Satomu Morita

Usefulness of High Suction Pressure for Sufficient Tissue Collection During Endobronchial Ultrasound Guided Transbronchial Needle Aspiration

Introduction The optimal suction pressure during endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) remains to be determined. The aim of this study was to compare suction pressures for performance in collecting sufficient tissue specimens from mediastinal and hilar lymph nodes during EBUS-TBNA. Methods Retrospective analysis of consecutive patients with mediastinal and hilar lymphadenopathy who underwent EBUS-TBNA over a 3-year period. Results from patients who underwent EBUS-TBNA using a dedicated 20-mL VacLoc (Merit Medical Systems, Inc, South Jordan, UT) syringe (conventional method, group C) were compared with results from patients in whom a disposable 30-mL syringe (high pressure group, group H) was used. The yield for sufficient histologic specimen retrieval and amount of tissue obtained were compared between the 2 groups. Results Of 178 patients who underwent EBUS-TBNA, 131 had lung cancer confirmed by EBUS-TBNA: 35 in group C and 96 in group H. There were 7 patients in group C and 6 in group H who received final diagnoses by cytology alone. There were 28 in group C and 90 in group H who were diagnosed by both cytology and histology. There was a statistically significant difference between the groups in terms of the rate of sufficient sampling for histological specimens (p = 0.04). The H group revealed a tissue area approximately twice that of the C group (p = 0.003). There were no major procedure-related complications in either group. Conclusion Higher suction pressures with larger syringe volumes during EBUS-TBNA may be useful for safely collecting sufficient tissue specimens.

Tubular nephrotoxicity induced by docetaxel in non-small-cell lung cancer patients

Renal dysfunction is a characteristic of many patients with cancer; however, a standard therapy has not been established for stage III or IV non-small-cell lung cancer (NSCLC) complicated with chronic renal failure. Docetaxel has a proven significant activity against NSCLC. This agent is predominantly eliminated by hepatobiliary extraction and is safe in patients with renal failure, including dialysis patients. Docetaxel is, thus, a therapeutic option in that patient population. Here, we report acute tubular nephrotoxicity secondary to docetaxel in NSCLC patients, even in patients with normal renal function. Little is known about tubular nephrotoxicity induced by docetaxel; however, oncologists should be aware of its possibility.

Usability of Histological Assessment of Cerebellar Granule Cell LayerRegardless of Postmortem Interval

We often encounter many decomposed cases in the forensic science fields. Damage to organs by bacteria complicates our diagnosis, examination and study. The central nerve system is one of the most hardly decomposed organs. The cerebellar granule cell layer (GCL) is useful for some investigation. We histologically evaluated cerebellar GCL of decomposed and fresh cases using Photoshop™ application. No statistical difference was found between two groups. In addition, we grouped by agonal situation and histologically evaluated cerebellar GCL. We could only show the statistical difference between carbon monoxide (CO) poisoning and house fire because of shortage number of some groups, but the comparison of the box plots suggested some relations between GCL and agonal situation. We suggest conservation of histological findings of cerebellar GCL regardless of postmortem interval and usability for detecting agonal situation.

Successful retreatment with osimertinib after osimertinib-induced acute pulmonary embolism in a patient with lung adenocarcinoma: A case report

Pulmonary embolism (PE) can be life-threatening, and it is challenging to diagnose because of its nonspecific signs and symptoms. PE is also an important potential risk of osimertinib treatment, however, clinical courses regarding retreatment after osimertinib-induced acute pulmonary embolism remain unclear. We described a 77-year-old woman with postoperative recurrent lung adenocarcinoma who developed osimertinib-induced acute PE. She received apixaban and was later successfully retreated with osimertinib. This case suggests that retreatment with osimertinib after osimertinib-induced acute PE may be a treatment option when alternative therapeutic options are limited.

A Survey of Solitary Deaths in Japan for Shortening Postmortem Interval Until Discover/ Студија На Смртни Случаи На Самци Во Јапонија За Скратување На Постмортем Интервалот До Откривањето

Abstract Recently in advanced nations, the number of solitary households is increasing. Data from Japanese population survey in 2010 showed that the percent of solitary households was 32.4% and that was the largest category of household types. The Japanese government regards solitary death as important problem, but a useful survey on solitary death has not been performed. We have focused on the postmortem interval until discovery of the death as a measure of solitary deaths. We conducted a survey of 582 forensic autopsy cases in the Osaka medical examiner’s office over three years, from April in 2010 till March in 2012. We excluded suicide cases. We collected data on the, gender, age, postmortem interval (PMI) until discovery, family structure, situation of discovery of the body, cause of death, and the time interval from the last hospital visit. Here, we found that people who had high risk of solitary death ranged in, age from 60 to 69 which is the age of retirement for many people. In order to prevent solitary death, we suggest that people who live alone should take better care of themselves and participate in a community setting after their retirement. We can show that the recent efforts of the Japanese government for reducing solitary death had been working well. The government care givers take care of the person living alone almost like their own family. We also suggest that the people who unfortunately do not have any home care should subscribe to a newspaper for shortening the PMI. Во последно време во развиените земји бројот на домаќинствата на самци се зголемува. Податоците од истражувањето на населението во Јапонија во 2010 година покажаа дека про- центот на домаќинствата на самци беше 32,4% и тоа беше најголемата категорија на типови до- маќинство. Јапонската влада ја смета смртта на самците како голем проблем, но сè уште не е на- правено корисно истражување за оваа пробле- матика. Ние се фокусиравме на постмортем ин- тервалот до откривањето на смртта, како мерка за смрт на самци. Спроведовме студија на 582 случаја од об- дукција на судска медицина во Одделот за медицински истражувања во Осака во период од три години, од април 2010 година до март 2012 година. Ги исклучивме случаите на самоубиство. Собравме податоци за полот, возраста, пост- мортем интервалот (PMI) до откривањето, се- мејната структура, ситуацијата на откривањето на телото, причината за смртта и временскиот интервал од последната посета на болница. Откривме дека луѓето кои имале висок ризик од смрт на самци беа на возраст од 60 до 69 години, што е возраст на пензионирани лица. Со цел да се спречи смртна самци, укажуваме на тоа дека луѓето кои живеат сами треба подобро да се грижат за себе и да учествуваат во општес- твеното опкружување по нивното пензиони- рање. Може да укажеме дека напорите што ги вложува јапонската влада за намалување на смртта кај самци даваат резултати. Владините лица за давање нега се грижат за самци речиси како за свои родители. Исто така, укажуваме на тоа дека луѓето кои, за жал, немаат домашна нега е пожелно да се претплатат на весници, а со тоа ќе се скрати PMI.

Immunohistochemical evaluation of hypoxia markers in the myocardium

Some proteins, termed hypoxia markers, are more highly expressed in hypoxic cells including ischemic cells. We evaluated the timing of the expression of various hypoxia markers and their specificity of expression in the myocardium in various causes of death. We selected two cases for each cause of death from the forensic autopsies performed by our department and evaluated the diffuse expression of hypoxia markers in the myocardium. We also evaluated the focal expression of these markers in the ventricles of five sudden cardiac death cases. We found that the expression of hypoxia markers in the myocardium varied depending on the cause of death and length of the dying process. This information may help in determining the cause of death in forensic medicine. In particular, we identified RBM3 and CCC9 as markers for ischemic heart disease. Immunohistological staining of myocardium with hypoxia markers could help to find the cause leading to death.

Classification of Contraction Bands Using Immunohistochemistry

AbstractPathological contraction bands (CBs) are a type of necrosis pattern found in the myocardium. The composition of CB is not well studied. This is because CBs have diverse forms and can be observed in various causes of death. In pathology fields, CBs are classified artifactual CB and CB necrosis. We have identified different forms of CB by examining the expression and distribution of complement component C9 (CCC9) and Sirtuin1 by immunohistochemistry in the myocardium of patients who died because of different causes of death. We used cardiac tissues with CB from 30 forensic autopsy cases in our department from the last 2 years. We excluded the cases that had very little CB. We found that our CB classification based on expression levels of both CCC9 and Sirtuin1 correlated well with the agonal situation, including high temperature, myocardial infarction, cardiopulmonary resuscitation, and hypothermia. On the basis of these results, we here advocate a classification scheme based on immunohistochemistry. Furthermore, we found that CB necrosis could be detected using immunostaining with CCC9. Using our classification scheme, it will be possible to more accurately research each type of CB and the causative mechanisms.

Clinical course of acute chemical lung injury caused by 3-chloropentafluoropene.

Perfluoroallyl chloride (PFAC), a fluorine-containing compound, has very severe toxicity, but this toxicity is not well characterised. We report a fatal case of acute chemical lung injury caused by the inhalation of PFAC. A 39-year-old man, working at a chemical factory, inhaled PFAC gas and died 16 days later of acute lung injury with severe pneumothorax. We present his clinical course together with thoracic CT findings, autopsy and analysis of PFAC in blood and urine samples with gas chromatograph–mass spectrometry. Previously, a fatal case of PFAC was reported in 1981 but PFAC was not identified in any of the patients samples. In our patient, we identified PFAC in both blood and urine samples. Our toxicological analysis may be used as a reference to detect PFAC toxicity in the future. Our study should be helpful for diagnosing lung injury induced by a highly toxic gas, such as PFAC.

Histochemical and Morphological Characteristics of the HassallâÂÂs Corpuscles. The Stress Affects Involution of the Ectopic Intra-Thyroidal and the Normal Position Thymus and Morphological Changes of the HassallâÂÂs corpuscles

We encountered three cases of the intra-thyroidal ectopic thymus at autopsy and also performed three autopsy cases consisted of mothers and children, and children with severe stress. The morphological and immune histochemical characteristics of the Hassall’s corpuscles were examined in those in ectopic and normal positioned thymus, and in the thymuses obtained from mothers and children, and children with severe stress. The Hassall’s corpuscles obtained from ectopic and normal positioned thymus showed resemble morphology and stainability with antibodies. These results indicate the Hassall’s corpuscles in the intra-thyroidal ectopic thymuses also possess the biological significance.

Strangulated Transomental Hernia with Intestinal Necrosis: An AutopsyCase

Transomental openings are usually congenital. Transomental hernia is a rare cause of intestinal obstruction. A 36-year-old female was found to have a transomental hernia at autopsy. We report the case of the strangulated intestinal obstruction with no past history.