Carcinomatous Pericarditis in 3 Breast Cancer Patients with Long-Term Survival

With advances in drug treatment of breast cancer, the number of patients experiencing cardiac toxicity or carcinomatous pericarditis is expected to increase. These conditions can cause cardiac tamponade, which is a potentially fatal condition requiring prompt diagnosis and treatment. We experienced 3 breast cancer patients with cardiac tamponade due to carcinomatous pericarditis who survived for prolonged periods after treatment with pericardiocentesis and intrapericardial instillation. The 3 women were 68, 46 and 46 years old, respectively, and receiving treatment for recurrent breast cancer after surgery. They developed dyspnea and cough and were diagnosed with cardiac tamponade by echocardiography. Pericardiocentesis was performed, and cytology of the effusion confirmed the diagnosis of carcinomatous pericarditis. Intrapericardial instillation of cisplatin reduced the cardiac effusion, ameliorating symptoms. The patients died 13, 31 and 14 months later, respectively. In our clinical review of 13 other cases of cardiac tamponade due to breast cancer, 85% achieved local control after the aforementioned local treatments, which were considered to be effective. Although the overall prognosis was poor with a median survival time of only 4 months, some patients were able to survive more than 1 year after local treatment with subsequent systemic therapy

MHD Instabilities and Their Effects on Plasma Confinement in the Large Helical Device Plasmas

"Characteristic of MHD instabilities and their impacts on plasma confinement are studied in current free plasmas of the Large helical Device (LHD). Spontaneous L-H transition is often observed in high beta plasma in the range of 2% averaged beta at low toroidal field (B_t leq 0.6T). The stored energy rapidly rises by the transition, but quickly saturates by the growth of m=2/n=3 and m=2/n=2 modes (m and n:poloidal and toroidal mode numbers) excited in the plasma edge region. Even low beta plasmas, ELM like activities are sometimes induced in high performance plasmas with high edge pressure pedestal, and transiently reduce the stored energy by about 10%. Energetic ion driven MHD modes such as Alfven eigenmodes are studied in the very wide parameter range of the averaged beta of energetic ions up to 5% and the ratio of energetic ion velocity to the alfvben velocity V_(bparallel)/V_A up to 2.5. In addition to the observation of toroidicity indued Alfven eigenmodes (TAEs), coherent magnetic fluctuations of helicity induced induced Alfven eigenmodes (HAEs) have been observed for the first time in NBI heated plasmas. Transition of TAE to global Alfven eigenmode(GAE) is also observed in a discharge with temporal evolution of the rotational transform profile, having a similarity to the phenomenon in a reversed shear tokamak. At the low magnetic field, bursting TAEs enhance energetic ion loss transiently, but lead to the transient improvement of bulk plasma confinement in the plasma central region.