論文

Region of interest (ROI) coding is a useful function for many applications. JPEG2000 supports ROI coding and can decode ROIs preferentially regardless of the shape and number of the regions. However, if the number of regions is quite large, the ROI coding performance of JPEG2000 declines because the code-stream includes many useless non-ROI codes. This paper proposes a wavelet-based ROI coding method suited for multiple ROIs. The proposed wavelet transform does not access any non-ROIs when transforming the ROIs. Additionally, the proposed method eliminates the need for unnecessary coding of the bits in the higher bit planes of non-ROI regions by adding an ROI map to the code-stream. The experimental results show that the proposed method achieves a higher peak signal-to-noise ratio than the ROI coding of JPEG2000. The proposed method can be applied to both max-shift and scaling-based ROI coding.

真性多血症とIgA腎症の合併報告は稀で,合併例でのlgA腎症は重症のことが多く,両者がお互いの進展を促進している可能性も想定されている.症例は55歳男性.以前より真性多血症を指摘され, 1～2カ月に一度,瀉血を施行していた.経過中,血尿,蛋白尿が出現し,徐々に腎機能増悪を認めるようになった.腎生検でIgA腎症と診断され,プレドニゾロン内服を開始したが治療抵抗性で,急速な腎機能悪化が見られた.

A 71-year-old woman was admitted to our hospital complaining of right lower abdominal mass. Computed tomography, and magnetic resonance imaging showed a cystic tumor, 14 cm in diameter, located at the right lower abdomen with cyst wall calcification. Immunohistochemical staining was positive for CA19-9, but not for CEA and CA125. A transabdominal tumorectomy was performed. The removed tumor was 17.7 x 14.4 x 11.2 cm in size, weighing 1,870 g, and hisotopathological retroperitoneal cystadenocarcinoma.

Background: Fabry's disease is a rare X-linked, hereditary lysosomal storage disease caused by a deficiency of the enzyme alpha-galactosidase A. Granulomatosis with polyangiitis is characterized by the involvement of the respiratory tract and kidneys. Here, we report the first case of the coexistence of these diseases. Case presentation: We describe a 29-year-old man suffering from fever with maxillary sinusitis, multiple lung nodules, and proteinuria. He was diagnosed with Fabry's disease accompanying granulomatosis with polyangiitis on the basis of the low activity of peripheral leukocyte alpha-galactosidase A and pathological findings in the lung and kidney. Glucocorticoid and cyclophosphamide were administered, followed by enzyme replacement therapy. Progression to end-stage renal disease has not been observed for 6 years until the time of drafting this manuscript. Conclusion: Because both Fabry's disease and granulomatosis with polyangiitis or crescentic glomerulonephritis are rare diseases, their concurrence in this and related cases suggests there may be a pathogenic link between these two conditions. Fabry's disease may be underdiagnosed, particularly in cases of granulomatosis with polyangiitis or crescentic glomerulonephritis.

Objective. Megakaryocytopoiesis was dramatically augmented in human granulocyte colony-stimulating factor transgenic mice (G-Tg) compared to littermates. We examined the characteristics of megakaryocytes and megakaryocyte progenitor cells in these mice. Materials and Methods. The numbers of colony-forming unit megakaryocytes (CFU-MK) and megakaryocytes in hematopoietic organs were counted. The megakaryocytes of G-Tg were examined ultrastructurally, and bone marrow transplantation studies using congenic G-Tg (Ly5.2) and C57BL/6 (Ly5.1) were performed. The number of day-14 colony-forming unit spleen (CFU-S) that contained megakaryocytes in [Ly5.1 > G-Tg] and [G-Tg > Ly5.1] mice also was counted. Results. The number of CFU-MK increased markedly in the spleen, bone marrow, and peripheral blood. The number of megakaryocytes in the spleen and bone marrow also were increased in G-Tg mice. Ultrastructural analyses revealed that megakaryocytes in G-Tg mice were immature. Bone marrow transplantation studies of [Ly5.1 > G-Tg] mice resulted in a significantly increased number of megakaryocytes compared to [G-Tg > Ly5.1] mice. The number of day-14 CFU-S that contained megakaryocytes was increased markedly in [Ly5.1 > G-Tg] mice compared to [G-Tg > Ly5.1] mice. In vitro differentiation of megakaryocytes in [Ly5.1 > G-Tg] mice was induced by interleukin-11 and thrombopoietin. Conclusion. The results showed that the hematopoietic marrow microenvironment of G-Tg is important in augmenting megakaryocytopoiesis. [Ly5.1 > G-Tg] mice are potentially useful as a source of murine megakaryocytes and their progenitors. (C) 2001 International Society for Experimental Hematology. Published by Elsevier Science Inc.

Diagnosis of hepatocellular carcinoma (HCC) on the basis of digital images is a challenging problem because, unlike gastrointestinal carcinoma, strong structural and morphological features are limited and sometimes absent from HCC images. In this study, we describe the classification of HCC images using statistical distributions of features obtained from image analysis of cell nuclei and hepatic trabeculae. Images of 130 hematoxylin-eosin (HE) stained histologic slides were captured at 20X by a slide scanner (Nanozoomer, Hamamatsu Photonics, Japan) and 1112 regions of interest (ROI) images were extracted for classification (551 negatives and 561 positives, including 113 well-differentiated positives). For a single nucleus, the following features were computed: area, perimeter, circularity, ellipticity, long and short axes of elliptic fit, contour complexity and gray level co-occurrence matrix (GLCM) texture features (angular second moment, contrast, homogeneity and entropy). In addition, distributions of nuclear density and hepatic trabecula thickness within an ROI were also extracted. To represent an ROI, statistical distributions (mean, standard deviation and percentiles) of these features were used. In total, 78 features were extracted for each ROI and a support vector machine (SVM) was trained to classify negative and positive ROIs. Experimental results using 5-fold cross validation show 90% sensitivity for an 87.8% specificity. The use of statistical distributions over a relatively large area makes the HCC classifier robust to occasional failures in the extraction of nuclear or hepatic trabecula features, thus providing stability to the system.

Recent advances in information technology have improved pathological virtual-slide technology and diagnostic support system studies of pathological images. Diagnostic support systems utilize quantitative indices determined by image processing. In previous studies on diagnostic support systems, carcinomatous areas of breast or lung have been recognized by the feature quantities of nuclear sizes, complexities, and internuclear distances based on graph theory, among other features. Improving recognition accuracy is important for the addition of new feature quantities. We focused on hepatocellular carcinoma (HCC) and investigated new feature quantities of histological images of HCC. One of the most important histological features of HCC is the trabecular pattern. For diagnosing cancer, it is important to recognize the tumor cell trabeculae. We propose a new algorithm for calculating the number of cell layers in histological images of HCC in tissue sections stained by hematoxylin and eosin. For the calculation, we used a Delaunay diagram that was based on the median points of nuclei, deleted the sinusoid and fat droplet regions from the Delaunay diagram, and counted the Delaunay lines while applying a thinning algorithm. Moreover, we experimented with the calculation of the number of cell layers with our method for different histological grades of HCC. The number of cell layers discriminated tumor differentiations and Edmondson grades; therefore, our algorithm may serve as an index of HCC for diagnostic support systems.

症例1:77歳男。慢性閉塞性肺疾患(COPD)とされていたが、呼吸機能正常などより慢性血栓塞栓性肺高血圧症(CTEPH)と診断した。下肢静脈には高輝度びまん性血栓のみ認め、下大静脈フィルター(IVCF)は使用しなかった。しかし、その後酸素必要量が上昇して入院し、心エコーで右室内に小血栓像を認めた。永久型IVCFを留置し血栓溶解療法を施行したが、肺炎を併発して死亡した。症例2:84歳男。COPDとされていたが、呼吸困難、低酸素血症で入院し、右室負荷を認めてCTEPHと診断した。下肢静脈エコーで高輝度びまん性血栓を認め、入院2日目に死亡した。剖検所見で、左大腿静脈壁内膜の線維性肥厚を認め、器質化陳旧性血栓の所見がみられた。肺動脈内にも内膜の肥厚を認め、下肢静脈の器質化血栓と類似していた。肥厚が強い狭窄部には、剥離と新鮮血栓が形成されている箇所も認めた。

症例は71歳,女性。腹部腫瘤を主訴に来院した。CT・MRIの結果,右下腹部に内部に充実成分を含む12×14×18cmの嚢胞性腫瘤を認めた。後腹膜原発の粘液嚢胞腺腫が疑われたが,悪性腫瘍が否定できなかったため,正中開腹にて後腹膜腫瘍摘出術を施行した。摘出標本の病理組織学的所見は粘液嚢胞腺癌であった。(著者抄録)

症例は80歳、男性。2005年5月に食思不振を自覚し来院し、軽度蛋白尿と腹部CTで左腎細胞癌を認め、腹腔鏡下腎尿管摘出術を施行した。術後に蛋白尿がさらに増悪し下腿浮腫が出現したため、同年12月に精査目的で再入院した。蓄尿蛋白4.2g/日、血清TP 5.0g/dL,Alb 2.4g/dL,TC 214mg/dL,Cr 1.4mg/dL、クレアチニンクリアランス39mL/minよりネフローゼ症候群と診断されたが、精査により転移および他の悪性腫瘍の合併は否定された。摘出した左腎の非悪性腫瘍部位のHE染色による検討では、有意な異常所見を認めなかったが、念のためコンゴーレッドによる特殊染色をしたところ、小血管壁および糸球体にアミロイド沈着を認めた。アミロイド沈着は過マンガン酸カリウム処置後も残存しており、AL型原発性アミロイドーシスと診断した。その後、骨髄検査で多発性骨髄腫は否定され、尿蛋白電気泳動でわずかなベンスジョーンズ蛋白と上部消化管内視鏡で胃潰瘍病変部位のアミロイド沈着を認めた。腎細胞癌にAL型原発性アミロイドーシスを合併した症例報告はきわめて少なく、術後にネフローゼ症候群が顕在化したことを契機に摘出腎の詳細な検討を加えた結果、診断し得た貴重な症例と考えられた。(著者抄録)

症例は48歳、女性。21歳時に、顔面、四肢の紅斑および発熱を認め、全身性エリテマトーデス(systemic lupus erythematosus:SLE)と診断され、副腎皮質ステロイド(プレドニゾロン)が開始された。当院入院の13日前にかかりつけ医を受診し、SLEの再燃が疑われて当科紹介となった。当院入院時の血液検査では、汎血球減少症、低補体血症、腎機能障害、ループス抗凝固因子の陽性、検尿では血尿と高度の蛋白尿が認められた。ループス腎炎の活動性評価目的で腎生検を施行後、プレドニゾロンによる免疫抑制療法に加え、抗血小板療法、抗凝固療法を開始した。第22病日には、破砕赤血球の出現を伴う溶血性貧血、血小板減少、腎機能障害の進行が認められた。新鮮凍結血漿を置換液とした血漿交換療法を計10回施行し全身状態や血小板減少は改善したが、腎機能の改善はなく、第36病日には血液透析を導入した。腎生検病理所見は、半月体形成と管内増殖を呈する高度の増殖性腎炎に加え、糸球体係蹄腔内には粗大な血栓を認め、細動脈内腔には閉塞性の硝子様沈着が認められた。蛍光抗体法による染色では、係蹄壁に免疫グロブリンと補体の顆粒状沈着を認め、電子顕微鏡では、分節性に上皮下と基底膜内の高電子密度沈着物を認めたものの、明らかな内皮下沈着物はみられなかった。ループス腎炎では、ステロイドを中心とした免疫抑制療法が治療の主体となるが、APSや血栓性微小血管症を合併した場合、免疫抑制療法に加え、抗血小板療法、抗凝固療法、血漿交換療法を含めた集学的治療が必要となる。ループス腎炎の病態は不明な点が多いが、今回われわれは、TMAが腎障害の進行に関与した可能性が示唆されたループス腎炎の1例を経験したので報告する。(著者抄録)

55歳男.真性多血症を指摘され,その後頭痛を自覚,RBC 650万/μl,Hct 60%を認め,1〜2ヵ月に1度,瀉血を施行していた.経過中,血尿,蛋白尿があり,徐々に腎機能増悪を認め,血清クレアチニン 2.5mg/dlまで上昇した.腎生検の結果IgA腎症の診断で,尿蛋白6.9g/日,クレアチニンクリアランス 22ml/minであった.第3病日よりプレドニゾロン(PSL)60mgの内服を開始,弟9病日にはRBC 735万/μl,Hct 58%まで増加したため,瀉血を行った.第24病日にはPSL 40mgまで漸減したが尿蛋白は6.0g/日前後で遷延し,高血圧も認めたため,カンデサルタン 4mgの内服を開始した.弟38病日にはPSL 35mg投与下で,尿蛋白は3.4g/日まで減少し,外来経過観察となった

病理組織所見の写真300枚を電子画像化し,そのデータをもとに病理学総論実習のパソコン用教材を作成した.作成にあたってはマイクロメディア社のディレクタを用いた.この教材をCD-ROMにして学生に配布し,実習終了後にアンケート調査を行った結果,本教材には次のような利点のあることが明らかになった.何時何処でも利用できることから学習の機会を増やせる.予習・復習に活用することで実習を有意義に行える.実際の顕微鏡像が見られること,及びマーキングなどの補助手段により学習が容易になる