Purpose: Ketamine is effective on neuropathic pain that is difficult to respond to opioids among cancer pains, due to its N-methyl-D-aspartate (NMDA) receptor antagonism action. The purpose of this study was to evaluate the effect of oral ketamine on neuropathic pain. Methods: We retrospectively investigated the dosage and the administration period of oral ketamine in 31 patients for one year from December 2004. Results: Pain-relief was achieved in 22 of 31 patients, the average of initial dose was 107.3mg/day and the average administration period was 63 days. Seven patients discontinued oral ketamine within 7 days because of nausea/ vomiting (4 patients) or drowsiness (3 patients). Two patients had no sufficient pain-relief. Conclusion: This experience suggests that oral ketamine is effective on the management of neuropathic pain. Palliat Care Res 2008; 3(1): 216-220

Mistake in Japanese Sentence had been corrected

Boccia is a targeted sport that has been devised in Europe for people with severe cerebral palsy (CP) or similar severe limbs dysfunction. In the target sport, it is important that the parasympathetic nerve becomes dominant during the competition, and it is said that the parasympathetic nerve activity tends to become dominant by training to raise the heart rate. The training protocol incorporates a rolling movement, which is an Activities of Daily Living (ADL) that can be performed even with severe CP. The purpose of this study is to verify whether interval rolling movement (IR), which repeats rolling movement at the maximum speed, is effective as training for increasing heart rate associated with effort exercise for people with severe CP. One workout consisted of 1minute rolling movement and 30seconds of rest, and three times of this workout were as 1set of IR. Subjects performed 3sets of IR with a 5minutes rest and performed this training for 6months. Six severe CP boccia players were divided into two groups, 1/week group and 1/month group, depending on the frequency of intervention. As a result, the post-exercise heart rate and the number of turns per minute increased significantly in the weekly group, and no significant change was observed in the monthly group. For severe CP boccia players, it was suggested that conducting IR at least once a week is an effective method of training aimed at increasing heart rate associated with effort exercise.

We performed gamma knife treatment for multiple brain metastases including a left frontal lobe lesion in a patient in his 60s who had renal cell carcinoma. After treatment, the left frontal lobe lesion initially shrank but then began to grow again, resulting in extensive edema, right hemiparesis, impaired activities of daily living (ADL), and decreased motivation. Although the renal cell carcinoma was in the terminal stage, we judged that recovery of ADL could be expected by removing the left frontal lobe lesion and therefore performed craniotomy tumor removal. As a result, the patient’s motivation and right hemiplegia markedly improved and ADL dramatically improved. Although the period from craniotomy tumor removal to death was as short as 2 months, significant improvement of ADL during this time was achieved by removing the tumor. Tumor resection for metastatic brain tumors is rarely performed in the setting of end-stage cancer. However, this case highlights the potential of brain tumor resection as palliative treatment that can be considered for improving ADL even in patients with terminal cancer.