A 36-year-old woman presented to our hospital with a rapidly growing lump in her left breast. Fine-needle aspiration (FNA) cytology of the mass revealed many epithelioid cells admixed with multinucleated Langhans-type giant cells, neutrophils, lymphocytes, and stromal cells, leading to a diagnosis of granulomatous mastitis. This report describes the clinical course of this patient in whom granulomatous mastitis was successfully treated with corticosteroid therapy. Special reference is made to the usefulness of FNA cytology in the diagnosis and follow-up of this disease.

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Background Bilirubin has been recognized as an antioxidant. The purpose of this study was to examine whether bilirubin would act as an antioxidant for surgical stress in humans. Materials and Methods Serum bilirubin and urinary bilirubin oxidative metabolites (BOM) were measured in 96 patients who underwent surgery. The antioxidant activity of bilirubin was assessed using BOM measured by enzyme-linked immunosorbent assay with an anti-bilirubin monoclonal antibody. Results Serum bilirubin levels increased after surgery in all 96 patients (p<0.01), but did not correlate with operation time or blood loss (p=0.53 and p=0.28, respectively). BOM increased only in patients with major surgeries (p=0.048). Significant correlations between BOM and operation time and blood loss were found (p<0.01). Conclusions Bilirubin appears to act as an antioxidant for invasive surgery in humans. Urinary BOM could be a reliable marker for the degree of surgical stress.

Selective portal vein occlusion prior to aggressive hepatic resection is now an alternative way to decrease postoperative morbidity and mortality rates. However, the detailed changes in the hepatic energy status and DNA synthesis rate in both portal vein ligated (PVL) and nonligated (PVNL) lobes of the liver are not clear. In rats, the portal branch that supplies 70% of the liver volume was ligated, and changes in arterial ketone body ratio (AKBR), liver weight, histology, DNA synthesis rate and adenine nucleotides of the PVL and PVNL liver lobes were determined before and 1, 2, 4 and 7 days after portal vein ligation, and compared with those in sham-operated rats. The weight of the PVL lobes decreased, while that of the PVNL lobes increased depending on time. The DNA synthesis rates of the PVNL lobes were significantly higher than those in sham-operated control liver during the first 4 days with the maximal value on the 2nd day, while those of PVL lobes were essentially similar to the control values. Energy charge (EC) in both PVL and PVNL lobes significantly decreased on day 1 and recovered gradually, but with less extent in the regenerating PVNL lobes. The concentrations of total adenine nucleotides (TAN) in both the PVL and PVNL lobes were essentially similar during the first 2 days, but became significantly lower in PVL lobes after day 4. A decrease in EC preceded an increase in DNA synthesis only in the PVNL lobes, in contrast to the PVL lobes. Mitosis of hepatocytes on day 2 and subsequently enlarged lobules with an increased number of hepatocytes were histologic features in the PVNL liver. The AKBR was not correlated with hepatic energy charge of the liver. In conclusion, PVNL liver regenerates preceded by a decrease in EC and a subsequent increase in DNA synthesis keeping TAN constant, while PVL liver becomes atrophic, with a similar change in EC of the PVNL liver but ultimately decreased TAN without any change in DNA synthesis. AKBR is not a parameter reflecting the hepatic EC after portal branch ligation.

The differences in lithogenicity of gallbladder bile, biliary lipid composition, cholesterol saturation index (CSI), cholesterol nucleation time (NT), bilirubin, and ionized calcium were compared in patients who had previously undergone gastrectomy or colectomy. The increased CSI and the rapid NT were absent in gastrectomized patients, while colectomy significantly increased the CSI and accelerated the NT. The levels of ionized calcium and unconjugated bilirubin, possibly responsible for pigment stone formation, were significantly higher in patients after gastrectomy, but were nearly absent in patients after colectomy. The results suggest that after gastrectomy the gallbladder bile indicates a trend towards pigment stone formation, whereas there is a trend towards cholesterol gallstones after colectomy. The different alterations of the gallbladder bile lithogenicity are clinically important.