Clinical Laboratory

List of clinical test reference values

Laboratory test department

In laboratory tests, biochemical and immunological tests (blood drugs, endocrine, tumor markers), hematological tests (blood count, coagulation, morphology), general tests (qualitative, sediment, cerebrospinal fluid tests), and emergency tests are performed. increase. We perform tests using a variety of methods, including automatic analyzers and microscopes, and promptly report highly accurate test results to assist in the diagnosis, treatment, and follow-up of diseases.

Biochemical/immunological test

In biochemical and immunological tests, the components contained in the blood (mainly serum), urine, pleural effusion, ascites, and cerebrospinal fluid collected from the patient are examined. Components such as sugars, lipids, electrolytes, and proteins contained in blood and urine fluctuate due to organ damage. Depending on the measurement method, it is divided into biochemical tests such as enzymes, proteins, lipids, and electrolytes, and immunological tests such as hormones and tumor markers. We report the results within about an hour after the arrival of the specimen, and strive to make the test results available before the examination.

List of biochemical and immunological test items

biochemical test

• total protein
• albumin
• total bilirubin
• indirect bilirubin
• AST (GOT)
• ALT (GPT)
• LDH
• ALP
• Y GPT
• LAP
• Ch-E
• CK
• CK MB
• AMY
• LIP
• BUN
• CRE
• UA
• Na
• K.
• Cl
• Ca
• IP
• Fe
• UIBC
• Mg
• TG
• T-CHO
• HDL
• LDL
• Glu
• glycoalbumin
• HbA1c
• NAG
• UTP
• blood gas
• ethanol
• ammonia
• unbound bilirubin
• ICG
• Osmotic pressure
• Blood drug concentration
• Phenytoin
• Phenobarbital
• carbamazepine
• sodium valproate
• Theophylline
• Digoxin
• Acetaminophen
• lithium carbonate
• salicylic acid
• methotrexate

immunological test

• CRP
• IgG
• IgA
• IgM
• IgE
• C3
• C4
• pre ALB
• RF
• β2MG
• KL 6
• sIL 2R
• NGAL
• AFP
• CEA
• CA19-9
• CA15-3
• Cifra
• CA125
• insulin
• CPR
• ferritin
• prolactin
• cortisol
• TSH
• T3
• T4
• FT3
• FT4
• thyroglobulin
• TGAb
• TRAb
• TPOAb
• HCG
• GH
• procalcitonin
• NT Pro BNP
• PIVKA Ⅱ
• Favorable PSA
• SCC
• LH
• FSH
• Troponin T
• ACTH
• iPTH

Blood test

In the hematology laboratory, general blood tests to check the number and size of red blood cells, white blood cells and platelets, hemoglobin concentration, etc., blood imaging tests to check the classification and morphology of white blood cells, and the morphology of red blood cells and platelets, as well as diseases that bleed easily We perform coagulation and fibrinolysis tests to check diseases that are prone to thrombus formation. In addition, we perform tests such as platelet aggregation ability and erythrocyte sedimentation rate, which are one of the tests for platelet function.

List of items such as general blood and coagulation

List of items such as general blood and coagulation

• WBC
• RBC
• HGB
• HCT
• PLT
• RET
• Leukocyte classification
• visual inspection

Coagulation test

• PT
• APTT
• fibrinogen
• D-dimer
• Thrombotest
• ATⅢ
• cross mixing

others

• erythrocyte sedimentation rate
• βD-glucan
• malaria
• red blood cell resistance test
• Agglutination test
• eosinophil
• Special dyeing

General inspection department

In the general examination room, we carry out necessary examinations such as urinalysis (qualitative, sediment), stool examination (fecal occult blood), auxiliary diagnosis of diseases of kidneys and other organs, and follow-up of treatment. Urine and stool, which are human excreta, do not cause pain to the patient and can be collected most easily, so they are used as basic examinations. Urinalysis is useful for diagnosing not only kidney and urinary tract diseases but also various other diseases such as diabetes, based on quantitative changes in normal urine components and appearance of abnormal components.

List of urine and stool test items

Urinalysis

• urine qualitative
• urine sediment
• Urinary BTA

stool test

• fecal hemoglobin
• stool fat staining

others

• Cerebrospinal fluid examination
• Puncture fluid Ph, specific gravity
• joint fluid crystals
• urea breath test

Pathological examination

Nine clinical technologists (including four cytologists and two certified pathologists) are engaged in histopathology and cytology tests for accurate diagnosis of benign and malignant diseases under the guidance of pathologists at Clinical Pathology (Director substitute and Shigeo Hara doctor).

Histopathological examination is an examination in which a tissue piece collected by surgery or biopsy is subjected to HE staining or immunostaining after certain manipulations, and a pathologist examines the tissue morphology under a microscope. As special tests, we also support fluorescent antibody tests for kidney diseases, tests related to drug therapy for breast cancer, and tests related to compatibility with molecular-targeted drugs.

Cytological examination involves collecting cells from the cervix, uterine body, sputum, urine, pleural effusion, ascites, and various other organs, staining them after a certain procedure, and having a cytologist examine cancer cells under a microscope. This is a test to check for the presence or absence of Since 2017, our hospital has also introduced a sample processing method using the liquefaction cytology (LBC) method to improve diagnostic accuracy.

In addition, we actively support intraoperative rapid diagnostic tests, assistance with pathological autopsies, clinical pathology conferences (CPC), support for presentations by clinicians at academic conferences, and clinical trials. In addition, it also serves as a pathology laboratory as a cancer genomic medicine collaboration hospital.

Department of Cell Genetics

In the detection of measurable residual disease (MRD), which is important for diagnosing hematopoietic malignancies, judging therapeutic effects, and prognostic classification, flow cytometry (FCM) and genetic Testing is becoming more and more important.

Our department has a testing system that is rare in Japan, where bone marrow imaging, FCM-based cell testing, and PCR-based genetic testing are conducted in the same department. In addition to being able to report test results quickly, it is possible to enhance the ability to interpret test results comprehensively and to have close discussions with clinicians and other laboratory departments.

For FCM testing, we have introduced a next-generation flow cytometer capable of 10-color analysis, and we implement KobeFlow, which was developed in our hospital based on the analysis method advocated by EuroFlow, to provide highly accurate testing. In genetic testing, we have introduced the latest equipment such as digital PCR to detect a wide variety of genetic abnormalities. Recently, we have introduced PCR tests for new coronaviruses and PCR tests for opportunistic infections-related viruses, and we are utilizing the know-how we have cultivated over many years not only in the field of hematological malignancies but also in the field of infectious diseases.

Inspection item

bone marrow imaging

1. Bone marrow interpretation

Cytometry (FCM)

1. Peripheral blood lymphocyte subset test
   • T cell/B cell/NK cell percentage test
   • T cell subset percentage test
2. Hematopoietic tumor cell antigen test
3. CCR4 protein
4. CD34-positive hematopoietic stem cell count measurement
5. CD3 positive T cell count measurement
6. reticulated platelet ratio
7. Highly sensitive PNH blood cell test

Genetic testing (PCR)

1. Hematopoietic tumor gene test
   • Major BCR-ABL1 quantitative test
   • minor BCR-ABL1 quantitative test
   • RUNX1-RUNX1T1 quantitative test
   • PML-RARA quantitative test
   • CBFB-MYH11 quantitative test
   • TCF3-PBX1 quantitative test
   • FUS-ERG quantitative test
   • DEK-NUP214 quantitative test
   • NPM1 mutation quantification test
   • WT1 mRNA quantitative test
   • MYD88 L265P quantitative inspection
   • RHOA G17V quantitative inspection
   • BRAF V600E quantitative inspection
   • JAK2 V617F quantitative inspection
   • MPL mutation test
   • CALR mutation test
   • JAK2 exon12 mutation test
   • CD79B mutation test
   • EZH2 mutation test
   • SF3B1 mutation test
   • KIT mutation test
   • IGH/BCL2 test
   • Comprehensive AML gene mutation test
     (FLT3-ITD, FLT3-TKD, NPM1, KRAS, NRAS, IDH1, IDH2, TP53, DNMT3A, CEBPA, ASXL1, RUNX1)
   • Patient-specific FLT3-ITD quantitative test
2. Immune-related gene rearrangement
   • IGH reconstruction test
   • IGL reconstruction examination
   • TCRB reconstruction test
   • TCRG reconstruction test
   • TCRD reconstruction test

chimerism analysis

1. Pre-transplant screening analysis
2. Post-transplant chimerism analysis

virus check

1. COVID-19 PCR test (National Institute of Infectious Diseases Act)
2. Quantitative testing of viruses associated with opportunistic infections
   (HSV1,HSV2,VZV,CMV,EBV,HHV6,HHV7,HHV8,ParvoB19,BKV,JCV,ADV)

Microbiology Department

We carry out bacterial culture, drug susceptibility testing, and immunological/genetic infectious disease testing for various clinical specimens. We have a system that allows us to perform rapid diagnostic tests for various bacteria and viruses at any time. In addition, we actively participate in ICT and AST activities as team medical care and contribute to preventive measures against nosocomial infections.

Inspection item

General bacteriological examination

1. smear test
2. culture
3. Identification test (mass spectrometry, etc.)
4. Drug susceptibility test
5. genetic test
   • Detection of mycoplasma by LAMP method
   • Detection of Bordetella pertussis by LAMP method
   • 16S rRNA gene PCR and sequence analysis
   • ITS region gene PCR and sequence analysis
   • D1/D2 region gene PCR and sequence analysis
   • Various drug resistance gene PCR
   • Species-specific gene PCR
   • Typing using the POT method

Mycobacterial test

1. smear test
2. Culture/identification test
3. Drug susceptibility test
4. genetic test
   • Detection of Mycobacterium tuberculosis complex by LAMP method
   • Detection of Mycobacterium avium, M.intracellulare, and Mycobacterium tuberculosis complex by TaqMan PCR

rapid test

1. Antigen, antibody and toxin detection tests (each test material is different)
   • influenza virus
   • adenovirus
   • respiratory syncytial virus
   • rotavirus
   • norovirus
   • human metapneumovirus
   • dengue virus
   • Meningococcal bacteria
   • Escherichia coli O-157
   • pneumococcus
   • legionella
   • CD toxin, etc.
2. HBV-DNA quantitative test
3. HCV-RNA quantitative test

Infectious disease marker test

1. Hepatitis B-related markers
2. Hepatitis C-related markers
3. syphilis test
4. HIV-associated markers
5. HTLV-1 associated markers

Immunosuppressant

1. Tacrolimus blood concentration measurement
2. Cyclosporine blood concentration measurement

Anti-MRSA drugs

1. Vancomycin blood concentration measurement

Blood transfusion control room

This department conducts blood group tests, irregular antibody tests, cross-matching tests, centrally manages blood products and albumin products, and supervises and manages operations related to blood transfusion. The emergency outpatient department is always equipped with transfusion preparations for extreme emergencies, and a system is in place to handle highly urgent blood transfusions 24 hours a day, 365 days a year.

Furthermore, in cooperation with doctor, pharmacists, and clinical engineers, we provide comprehensive services related to hematopoietic stem cells, including CAR-T cell therapy, peripheral blood stem cell preparation, cord blood/bone marrow transplantation, granulocyte transfusion, and donor lymphocyte transfusion. We also manage.

Inspection item

blood typing

1. ABO blood group test
2. Rh(D) blood group test
3. ABO subtyping
4. Transplantation blood type test

Irregular antibody test

1. Antibody screening test
2. Irregular antibody identification test

cross-matching

Other inspections

1. direct coombs test
2. Indirect Coombs test
3. D-L antibody
4. Antibody titer measurement

Special inspection department

Today, with the spread of the Internet, etc., it has become possible to easily obtain information on poisoning and various drugs and poisons. We have to deal with it. Our department searches for poisoning-causing substances using simple measurement reagents and precision analysis measurement equipment. In addition, we also carry out detailed examinations such as separation analysis in response to clinical requests.

Inspection item

1. Inspection using simple measurement reagents
   • urinary methanol
   • Organophosphorus pesticides in urine
   • Carbamate pesticides in urine
   • Paraquat in urine
   • Arsenic compounds in urine
   • blood cyanide
2. Inspection using precision analysis and measurement equipment (gas chromatograph mass spectrometer: GC/MS)

Inspection information management department

We manage outsourced work and coordinate the operation of laboratory test work for PFI projects. In order to maintain and manage the testing system and improve the quality of medical care, we participate in various team medical care (NST, diabetes classroom, kidney disease classroom, etc.). In addition, we have an examination consultation room as a service business for patients and clinics, providing information related to all examinations to the medical side, consultation response, complaint handling, updating the website, issuing examination information for patients, and medical care support using the database. We also provide support for clinical research and clinical trial operations.

Department of Neurophysiology

We perform neurophysiological examinations of the peripheral and central nervous systems and ultrasonography of the head and neck vasculature. Functional tests include electroencephalography, nerve conduction tests, evoked potential tests (auditory brainstem response, somatosensory evoked potentials, visual evoked potentials), and needle electromyography. Neurophysiological testing is a testing method that evaluates nerve function by stimulating the peripheral and central nerves and applying the electrical activity of the nerves. In recent years, intraoperative neuromonitoring using this method has become popular, and in our laboratory, we monitor brain and spinal cord functions in real time under intraoperative anesthesia, and there is a demand for surgeries aimed at preserving neurological function. is responding to We also perform E-ABR to confirm the auditory nerve pathway after cochlear implant surgery.

Inspection item

Nerve conduction studies (NCS)

1. Motor nerve conduction test (MCS, F wave)
2. Sensory nerve conduction studies (SCS)
3. repeated stimulation test
4. Magnetic stimulation test

Cerebral/brain stem evoked potential

1. Auditory Brainstem Response (ABR)
2. Somatosensory evoked potential (SEP)
3. Visual evoked potential (VEP)

Other evoked potentials

1. blink reflex
2. Magnetic stimulus motor evoked potential

Intraoperative neuromonitoring (IOM)

Electroencephalography (EEG)

Overnight sleep polysomnography (PSG)

carotid ultrasound

Transcranial cerebrovascular ultrasound

Outpatient blood collection department

We collect blood from over 10,000 outpatients per month. An automatic reception system issues a blood collection numbered ticket just by swiping the patient's examination card, and the number is used to guide the patient to the blood collection booth. I'm here.

There are 8 blood collection booths, and in addition to outpatient general blood collection, sterile blood collection for blood culture, clinical trial cases, and blood collection for cancer genome medical treatment are also performed.

Department of Abdominal Ultrasonography

Screening examinations, examinations to investigate the causes of symptoms, and follow-up examinations for general abdominal organs, mammary glands, thyroid glands, otolaryngological systems (parotid glands, submandibular glands), and vascular systems (aorta, peripheral blood vessels, etc.)・Evaluation before and after surgery ・Emergency measures such as acute abdomen and contrast-enhanced echo using ultrasound contrast media are available. In addition, we perform hemodynamic evaluation of organs and lesions using color Doppler and pulsed Doppler methods, and perform qualitative diagnosis such as benign/malignant differentiation and inflammation stage classification.

Abdominal surface ultrasonography

Ultrasound examination is a test that uses ultrasonic waves from outside the body to create images from the signals bounced back from organs, etc., and diagnoses the pathology from the distance and shape. Special examinations such as abdominal ultrasonography, mammary gland ultrasonography, thyroid ultrasonography, vascular ultrasonography of upper and lower extremities, and contrast-enhanced ultrasonography using contrast agents are also performed in our laboratory. Ultrasound is a safe and painless examination. Pregnant women can also take it safely.

In addition, we perform detailed examinations including skin perfusion pressure measurement and arterial ultrasonography related to revascularization treatment (clinical trial) for severe lower extremity ischemia.

Inspection item

1. abdominal ultrasound
2. breast ultrasound
3. thyroid ultrasound
4. body surface ultrasound
5. Vascular ultrasonography (lower limb arteries and veins, upper limb arteries and veins)
6. Abdominal contrast-enhanced ultrasonography (examination, screening)
7. mammography ultrasound

Lower extremity artery workup

We are examining clinical trials of revascularization treatment using CD34-positive cell transplantation for arteriosclerosis obliterans and Buerger's disease. This is a detailed examination to evaluate the arterial hemodynamics of the affected limb by measuring perfusion pressure at the capillary level, percutaneous partial pressure of oxygen, and fingertip arterial pressure. We conduct specialized examinations and evaluate patients before and after regenerative treatment of lower extremity arterial blood vessels.

Inspection item

1. lower extremity arterial ultrasonography
2. Skin perfusion pressure measurement
3. Transcutaneous partial pressure measurement
4. Digital artery pressure measurement

Cardiopulmonary function test department

It examines the functions of the circulatory system (mainly heart) and respiratory system (mainly lungs and bronchi). Cardiovascular examinations include electrocardiography and cardiac ultrasound (echocardiography) to check the condition of the heart. On the other hand, respiratory tests include pulmonary function tests and airway reversibility tests, which examine the ventilatory function (ventilation state of air into the lungs) and the gas exchange function of oxygen and carbon dioxide.

Inspection item

electrocardiogram

1. resting electrocardiogram
2. Exercise stress electrocardiography (treadmill stress electrocardiography)
3. Ambulatory ictal ECG
4. 24-hour ECG (Holter ECG)
5. Autonomic function test (CVRR)

Blood pressure plethysmography (PWV/ABI)

Skin perfusion pressure test (SPP)

pulmonary function test

1. vital capacity (VC)
2. % vital capacity (%VC)
3. Forced vital capacity (FVC)
4. Volume in 1 second (FEV1)
5. 1 second rate (%FEV1)
6. Residual air content (FRC)
7. Lung spreading capacity (DLCO)
8. Airway reversibility test
9. respiratory resistance test

echocardiography

1. Transthoracic echocardiography (TTE)
2. Transesophageal echocardiography (TEE)
3. Stress echocardiography (exercise/drug)

team medical

Team medical care is a patient-centered approach in which doctor, nurses, clinical laboratory technologists, pharmacists, registered Registered Dietitian, physical therapists, and other medical staff make use of each other's expertise and bring out their maximum capabilities. This is an initiative at a medical site that provides treatment. The most effective treatment methods and policies for patients are considered through close communication with staff members in each specialized field.

In-hospital team medical care involving clinical laboratory technologists

1.Nutrition support team

This is a specialized team nutrition support team that is involved in in-hospital nutrition therapy and considers the nutrition of individual patients. We measure the test items for nutritional evaluation, provide information such as nutritional status and general condition that can be understood from the test data, and are involved in nutritional management of patients in cooperation with other medical staff.

2. In-hospital patient classroom

Classes held in hospital for patients and their families. We participate in diabetes classrooms and kidney and kidney disease classrooms, where we explain test data and perform simple tests together using simple equipment. We aim to raise awareness of the importance of testing in the early detection of diseases and the determination of therapeutic effects.

3. Infection control team

A dedicated team responsible for infection control within the hospital. MRSA and multi-gram staining conference We provide data on the detection of drug-resistant Pseudomonas aeruginosa as well as chemical and blood test data. We are striving to prevent At our hospital, which provides highly advanced medical care, there are many patients with weakened immune systems who are prone to in-hospital infections. In order to provide advanced medical care based on medical safety, infection control in medical care is very important and plays a role.

4.Foot care team

This is a team that works with the goal of "protecting the feet" for patients with blood flow disorders and ulcers in the lower extremities. We hold case review meetings with Dermatology, Cardiology, and nurses specializing in chronic disease nursing. Clinical laboratory technologists perform various tests and provide data related to detailed blood flow evaluations that are necessary for deciding treatment strategies.

5.Medical Safety Management Team

Incident reports reported at hospitals are statistically said to be "the number of hospital beds x 5" (in the case of our hospital, there are approximately 3,500 incidents per year). The Chief Technologist joins the Medical Safety Management Team as the Deputy Director of the Medical Safety Management Risk Management, and works jointly with a multidisciplinary team to clarify the causes of incidents reported from all departments within the hospital, and to implement responses and improvement measures in each department. We verify the status of PDCA for planning and recurrence prevention. In addition, in order to promote a culture of medical safety in the Clinical Laboratory, we verify case studies of the testing department, monitor the progress of improvement measures, and control medical safety in the testing department.

6. Clinical path

A clinical path is a medical treatment schedule table that contains information such as treatment, care, and examinations necessary to cure an inpatient's illness, and was created for the purpose of standardizing and improving the efficiency of medical care. We have created a pamphlet that describes the content, necessity, and precautions of the examination so that patients can be relieved of their anxieties about the examination and receive the examination with peace of mind.

7. Inspection consultation room

The Laboratory Consultation Office aims to centralize the consultations, inquiries, complaints, and requests received from medical professionals in the hospital to ensure the smooth functioning of hospital operations. We issue “test information” that describes test items for patients and distribute it at the blood sampling room and general reception.

◆◆Feature No. 26◆◆

Introduction of outpatient blood collection room

Outpatient blood collection room Tsuyoshi Yamamoto

Blood sampling is a medical practice necessary to "diagnose disease" and "understand the condition" by examining the blood components flowing through the body. Blood collection is a highly safe procedure because blood is collected from a vein, but in rare cases, "blood collection complications" may occur. If it is determined that the biological information to be confirmed by blood sampling is higher than the risk of blood sampling complications, blood sampling will be ordered by the doctor in charge. "Blood sampling complications" will be described later, but please understand the necessity and risks of blood sampling before receiving blood sampling.

2. Request to patients who can receive blood collection

From the viewpoint of medical safety, the following items are checked at the time of blood collection (Fig. 1). If applicable, please inform the blood collection staff at the time of blood collection.

1) Confirmation of the arm for blood sampling

Blood collection is performed by damming up the blood in the vein with a tourniquet, but there are cases where the tourniquet cannot be wrapped. Please let us know in advance if you have any of the following conditions.

① Those who have a shunt for artificial dialysis
②Those who are in port for chemotherapy
(3) Those who wear Libre for self-monitoring of blood sugar
④Those who have implanted parathyroid glands

Also, if you have a history of allergies, please let us know at the time of blood collection.

⑤ If you have a history of allergies to alcohol: use antiseptics other than alcohol.
6.Have a history of allergies to tapes: use adhesive plaster or paper bandages.

2) Guidance on blood sampling complications

In rare cases, the following health hazards (blood sampling complications) may occur during blood sampling (Figure 2).

(1) Nerve damage: Pain at the puncture site and numbness in the fingertips.
(2) Subcutaneous hematoma (bruise): This occurs when bleeding is not sufficiently stopped after blood collection.
(3) Allergies: Rubbing alcohol or tape causes a rash, redness, or itching.
④ Vasovagal reflex (feeling bad): Woke up by nerve reflex when stabbing. Blood pressure drops or tachycardia.

3. Flow up to blood collection

1) Reception

① Reception will be done at the automatic reception machine or reception C (manned). Please have your medical card ready.
② Please issue a "reception number" at the reception. If you do not receive a number, please issue a ticket at reception C (manned).
③ The start time of the reception time is as follows.
a) Automatic reception machine: Starts at 7:30 AM.
b) Reception C (manned): Starts at 8:15 AM.
In addition, if you need to check the contents even with the automatic reception machine, it will be displayed as "Please come to the reception C counter." In that case, you may be asked to go to Reception C (manned). note that.
④Please wait in the outside waiting area until the "reception number" is displayed on the bulletin board. Please enter the blood collection room when it is displayed.
⑤ If you are wearing a long-sleeved shirt, please wait with your arm out.

2) Preparation for blood collection

①When the "reception number" is displayed on the bulletin board of the blood collection table, please proceed to the blood collection table.
② Hand the “reception number slip” to the person in charge of blood collection. Required for name verification.
③ We will ask for your name and date of birth to verify your identity.
④ Depending on the item (such as renin blood sampling), blood sampling may be performed after resting for 30 minutes. Follow your doctor's instructions.
⑤ For the glucose tolerance test, blood is collected 30, 60, and 120 minutes after drinking the glucose solution.

3) Blood sampling

(1) Blood will be collected mainly from the elbow, so please place your elbow on the blood collection pillow.
(2) Hold it lightly with your thumb inside.
(3) Extend your elbow to collect blood.
④ If blood cannot be collected from the elbow, we may collect blood from the forearm or the back of the hand.
⑤ If you are using a wheelchair, blood will be drawn while you are sitting. In that case, the order may change. note that.
⑥ If you feel unwell or have felt unwell in the past, please let us know so that we can collect blood on your bed.
⑦ After removing the needle, firmly press the place where blood was collected for 5 minutes (pressure hemostasis). If you are taking blood-thinning medication, press firmly for 10 minutes.

Four. Crowded blood collection room

It is very crowded in the morning, so it is recommended for those who come only for blood collection after 14:00 as it is relatively free (Fig. 3). Please help us to eliminate the waiting time in the blood collection room.

Our Clinical Laboratory has acquired ISO15189 certification. In the outpatient blood collection room, we are striving to improve patient waiting time by managing TAT (turn around time: response time for examination). From fiscal 2019 to fiscal 2020, we were able to significantly shorten the waiting time by improving staff allocation and work content in order to shorten the waiting time (Fig. 4). We will continue to investigate waiting times and strive to further shorten waiting times.

Five. Overview of outpatient blood collection room

(1) The outpatient blood collection room has 9 booths, and clinical laboratory technologists and nurses are in charge of blood collection.
(2) Blood collection work by clinical laboratory technologists is handled by all staff, regardless of specimen testing or physiological testing.
③ The number of patients for blood sampling is about 500 to 700 every day.
(4) The blood collection system is built with Sysmex CNA, and two BC-ROBO 8001 RFID blood collection tube supply devices are installed.
⑤ We conduct various training throughout the year for new employee education.

6. others

①Please come to the hospital wearing clothes that are easy to draw blood on the day of the procedure.
(2) In the case of clothes with tight sleeves, it may not be possible to collect blood from the elbow, or the bleeding may not be sufficiently stopped.

◆◆ Special Feature No. 1 ◆◆ Genetic Testing: FLT3 Mutation and NPM1 Mutation”

About genetic testing: FLT3 and NPM1 mutations

About genetic testing: FLT3 and NPM1 mutations

In the cytogenetic laboratory, we conduct cell-level tests using flow cytometry ^*1 and gene-level tests using PCR*2, mainly for blood tumors such as leukemia and malignant lymphoma. Responsible for relevant inspections. Research in the field of hematologic malignancies has been impressive in the last decade, and significant advances have been made in diagnosis and treatment. Genetic testing is now indispensable in the definitive diagnosis of leukemia, and is used for detailed classification of disease types. The test results obtained are used to determine the optimal treatment strategy for each disease type.

"FLT3 mutation and NPM1 mutation" ^*3 in the title are genetic abnormalities that are attracting attention in relation to acute myeloid leukemia. Using the PCR method, it is possible to predict the therapeutic effect of chemotherapy by examining the presence or absence of "FLT3 mutation and NPM1 mutation" at the time of diagnosis of acute myeloid leukemia. can provide important information to the attending physician. In addition, if a genetic abnormality is discovered, detailed genetic ^pattern analysis will be performed, and an optimal test method for each individual patient will be developed. effect can be determined accurately.

Currently, there are only a limited number of medical institutions that can test for "FLT3 mutations and NPM1 mutations." Our laboratory started testing in 2008 ahead of the rest of the country, and has a track record of more than 100 cases. In addition to the tests introduced this time, we would like to actively work on the introduction and development of the latest and best test methods while maintaining close cooperation with clinicians, and disseminate the results obtained both domestically and internationally. thinking about.

*1: Flow cytometry
A method to comprehensively measure the presence or absence of proteins in specific cells using a flow cytometer and special reagents to analyze the characteristics of the cells.
*2: PCR
A technique that uses a device called a thermal cycler and special reagents to amplify a very small amount of genes and analyze the presence or absence of genetic abnormalities.
*3: FLT3 mutation and NPM1 mutation
FLT3 and NPM1 mutations are attracting attention as prognostic factors for acute myeloid leukemia. In the 4th edition of the WHO classification, acute myeloid leukemia with genetic mutations is established as an independent disease type, one of which includes NPM1 mutations. On the other hand, FLT3 mutations are not defined as a subtype, but mutation analysis is recommended at the time of diagnosis.
*4: Minimal residual disease
Remaining state of very few leukemia cells that cannot be detected with a microscope

Inspection department news

New inspection item

*November 2011 Inspection items implemented in-hospital

1. glycoalbumin
2. magnesium

Academic report

Paper presentation

• Keiji Takekawa:
  Facts of fungal identification II.
  Clinical and Microbiology 38; 551-557.2011. paper

Presentations, Lectures, etc. July to December 2011

• July 9, 2011
  Kyoto Prefectural Medical Technologists Association Physiological Examination Workshop Abdominal Ultrasound Hands-on & Lecture Course
  Lecturer: Nobuhiro Iwasaki "Gastrointestinal tract - neoplastic lesions"
• July 23, 2011
  Japanese Gastrointestinal Cancer Screening Society Kinki Branch Ultrasound Subcommittee 12th Annual General Meeting/Academic Meeting
  Educational Lecture: Nobuhiro Iwasaki "US and Blood Flow"
• June 25, 2011
  The 111th Regional Meeting of the The Japanese Circulation Society Education Session for Residents
  Hands-on lecturer: Toshiko Konda
• August 20, 2011
  Wakayama Association of Clinical Technologists Physiological Testing Workshop
  Educational Lecture: Nobuhiro Iwasaki "Step-up Gastrointestinal Ultrasound"
• September 20, 2011
  The 111th Hyogo Prefecture Association of Clinical Laboratory Technicians Microbiological Testing Workshop
  Lecturer: Keishi Takegawa "Series: Fungal Testing ② -Let's Master Fungal Testing Methods-"
• September 17, 2011
  Gastrointestinal Echo Live Seminar
  Lecturer: Nobuhiro Iwasaki "Step-up gastrointestinal ultrasonography - A guidepost for diagnosis learned from cases -"
• September 25, 2011
  Hyogo Prefecture Medical Technologists Association Abdominal Ultrasound Practical Training Course
  Lecturer: Nobuhiro Iwasaki "Precautions in device settings and examinations, liver anatomy and physiology"
• October 9, 2011
  Hyogo Prefecture Medical Technologists Association Abdominal Ultrasound Practical Training Course
  Lecturer: Nobuhiro Iwasaki "Anatomy and physiology of the biliary system"
• October 16, 2011
  Hyogo Prefecture Medical Technologists Association Abdominal Ultrasound Practical Training Course
  Lecturer: Nobuhiro Iwasaki "Anatomy and Physiology of the Pancreas"
• October 23, 2011
  Hyogo Prefecture Medical Technologists Association Abdominal Ultrasound Practical Training Course
  Lecturer: Nobuhiro Iwasaki "Kidney anatomy and physiology"
• October 15, 2011
  Advanced Medical Foundation CAS-CARE Ultrasound Examination Seminar
  Lecturer: Ichiro Sasaki
• October 29, 2011
  Echo Heart Izumo 2011
  Lecture and practical instruction: Toshiko Konda "Fever of unknown origin"
• October 29, 2011
  Echo Heart Izumo 2011
  Lecture and practical instruction: Junichi Kawai "Examination of chest pain"
• November 6, 2011
  Hyogo Prefecture Medical Technologists Association Tantan Area Academic Research Group
  Lecturer: Nobuhiro Iwasaki "Ultrasound diagnosis of gastrointestinal neoplastic lesions"
• November 13, 2011
  The 38th Kansai Regional Conference of the The Japan Society of Ultrasonics in Medicine
  Presentation: Nobuhiro Iwasaki "A case of colon angioectasia for which Doppler examination was useful"
• November 13, 2011
  The 38th Kansai Regional Conference of the The Japan Society of Ultrasonics in Medicine
  Presentation: Nobuhiro Iwasaki "A case of intralymphangioma hemorrhage"
• November 17, 2011
  The 170th Osaka Abdominal Ultrasound Study Group
  Presentation: Nobuhiro Iwasaki "Contrast-enhanced ultrasonography for gastrointestinal diseases: Current situation at our hospital"
• November 27, 2011
  Gastrointestinal Echo Hands-on Seminar
  Lecturer: Nobuhiro Iwasaki
• November 13, 2011
  The 38th Kansai Regional Conference of the The Japan Society of Ultrasonics in Medicine
  Presentation: Mamiko Takebayashi "A case of pancreatic tumor detected by screening test"
• November 17, 2011
  The 170th Osaka Abdominal Ultrasound Study Group
  Presentation: Mamiko Takebayashi "A case of pancreatic tumor detected by screening test"
• November 5, 2011
  17th Kobe Clinical Forum
  Educational Lecture: Hayato Maruoka "Flow cytometry and genetic testing in hematological tumor diagnosis"
• November 19, 2011
  The 58th Annual Meeting of the Japanese Society for Laboratory Medicine
  Presentation: Hayato Maruoka "Immunophenotyping of mature lymphoid tumors using 6-color flow cytometry"
• December 7, 2011
  First Aid Open Seminar
  Lecturer: Nobuhiro Iwasaki "Ultrasonography in acute abdomen"
• December 21, 2011
  First Aid Open Seminar
  Lecturer: Ichiro Sasaki "Seminar for dealing with brain death in emergency medicine"
• December 18, 2011
  The 111th Lecture Seminar on Medical Ultrasound, Japanese Society of Ultrasonography
  Lecturer: Nobuhiro Iwasaki "How to proceed with ultrasonography in acute abdomen"

◆◆Feature No. 2◆◆

Advances in contrast-enhanced ultrasound

Physiological Function Testing Room Nobuhiro Iwasaki

contrast-enhanced ultrasonography

Hemodynamic evaluation of mass lesions is extremely important for diagnosis and decision of treatment strategy. Color Doppler examination has been conventionally used as a method for evaluating hemodynamics using ultrasound, but since it uses only the reflected sound waves from blood cells, the sensitivity decreases if the reflected sound waves are weak. However, in contrast-enhanced ultrasonography, the contrast agent serves as a strong reflection source, so it is possible to evaluate hemodynamics with higher sensitivity.

Contrast agent for ultrasound: SonazoidⓇ

SonazoidⓇ is an ultrasound contrast agent for the diagnosis of hepatic mass disease. This contrast agent is a formulation containing perflubutane (PFB; Fig. 1), which is a chemically stable gas, and is excreted in the breath after administration. Five years have passed since the start of sales in January 2007, but there have been almost no reports of serious side effects. Imaging diagnostic methods using other contrast agents such as CT and MRI have a certain percentage of serious side effects, and cannot be performed in patients with hypersensitivity to contrast agents. It can also be performed in multiple ways, and may be the only hemodynamic diagnostic method for hepatic mass disease.

Current status of contrast-enhanced ultrasonography at our hospital

Contrast-enhanced ultrasonography requires dedicated equipment with a contrast-enhanced mode. The abdominal ultrasound examination room is equipped with six high-end ultrasound diagnostic equipment ^*1, and we have been actively working on this since the beginning of sales of contrast agents. In addition, although advanced technology and knowledge are required for examinations, multiple technicians who are well-versed are permanently stationed to respond to various requests from clinical practice. At our hospital, contrast-enhanced ultrasonography is divided into screening contrast-enhanced examination and detailed contrast-enhanced examination. The main purpose of screening contrast-enhanced examination is to diagnose the presence of a mass. Contrast media is administered in the outpatient central treatment room, and then moved to the ultrasonography room to observe the presence or absence of defects in the Kupffer phase ^*2 (post vascular phase). On the other hand, detailed angiography is mainly aimed at qualitative or differential diagnosis of masses. In order to observe the vascular phase ^*3 (vascular phase) and Kupffer phase immediately after contrast agent administration, everything from contrast agent administration to the end of the examination is performed in the abdominal ultrasonography room. In addition, in cases where multiple masses are observed or new defect images are observed in other sites, the contrast agent is re-administered to evaluate the vascular phase of the lesion, and the ``Defect Reperfusion Ultrasound'' proposed by Kudo et al. Imaging ^*4” (Fig. 2). Therefore, compared to screening angiography, it may take about 1 hour, so we have a reservation frame of 1 person / 1 hour from the afternoon. In addition, in the treatment of hepatocellular carcinoma, when it is difficult to recognize the lesion during radiofrequency ablation ^*5 (RFA), we use "Defect Reperfusion Ultrasound Imaging" to support treatment so that RFA can be performed safely and accurately. are actively implemented as

*1 High-end ultrasonic diagnostic equipment: Ultrasonic diagnostic equipment that employs the latest technology and pursues high functionality and performance.
*2 Kupffer phase: Part of the contrast agent (microbubbles) is taken up by the reticuloendothelial system (Kupffer cells in the liver). Tumors without Kupffer cells are not contrasted, the difference in contrast between the tumor and normal liver tissue becomes clear, and the time phase after 5 to 10 minutes after administration of the contrast medium, when the presence of the tumor can be diagnosed.
*3 Vascular phase: The time phase from immediately after administration of a contrast medium to 3 minutes in which blood vessels within, at the periphery of, and surrounding hepatic tumor lesions can be imaged.
*4 After a nodule that cannot be detected by normal ultrasonography is detected as a defective image (defect) in the Kupffer phase, the contrast medium is re-administered to determine whether the defective nodule has arterial blood flow or not. ).
*5 Radiofrequency ablation treatment: A treatment method in which an electrode needle is inserted from outside the body into the affected area under ultrasound guidance, and high heat generated by applying radio waves causes coagulation necrosis of the affected area.

Applications of contrast-enhanced ultrasonography

At present, contrast-enhanced ultrasonography is not only used for the diagnosis of hepatic mass disease, but is also being applied to guide puncture for local treatment of liver cancer and to evaluate treatment as treatment support. Intense focused ultrasound therapy (HIFU) using microbubbles as agents is also being investigated). In addition, intraoperative contrast-enhanced ultrasonography is also spreading in liver resection. Intraoperative angiography can probe the liver directly, enabling more detailed observations and detecting small lesions that cannot be detected from outside the body. Therefore, it is a useful index for determining or changing the surgical method such as the extent of resection.

case

1. Hepatocellular carcinoma: early vascular phase (Figure 3)

A 1-cm-sized, internally heterogeneous hyperechoic mass (arrow) is observed in liver S6. Ten seconds after administration of the contrast agent, the entire mass is darkened.

2. Portal vein tumor embolism: reperfusion image (MFI) (Fig. 4)

A faint solid echo is observed in the portal vein (P6) (arrow). Intratumor blood vessels running inside are clearly visualized by MFI.

3. Small Bowel Malignant Lymphoma: Vascular Phase (Figure 5)

Focal wall thickening was observed in the ileum, and the layered structure was obscured (arrows). Early enhancement and dendritic vascular architecture within the tumor are captured.

4. Metastatic liver cancer: Kupffer phase (Figure 6)

A clear image of a 1.5 cm-sized defect was captured in S6 of the liver (arrow).

Conclusion

At our hospital, the introduction of contrast-enhanced ultrasonography has dramatically improved the ability to diagnose hepatic mass disease. In addition, it plays a major role in supporting the treatment of liver cancer, and we would like to further enhance the examination and treatment system, including the training of operators.

1) Kudo M, Hatanaka K, Maekawa K: Newly developed novel ultrasound technique, defect reperfusion ultrasound imaging, using sonazoid in the management of hepatocellular carcinoma.Oncology, 2010 Jul;78 Suppl 1:40-5. Epub 2010 Jul 8.

Inspection department news

New inspection item

*April 2012 Inspection items implemented in-hospital

1. Anti-thyroglobulin antibody (Tg-Ab)
2. Anti-thyroid peroxidase antibody (TPO-Ab)

Academic report

Presentations, Lectures, etc. January to March 2012

• Hitoshi Kazuo and others:
  Appropriate disinfection time for intravenous blood sampling with chlorhexidine gluconate in alcohol-free patients: a bacteriological study with blood sampling simulation
  Medical Examination Vol.61:374-379, 2012

Presentations, Lectures, etc. July to December 2011

• February 24, 2012
  21st Abdominal Ultrasound Practical Training Course "Lower Limb Vein Ultrasound"
  Lecture: Kazushi Minowa Practice: Kuroda, Hajime Hamada, Araki, Miwa
  18 participating doctor
• February 25, 2012
  Hyogo Prefecture Technician Association Abdominal Ultrasound Practical Training Course "Gastrointestinal Echo"
  Practical: Kazushi Minowa, Nobuhiro Iwasaki
• March 3, 2012 Place Kyoto Terrsa
  Lecturer, 5th EEG/EMG Seminar
  Ichiro Sasaki : "Legal judgment of brain death"
• March 15, 2012 Venue Kobe City Medical Center Auditorium
  Presented at the 109th Abdominal Ultrasound Conference
  "Consider a flowchart for diagnosing gastrointestinal diseases"
  Nobuhiro Iwasaki: "About the flow chart of gastrointestinal disease diagnosis at our hospital"
  Mamiko Takebayashi: "US Diagnosis Flowchart for Typical Gastrointestinal Disorders"
  Eriko Miwa: "Problems in the gastrointestinal disease diagnosis flow chart"
• March 24, 2012 Location: Tajima Area Local Industry Promotion Center
  Presentation at the 10th North Kinki Heart Imaging Study Group
  Junichi Kawai: "Evaluation of mitral regurgitation by transesophageal echocardiography and three-dimensional echocardiography"

◆◆Feature No. 3◆◆

Introduction of microbiology laboratory

Microbiology Laboratory Marie Niki

Microorganisms are organisms that cannot be observed with the naked eye, such as bacteria, yeast, and viruses, and are essential to human life. When we hear the word microbes, we tend to get a vague image of them, but there are more than 100 trillion of them in the human body, and these are called indigenous bacteria. For example, intestinal bacteria such as Escherichia coli that live in the intestine protect our bodies by helping the digestion of food and eliminating newly invading bacteria. However, for people with weakened immune systems, these indigenous bacteria may become the causative bacteria (pathogenic microorganisms) of infectious diseases. In addition, there are microorganisms (pathogenic microorganisms) that enter the body and harm people, such as pathogenic Escherichia coli O-157 and Campylobacter. The microbiology laboratory provides information on such pathogenic microorganisms to the attending physician.

The role of the microbiology laboratory can be broadly divided into four

① General bacteria test

Patient specimens such as sputum, urine, pus, and blood are used to test for the presence of pathogenic microorganisms. First, the submitted sample is applied to a slide glass and Gram staining ^*1 is performed. The Gram stain distinguishes between Gram-positive bacteria, which stain dark purple, and Gram-negative bacteria, which stain pink. These are observed under a microscope, and the type of bacteria is estimated from the stained color and morphology of the bacteria. Gram staining is the most important step in classifying and identifying bacteria.

Next, the sample is applied to several types of media and incubated in an incubator. When cultured overnight, bacteria that could not be seen with the naked eye grow on the medium, multiply, form colonies, and grow to a visible size. By applying it to several types of media, the name of the fungus can be guessed to some extent from the presence or absence of growth on the media, and the color and shape of the colonies.

Once colonies are formed, the bacteria are identified and tested for drug susceptibility. In the identification test, the type of bacteria is determined by examining the properties of the bacteria, such as whether they can decompose glucose or lactose. On the other hand, drug susceptibility testing examines drugs that are effective against pathogenic microorganisms detected in patient specimens. Identification and drug susceptibility testing are performed by a fully automatic bacteria analyzer using an identification panel like the photograph, except for some bacteria.

②Rapid antigen test

By examining the antigens*2 of pathogenic bacteria excreted in feces and urine, it is possible to quickly report the presence or absence of pathogenic bacteria. A rapid antigen test can report results within 15 to 30 minutes, whereas normal culture tests can take more than two days to detect bacteria. In our hospital, we perform influenza virus antigen test, fecal rotavirus antigen test, pharyngeal mucus adenovirus test, urinary pneumococcal antigen test, urinary Legionella antigen test, etc.

Urinary pneumococcal antigen test: antigen positive on the left, antigen negative on the right

③ Acid-fast bacteria test

Our hospital also conducts testing for acid-fast bacilli such as tuberculosis. In the smear examination, fluorescence staining and Ziehl-Nensen staining are performed. These stains do not stain bacteria other than acid-fast bacteria, so they can be distinguished from other general bacteria.

Many mycobacteria grow slowly and it takes a long time to culture them, so it may take 1-2 months to get culture results. However, by performing the PCR method ^*3 at the same time, it is possible to report the results within half a day.

④ Nosocomial infection control

As a member of the infection control team (ICT), bacteria that cause nosocomial infections such as MRSA (methicillin-resistant Staphylococcus aureus), MDRP (multidrug-resistant Pseudomonas aeruginosa), and ESBL (extended specificity beta-lactamase)-producing bacteria We are investigating the detection status of this and are working to prevent nosocomial infections. In addition, we are working to prevent outbreaks*4 by conducting environmental surveys to check for drug-resistant bacteria that cause nosocomial infections around the water in the ward.

However, when an outbreak does occur, we conduct an epidemiological investigation using genetic analysis. Pulsed-field gel electrophoresis (PFGE) is widely used for this genetic analysis, but it lacks simplicity and speed. I'm here.

Numbers 1 and 4 are from different patients. 2 and 3 are bacteria found around the water in patient number 1's room. 5 is a fungus that was around the water in the room of patient number 4. In other words, in the right figure, 1 and 2 have 98.3% homology ^*5, which proves that they are almost the same strain, but 1 and 4 have 65.5% homology, so they are derived from different strains.

Requests to Patients

Since the microbiology laboratory handles living organisms, it is sometimes difficult to report the results immediately, but we make every effort to find pathogens as quickly as possible and provide information on appropriate antibiotics to the attending physician.

しかし、せっかく検体を提出していただいたのにも関わらず、検査に不適切な検体もあります。例えば、喀痰の場合は唾液の含まれる粘液状のものだと口腔内には常在菌がたくさんいるため、病原微生物以外の菌のみが発育してしまい、検査結果の意味がなくなってしまいます。正確な検査結果を報告するために、喀痰を提出していただく際には、まずはうがいをし、口腔内の常在菌をできるだけ減らしてから、膿性な喀痰を提出していただくようにお願いします。

*1 Gram staining: Bacteria are classified into Gram-positive bacteria that stain dark purple and Gram-negative bacteria that stain pink, depending on the structure of the cell wall of bacteria.

*2 Antigen: A general term for substances (structural proteins of microorganisms, etc.) that provoke an immune response for biological defense when they enter the body. This principle of immune reaction is used in clinical tests.
*3 PCR method: A method that allows easy confirmation of the presence or absence of very small amounts of bacteria by amplifying the DNA of bacteria using a machine called a thermal cycler and special reagents.
*4 Outbreak: An outbreak of an infectious disease caused by the same strain of bacteria in a specific location within a certain period of time.
*5 Homology: A specific part of a gene that shares an evolutionary common ancestor. It can be determined that those with a high homology rate are derived from the same strain.

Postscript

From this June, the waiting hallway of the physiological examination room on the second floor has been decorated with cute flowers. Are these flowers used by the staff of the physiological examination room and the blood collection room in your home garden, rental farm, roadside? I bring flowers that are blooming and growing in the garden and decorate them. It's not the gorgeous flower you see in stores, but because it's a wild flower, I feel like I'm calming down and calming down.

In addition, when the flowers are displayed, patients and other staff say, "The flowers are pretty, aren't they?"

Wildflowers are not gorgeous and gorgeous flowers that shine brightly, but bloom quietly and unnoticeably, but soften the heart in the scenery of people who pass by.

doctor and nurses, we do not interact with patients all the time. I want to do my best to make sure that you feel comfortable and have a good examination.

◆◆Feature No. 4◆◆

The relationship between HPV and actual cervical cancer screening

Pathology Laboratory Masahito Omatsu

Cervical cancer is mostly caused by HPV (human papillomavirus) infection. HPV is a virus that infects the skin and mucous membranes. Currently, more than 100 types of HPV have been discovered, and they are numbered in order of discovery. HPV that infects the genital mucosa is divided into high-risk and low-risk types according to the degree of carcinogenesis risk. Among the high-risk types, types 16 and 18 are said to be particularly involved in carcinogenesis. It has been.

Cervical cancer occurs frequently in people in their 40s and 50s, but in recent years the prevalence of cervical cancer among women under the age of 40 is increasing. However, since dysplasia (lesion before cervical cancer develops) can be detected, it is possible to prevent the onset of cancer by detecting and treating dysplasia at the stage of cervical cancer through regular cervical cancer screening. . In addition, bivalent HPV vaccines (types 16 and 18) and quadrivalent vaccines (types 6, 11, 16, and 18) against the HPV virus, which is said to account for the majority of cervical cancers, are now available. It is said that this vaccine is highly effective in preventing cancer.

In the pathology laboratory, cytological examinations of the cervix and cervix are performed to check for cervical cancer and precancerous lesions, as well as for HPV and other infectious diseases. Therefore, this time, we will introduce the actual cytological examination of cervical cancer performed in the pathology laboratory.

A. Cell collection and sample preparation method for cytological examination

The cervix is composed of squamous epithelium continuously from the outside to the skin, vulva, and vagina. And there is a place where it collides with the lineal cells that make up the epithelium just after entering the entrance of the uterus. Cervical cancer frequently occurs at the junction between the squamous epithelium and the glandular epithelium (S-C junction), so this area is scraped with instruments such as cotton swabs, spatulas, and brushes.

Next, the collected smear is smeared on a preparation and quickly placed in a 95% alcohol solution before it dries to fix the cells. After that, Papanicolaou staining is performed, and the stained specimen is examined under a microscope for abnormal findings by a clinical laboratory technologist with specialized qualifications called a cytotechnologist.

B Various cell images and their characteristics

① Coilosite

It is a change seen in HPV-infected cells, and distinct vacuoles are observed around the nucleus, which is called a nuclear perimeter.

② Mild dysplasia (mild dysplasia, low-grade squamous intraepithelial lesion [LSIL])
Classification: Class Ⅲa

Cells with nuclear atypia of superficial to middle-layer squamous epithelial cells are seen. The nuclei are larger than normal cells and stain dark purple. An increase in the N/C ratio (nuclear/cytoplasmic ratio) is seen. Further investigation may be required and colposcopy and tissue biopsy may be performed.

③ Severe dysplasia, high-grade squamous intraepithelial lesion [HSIL]
Class classification: Class Ⅲb

Cells with nuclear atypia of parabasal squamous epithelial cells are mainly seen. The size of the nucleus relative to the cytoplasm becomes larger, irregular shapes and notches are often observed, and the nucleus is stained darker. As with mild dysplasia, close examination is required.

④ Squamous cell carcinoma Invasive cancer
Classification: Class V

The background has a lot of necrosis and looks dirty, and the cells are distorted, and small to large malignant cells are seen in flat clumps. The size of the nucleus is large and small, and the variation is conspicuous. The cytoplasm shows spindle-shaped, snake-shaped, and tadpole-shaped morphologies, and malignant cells that stain dark orange may also be seen. We will conduct detailed examinations such as histological examinations and decide on a treatment policy.

C Summary

Most cervical cancers are caused by HPV infection. However, as explained this time, it is a cancer that can be detected and treated at an early stage by confirming cell dysplasia by cytological examination. It is thought to be preventable through regular cervical cancer screening and vaccination.

* Vaccines are quite expensive (at our hospital, the total cost for three doses is around 52,000 yen), but some local governments subsidize vaccination costs. Kobe City subsidizes the full amount for girls from the first year of junior high school to the first year of high school. For details, please check the website of Kobe City.

Contact information

Kobe City Public Health Center Preventive Health Division Tuberculosis and Infectious Disease Section
TEL 078-322-6788
Our hospital
TEL 078-302-4321 (representative)

《Postscript June 20》
On June 14, 2013, the Ministry of Health, Labor and ministry of Health, Labor and Welfare notation issued a statement about routine vaccination of human papillomavirus infections (recommendation), which states that "the occurrence frequency of side reactions will be clarified, and appropriate measures will be taken." It should not be actively recommended until information can be provided." For details, please contact the above contact information or each medical institution.

Inspection department news

Academic report

Paper presentation

• Inoue D, Matsushita A, Kiuchi M, Takiuchi Y, Nagano S, Arima H, Mori M, Tabata S, Yamashiro A, Maruoka H, Oita T, Imai Y, Takahashi T.：Successful Treatment of γ-Heavy-Chain Disease with Rituximab and Fludarabine.　Acta Haematol. 128: 139-143, 2012

Conference presentation

• September 19, 2012
  Osaka Ultrasonic Society Osaka International Conference Center
  Presented by Masafumi Sugawara, Hitoshi Kazuo, Hokaku Jeong, et al.: "A case of pediatric acute appendicitis that appears like a cystic mass"
• September 19, 2012
  Japanese Society for Clinical Medical Examinations Kansai Branch General Meeting Shirahama, Wakayama Prefecture
  Presentation: Natsumi Nomoto, Hayato Maruoka, Koji Nasu, Tatsuo Oita: "Immunophenotyping of plasma cell tumors using 6-color flow cytometry"
  Presentation: Akiko Yamashiro, Yoko Shibata, Akiyo Tamura, Kanji Miki, Tatsuo Oita: "Report on five years after the opening of the examination consultation room"
  Presented by: Hitoshi Kazuo, Kenji Sakizono, Keishi Takekawa, Masaaki Eto:
  "Appropriate disinfection time for intravenous blood collection with chlorhexidine gluconate in alcohol-free patients"
• October 6, 2012
  The 39th Kansai Regional Conference of the The Japan Society of Ultrasonics in Medicine, Osaka
  Presentation: Mamiko Takebayashi, Nobuhiro Iwasaki, Yoshiki Suginoshita, et al.: “Study of Abdominal Tumors in the Past Five Years at Our Hospital”
  Presentation: Nobuhiro Iwasaki, Mamiko Takebayashi, Yoshiki Suginoshita, et al.: "A case of pancreatic pseudoarteriovenous malformation (AVM) associated with acute pancreatitis"
  Presentations: Nobuhiro Iwasaki, Mamiko Takebayashi, Yoshiki Suginoshita, et al.: "A case of diverticulum perforation caused by amoeba infection"
  Presentation: Kazumi Hamada, Takako Tosaka, Sho Sasaki, et al.: "A case of diffuse sclerosing papillary carcinoma in the residual lobe of follicular cancer"
  Presentation: Eriko Miwa, Naoko Araki, Nobuhiro Iwasaki, et al.: "A case of hepatic malignant lymphoma treated with contrast-enhanced ultrasound"
  Presentation: Masafumi Sugawara, Hitoshi Kanoo, Kazumi Hamada, et al.: "A case of pediatric perforated appendicitis with hydronephrosis: On the mechanism that appears like a cystic mass"
  Presentation: Namiko Nomura, Tomoko Tani, Toshiko Konda, et al.: "Two cases in which left ventricular hypertrophy was suspected on electrocardiogram, but left ventricular wall thickening was not confirmed by transthoracic echocardiography"
• October 11, 2012
  Japanese Audiological Society Kyoto International Conference Center Kyoto
  Presentation: Mitsuo Hamada: "A case of unilateral auditory neuropathy with mild laterality in hearing tests"
• November 5, 2012
  The The Japanese Association for Infectious Diseases Central Japan Regional Society ACROS Fukuoka
  Presentation: Marie Niki, Kanji Miki, Keishi Takekawa: "Epidemiological survey of Pseudomonas aeruginosa by rep-PCR analysis"
• November 30, 2012
  General Assembly of the Japanese Society for Laboratory Medicine, Kyoto
  Presentation: Hayato Maruoka, Tatsuo Oita, Takayuki Ishikawa: "Immunophenotyping of B-ALL by 6-color flow cytometry"

Lecture

• June 28, 2012
  Abdominal Ultrasound Conference Kobe
  Lecture: Nobuhiro Iwasaki: "Ultrasound Diagnosis of Abdominal Tumors"
• July 21, 2012
  Physiology Department System Forum Osaka
  Lecture: Junichi Kawai: "Efforts to introduce a departmental system"
• July 26, 2012
  The 13th Kobe Glam Dyeing Conference Kobe ANA Crowne Plaza Hotel
  Lecture: Hiroshi Takegawa: "A Case of Cellulitis in a Patient with Castleman's Disease"
• September 21, 2012
  emergency conference
  Lecture: Yoko Shibata: "For safe blood transfusion"
• September 30, 2012
  General Meeting of the Kansai Branch of the Society of Clinical Medical Examinations (Shirahama, Wakayama)
  Lecture: Keiji Takekawa: "Minimum reporting for Gram staining"
  Lecture: Hitoshi Kazuo: "Tips for evaluating hepatocellular carcinoma (HCC)"
• September 15, 2012
  2012 Infection Control Certified Nurse Education Course Kobe Training Center
  Lecture: Hiroshi Takegawa: "Fungi and hard-to-cultivate microorganisms"
• September 21, 2012
  2012 Infection Control Certified Nurse Curriculum Kobe University Graduate School of Health Sciences
  Lecture: Keishi Takegawa: "Introduction to Microbial Testing/Basic Operation of Testing"
• September 22, 2012
  2012 Infection Control Certified Nurse Curriculum Kobe University Graduate School of Health Sciences
  Lecture: Keishi Takegawa: "Observation and Judgment of Culture Medium"
• September 23, 2012
  2012 Infection Control Certified Nurse Curriculum Kobe University Graduate School of Health Sciences
  Lecture: Hiroshi Takegawa: "Mycobacterial test, observation of fungi, determination of drug susceptibility, etc."

Postscript

Autumn is the season for academic conferences. Members of our Clinical Laboratory also energetically made presentations at academic conferences such as the Medical Examination Society, the Ultrasonic Society, and the Society for Infectious Diseases. There were 5 presentations by the newcomers hired in 2011 and 2012, and I think it is a showcase of their efforts as well as the skills of their instructors. This year, previews were held throughout the examination room. Since clinical testing is divided into a wide range of fields, such as blood testing, bacteriological testing, pathological testing, and ultrasonography, the presenter first gives a brief lecture on technical terms and measurement principles in order to give the audience a background knowledge of the content of the presentation. The announcement was made after deepening the understanding of the audience. The newcomer calmly made a solid presentation, and responded well to the questions and answers after the presentation. There were also comments from outside the field, and a great deal of discussion took place, making the meeting very meaningful.

◆◆Feature No. 5◆◆

About the sample test flow - from sample collection to result reporting -

General examination room: Asami Yorioka, Biochemical examination room: Chihiro Miyazaki

Our laboratory is located on the 2nd and 3rd floors. In the back of the urine collection room on the 2nd floor, there is a general examination room, which mainly analyzes the urine submitted from the urine collection room. In addition, the blood collected in the blood collection room is transported to the 3rd floor on a transport tray, where it is analyzed in the biochemical test, immunological test, and blood test departments.

In our laboratory, we are making various efforts to report accurate test results quickly. For outpatient pre-examination testing, we implement immediate reporting, which means that results are reported within one hour of the specimen's arrival at the laboratory, so that test results can be provided before the examination. Nearly 100 items including hormones and tumor markers, as well as general test items for liver function and anemia, are subject to immediate test items. In addition, we have established a system in which clinical laboratory technologists urgently contact the attending physician if, judging from the test results, a test value (panic value) indicating a pathological condition requiring immediate treatment is detected. In addition, we have established a system that enables emergency examinations 24 hours a day, 365 days a year to support emergency medical care at our hospital.

This time, I will briefly introduce the flow from the examination of the specimen after blood and urine collection from the patient until the results are obtained.

Did you understand the blood test items that are affected by diet and exercise?

Exercising, eating, drinking alcohol, smoking, etc. on the previous day or the day of the test may affect the test results and cause them to fluctuate. In order to provide more accurate test results, the patient's cooperation is essential.

In addition, all the staff are working hard to provide each clinical department with quick and accurate test results, but depending on the test content, it may take time. We ask that you complete blood and urine collection in advance.

Academic report

Paper presentation

• Inoue D, Matsushita A, Kiuchi M, Takiuchi Y, Nagano S, Arima H, Mori M, Tabata S, Yamashiro A, Maruoka H, Oita T, Imai Y, Takahashi T.：Successful Treatment of γ-Heavy-Chain Disease with Rituximab and Fludarabine.　Acta Haematol. 128: 139-143, 2012

Conference presentation

• ○September 19, 2012
  Osaka Ultrasonic Society Osaka International Conference Center
  Presented by Masafumi Sugawara, Hitoshi Kazuo, Hokaku Jeong, et al.: "A case of pediatric acute appendicitis that appears like a cystic mass"
• September 19, 2012
  Japanese Society for Clinical Medical Examinations Kansai Branch General Meeting Shirahama, Wakayama Prefecture
  Presentation: Natsumi Nomoto, Hayato Maruoka, Koji Nasu, Tatsuo Oita: "Immunophenotyping of Plasma Cell Tumors Using 6-Color Flow Cytometry"
  Presentation: Akiko Yamashiro, Yoko Shibata, Akiyo Tamura, Kanji Miki, Tatsuo Oita: "Report on five years after the opening of the examination consultation room"
  Presented by: Hitoshi Kazuo, Kenji Sakizono, Keishi Takekawa, Masaaki Eto:
  "Appropriate disinfection time for intravenous blood collection with chlorhexidine gluconate in alcohol-free patients"
  Presentation: Toyokazu Akita, Hiromi Takano: "A Trial to Introduce a Training Program for Newcomers to Blood Transfusion Testing Facilities"
  Presentation: Hisae Suzuki, Fumie Inoue, Yukiko Shishido, Toshiyuki Ueno: "Search for D-dimer quantitative values and disease relevance in our hospital"
  Presentation: Miyuki Hasegawa, Yayoko Kaizuma, Mineyo Kiuchi, Toyokazu Akita: "Fundamental study of reagents for TgAb and TPOAb measurement by automatic electrochemiluminescence immunoanalyzer cobas e411"
• October 6, 2012
  The 39th Kansai Regional Conference of the The Japan Society of Ultrasonics in Medicine, Osaka
  Presentation: Mamiko Takebayashi, Nobuhiro Iwasaki, Yoshiki Suginoshita, et al.: “Study of Abdominal Tumors in the Past Five Years at Our Hospital”
  Presentation: Nobuhiro Iwasaki, Mamiko Takebayashi, Yoshiki Suginoshita, et al.: "A case of pancreatic pseudoarteriovenous malformation (AVM) associated with acute pancreatitis"
  Presentations: Nobuhiro Iwasaki, Mamiko Takebayashi, Yoshiki Suginoshita, et al.: "A case of diverticulum perforation caused by amoeba infection"
  Presentation: Kazumi Hamada, Takako Tosaka, Sho Sasaki, et al.: "A case of diffuse sclerosing papillary carcinoma in the residual lobe of follicular cancer"
  Presentation: Eriko Miwa, Naoko Araki, Nobuhiro Iwasaki, et al.: "A case of hepatic malignant lymphoma treated with contrast-enhanced ultrasound"
  Presentation: Masafumi Sugawara, Hitoshi Kanoo, Kazumi Hamada, et al.: "A case of pediatric perforated appendicitis with hydronephrosis: On the mechanism that appears like a cystic mass"
  Presentation: Namiko Nomura, Tomoko Tani, Toshiko Konda, et al.: "Two cases in which left ventricular hypertrophy was suspected on electrocardiogram, but left ventricular wall thickening was not confirmed by transthoracic echocardiography"
• October 11, 2012
  Japanese Audiological Society Kyoto International Conference Center Kyoto
  Presentation: Mitsuo Hamada: "A case of unilateral auditory neuropathy with mild laterality in hearing tests"
• November 5, 2012
  The The Japanese Association for Infectious Diseases Central Japan Regional Society ACROS Fukuoka
  Presentation: Marie Niki, Kanji Miki, Keishi Takekawa: "Epidemiological survey of Pseudomonas aeruginosa by rep-PCR analysis"
• November 30, 2012
  General Assembly of the Japanese Society for Laboratory Medicine, Kyoto
  Presentation: Hayato Maruoka, Tatsuo Oita, Takayuki Ishikawa: "Immunophenotyping of B-ALL by 6-color flow cytometry"

Lecture

• June 28, 2012
  Abdominal Ultrasound Conference Kobe
  Lecture: Nobuhiro Iwasaki: "Ultrasound Diagnosis of Abdominal Tumors"
• July 21, 2012
  Physiology Department System Forum Osaka
  Lecture: Junichi Kawai: "Efforts to introduce a departmental system"
• July 26, 2012
  The 13th Kobe Glam Dyeing Conference Kobe ANA Crowne Plaza Hotel
  Lecture: Hiroshi Takegawa: "A Case of Cellulitis in a Patient with Castleman's Disease"
• September 21, 2012
  emergency conference
  Lecture: Yoko Shibata: "For safe blood transfusion"
• September 30, 2012
  General Meeting of the Kansai Branch of the Society of Clinical Medical Examinations (Shirahama, Wakayama)
  Lecture: Keiji Takekawa: "Minimum reporting for Gram staining"
  Lecture: Hitoshi Kazuo: "Tips for evaluating hepatocellular carcinoma (HCC)"
• September 15, 2012
  2012 Infection Control Certified Nurse Education Course Kobe Training Center
  Lecture: Hiroshi Takegawa: "Fungi and hard-to-cultivate microorganisms"
• September 21, 2012
  2012 Infection Control Certified Nurse Curriculum Kobe University Graduate School of Health Sciences
  Lecture: Keishi Takegawa: "Introduction to Microbial Testing/Basic Operation of Testing"
• September 22, 2012
  2012 Infection Control Certified Nurse Curriculum Kobe University Graduate School of Health Sciences
  Lecture: Keishi Takegawa: "Observation and Judgment of Culture Medium"
• September 23, 2012
  2012 Infection Control Certified Nurse Curriculum Kobe University Graduate School of Health Sciences
  Lecture: Hiroshi Takegawa: "Mycobacterial test, observation of fungi, determination of drug susceptibility, etc."

Postscript

said. ran away. And I'm about to leave
Monthly events in 2013.
The deadline for updating the website has passed. Time flies fast. too fast.
Thankfully.
I have a lot to do. Too many. But I am grateful to be able to do it.
I am happy.
However, it has not been done. That's why "time" passes quickly.

It's been a year since the birth of "TEKARI" by The Inspection Department Times.
Although it is updated only 4 times once every 3 months, it continues.
It is growing steadily.
has become respectable.
Good content anyway. Thanks to contributors.
Aiming for my 2nd birthday, let's do our best again for another year.
"Transmission from Kobe to the world, Kobe Kobe City Medical Center Clinical Laboratory"

H.T

Certificate of Participation in Clinical Laboratory Accuracy Control Survey Japan Medical Association

Certificate of Participation in Nichiringi Clinical Laboratory Accuracy Control Survey

Military skill accuracy control survey participation certificate

Inspection results Fiscal 2021

Number of people with various certifications

Affiliated academic society