Opioids are generally used to treat severe cancer pain. Usually, it is common to increase the dose of opioids to maintain analgesia. Opioid-induced hyperalgesia (OIH) is a paradoxical response to opioid resulting in increased perception of pain rather than antinociceptive effect. A 64-year-old female with pancreatic cancer was suffering from whole abdominal pain. She took massive opioid therapy, however, her pain had been worse and widen in the 3 months. Radiologic imaging was performed to exclude metastatic cancer. The result was negative. We suspected OIH, and reduced the amount of opioids, then, added to adjuvant analgesics. And also we performed celiac plexus neurolysis with the use of alcohol and continuous epidural catheter insertion. Her numeric rating pain scale (NRS) decreased from 9/10 to 3/10. This case suggests that adjuvant analgesics and interventional treatments can resolve a OIH patient with intractable cancer pain.
Abdominal Pain ; Analgesia ; Analgesics ; Analgesics, Opioid ; Catheters ; Celiac Plexus ; Female ; Humans ; Hyperalgesia ; Middle Aged ; Pain Management ; Pancreatic Neoplasms ; Stress, Psychological

The B-type gamma knife unit was installed at Kyung-Hee University Hospital in March 1992. The selective beam plugging method can be used to reduce the low percentage isodose profiles of normal sensitive organ and to codify the isodose cuties of treatment volume for better shaping of the target volume. For representing the changes of the law percentage isodose profiles, the variations of dose distribution for several cases were discussed in this paper. The film dosimetry was performed for the evaluation of calculated isodose profiles predicted by KULA dose planning system. The results were verified by RFA-3 automatic densitometry. The clinical application of selective beam shielding method was performed in 17 patients in 100 patients who have undergone gamma knife radiosurgery for a year. The calculated and the measured isodose profiles for the high percentage regions were well consistent with each other. When the target of pituitary tumor is macro-size, the selective beam shielding method is the most applicable method. When the target size, however, is small, the correct selection of the proper helmet size is very important. All patients were exposed almost about 3~12 Gy for brain stem, and 3~11.2 Gy for optic apparatus. It is recommended that the same or other plugging patterns with multiple isocenters should be used for protection of the radiosensitive normal structures with precise treatment of CNS lesions.
Brain Stem ; Densitometry ; Film Dosimetry ; Head Protective Devices ; Humans ; Jurisprudence ; Pituitary Neoplasms ; Radiosurgery

Since March 1992, total 200 patients who visited our hospital as functional or organic lesions of central nervous system were treated by gamma knife stereotactic radiosurgery for 27 months. Thirty-nine patients of total cases was diagnosed as cerebral arteriovenous malformation. The rate of magnificantion of X-ray film was reduced by cutting fixation adaptor from 1.6 to below 1.45 times. In order to treat the deep- and lateral-seated cerebral arteriovenous malformation, we slightly modified the angiographic indicator, the commercial leksell system, by cutting each inner sides about 5mm. We performed the more distinction fo the scales by adapting 0.5mm or 1mm copper filter to angiographic indicator. The center point of indicator(X=100mm, Y=100mm, z=100mm) is corrected by adjusting scales of X-, Y-, Z- axis to each inner 100 and outer 100 point within 1-2mm by repeated exposure of X-ray on films in trial-and-errors. We have developed the "GKANGIO" programmed as the Fortran-77 in Microvax -3100, which can save treatment planning time and perform accurate pretreatment planning using the theoretical target metrix center form accurate pretreatment planning using the theoretical target metrix center. The theoretical description of the simplified method is presented for the reduction of experimental and numerical errors in treatment planning of radiosurgery.
Axis, Cervical Vertebra ; Central Nervous System ; Copper ; Humans ; Intracranial Arteriovenous Malformations* ; Radiosurgery* ; Weights and Measures ; X-Ray Film

BACKGROUND: Propofol has an antioxidant capacity and can be used for ischemia-reperfusion injury of the liver. However, the effects of propofol on the Kupffer cells have not been established. METHODS: Kupffer cells were isolated and cultured from male Sprague-Dawley rats. The effects of propofol on the Kupffer cells were evaluated by a phagocytosis assay, TNF-alpha gene expression, TNF-alpha production, and superoxide anion release after administering propofol in different concentrations on the cultured Kupffer cells. RESULTS: The latex bead phagocytosis by the Kupffer cells was suppressed when the Kupffer cells were exposed to propofol irrespective of concentrations. Higher propofol concentrations decreased the loss of Kupffer cells after latex bead phagocytosis. Propofol induced TNF-alpha mRNA expression in the Kupffer cells, but the mRNA expression level after 50microgram/ml of propofol decreased. The pattern of TNF-alpha mRNA expression induced by propofol was different to that induced by LPS: TNF-alpha mRNA was expressed continuously in the propofol-treated cells until 16 hours after exposure to propofol, whereas the level of TNF-alpha mRNA expression induced by LPS was evident after 2 hours and was not found thereafter. TNF-alpha production after propofol treatment was not higher than that of the control. Formazan precipitation did not show any qualitative differences between cells untreated or treated with propofol concentrations of 0.5, 5.0, and 50microgram/ml. CONCLUSIONS: These results showed that propofol might inhibit Kupffer cells. This suggests that propofol can be used for patients with ischemia-reperfusion injury of the liver.
Animals ; Gene Expression ; Humans ; Kupffer Cells* ; Liver* ; Male ; Microspheres ; Phagocytosis ; Propofol* ; Rats* ; Rats, Sprague-Dawley ; Reperfusion Injury ; RNA, Messenger ; Superoxides ; Tumor Necrosis Factor-alpha

This study was aimed to observe that extremely low frequency magnetic field (ELF-MF) may be relevant to changes of major neurotransmitters in rat brain. After the exposure to ELF-MF (60 Hz, 2.0 mT) for 2 or 5 days, we measured the levels of biogenic amines and their metabolites, amino acid neurotransmitters and nitric oxide (NO) in the cortex, striatum, thalamus, cerebellum and hippocampus. The exposure of ELF-MF for 2 or 5 days produced significant differences in norepinephrine and vanillyl mandelic acid in the striatum, thalamus, cerebellum and hippocampus. Significant increases in the levels of serotonin and 5-hydroxyindoleacetic acid were also observed in the striatum, thalamus or hippocampus. ELF-MF significantly increased the concentration of dopamine in the thalamus. ELF-MF tended to increase the levels of amino acid neurotransmitters such as glutamine, glycine and gamma -aminobutyric acid in the striatum and thalamus, whereas it decreased the levels in the cortex, cerebellum and hippocampus. ELF-MF significantly increased NO concentration in the striatum, thalamus and hippocampus. The present study has demonstrated that exposure to ELF-MFs may evoke the changes in the levels of biogenic amines, amino acid and NO in the brain although the extent and property vary with the brain areas. However, the mechanisms remain further to be characterized.
Animals ; Biogenic Amines ; Brain ; Cerebellum ; Dopamine ; Glutamine ; Glycine ; Hippocampus ; Magnetic Fields* ; Neurotransmitter Agents* ; Nitric Oxide ; Norepinephrine ; Rats ; Serotonin ; Thalamus

PURPOSE: The authors report a case of bilateral simultaneous central retinal vein occlusion caused by Waldenstrom's macroglobulinemia. CASE SUMMARY: A 65-year-old man presented to our department complaining of decreased visual acuity for the duration of about 6 months. On his initial visit, best-corrected visual acuity was 0.02 in the right eye and 0.06 in the left eye. Based on the findings of a funduscopic examination, the patient had bilateral diffuse retinal hemorrhages, dilated tortuous veins, and macular edema. He had experienced recurrent spontaneous epistaxis 6 months previously and had undergone treatments such as intravitreal bevacizumab injection and intravitreal dexamethasone implantation at another hospital. Laboratory tests at that hospital showed anemia and hyperproteinemia, for which he was referred to our hemato-oncology department. Bone marrow biopsy was consistent with Waldenstrom's macroglobulinemia/lymphoplasmacytoid lymphoma, and he was treated with systemic chemotherapy. One year after the systemic chemotherapy, his best-corrected visual acuity was 0.15 in the right eye and 0.6 in the left eye. Funduscopy showed decreased bilateral retinal hemorrhages and macular edema. CONCLUSIONS: When simultaneous bilateral central retinal vein occlusion occurs in a patient with no other underlying disease such as hypertension or diabetes, it might be a sign of serum hyperviscosity, and there should be a very high level of suspicion for presence or progression of systemic disease. If such a disease is properly and timely diagnosed, effective early systemic evaluation and therapy can be administered, and it is important to have initial general treatment as well as ophthalmic treatment.
Aged ; Anemia ; Bevacizumab ; Biopsy ; Bone Marrow ; Dexamethasone ; Drug Therapy ; Epistaxis ; Humans ; Hypertension ; Lymphoma ; Macular Edema ; Retinal Hemorrhage ; Retinal Vein* ; Veins ; Visual Acuity ; Waldenstrom Macroglobulinemia*

PURPOSE: This study is a prospective randomized clinical trial comparing the efficacy and complication of anti-emetic drugs for prevention of nausea and vomiting after radiotherapy which has moderate emetogenic potential. The aim of this study was to investigate whether the anti-emetic efficacy of ondansetron (Zofran(R)) 8 mg bid dose (Group O) is better than the efficacy of metoclopramide 5 mg tid dose (Group M) in patients undergoing fractionated radiotherapy to the abdominal region. MATERIALS AND METHODS: Study entry was restricted to those patients who met the following eligibility criteria: histologically confirmed malignant disease; no distant metastasis; performance status of not more than ECOG grade 2; no previous chemotherapy and radiotherapy. Between March 1997 and February 1998, 60 patients enrolled in this study. All patients signed a written statement of informed consent prior to enrollment. Blinding was maintained by dosing identical number of tablets including one dose of matching placebo for Group O. The extent of nausea, appetite loss, and the number of emetic episodes were recorded everyday using diary card. The mean score of nausea, appetite loss and the mean number of emetic episodes were obtained in a weekly interval. RESULTS: Prescription error occurred in one patient. And diary cards have not returned in 3 patients due to premature refusal of treatment. Card from one patient was excluded from the analysis because she had a history of treatment for neurosis. As a result, the analysis consisted of 55 patients. Patient characteristics and radiotherapy charcteristics were similar except mean age was 52.9+/-11.2 in group M, 46.5+/-9.6 in group O. The difference of age was statistically significant. The mean score of nausea, appetite loss and emetic episodes in a weekly interval was higher in group M than O. In group M, the symptoms were most significant at 5th week. In a panel data analysis using mixed procedure, treatment group was only significant factor detecting the difference of weekly score for all three symptoms. Ondansetron (Zofran ) 8 mg bid dose and metoclopramide 5 mg tid dose were well tolerated without significant side effects. There were no clinically important changes in vital signs or clinical laboratory parameters with either drug. CONCLUSION: Concerning the fact that patients with younger age have higher emetogenic potential, there are possibilities that age difference between two treatment groups lowered the statistical power of analysis. There were significant difference favoring ondansetron group with respect to the severity of nausea, vomiting and loss of appetite. We concluded that ondansetron is more effective anti-emetic agents in the control of radiotherapy-induced nausea, vomiting, loss of appetite without significant toxicity, compared with commonly used drug, i.e., metoclopramide. However, there were patients suffering emesis despite the administration of ondansetron. The possible strategies to improve the prevention and the treatment of radiotherapy-induced emesis must be further studied.
Appetite ; Drug Therapy ; Humans ; Informed Consent ; Metoclopramide* ; Nausea* ; Neoplasm Metastasis ; Ondansetron* ; Prescriptions ; Prospective Studies* ; Radiotherapy* ; Statistics as Topic ; Tablets ; Treatment Refusal ; Vital Signs ; Vomiting*

Hypertrophic pachymeningitis is a progressive disease resulting in a diffuse thickening of dura mater due to inflammation, tumor or autoimmune diseases, but most cases are idiopathic. It is seldom reported to be related to sensorineural hearing loss, but it can cause sensorineural hearing loss which can be potentially reversed through treatment. Here, we report the case of a 54-year-old woman who had progressive, bilateral, worse in the left, sensorineural hearing loss and visual disturbance with an accompanying headache over several months. Brain MRI showed diffusely thickened dura mater, highly enhanced after gadolinium administration, which was consistent with pachymeningitis. It was assumed to be related to autoimmune pathogenesis on the basis of elevated serum myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) titers. After empirical steroid and cyclophosphamide therapy, auditory impairment improved, especially in the high frequency region of the pure tone audiogram, and significant improvement in the word recognition test. Moreover, a follow-up MRI revealed much decreased enhancement of the dura mater, and the MPO-ANCA titer decreased to within the normal range. In the case of rapidly progressive sensorineural hearing loss or hearing impairment accompanying other cranial neuropathy, pachymeningitis should be taken into consideration, and brain MRI with gadolinium enhancement is the best method of detecting it. Also, to ensure proper treatment, a cautious evaluation including an ANCA work-up should be performed.
Antibodies, Antineutrophil Cytoplasmic ; Autoimmune Diseases ; Brain ; Cranial Nerve Diseases ; Cyclophosphamide ; Cytoplasm ; Dietary Sucrose ; Dura Mater ; Female ; Follow-Up Studies ; Gadolinium ; Headache ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; Inflammation ; Meningitis ; Middle Aged ; Reference Values ; Wegener Granulomatosis

OBJECTIVE: The beneficial effect of decompressive craniectomy in the treatment of severe traumatic brain injury (TBI) is controversial, but there is no debate that decompression should be performed before irreversible neurological deficit occurs. The aim of our study was to assess the value of ultra-early decompressive craniectomy in patients with severe TBI. METHODS: Total of 127 patients who underwent decompressive craniectomy from January 2007 to December 2013 was included in this study. Among them, 60 patients had underwent ultra-early (within 4 hours from injury) emergent operation for relief of increased intracranial pressure. Initial Glasgow coma scale, brain computed tomography (CT) scan features by Marshall CT classification, and time interval between injury and craniectomy were evaluated retrospectively. Clinical outcome was evaluated, using the modified Rankin score. RESULTS: The outcomes of ultra-early decompressive craniectomy group were not better than those in the comparison group (p=0.809). The overall mortality rate was 68.5% (87 patients). Six of all patients (4.7%) showed good outcomes, and 34 patients (26.8%) remained in a severely disabled or vegetative state. Forty of sixty patients (66.7%) had died, and two patients (3.3%) showed good outcomes at last follow-up. CONCLUSION: Ultra-early decompressive craniectomy for intracranial hypertension did not improve patient outcome when compared with "early or late" decompressive craniectomy for managing severe TBI.
Brain Injuries ; Brain* ; Classification ; Decompression ; Decompressive Craniectomy* ; Follow-Up Studies ; Glasgow Coma Scale ; Humans ; Intracranial Hypertension ; Intracranial Pressure ; Mortality ; Persistent Vegetative State ; Retrospective Studies ; Treatment Outcome

No abstract available.
Lung* ; Neoplasm Metastasis* ; Sebaceous Glands*