Clinical and radiobiological consideration of cyclical hypofractionated radiation therapy also known as QUAD Shot for neglected skin cancer disfiguring the face of a non-compliant patient who was refusing surgery and protracted radiation therapy: case report

Although surgery is the mainstay of local treatment for skin cancer, definitive radiation therapy (RT) has been also applied for patients who are unable to tolerate surgery. Definitive RT regimens usually consist of daily treatment for 4–7 weeks. Such protracted daily RT regimens, however, would not be feasible for non-compliant patients or patients who are unable to make multiple daily trips for weeks. Without treatment, however, skin cancers can continuously progress and cause distressing symptoms. A cyclical hypofractionated RT (QUAD Shot: 14 Gy in 4 fractions, twice-daily treatments with 6 hours interval on 2 consecutive days) can be a practical RT regimen for those patients. In this report, we present the successful treatment course of repeated QUAD Shots in a 79-year-old patient with neglected skin cancer that was disfiguring his face yet declined definitive surgery and protracted RT. We also evaluated and compared biologically equivalent doses between QUAD Shots and conventionally fractionated protracted RT regimens.

Anesthetic Management of a Patient with Antiphospholipid Antibody Syndrome: A case report / 대한마취과학회지

The antiphospholipid antibody syndrome (APS) is characterized by the presence of auto antibodies to phospholipids in association with in vitro prolongation of phospholipid-dependent coagulation tests, recurrent pregnancy loss, multiple thrombotic events, etc. Due to strong predilection for thrombosis in both the arterial and venous system, perioperative thromboprophylaxis for APS patients is very important to avoid catastrophic major cardiovascular complications. We experienced general anesthesia for a total abdominal hysterectomy in a 47-year-old patient diagnosed as having APS by a past medical history of deep vein thrombosis, fetal wastages, and laboratory confirmation. Pre and postoperative management for hypercoagulability was done with oral warfarin and low dose heparin. To prevent intraoperative thrombosis, we maintained an activated clotting time (ACT) over 200 seconds by heparin 3000 U injection, applied antithrombotic stockings, and tried to avoid dehydration, hypothermia and infections.

Cytokine mRNA Expression in Mononuclear Cells from Lymph Nodes of Tuberculous Lymphadenitis Patients after In Vitro Stimulation with the TSP Antigen of Mycobacterium tuberculosis H37Rv

We isolated Triton X-100 solubilized protein (TSP) antigen which may be preferentially associated with the cell wall of M. tuberculosis. In this study, the proliferative activities and cytokine mRNA expression patterns of the TSP antigen were investigated in peripheral blood mononuclear cells (PBMCs) and lymph node mononuclear cells (LNMCs) from 4 patients with tuberculous lymphadenitis. The results of the TSP antigen were compared with those of the PPD antigen, known as a major seretory protein antigen of M. tuberculosis. The peak proliferative response to the TSP by PBMCs was observed at 0.1 ug/ml, whereas that of LNMCs was at 1.0 ug/ml. All of the patients showed greater blastogenic responses for the PPD than those for the TSP. IFN-r, IL-2, and IL-2Ru mRNA production from PBMCs after stimulation with the TSP were greatly augmented after 48 hrs, whereas IL-4 and IL-10 mRNA were gradually suppressed. In addition, high levels of IL-12 p40 mRNA were detected by PBMCs to the TSP antigen at 3 hrs. Elevated IFN-r and IL-2 mRNA production were observed in freshly isolated LNMCs, whereas IL-4 mRNA production was undetectable in either freshly isolated or mycobacterial antigen-stimulated LNMCs. Furthermore, IL-10 mRNA expression from LNMCs was markedly increased by the PPD antigen, but it was considerably reduced by the TSP antigen after 18 hrs. These data suggest that the TSP antigen may be a strong inducer of cytokine mRNA such as IFN-r, IL-2, and IL-12 which are involved in Thl cell and macrophage activation, and inhibit IL-10 mRNA production in LNMCs. In conclusion, the TSP antigen can be used as a preferential Thl cell immunogen in tuberculous lymphadenitis.