A case of allergic reaction to surgical metal clips inserted for postoperative boost irradiation in a patient undergoing breast-conserving therapy.

We report a case of a 28-year-old woman with right-sided breast cancer. The patient had been treated for atopic dermatitis since her infancy. She underwent breast-conserving surgery (BCS) in July 1998, and three titanium clips were placed at the margin of the excision cavity at the time of surgery. Two months after surgery, the patient exhibited a rapid exacerbation of atopic dermatitis. Various drugs were suspected to be the cause of the allergic reaction, but the results of a bi-digital O-ring test (BDORT) suggested an allergic reaction to titanium clips. In August 1999, the patient underwent a second operation to remove the titanium clips under local anesthesia. Allergy to surgical titanium clips is a rare complication, but in patients with a history of severe allergic diseases, a preoperative immunologic examination should be performed and the patient's history of metal allergy should be investigated.

[Synthetic glucocorticoid in the treatment of connective tissue diseases].

Synthetic glucocorticoids are the most potent anti-inflammatory and immunosuppressive drugs, which have been used for almost 50 years as a core drug for the treatment of connective tissue diseases. The mechanism of action of glucocorticoids as anti-inflammatory or immunosuppressive drug is considered as the repression of inflammatory cytokines, receptors of cytokines, and adhesion molecules. When 60 mg of prednisolone is administered in 3 divided doses, the plasma concentrations are around 20-30 micrograms/dl during the day time, in which condition around 90% of GC receptors are occupied. However, the concentration will decrease almost to 0 microgram/dl in the next early morning. In case of methyl prednisolone pulse therapy, about 40 micrograms/dl of the steroid is present in the next morning. These kinetics are important when we consider the glucocorticoid therapy. In the treatment of connective tissue diseases, the combination of the steroid therapy with the immunosuppressive therapy should always be considered. In diffuse proliferative lupus nephritis, glucocorticoid dosage, started at high level to suppress the clinical activity of SLE, decrease rather rapidly while cytotoxic drugs are administered at least for 2 years. In the treatment of systemic sclerosis, normotensive scleroderma kidney is treated with moderate dose of glucocorticoid and cytotoxic drugs. It is our clinical impression that low dose glucocorticoid is quite effective in the treatment of rheumatoid arthritis. However, low dose glucocorticoid therapy is effective for the patient's sense of well-being, but is scarsely effective for the articular symptoms itself and shows intense rebound phenomenon when glucocorticoid is withdrawn.

[Lung cancer surgery in a patient with idiopathic thrombocytopenic purpura (ITP)].

A 59-year-old woman was hospitalized due to an abnormal chest X-ray film. Chest X-ray examination revealed an irregular opacity in the right S6 area. Adenocarcinoma was diagnosed by bronchoscopic exfoliative cytology. Preoperative hematology tests showed a low platelet count and further investigation suggested the presence of idiopathic thrombocytopenic purpura. Preoperative high-dose immunoglobulin therapy (400 mg/kg/day for five days) and platelet transfusion allowed the operation to be performed successfully (resection of the inferior lobe of the right lung and removal of regional lymphnodes). High-dose immunoglobulin therapy is thought to be a very useful method with few adverse effects for the rapid increase of platelet count to prevent massive hemorrhage.

Transcatheter arterial infusion therapy combined with radical hysterectomy in the treatment of advanced cervical cancer.

Two or three sessions of transcatheter arterial infusion (TAI) therapy were performed preoperatively in 13 patients with advanced cervical cancer (stage 3 or more). The efficacy of TAI was evaluated by tumor markers, magnetic resonance imaging (MRI), and postoperative histopathological examination. In all cases, tumor marker levels decreased after TAI therapy, and MRI also showed a decrease in the tumor size in 11/12 patients. The tumor tissue resected at radical hysterectomy showed no viable cancer cells in 6 patients, and no viable extrauterine cancer was detected in 5 more patients. Thus, TAI performed via both internal iliac arteries reduced both tumor size and extension to the parametrium, and it appears to have the potential to be an effective treatment modality for advanced cervical cancer.

Immunomodulation by a unicellular green algae (Chlorella pyrenoidosa) in tumor-bearing mice.

A unicellular algae, Chlorella pyrenoidosa, was used as a biological response modifier. In C57BL/6(B6), C3H/He and DDD/1 mice, both intraperitoneal or oral administrations of autoclaved Chlorella cells or heat-extracted substance were carried out every other day for 10 days before mouse mammary carcinoma (MM-2) or Ehrlich ascites cells were transplanted into the peritoneal cavity. In case of mouse leukemia cells (EL-4), subcutaneous transplantation was carried out. All control mice died within 20 days after each tumor cell transplantation, while 73.3-80% of the treated groups survived over 60 days in the combination of MM-2 vs. C3H/He and EL-4 vs. B6, respectively. The cytotoxic activities against tumor cells, that were abolished by treatment with anti-Thyl.2 monoclonal antibody plus complement, were evidenced in the experimental host. Since Chlorella cells and derivatives showed no indication of direct in vitro cytotoxicity to either tumor or mouse spleen cells, the antitumor effects documented may be mediated by host immune response.