Hideyuki Ajisaka

Early electroencephalographic findings in patients with anoxic encephalopathy after cardiopulmonary arrest and successful resusitation

This study investigated whether or not early electroencephalographic (EEG) findings and brain computed tomographic (CT) features reflect the prognosis of comatose patients for 48 h after cardiopulmonary resuscitation (CPR). EEGs and brain CT scans were collected from 21 patients within 72 h after CPR. The EEG findings were classified according to the five Hockaday grades. The Glasgow outcome scale (GOS) applied 3 months after CPR was used for prognosis. Of the nine patients with grade 1 and 2 EEGs, eight had a good outcome (five recovered satisfactorily and three remained moderately disabled). Of the eight patients with grade 4 and 5 EEGs, seven had a poor outcome (three died and four remained in a persistent vegetative state). On the other hand, there was no correlation between early CT features and prognosis except for two severe cases, one whose gray/white matter interface had disappeared and the other with relatively increased density of the thalami, brain stem and cerebellum. These findings suggest that EEG is more useful than CT scan as a diagnostic tool for anoxic encephalopathy after CPR.

A case of lymphocytic mastopathy requiring differential diagnosis from primary breast lymphoma.

Lymphocytic mastopathy is a benign breast disease characterized by dense fibrosis, lobular atrophy, and aggregates of lymphocytes in a periductal and perivascular distribution. The condition affects young to middle-aged women and frequently shows an association with diabetes mellitus or autoimmune disorders. Here, we report a case of the disease clinically and radiologically mimicking primary breast neoplasms. The patient was a 50-year-old woman without diabetes who presented with two firm lumps in her right breast. Breast imaging findings from mammography, ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI), respectively, revealed an abnormal appearance suspicious of malignancy. A core-needle biopsy specimen showed atypical accumulation of lymphoid cells, which was not easy to differentiate from primary breast lymphomas. Moreover, 18fluorodeoxyglucose positron emission tomography (FDG-PET) examination detected abnormal uptake in the same lesions. Histological examination of a surgically obtained specimen showed characteristic appearance of lymphocytic mastopathy, which predominantly consisted of B-lymphocytes. In our case, it was difficult to distinguish this entity from breast cancer or low-grade B-cell lymphoma without surgical biopsy.

Histological subtypes of ductal carcinomain situ of the breast

BackgroundIt has become common to divide ductal carcinomain situ (DCIS) of the breast into two main groups, comedo or noncomedo by tumor morphology. But noncomedo DCIS can be further stratified into several morphological patterns that exhibit several different growth patterns and most DCIS lesions have more than one pattern. In this study, DCIS elements were classified by morphological pattern and the association between predominant or recessive elements of DCIS lesions and clinicopathological findings was evaluated.MethodsDCIS lesions from 46 patients were studied regarding the histological architectural patterns: comedo, cribriform, papillary, solid and micropapillary. The predominant architectural pattern which comprised more than 50% of the cells of the cancerous lesion was defined as the major element of the tumor and minor elements consisted of less than 50% but more than 25% of cells comprising the tumor.ResultsOf 24 tumors containing a comedo pattern as the major or minor element, 9 (38%) had microscopic intraductal spread over 2 cm and 11 (46%) had involvement of lobules, which was significantly higher than that observed in other types. Of 20 tumors containing a cribriform pattern as the major or minor element, 8 (40%) had microscopic intraductal spread over 2 cm and 9 (45%) had involvement of lobules, which was significantly higher than that seen in other types. Of 10 tumors containing a papillary type as the major or minor element, 5 (50%) had discrete multicentric lesions in the ipsilateral or contralateral breast, which was significantly higher than that seen in other types.ConclusionsDCIS lesions containing a comedo or cribriform element are more likely to have microscopic spread and involvement of lobules and DCIS lesions containing a papillary element are likely to be multicentric, whether the pattern are predominant in the tumor or not.

Multiple Repeat Metastasectomies for Recurrences of Colorectal Cancer

Background/Aim: The disease-free interval after resection of the primary tumour was found to be an independent significant prognostic factor for single repeat metastasectomy for colorectal cancer. In the present study, the intervals from resection to relapse for multiple repeat metastasectomies were evaluated. Methods: Sixteen patients who underwent multiple repeat metastasectomies after the first curative resection were studied to determine whether their intervals from resection to relapse were associated with the prognosis. Results: The patients could be classified into three types by the intervals from resection to relapse: (1) the intervals of 4 patients between recurrences were constant and lasted a few years (long-term regular-type group); (2) those of 6 patients were almost constant between recurrences and lasted about 1 year (short-term regular-type group), and (3) the intervals of 6 patients became shorter with each recurrence (shortening-type group). 3 of the 4 patients in the long-term regular-type group, 2 of the 6 patients in the short-term regular-type group, and none of the 6 patients in the shortening-type group are currently alive without recurrence. The survival rate was significantly higher in the long-term regular-type group than in the shortening-type group. Conclusion: For patients with constant intervals of relapse, achieving curative resection is the most relevant prognostic factor for a favourable prognosis after repeat metastasectomies for recurrence of colorectal cancer.