Successful Prevention of Tumour Lysis Syndrome in HER2-positive Breast Cancer: Case Report and Literature Review.

BACKGROUND/AIM: Tumour lysis syndrome (TLS) is a life-threatening oncological emergency. TLS is rare and associated with a higher mortality rate in solid tumours than in haematological malignancies. Our case report and literature review aimed to identify the distinctive features and hazards of TLS in breast cancer. CASE REPORT: A 41-year-old woman complained of vomiting and epigastric pain and was diagnosed with HER2-positive, hormone-receptor-positive breast cancer with multiple liver and bone metastases and lymphangitis carcinomatosis. She had several risk factors for TLS: high tumour volume, high sensitivity to antineoplastic treatment, multiple liver metastases, high lactate dehydrogenase levels, and hyperuricaemia. To prevent TLS, she was treated with hydration and febuxostat. One day after the first course of trastuzumab and pertuzumab, she was diagnosed with disseminated intravascular coagulation (DIC). After 3 further days of observation, she was relieved of DIC and administered a reduced dose of paclitaxel without life-threatening complications. The patient achieved a partial response after four cycles of anti-HER2 therapy and chemotherapy. CONCLUSION: TLS in solid tumours is a lethal situation and can be complicated by DIC. Early recognition of patients who are at risk of TLS and initiation of therapy is essential to avoid fatal situations.

Choroidal thickness in healthy Japanese subjects.

Purpose. To study posterior choroidal thickness and its profile based on location in healthy Japanese subjects and the correlation with axial length, refractive error (RE), and age. Methods. Eighty-six eyes of 43 healthy volunteers with no ophthalmic or systemic symptoms were examined with prototype high-penetration optical coherence tomography using a 1060-nm light source. Eyes with high myopia (exceeding -6 D) or with retinal/choroidal disease were excluded. The spherical equivalent RE was measured by autorefractometry, and the axial length was measured by partial coherence inferometry. Results. Mean choroidal thicknesses were 354 +/- 111 mum at the fovea, 364 +/- 86 mum superiorly, 345 +/- 108 mum inferiorly, 227 +/- 532 mum nasally, and 337 +/- 102 mum temporally. Subfoveal choroidal thickness was significantly greater than nasal (P < 0.01) and temporal (P < 0.05) choroidal thickness; however, there was no significant difference compared with superior (P = 0.20) and inferior (P = 0.17) choroidal thickness. The temporal choroid was significantly (P < 0.01) thicker than the nasal choroid, and the inferior choroid was significantly (P < 0.01) thinner than the superior choroid. There was a significant negative correlation between foveal choroidal thickness and axial length (P < 0.05) but a borderline correlation with the RE (P = 0.086) and age (P = 0.07). Age was the factor that was most associated with the choroidal thickness (F = 20.86; P < 0.001), followed by RE (F = 5.37; P < 0.05); axial length was not a significant factor (F = 1.47; P = 0.22) by stepwise analysis. Conclusions. The profile of choroidal thickness depends on its location. RE, axial length, and especially age are critical for evaluation of choroidal thickness.

The effect of acupressure at the extra 1 point on subjective and autonomic responses to needle insertion.

BACKGROUND: Premedication with sedatives can decrease the discomfort associated with invasive anesthetic procedures. Some researchers have shown that acupressure on the acupuncture extra 1 point is effective for sedation. We investigated whether acupressure on the extra 1 point could alleviate the pain of needle insertion. METHODS: We investigated the effect of acupressure at the extra 1 point or a sham point on needle insertion using verbal rating scale (VRS) pain scores and heart rate variability (HRV). Twenty-two healthy female volunteers were randomly allocated to two groups: the extra 1 group received acupressure at the extra 1 point, and the sham group received acupressure at a sham point. After starting the electrocardiogram record, a 27-gauge needle was inserted into the skin of a forearm. Thereafter, another needle was inserted into the skin of the other forearm during acupressure. RESULTS: Acupressure at the extra 1 point significantly reduced the VRS, but acupressure at the sham increased the VRS. Acupressure at the extra 1 significantly reduced the low frequency/high frequency ratio of HRV responding to needle insertion. CONCLUSIONS: Acupressure at the extra 1 point significantly reduced needle insertion pain compared with acupressure at the sham point. Also, acupressure at the extra 1 point significantly reduced the low frequency/high frequency ratio of HRV responding to needle insertion, which implies a reduction in sympathetic nervous system activity.