Purpose: To quantitatively analyze ultrasound elastographic findings and histopathological images of patients with ductal carcinoma in situ (DCIS) and determine the predictors of a low elastography score. Subjects and Methods: Eighteen patients with a confirmed diagnosis of DCIS after surgery performed between January 2012 and August 2013 were included. We calculated cancer cell density and lumen density from histopathological images and examined their association with elastography scores. Patients were classified into low and high score groups according to an elastography score of 1 to 3 and 4 to 5, respectively, and into mass and non-mass abnormality groups according to lesion type. Differences in cancer cell density were determined between groups. Results and Discussion: The most common score was 2, which was seen in nine patients. The elastography scores were positively correlated only with cancer cell density. The low score group had a larger number of patients (n=13) and a significantly lower cancer cell density compared with the high score group, while the non-mass abnormality group had a larger number of patients (n=11) and a significantly lower cancer cell density compared with the mass group. In addition, the pathohistological subtype of non-mass abnormalities was comedo type in four patients, papillary type in three patients, low papillary type in two patients, and solid type in two patients. Conclusion: A low cancer cell density may be a predictor of a low elastography score in DCIS patients.

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Purpose: Ultrasound examination of enthesitis is used to diagnose spondyloarthritis (SpA) early and to evaluate SpA activity. We used the Glasgow ultrasound enthesitis scoring system (GUESS) to screen and evaluate SpA. GUESS defines the cut-off values for the thicknesses of entheseal insertions. However, the thicknesses of entheseal insertions among Japanese individuals is not known. We aimed to clarify the normal thicknesses of entheseal insertions in the lower limbs of Japanese individuals. Subjects and Methods: We evaluated subclinical sites in 77 individuals (770 sites) to screen for SpA and excluded persons with radiographic evidence of enthesophytes, inflammatory bowel disease, psoriasis, and collagen diseases such as SpA and rheumatoid arthritis. Results and Discussion: We evaluated 41 insertions of the quadriceps muscle, 58 insertions of the proximal patellar tendon, 53 insertions of the distal patellar tendon, 24 insertions of the Achilles tendon, and 39 plantar fascia. The mean thickness of quadriceps muscle insertions was 5.11 mm (95% confidence interval [CI], 4.88-5.34, p<0.01). The mean thickness of proximal patellar tendon insertions was 3.25 mm (95% CI, 3.08-3.43, p<0.01). The mean thickness of distal patellar tendon insertions was 3.84 mm (95% CI, 3.64-4.05, p<0.01). The mean thickness of Achilles tendon insertions was 4.16 mm (95% CI, 3.90-4.43, p<0.01). The mean thickness of the plantar fascia was 2.69 mm (95% CI, 2.46-2.92, p<0.01). Conclusion: Our results provide a useful guide for the average thicknesses of entheseal insertions among Japanese individuals. The normal thicknesses should be validated in a larger Japanese cohort to consider factors such as activities of daily living, body shape, participation in sports, sex, radiographic evidence of enthesophytes, and disease.

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Purpose: Pulse wave velocity (PWV) is the propagation velocity of the pressure wave along the artery due to the heartbeat. The PWV becomes faster with progression of arteriosclerosis and, thus, can be used as a diagnostic index of arteriosclerosis. Measurement of PWV is known as a noninvasive approach for diagnosis of arteriosclerosis and is widely used in clinical situations. In the traditional PWV method, the average PWV is calculated between two points, the carotid and femoral arteries, at an interval of several tens of centimeters. However, PWV depends on part of the arterial tree, i.e., PWVs in the distal arteries are faster than those in the proximal arteries. Therefore, measurement of regional PWV is preferable. Methods: To evaluate regional PWV in the present study, the minute vibration velocity of the human carotid arterial wall was measured at intervals of 0.2 mm at 72 points in the arterial longitudinal direction by the phased-tracking method at a high temporal resolution of 3472 Hz, and PWV was estimated by applying the Hilbert transform to those waveforms. Results: In the present study, carotid arteries of three healthy subjects were measured in vivo. The PWVs in short segments of 14.4 mm in the arterial longitudinal direction were estimated to be 5.6, 6.4, and 6.7 m/s, which were in good agreement with those reported in the literature. Furthermore, for one of the subjects, a component was clearly found propagating from the periphery to the direction of the heart, i.e., a well known component reflected by the peripheral arteries. By using the proposed method, the propagation speed of the reflection component was also separately estimated to be -8.4 m/s. The higher magnitude of PWV for the reflection component was considered to be the difference in blood pressure at the arrivals of the forward and reflection components. Conclusion: Such a method would be useful for more sensitive evaluation of the change in elasticity due to progression of arteriosclerosis by measuring the regional PWV in a specific artery of interest (not the average PWV including other arteries).

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A 58-year-old man received a diagnosis of idiopathic hypertrophic cardiomyopathy at another hospital in 2004, and he was also told he had proteinuria at around the same time. After his doctor referred him to our hospital for worsening renal function in March 2011, he was diagnosed with chronic kidney disease (stage IV). Abdominal computed tomography demonstrated bilateral renal atrophy; therefore, renal biopsy was withheld. Conservative medical therapy was then started. Transthoracic echocardiography (TTE) performed at the initial visit showed concentric left ventricular hypertrophy (interventricular septum; IVS 16 mm) and diastolic dysfunction. He stopped visiting our hospital for the reason of general fatigue after December 2012. However, he returned to our hospital with complaints of nausea and anorexia in April 2013. He progressed to end stage renal disease, and hemodialysis was initiated. TTE showed progression of left ventricular hypertrophy (IVS 18 mm) and diastolic dysfunction. His sister had Fabry disease, and he was also suspected of having the same disease. He had deficiency of alpha-galactosidase A activity in peripheral leukocytes and the genetic mutation. These findings confirmed that he had Fabry disease. Despite 6 months of enzyme-replacement therapy, TTE revealed progressive left ventricular hypertrophy (IVS 21 mm) and diastolic dysfunction. While Fabry disease is rare, this case highlights the importance of an early diagnosis of Fabry disease among patients with left ventricular hypertrophy and chronic kidney disease.

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A 79-year-old woman visited our hospital because of lower abdominal discomfort. She had been taking lansoprazole for gastroesophageal reflux disease during the past three months. Abdominal CT showed thickening of the sigmoid colon wall. Abdominal ultrasound showed thickening of the sigmoid colon wall with unclear stratification. Colonoscopy revealed a longitudinal ulcer of the sigmoid colon. Histopathological assessment of biopsy specimens showed deposition of a collagen band beneath the epithelium and inflammatory cell infiltration in the lamina propria. These findings were consistent with collagenous colitis. After discontinuation of lansoprazole, her symptom improved and thickening of the sigmoid colon wall resolved.

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Premature constriction of the ductus arteriosus (PCDA) has a comparatively good prognosis if diagnosed early in utero and appropriately treated. If patients whose ductus arteriosus has closed completely are treated at the incorrect time, however, blood flow to the fetal lungs increases and thickening the smooth muscle layer of the pulmonary artery occurs, as well as potentially fatal complications such as fetal right heart failure, fetal hydrops, and persistent pulmonary hypertension of the newborn (PPHN). We report a case of serious atypical PCDA complicated by PPHN in which fetal diagnosis proved lifesaving. A 27-year-old gravida 1, para 1, who had not experienced any complications during her previous pregnancy and delivery underwent a non-stress test at 36 weeks gestation that revealed mild variable deceleration. Fetal echocardiography showed that on three-vessel view and three-vessel trachea view, compared to the aorta, the ductus arteriosus was dilated and blood flow was absent; therefore, the patient was transferred to a tertiary care facility at 38 weeks 4 days of gestation. This case resembled a regular PCDA in that the right ventricular lumen was dilated and the right ventricular ejection fraction (24%) and the right ventricular fractional area change (3.6%) were both low; in addition, the Tei index was high at 1.16, but was atypical in terms of the thinning of the ventricular wall and low right ventricular pressure. The development of this state, despite the fact that the ductus arteriosus had not completely closed, cannot be explained solely in terms of “afterload mismatch” of the right ventricle; although other possibilities such as impaired coronary perfusion must be considered, there were no findings that directly explained the condition, and many points remain unclear. It is conceivable, however, that atypical thinning of the right ventricular myocardium and low right ventricular pressure may be indicative of increased severity of PCDA.

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Introduction: We report a case that presented with polyhydramnios and resulted in a diagnosis of a very rare anomaly, i.e., otocephaly, at 29 weeks of pregnancy. Case: The patient was 29 years old and gravida 0. She had asthma and was being treated with inhalants including fluticasone propionate. She experienced nausea and was referred to our center from her first physician owing to the polyhydramnios at 29 weeks’ pregnancy. After she was hospitalized for preterm labor, three-dimensional ultrasound precisely demonstrated craniofacial anomalies including agnathia, protuberance of the nose-mouth fusion, and synotia. The fetus was diagnosed with otocephaly. After informed consent was obtained, we decided not to treat her or her baby aggressively. She left the hospital at 29 weeks and 6 days of pregnancy. A male newborn weighing 1,304 g was delivered at 30 weeks’ gestation. Death occurred spontaneously 21 minutes after birth. Discussion: Otocephaly has been reported to occur in fewer than 1 in 70,000 births. It has been reported that theophylline, beclomethasone, and salicylates are causes of otocephaly, but the anomaly strikes suddenly. Three-dimensional ultrasound is useful, and screening at around 20 weeks of pregnancy is recommended for early prenatal diagnosis.

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Meckel’s diverticulum is one of the representative diseases that causes melena in childhood. ^99mTc scintigram is performed for a definitive diagnosis. However, we still encounter false-negative cases. We report a case of Meckel’s diverticulum in a 3-year-old girl in which abdominal ultrasonography findings served as diagnostic clues for the operation, despite the negative findings of ^99mTc scintigram. She visited our hospital with vomiting and melena. We found a low echoic intraabdominal mass like a target sign approximately 11 mm in size with rich blood flow. In addition, she had blueberry-like melena after enema. Therefore, we considered Meckel’s diverticulum. However, ^99mTc scintigram was negative. We performed surgery because the ultrasonographic findings did not change. We found an invagination caused by Meckel’s diverticulum. This case demonstrates that it is possible to make a diagnosis of Meckel’s diverticulum with abdominal ultrasonography even if ^99mTc scintigram is negative.

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