Rinsho byori. The Japanese journal of clinical pathology
-
Today, I will talk about the profession "Ultrasound Technologist." The written examination to gain this license includes clinical questions (35 questions including those using photographs; 70 minutes to answer) and basic questions related to ultrasound for medical use (35 questions including those requiring calculation; 70 minutes to answer). The answer to each question is selected from 5 alternatives. The questions used in the examination are not officially disclosed. ⋯ So, clinical questions are being increasingly adopted that cover recent topics in this field. In any event, knowledge covering extensive areas is needed to prepare for the clinical questions. For those who desire to attain the license "ultrasound technologist" despite insufficient clinical experience, the only possible approach may be to read through collections of questions and reference books.
-
Sepsis is a systemic inflammatory response syndrome (SIRS) caused by infection, and it is one of the major causes of mortality of critical care patients. Since it has been reported that early, optimal treatment of patients is important to reduce mortality from sepsis, a sepsis marker with a high sensitivity and specificity is required. Presepsin (P-SEP) was discovered as a new marker whose levels elevated specifically in the blood of patients with sepsis in Japan in 2002. ⋯ Since one of the production mechanisms of presepsin is related to the phagocytosis of bacteria, the biological characteristics of presepsin are different from those of other inflammatory markers. Presepsin has three features in comparison with procalcitonin(PCT), C-reactive protein(CRP), and interleukin-6 (IL-6): 1) Presepsin can be detected earlier after the onset of infection; 2) Presepsin is not affected by severe trauma, severe burn, or invasive surgical procedures, which lead to SIRS, more than PCT, CRP, or IL-6; 3) Presepsin levels reflect the clinical condition of septic patients. Although clinical evidence is not sufficient at present, presepsin may be a strong tool for the development of novel treatment strategies for sepsis.
-
Spirometry and the flow-volume curve test are commonly performed lung function tests. However, a unique clinical entity occasionally shows almost normal data in these tests, and is therefore missed on screening tests. The clinical entity of combined pulmonary emphysema and pulmdoary fibrosis was recognized and documented in the 90's in Japan, the USA, and Europe. ⋯ As a matter of course, these patients have damaged upper and lower lobes: their diffusing capacity of the lung shows a low performance, their saturation of blood hemoglobin decreases soon after light exercise, and their KL-6 (a blood marker of pulmonary fibrosis) usually shows a high value. They are considered a high risk group regarding complications of post-surgical treatment. Thus, when medical technologists identify suspicious cases, they should advise doctors to add diffusing capacity and KL-6 tests. (Review).
-
Massive transfusion (hemorrhage) is defined as blood transfusion exceeding the circulatory blood volume within 24 hours. Here, we investigated cases of massive transfusion, defined as transfusion of more than 21 units of red blood cells within 24 hours, in our institution in the period from August 2005 to March 2013. Massive transfusion accounted for approximately 1% of all blood transfusions in our institution, and the majority were cardiac surgery cases (75%), with 80% of the cases receiving blood transfusion irtfhe operating theater. ⋯ Through this system, the anesthetists and blood transfusion service staff can check the list of blood products available for the surgical patient as well as those already transfused, on a real-time basis. For analysis of the improvements achieved, we compared the number of non-used blood units, i.e., the number of those provided minus the number of transfused units in the surgical theater, in the period after (2009-2012) and before (2005-2006) the implementation of this computer network system. In the period after its implementation, the number of non-used units decreased from 17.4 units to 7.5 units (P<0.001), leading us to conclude that this system helped avoid the excessive ordering of blood products by the anesthetists. (Review).
-
Chronic obstructive pulmonary disease (COPD) is characterized by the presence of airflow limitation caused by a loss of elastic recoil of the lung and/or small airway remodeling. Emphysema is the major pathological lesion in COPD, defined as the abnormal and permanent enlargement of distal airspaces and destruction of alveolar walls. Emphysema correlates most closely with a loss of elastic recoil of the lung and is associated with both airflow limitation and loss of diffusion capacity, while the airway component contributes mainly to airflow limitation. ⋯ These CT indices shows the morphological changes/abnormalities that correspond to pathological changes. Thus, CT indices reflect pathological abnormality more precisely and have several advantages over pulmonary functions because those can give us regional information that pulmonary function tests cannot offer. Through the rigorous investigation of COPD pathophysiology using these CT indices, some aspects of the COPD course, such as emphysema progression, and the relationship between COPD pathophysiology and systemic manifestations are becoming clear. (Review).