Keiko Hirakawa

Complications after Autologous Fat Injection to the Breast

Background: Although autologous fat injection (fat grafting) to the breast was performed widely throughout the twentieth century, the authors at their hospital have recently had to repair the damage suffered by a number of patients subjected to this procedure. The authors are concerned that this procedure is being performed incorrectly by untrained and untutored individuals, especially in Japan. The authors report several cases of complications after this procedure. Several related issues are discussed. Methods: The authors retrospectively reviewed 12 patients who had received autologous fat grafts to the breast and required breast surgery and/or reconstruction to repair the damage presenting between 2001 and 2007. The symptoms are described and the fat grafting procedures that were used are analyzed. Results: All 12 patients (mean age, 39.3 years) had received fat injections to the breast for augmentation mammaplasty for cosmetic purposes. They presented with palpable indurations, three with pain, one with infection, one with abnormal breast discharge, and one with lymphadenopathy. Four cases had abnormalities on breast cancer screening. All patients underwent mammography, computed tomography, and magnetic resonance imaging to evaluate the injected fats. Conclusions: Autologous fat grafting to the breast is not a simple procedure and should be performed by well-trained and skilled surgeons. Patients should be informed that it is associated with a risk of calcification, multiple cyst formation, and indurations, and that breast cancer screens will always detect abnormalities. Patients should also be followed up over the long-term and imaging analyses (e.g., mammography, echography, computed tomography, and magnetic resonance imaging) should be performed.

Pattern Recognition Analysis of Proton Nuclear Magnetic Resonance Spectra of Brain Tissue Extracts from Rats Anesthetized with Propofol or Isoflurane

Background General anesthesia is routinely used as a surgical procedure and its safety has been endorsed by clinical outcomes; however, its effects at the molecular level have not been elucidated. General anesthetics influence glucose metabolism in the brain. However, the effects of anesthetics on brain metabolites other than those related to glucose have not been well characterized. We used a pattern recognition analysis of proton nuclear magnetic resonance spectra to visualize the changes in holistic brain metabolic phenotypes in response to the widely used intravenous anesthetic propofol and the volatile anesthetic isoflurane. Methodology/Principal Findings Rats were randomized into five groups (n = 7 each group). Propofol and isoflurane were administered to two groups each, for 2 or 6 h. The control group received no anesthesia. Brains were removed directly after anesthesia. Hydrophilic compounds were extracted from excised whole brains and measured by proton nuclear magnetic resonance spectroscopy. All spectral data were processed and analyzed by principal component analysis for comparison of the metabolite profiles. Data were visualized by plotting principal component (PC) scores. In the plots, each point represents an individual sample. The propofol and isoflurane groups were clustered separately on the plots, and this separation was especially pronounced when comparing the 6-h groups. The PC scores of the propofol group were clearly distinct from those of the control group, particularly in the 6-h group, whereas the difference in PC scores was more subtle in the isoflurane group and control groups. Conclusions/Significance The results of the present study showed that propofol and isoflurane exerted differential effects on holistic brain metabolism under anesthesia.

Experimental estimation of postmortem interval using multivariate analysis of proton NMR metabolomic data

Nuclear magnetic resonance (NMR) spectroscopy has recently been applied to metabolic studies. In particular, metabolic profiles of tissues or of the whole body can easily be acquired through multivariate analysis of NMR spectra. The present study investigates metabolic changes after death in rat femoral muscles using pattern recognition of proton NMR spectra. Rats were killed by suffocation, cocaine overdose and induced respiratory failure, and then low molecular weight metabolites extracted using perchlorate from excised tissues were measured using proton NMR. All spectral data were processed and assessed by multivariate analysis to obtain metabolic profiles of the tissues. The results of principal component analysis (PCA) score plots soon after death showed that the metabolic profiles of the tissues differed according to the mode of death. The principal component (PC) scores of the data varied hourly and correlated with postmortem interval. The present results showed that NMR-based metabolic profiling could provide useful information with which to estimate postmortem intervals and causes of death.

Clinical imaging diagnosis of implant materials for breast augmentation.

Background:The ingredients of substances implanted for breast augmentation sometimes remain unknown due to lack of information from patients. Significant clinical problems sometimes necessitate removal and reconstruction. Thus, preoperative diagnostic imaging to identify the ingredients of implants may improve the treatment decision-making process. In this report, we created a clinical imaging index. Purpose:Here, we summarize computed tomography (CT) and magnetic resonance imaging (MRI) imaging of implant materials to predict the ingredients of implant substances preoperatively. Methods:A total of 104 patients with late complications after receiving breast augmentations between 1971 and 2002 were examined using CT and MRI. In addition, further examinations were conducted, including postoperative chemical analysis using Nuclear magnetic resonance (NMR) spectroscopy and MRI imaging of various implanted substances using an experimental magnetic resonance system. Results:We identified the ingredients of implant materials used for breast augmentation by imaging diagnostics as follows: silicone: radiopaque-low/high (CT-MRI T1/T2); hydrogel: radiolucent-low∼iso/high; hydrocarbon: radiolucent-high∼iso/low∼iso; saline: radiolucent-low/high. Conclusion:We have identified by imaging diagnosis the ingredients of implant materials.

High-resolution 3D-MRI of postmortem brain specimens fixed by formalin and gadoteridol.

PURPOSE The purpose of this investigation was to compare magnetization-prepared rapid gradient echo (MP-RAGE) images with T1-weighted images (T1WI) and T2-weighted images (T1W2) of postmortem brain tissue fixed by admixtures of formalin and gadoteridol. We additionally sought to explore the feasibility of using fixed brain magnetic resonance imaging (MRIs) in forensic practices. METHODS Specimens included in the study were eight whole brains that had been removed during forensic autopsy. Brain specimens were randomly divided into three groups and MRIs were performed either (A) the day of autopsy (n=2) on unfixed tissue, (B) after immersion fixation in 20% formalin (n=3), or (C) after immersion fixation in 20% formalin mixed with 4 mL/L ProHance® (gadoteridol) (n=3). T1WI, T2WI, and MP-RAGE images of all group samples were acquired with a 3T clinical MR scanner. Gray and white matter contrasts of the cortex and basal nucleus in every fixation group and image sequence were then visually compared. RESULTS Gray/white matter contrasts of the cortex were good in all images obtained by MP-RAGE, and T1WIs of specimens fixed by formalin and gadoteridol-mixed formalin. Additionally, gray/white matter contrast in the basal nucleus was sufficient in the MP-RAGE sequence of specimens fixed by gadoteridol-mixed formalin. CONCLUSIONS MRI of brains immersion-fixed in formalin and gadolinium could serve as a promising tool for neuropathological assessment in forensic practices.

Measurement of temperature changes in cooling dead rats using magnetic resonance thermometry.

Magnetic resonance imaging thermometry has been introduced as a technique for measurement of temperature changes in cooling dead rats. Rat pelvic magnetic resonance images were acquired sequentially more than 2h after euthanasia by halothane overdose. A series of temperature difference maps in cooling dead rats was obtained with calculating imaging phase changes induced by the water proton frequency shift caused by temperature changes. Different cooling processes were monitored by the temperature difference maps in the rats. Magnetic resonance imaging thermometry applied in the study of laboratory animals could theoretically reproduce a variety of causes of death with different environmental conditions. Outcomes from experimental animal studies could be translated into a temperature-based time of death estimation in forensics.

Visualization of different characteristics of cerebrospinal fluid with acute encephalopathy and febrile seizures using pattern recognition analysis of 1H NMR.

Background:In acute encephalopathy, deterioration of the condition can be rapid, and early intervention is essential to prevent progression of the disease. However, in the acute period, differentiating acute encephalopathy from febrile seizures is difficult. Thus, an early diagnostic marker has been sought to enable early intervention. Proton nuclear magnetic resonance (1H NMR) spectroscopy is used to study the chemical characteristics of biological fluids such as cerebrospinal fluid (CSF). The purpose of this study was to ascertain if pattern recognition of 1H NMR spectra could differentiate CSF obtained from patients with acute encephalopathy and febrile seizures.Methods:CSF was obtained from patients with acute encephalopathy (n = 4), complex febrile seizures (n = 9), and simple febrile seizures (n = 9).Results:NMR spectra of CSF did not visually differ across the three groups. Spectral data were analyzed by partial least squares discriminant analysis and visualized by plotting the partial least squares scores of each sample. The three patient groups clustered separately on the plots.Conclusion:In this preliminary study, we were able to visualize different characteristics of CSF obtained from patients with acute encephalopathy and simple and complex febrile seizures using pattern recognition analysis of 1H NMR data.

Pattern recognition analysis of proton nuclear magnetic resonance spectra of postmortem cerebrospinal fluid from rats with drug-induced seizure or coma

Cerebrospinal fluid (CSF) is routinely subjected to gross evaluation in postmortem investigations; however, its use in chemical evaluations has not been fully realized. Analysis of nuclear magnetic resonance (NMR) spectra with pattern recognition methods was applied to CSF samples. Rats were treated with pentylenetetrazol (PTZ) to induce seizure or pentobarbital (PB) to induce coma, and postmortem CSF was collected after CO2 gas euthanization. Pattern recognition analysis of the NMR data was performed on individual postmortem CSF samples. The aim of this study was to determine if pattern recognition analysis of NMR data could be used to classify the rats according to their drug treatment. The applicability of NMR data with pattern recognition analysis using postmortem CSF was also assessed. Partial Least Squares-Discriminant Analysis (PLS-DA) score plots indicated that the PTZ, PB, and NS (control) groups were clustered and clearly separated. PLS-DA correlation loading plots showed respective spectral and category variances of 41% and 42% for factor 1, and 17% and 27% for factor 2. Thus, factors 1 and 2 together described 58% (41%+17%) and 69% (42%+27%) of the variation, respectively. NMR study of postmortem CSF has the potential to be utilized as both a novel forensic neurochemistry method and in the clinical setting.

Proton nuclear magnetic resonance and pattern recognition analysis of liver extracts from rats under different anesthetics

BackgroundAlthough general anesthesia is widely used in the surgical arena, the mechanisms by which general anesthetics act remain unclear. We previously described alterations in gene expression ratios in hepatic tissue taken from rats treated with anesthetics. Consequently, it is considered that anesthetics influence liver metabolism. Thus, the goal of this study was to use pattern recognition analysis of proton nuclear magnetic resonance spectra to visualize changes in liver metabolic phenotypes in response to widely used intravenous anesthetics (propofol and dexmedetomidine) and inhalational anesthetics (sevoflurane and isoflurane).MethodsRats were randomized into 13 groups (n = 6 in each group), and each group received one of following agents: propofol, dexmedetomidine, sevoflurane, isoflurane, or no anesthetic (control group). The liver was directly removed from rats immediately after or 24 h or 48 h after a 6-h period of anesthesia. Hydrophilic compounds were extracted from the liver and were analyzed with proton nuclear magnetic resonance spectroscopy. All spectral data were processed and analyzed by principal component analysis for comparison of metabolite profiles.ResultsData were visualized by plotting principal component (PC) scores. In the plots, each point represents an individual sample. Each group was clustered separately on the plots, and the PC scores of the propofol group were clearly distinct from those of the control group and other anesthetic groups. The difference in PC scores was more pronounced immediately after completion of anesthesia when compared with 24 or 48 h after completion of anesthesia. Although the effect of intravenous anesthetics on the liver dissipated over time, the effect of inhalational anesthetics persisted.ConclusionsPropofol, dexmedetomidine, sevoflurane and isoflurane exert different effects on liver metabolism. In particular, liver metabolism was markedly altered after exposure to propofol. The effect of anesthesia on the liver under propofol or dexmedetomidine resolved rapidly when compared with the effect under sevoflurane or isoflurane.

190C: NUCLEAR MAGNETIC RESONANCE SPECTROSCOPY AS A USEFUL TOOL FOR INGREDIENT ANALYSIS OF ARTIFICIAL MATERIALS

Introduction: There are a variety of commercially available artificial materials such as hyaluronic acid for dermal filler or even for breast augmentation. However, off-label materials which consist of unknown gradients have been also spread in some countries, which sometimes results in serious problems including erythema, induration and chronic inflammation. In order to identify such materials precisely, we performed chemical analysis of foreign materials postoperatively using nuclear magnetic resonance (NMR) spectroscopy.