Among infants wearing disposable diapers, there is an increased risk of UTI as the frequency of changing diapers decreases.

Our findings suggest that SCG prevents FDEIA caused by wheat allergy.

Objective: Cytological examination is inexpensive and relatively simple to carry out and deserves utilization in breast cancer screening. We investigated the status of cytological diagnosis at seven facilities in southern Fukuoka Prefecture, Japan. Methods: We collected data on the criteria for cytological judgments and status of breast cytological diagnosis at seven different facilities in this region. Results: Among 5693 individuals who underwent breast cytological examination, analyses were conducted on 1250 individuals (22.0%) in whom cytological diagnoses were confirmed by histological diagnoses. Among these patients, cytological diagnosis had an absolute sensitivity of 71.9%, a specificity of 76.0%, a false-negative value of 6.7% and a false-positive value of 0.08%. At three facilities with relatively large numbers of cases (.300), excluding a facility for specialized breast disease, similar trends of high complete sensitivity (94.3, 95.6 and 97.1%, respectively) and low absolute sensitivity (60.4, 74.8 and 57.2%, respectively) were found. No false-negative or false-positive cases were seen in individual facilities with relatively low numbers of cases (,150). Conclusions: The accuracy of cytological diagnosis at the facilities we surveyed was relatively high compared with the goals of assessment of diagnostic accuracy. However, the performance was dependent on the facility type, i.e. number of cases, staff involved and whether it was specialized or not, making the diagnosis specific for this region. We recommend that management of the accuracy of cytological diagnosis be undertaken jointly by multiple facilities to establish systems in Japan that lead to more useful diagnostic tools.

Late onset toxic epidermal necrolysis induced by mogamulizumab, an anti-CC chemokine receptor 4 antibody for the treatment of adult T-cell leukaemia/lymphomaTo the Editor Adult T-cell leukaemia/lymphoma (ATLL) is a rare type of highly aggressive peripheral T-cell malignancy induced by infection with human T-cell leukaemia virus type 1 (HTLV-1) [1]. Acute and lymphoma types of ATLL particularly display an aggressive clinical course with a poor outcome because of the resistance to conventional combination chemotherapies [2]. Mogamulizumab (MOG), a defucosylated humanized monoclonal antibody targeting CC chemokine receptor 4 (CCR4), has recently been launched for treatment of ATLL; almost all ATLL cells express CCR4 [3]. On the other hand, skin rashes have been reported as significant adverse effects of MOG [3]. It is often difficult to distinguish between a skin lesion caused by MOG and an ATLL lesion, and the detail characteristics, clinical course and treatment are still unclear, particularly in severe events including Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). Here, we report a case of TEN induced by MOG for the treatment of ATLL, which developed at a very late phase after the last infusion of MOG.A 77-year-old man was introduced to our hospital for general fatigue, palpitation and abnormal lymphocytes in peripheral blood. He was diagnosed as having acute type of ATLL by flow cytometry analysis and detection of HTLV-1 antibody. He received low-dose etoposide as an initial treatment; however, lung infiltration of ATLL cells was demonstrated by bronchoalveolar lavage and transbronchial lung biopsy 7 months after diagnosis. Because combination chemotherapies were considered to be a high risk for his general condition, MOG monotherapy was started for 8 months. Detail clinical course of the patient following the treatment of MOG was shown in Figure 1. At the initial infusion of MOG, an infusion reaction was diagnosed for the rapid development of respiratory failure, hyperthermia and systemic skin rash. Three courses of MOG monotherapy were given in combination with a steroid, and MOG was then discontinued owing to a grade 4 adverse effect of thrombocytopenia. He achieved complete remission in both peripheral blood and lung lesions after the therapy. Serum soluble interleukin-2 receptor levels were also significantly decreased from 6290 to 1190 U/ml. On day 5 after the last infusion of MOG, he developed systemic erythema. The skin lesions were improved by administration of 1 mg/kg of prednisolone; however, it was exacerbated again during the tapering of prednisolone. The results of a skin biopsy on day 30 after the last infusion of MOG were consistent with a drug eruption rather than an ATLL lesion. We increased the level prednisolone; however, the lesions continued to progress. On day 42 after the last infusion of MOG, a total of 25% of epidermal necrolysis and erosion, enanthema of the scrotum and systemic symptoms including fever had developed [ Figure 2(A) and (B)], leading to the diagnosis ...

BackgroundWe previously investigated the current status of breast cytology cancer screening at seven institutes in our area of southern Fukuoka Prefecture, and found some differences in diagnostic accuracy among the institutions. In the present study, we evaluated the cases involved and noted possible reasons for their original cytological classification as inadequate, indeterminate, false-negative and false-positive according to histological type.MethodsWe evaluated the histological findings in 5693 individuals who underwent cytological examination for breast cancer (including inadequate, indeterminate, false-negative and false-positive cases), to determine the most common histological types and/or features in these settings and the usefulness/limitations of cytological examination for the diagnosis of breast cancer.ResultsAmong 1152 cytologically inadequate cases, histology revealed that 75/173 (43.6%) cases were benign, including mastopathy (fibrocystic disease) in 38.6%, fibroadenoma in 24.0% and papilloma in 5.3%. Ninety-five of 173 (54.9%) cases were histologically malignant, with scirrhous growing type, invasive ductal carcinoma (SIDC) being significantly more frequent (49.5%) than papillotubular growing type (Papi-tub) (P < 0.0001), solid-tubular growing type (P = 0.0001) and ductal carcinoma in situ (DCIS) (P = 0.0001). Among 458 indeterminate cases, 54/139 (38.8%) were histologically benign (mastopathy, 30.0%; fibroadenoma, 27.8%; papilloma, 26.0%) and 73/139 (52.5%) were malignant, with SIDC being the most frequent malignant tumor (37.0%). Among 52 false-negative cases, SIDC was significantly more frequent (42.3%) than DCIS (P = 0.0049) and Papi-tub (P = 0.001). There were three false-positive cases, with one each of fibroadenoma, epidermal cyst and papilloma.ConclusionsThe inadequate, indeterminate, false-negative and false-positive cases showed similar histological types, notably SIDC for malignant tumors, and mastopathy, fibroadenoma and papilloma for benign cases. We need to pay particular attention to the collection and assessment of aspirates for these histological types of breast disease. In particular, several inadequate, indeterminate and false-negative cases with samples collected by aspiration were diagnosed as SIDC. These findings should encourage the use of needle biopsy rather than aspiration when this histological type is identified on imaging. Namely, good communication between clinicians and pathological staff, and triple assessment (i.e., clinical, pathological and radiological assessment), are important for accurate diagnosis of aspiration samples.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/7349809170055423