected from subjects before and after a meal. As a result, among the samples analyzed by the JSCC and IFCC methods, type A blood samples showed the lowest ALP activity and type B blood samples showed the highest rate of increase after meals compared with before meals. The ratio of ALP activity determined by the JSCC method to that determined by the IFCC method was approximately 3.0. These results were similar to those in previous reports. Approximately one year after the practical training workshop, the ALP reagent was switched to the IFCC method in April 2021. The knowledge and skills gained from the practical training workshop were useful, and the ALP activity could be measured with confidence. For persons in charge of clinical chemistry tests, it is essential to know the reagent components and characteristics and to be able to measure and calculate the activity value by yourself.

Lactococcus lactis is the most used species in the health food industry, including probiotics. A 74-year-old man presented to our hospital with decreased consciousness. He was hospitalized on suspicion of bacterial pneumonia and congestive heart failure. Blood cultures prepared on admission showed gram-positive chained cocci after 16 h. On hospitalization day 3, the blood cultures showed α-Streptococcus-like colonies positive for bile esculin (BE) and negative for catalase. Moreover, no aggregation was observed in the Lancefield classification test. Therefore, Enterococcus was speculated temporarily as the causative pathogen. On hospitalization day 4, this pathogen was identified using an automatic analyzer as L. lactis subsp lactis, which was consistent with the results of matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS). On hospitalization day 27, the patient’s condition improved after the administration of ABPC/SBT and CTRX; consequently, he was discharged from the hospital. L. lactis is BE-positive and can be easily mistaken for Enterococcus. Therefore, for its accurate identification, it is necessary to use an automatic analyzer and MALDI-TOF MS. In this case, the patient had hypoplasia of the spleen and had a history of daily intake of dairy products. It was considered that L. lactis translocated into the bloodstream through an unknown mechanism, resulting in the development of sepsis.

Xanthine crystals that appear during chemotherapy of tumors have been reported to be rare, and they are characterized as being plate-like. We encountered a case in which we suspected the appearance of xanthine crystals, but instead of seeing plate-like crystals, only granular agglomerates were seen, followed by the appearance of typical xanthine crystals. The patient was a female in her 30s. After remission of Ph-negative B-ALL, she underwent nonrelated peripheral blood stem cell transplantation. After hospitalization, chemotherapy was started. Febuxostat was administered to prevent tumor lysis syndrome (TLS) due to the marked disintegration of tumor cells. On day 7 of admission, urine sediment showed granular agglomerates, which were not identified, followed by the appearance of xanthine crystals on day 38, with plate-like and granular morphological characteristics. Both were soluble in potassium hydroxide and insoluble on heating and in hydrochloric acid and normal saline. On day 7 of hospitalization, the urine had a neutral pH of 7.0 and the urine volume was maintained, suggesting that the xanthine crystals were in the process of forming typical platelets. The urinary sediment suggests that crystals may have been involved in renal impairment. Therefore, the detection of xanthine crystals is highly significant, and it is important to understand that xanthine crystals may not show the typical platelet-like shape as in this case.

The patient was a male in his 60s. He was diagnosed as having acute myeloid leukemia (AML) on the basis of the finding of pancytopenia and blasts in the peripheral blood and 27.4% blasts in the bone marrow. However, because of left pneumonia and abnormally high CRP levels, chemotherapy was postponed to prioritize the treatment of pneumonia. About one month later, the pneumonia improved and the patient showed recovery of hematopoiesis of leukocytes and platelets. Moreover, another bone marrow biopsy revealed a marked decrease in the proportion of blasts to 2.4%. This phenomenon is called spontaneous remission of leukemia, and various causes such as infection, blood transfusions, and drugs have been speculated, but the detailed mechanism is unclear. In addition, this phenomenon is often transient and the disease type may change at the time of relapse; therefore, continued and detailed observation is necessary. Furthermore, when AML is associated with severe infection, the blast percentage may be lower than the baseline blast percentage, so caution is required at the time of diagnosis.

Hematoidin crystals are hemoglobin degradation products that form in the obstructed body cavity under a low-oxygen-tension environment. The presence of hematoidin crystals in urinary sediments has been increasingly observed in recent years. Because of the special environment required for the formation of hematoidin crystals, they rarely appear continuously in urinary sediments. We encountered a case in which hematoidin crystals were continuously observed in the urinary sediment. The patient was a man in his 70s on chemotherapy for prostate cancer. Urinary sediment examination was performed owing to repeated gross hematuria and urinary retention, and hematoidin crystals showing various morphologies were continuously observed. It was presumed that their continuous presence was due to an obstruction inside the bladder caused by urinary retention and repeated bleeding from the bladder tumor. Subsequently, clean intermittent self-catheterization (CIC) was introduced to improve the symptoms, and no hematoidin crystals were observed in the subsequent urinary sediment examination. After the introduction of CIC, urinary retention was reduced, and it was considered that the environment inside the bladder was no longer conducive to the formation of hematoidin crystals. Therefore, it is highly possible that no new hematoidin crystals were formed, and preexisting crystals disappeared. Hematoidin crystals are considered to have clinical significance in the sense that they result from bleeding. From the clinical course of this patient, we infer that if there is persistent bleeding in the bladder, the presence or absence of hematoidin crystals may be a practical index for objectively evaluating if CIC is performed correctly.

A female in her 60s suffered from chronic osteomyelitis of the tibia after injury resulting in an open fracture of the right lower leg. She was treated with various antibacterials and by curettage of the lesion and artificial bone implantation after indwelling cement beads containing antibacterials five times over four years and six months. The patient was admitted to our hospital for radical cure of her chronic osteomyelitis. Staphylococcus capitis subspecies urealyticus was isolated from the lesion on day 45 of hospitalization. Antibacterial susceptibility testing based on the agar dilution method and/or broth microdilution method showed high minimum inhibitory concentrations (MICs) of vancomycin (VCM), teicoplanin (TEIC), and daptomycin (DAP) (4, 64, and 2 μg/mL, respectively). The patient had no history of DAP administration, but the bacterial isolate was not susceptible to DAP. With linezolid administration since day 76, her fever was relieved, the white blood cell count declined, and the macroscopic findings of the wound were improved. The periapical culture was confirmed to be negative for the bacterium on day 79, and the patient was discharged on day 133. In this patient, VCM-containing artificial bone implantation was performed two years and two months after the injury. A long-term exposure to VCM-containing artificial bone implantation might have selected for these bacteria with low susceptibility to VCM, displaying thickened cell walls, which might have resulted in the reduced susceptibility to DAP. When a bacterium with reduced susceptibility to VCM or TEIC was isolated from a patient with a history of long topical exposure to these antibacterials as in this case, it would be important to predict the efficacy of DAP before administration, even if the patient has no history of DAP administration.

An 80-year-old man was diagnosed as having diffuse large B cell lymphoma in the posterior cervix on the basis of results of biopsy performed in another hospital, and he was admitted to our hospital for chemotherapy. Echocardiography revealed a mass in the pericardium, pericardial effusion, and hypokinesis of the left ventricular inferior wall. After four courses of chemotherapy, echocardiography showed reduction of the mass in the pericardium and improvement in the left ventricular inferior wall movement. Moreover, CT showed reduction of the mass in the posterior cervix and pericardium. However, three months later, the mass in the pericardium increased in size and the left ventricular inferior wall movement was reduced in echocardiography. Moreover, PET-CT showed an increase in the mass of the posterior cervix and pericardium again. The posterior cervical mass and pericardial mass decreased in size with chemotherapy. Therefore, we diagnosed the patient as having malignant lymphoma in the posterior cervix with cardiac infiltration. Recent reports have revealed that echocardiography showed pericardial effusion, ventricular wall thickness, and myocardial mass in cardiac infiltration of the hematopoietic tumor. In our patient, the mass in the pericardium and hypokinesis of the left ventricular inferior wall were revealed by echocardiography. Thus, echocardiography is an important tool for diagnosing cardiac infiltration of malignant lymphoma.

The patient is a female in her 30s, who has been drinking large amounts of alcohol for more than 10 years. Transthoracic echocardiography (TTE) showed enlargement of the left atrium and left ventricle and diffuse wall motion decline in the left ventricle. In addition, severe mitral regurgitation and moderate tricuspid regurgitation were observed, IVC expanded, and respiratory fluctuation decreased. Alcoholic cardiomyopathy (ACM) was suspected on the basis of her history of heavy drinking and TTE findings, and she was instructed to stop drinking and start medical treatment. In a re-examination about two months later, she said that she had reduced her alcohol intake. Follow-up TTE showed that her left atrium and left ventricle shrank, and her wall hypokinesia improved. Mitral regurgitation and tricuspid regurgitation were also mild, and IVC respiratory fluctuations were good. ACM is a secondary cardiomyopathy and is characterized by dilated cardiomyopathy-like myocardial damage due to long-term overdose of alcohol. In Europe and the United States, it has been reported that alcohol is involved in 23 to 40% of cases showing dilated cardiomyopathy-like pathology, and that abstinence from alcohol or a decrease in alcohol intake improves cardiac function and prognosis. This patient was also suspected of having ACM because she suffered from myocardial damage due to long-term alcohol overdose, and her cardiac function improved after abstinence from alcohol. In addition, the left ventricle was enlarged again when she increased her alcohol intake again. ACM seems to change not only the heart size but also cardiac functions such as left ventricular contractility depending on alcohol intake, and when ACM is suspected, follow-up by TTE is considered useful.