Histochemical demonstration of aluminum and iron deposition in pulmonary bony tissues in three cases of diffuse pulmonary ossification

Diffuse pulmonary ossification is a rare condition. We examined three cases of it in Japan, and attempted histochemically to stain for deposition of aluminum and iron in bony tissues. The patients were all female, and in their mid-twenties, mid- eighties, and later teen years. One of the patients had been exposed to heavy metals in her work involving heavy-metal analyses for 18 months. Aluminum staining and Berlin blue staining for iron were performed with dewaxed, undecalcified sections of pulmonary tissues from these three cases. Interestingly, all pulmonary bony tissues from the three cases examined exhibited linear regions of both aluminum and iron deposition in the calcifying fronts or the cement lines of bones. The patient exposed to heavy metals exhibited the most severe aluminum and iron deposition, and also exhibited positive reaction for both aluminum and iron in elastic fibers of blood vessels. Foreign body granulomas with multinucleated giant cells exhibiting elastophagia were also found in this case. This phenomenon, “endogenous pneumoconiosis”, appeared to have been the cause of pulmonary hemorrhage in this case, resulting in focal heavy hemosiderosis. It is of great interest that identical patterns of aluminum and iron deposition in hemodialysis patients were found in these three cases, This is the first report on histochemical demonstration of aluminum and iron deposition in diffuse pulmonary ossification, and detailed analysis of additional cases is needed

Slow Gait Speed and Rapid Renal Function Decline Are Risk Factors for Postoperative Delirium after Urological Surgery.

OBJECTIVES:The aim of this study was to identify risk factors associated with postoperative delirium in patients undergoing urological surgery. METHODS:We prospectively evaluated pre- and postoperative risk factors for postoperative delirium in consecutive 215 patients who received urological surgery between August 2013 and November 2014. Preoperative factors included patient demographics, comorbidities, and frailty assessment. Frailty was measured by handgrip strength, fatigue scale of depression, fall risk assessment, and gait speed (the timed Get-up and Go test). Postoperative factors included types of anesthesia, surgical procedure, renal function and serum albumin decline, blood loss, surgery time, highest body temperature, and complications. Uni- and multivariate logistic regression analyses were performed to assess pre- and postoperative predictors for the development of postoperative delirium. RESULTS:Median age of this cohort was 67 years. Ten patients (4.7%) experienced postoperative delirium. These patients were significantly older, had weak handgrip strength, a higher fall risk assessment score, slow gait speed, and greater renal function decline compared with patients without delirium. Multivariate analysis revealed slow gait speed (>13.0 s) and rapid renal function decline (>30%) were independent risk factors for postoperative delirium. CONCLUSIONS:Slow gait speed and rapid renal function decline after urological surgery are significant factors for postoperative delirium. These data will be helpful for perioperative patient management. This study was registered as a clinical trial: UMIN: R000018809

Predictive value of the risk stratification.

<p><b>A:</b> Patients characteristics that were significantly different between the groups (*, <i>P</i> < 0.01). Error bar demonstrated 95% CI. <b>B:</b> ROC curve analysis to determine optimal cut-off values of age, gait speed in Get-up and Go test, and fall risk assessment scores. The AUC values were 0.89 in age, 0.87 in Get-up and Go test, and 0.79 in fall risk assessment score. The optimal cut-off values were age older than 75 years, slower than 13.0 s in the Get-up and Go test, and higher than 10 points in fall risk assessment score. <b>C:</b> Patients were categorized according to the number of independent predictors (>75 years old, Get-up and Go > 13.0 s, eGFR decline > 30%) for postoperative delirium (scores 0–3). The occurrence of postoperative delirium was 0% in score 0, 1.4% in score 1, 26% in score 2, and 67% in score 3 (<i>P</i> < 0.001). <b>D:</b> Predictive accuracy of selected three factors by the ROC curve showed that the AUC value was 0.952 (<i>P</i> < 0.001, 95% CI 0.902–1.00).</p