1.Congenital Coronary Artery Fistula Associated with Infective Endocarditis of the Mitral Valve
Masahiro Ohno ; Tadashi Omoto ; Makoto Mohri ; Masaomi Fukuzumi ; Masaya Ohi ; Takahisa Okayama ; Noboru Ishikawa ; Takeo Tedoriya
Japanese Journal of Cardiovascular Surgery 2008;37(5):264-267
A 54-year-old woman complained of prolonged fever. Echocardiography showed severe mitral regurgitation with vegetation, and computed tomography showed right coronary artery (RCA) fistula to the coronary sinus (CS). Blood culture revealed Strep. viridans, thus a diagnosis of active infective endocarditis was established. The patient underwent urgent surgery. Surgical findings showed that vegetation was located in A3 to P3 of the mitral valve. The patient underwent mitral valve repair using a glutalualdehyde-treated autologous pericardial patch and artificial chordea. Epicardial ligation for fistula was performed. Her postoperative course was uneventful.
2.Predictive Factors for Inaccurate Diagnosis of Swollen Lymph Nodes in Endoscopic Ultrasound-Guided Fine Needle Aspiration
Yuki FUJII ; Yoshihide KANNO ; Shinsuke KOSHITA ; Takahisa OGAWA ; Hiroaki KUSUNOSE ; Kaori MASU ; Toshitaka SAKAI ; Keisuke YONAMINE ; Yujiro KAWAKAMI ; Toji MURABAYASHI ; Fumisato KOZAKAI ; Yutaka NODA ; Hiroyuki OKADA ; Kei ITO
Clinical Endoscopy 2019;52(2):152-158
BACKGROUND/AIMS: This study aimed to identify the predictive factors for inaccurate endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) diagnosis of swollen lymph nodes without rapid on-site cytopathological evaluation. METHODS: Eighty-three consecutive patients who underwent EUS-FNA for abdominal or mediastinal lymph nodes from January 2008 to June 2017 were included from a prospectively maintained EUS-FNA database and retrospectively reviewed. The sensitivity, specificity, and accuracy of EUS-FNA for the detection of neoplastic diseases were calculated. Candidate factors for inaccurate diagnosis (lymph node size and location, needle type, puncture route, number of passes, and causative disease) were evaluated by comparison between accurately diagnosed cases and others. RESULTS: The final diagnosis of the punctured lymph node was classified as neoplastic (65 cases: a metastatic lymph node, malignant lymphoma, or Crow-Fukase syndrome) or non-neoplastic (18 cases: a reactive node or amyloidosis). The sensitivity, specificity, and accuracy were 83%, 94%, and 86%, respectively. On multivariate analyses, small size of the lymph node was the sole predictive factor for inaccurate EUS-FNA diagnosis with a significant difference (odds ratios, 19.8; 95% confidence intervals, 3.15–124; p=0.0015). CONCLUSIONS: The lymph node size of <16 mm was the only independent factor associated with inaccurate EUS-FNA diagnosis of swollen lymph nodes.
Diagnosis
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Endoscopic Ultrasound-Guided Fine Needle Aspiration
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Endosonography
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Humans
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Lymph Nodes
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Lymphatic Diseases
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Lymphoma
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Multivariate Analysis
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Needles
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Prospective Studies
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Punctures
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Retrospective Studies
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Risk Factors
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Sensitivity and Specificity