Thyroid anaplastic cancer is one of the most malignant neoplasms encountered in human. These tumors usually present as rapidly enlarging neck mass in old patients who may or may not have had a previously recognized goiter. The distant metastases of anaplastic cancer eventually occur in about 50% patients, mostly in the lung and bone and are an important prognostic factor, substantially reducing survival time.A 66-year old man visited out hospital because of rapidly growing anterior neck mass and hoarseness. He was diagnosed as thyroid anaplastic cancer with lymph node and lung metastasis and received combined chemotherapy and radiation therapy. On the 8th hospital day, severe abdominal pain developed and exploratory laparotomy was conducted. During operation, two intestinal mass were discovered, one of which was perforated. The microscopic examinations showed that undifferentiated malignant cells were infiltrated in the wall of small bowel. We report this case because we first experienced thyroid anaplastic cancer with intestinal metastasis.
Abdominal Pain ; Drug Therapy ; Goiter ; Hoarseness ; Humans ; Intestines ; Laparotomy ; Lung ; Lymph Nodes ; Neck ; Neoplasm Metastasis ; Thyroid Gland

Neuroblastoma, which originates in the sympathetic division of the autonomic nervous system, is the most common extracranial solid malignancy in childhood but rarely occurs in adulthood. Only one case of neuroblastoma has been reported in Korean adult. Authors recently experienced a case of neuroblastoma originating from the retroperitoneal cavity with metastasis to the bone marrow and neck. A 29-year-old male was admitted at Inha University Hospital because of abdominal pain and back pain. The patient had a past history of chemotherapy for retroperitoneal tumor in a general hospital 4 years ago. In biochemical test, neuron specific enolase(NSE) was above 260 ng/mL and urine vanillylmandelic acid(VMA) was positive. Immunohistochemical stainings of bone marrow sections, showed positive reactions for NSE, chromogranin, and synaptophysin, however, revealed negative reactions for MIC2, vimentin, and mixed keratin. Pathologic examination showed the characteristic findings of neuroblastoma. We report this case with a review of literature.
Abdominal Pain ; Adult* ; Autonomic Nervous System ; Back Pain ; Bone Marrow* ; Drug Therapy ; Hospitals, General ; Humans ; Male ; Neck ; Neoplasm Metastasis ; Neuroblastoma* ; Neurons ; Synaptophysin ; Vimentin

Despite acknowledgment that pain is likely to be a major problem for many older adults, it is difficult to estimate the frequency of pain problems for this population. The main purpose of this study was to identify the various characteristics of chronic pain in the elderly by gender. It examines by gender, pain frequency, pain intensity, number of chronic pain sites, localization of pain, impact on activities, methods of pain management, and effects of chronic pain management. The subjects were 189 elderly people(65 years and older) living in an urban area. They were surveyed at their homes. They were surveyed by interview using a closed-ended questionnaire. The survey was done from Nov. 6th. to Dec. 6th. 1997. Descriptive statistics were used to determine all of the reported pain variables. Chi-square tests were used to determine crude differences between pain intensity and gender. T-test was used to determine differences in number of pain sites between men and women. The findings are as follows ; Of the 189 subjects, 83.6% reported experiencing pain, and men reported a lower prevalence(69.5%) than women(89.2%). Women had significantly more severe pain than did men(p=.001). Lower back pain(20.2%) and leg pain(20.2%) were the most prevalent, followed by knee pain(17.4%), arm pain(13.3%), neck and shoulder pain(11.6%), and headache(9.9%). Women experienced more multiple localizations of pain(p=.0001). The greatest impact was on movement(83.5%), followed by usual activities(60.8%), sleep(49.4%), visiting(29.1%), and hobbies and recreations(50.0%). No differences were observed between men and women in the proportion of subjects reporting a negative impact on each of these activities. The methods of pain management were hospital visit(70.9%), drug store medication(46.7%), oriental medicine clinic(32.9%), endurance(13.3%), self-management(6.3%). Drug therapy was the most effective pain management strategy(94%), followed by physical therapy(63%) and accupuncture byssocausis(55%). The conclusion: Pain is a symptom of great clinical importance that is often associated with disability, loss of independence, and reduced quality of life. In this study chronic pain symptoms were common but unevenly distributed in men and women. The results further advance understanding of the experience and impact of pain by gender. Future studies should incorporate questions that gather systemic and more detailed information on the characteristics of pain, expecially by gender and by age.
Adult ; Aged* ; Arm ; Chronic Pain ; Drug Therapy ; Female ; Hobbies ; Humans ; Knee ; Leg ; Male ; Medicine, East Asian Traditional ; Neck ; Pain Management ; Quality of Life ; Surveys and Questionnaires ; Shoulder

OBJECTIVETo clarify the effectiveness of Chinese herbal fomentation in treating chronic neck pain by means of changes in cervical kinematics.

METHODSSeventy-six patients with chronic neck pain were included in the study and were randomized into two groups based on the random number generator of the SPSS software: fomentation combined with Chinese herbal (Group 1) and fomentation without any medicine (Group 2). In both groups, the fomentation lasted for 60 min and heated to 35 °C, once a day for 28 consecutive days. Standard lateral radiographs of the cervical spine were obtained including the neutral, full flexion, and full extension positions. Before and after intervention, the following parameters were used to evaluate the changes in kinematics: range of motion (ROM), sagittal alignment and instantaneous center of rotation (ICR).

RESULTSAfter treatment, the ROM was signifcantly higher than that of before treatment in Group 1 (51.5, 95% CI: 49.8-55.9; P<0.05). There was no significant difference between before and after treatment in Group 2 (P>0.05). Although C2-C7 cervical alignment was increased in both groups after treatment, no significant difference was detected between before and after treatment (P>0.05). For Group 1, the significant X coordinate variation was only observed at C5/C6 level (38.1; 95% CI: 34.0, 42.1; P<0.05). There was a significant upward trend in the Y coordinate of the ICR at C5/C6 (-30.5; 95% CI: -34.3, -26.8; P<0.05) and C6/C7 after treatment (-6.1; 95% CI: -6.7, -5.4; P<0.05). For Group 2, the ICR location of each level was not statistically different between the pre- and post-treatment (P>0.05).

CONCLUSIONSChinese herbal fomentation could improve abnormal mobility in terms of ROM and ICR. Chinese herbal fomentation might be an effective treatment for chronic neck pain.

Adult ; Biomechanical Phenomena ; Cervical Vertebrae ; diagnostic imaging ; physiopathology ; Chronic Pain ; diagnostic imaging ; drug therapy ; physiopathology ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Neck Pain ; diagnostic imaging ; drug therapy ; physiopathology ; Radiography ; Range of Motion, Articular

PURPOSE: To compare the therapeutic effects on upper extremity paresthesia of intra-muscular steroid injections into the scalene muscle with those of stretching exercise only. MATERIALS AND METHODS: Twenty patients with upper extremity paresthesia who met the criteria were recruited to participate in this single-blind, crossover study. Fourteen of 20 patients were female. The average age was 45.0+/-10.5 years and duration of symptom was 12.2+/-8.7 months. Each participant completed one injection and daily exercise program for 2 weeks. After randomization, half of all patients received ultrasound-guided injection of scalene muscles before exercise, while the other was invested for the other patients. RESULTS: After two weeks, there was a significant decrease of the visual analog scale score of treatment effect compared with baseline in both groups (6.90 to 2.85 after injection and 5.65 to 4.05 after stretching exercise, p<0.01). However, injection resulted in greater improvements than stretching exercise (p<0.01). The number of patients with successful treatment, defined as >50% reduction in post-treatment visual analog scale, was 18 of 20 (90.0%) after injection, compared to 5 of 20 (25.0%) after stretching exercise. There were no cases of unintended brachial plexus block after injection. CONCLUSION: Ultrasound-guided steroid injection or stretching exercise of scalene muscles led to reduced upper extremity paresthesia in patients who present with localized tenderness in the scalene muscle without electrodiagnostic test abnormalities, although injection treatment resulted in more improvements. The results suggest that symptoms relief might result from injection into the muscle alone not related to blockade of the brachial plexus.
Adult ; Brachial Plexus/*drug effects ; Cross-Over Studies ; *Exercise Therapy ; Female ; Humans ; *Injections, Intramuscular ; Male ; Middle Aged ; Neck Muscles/drug effects ; Pain/drug therapy ; Pain Measurement ; Paresthesia/*drug therapy/rehabilitation ; Single-Blind Method ; Thoracic Outlet Syndrome/diagnosis/*drug therapy ; Treatment Outcome

A patient with extraskeletal cervical epidural Ewing's sarcoma who presented with cervical radiculopathy is reported. A 58-year-old woman presented with right posterolateral neck pain and upper extremity radiculopathy. The computed tomography myelography showed epidural and paravertebral masses on right side, with widening of the ipsilateral neural foramina at the C2-C3 level. On magnetic resonance images, the mass was isointense to soft tissue on T1-weighted images, hyperintense on T2-weighted images, and showed diffuse enhancement on GdTA enhanced T1-weighted images. The staged, combined posterior and anterior approach were done and the tumor mass was subtotally removed. During postoperative adjuvant chemotherapy with Cytoxane, Adriamycin, Vincristine, Prednisolone regimen, the patient died of severe compression of upper cervical cord by recurrent, extended tumor mass in the spinal canal.
Chemotherapy, Adjuvant ; Cyclophosphamide ; Doxorubicin ; Drug Therapy ; Female ; Humans ; Middle Aged ; Myelography ; Neck Pain ; Prednisolone ; Radiculopathy ; Sarcoma, Ewing* ; Spinal Canal ; Upper Extremity ; Vincristine

A malignant fibrous histiocytoma (MFH) is a major subset of soft tissue sarcomas, which occurs principally on the extremities or in the retroperitoneum, as well as on the head and neck of elderly patient. However, it is an extremely rare event when a MFH occurs primarily in the diaphragm of a young people. A 25-year-old woman visited our hospital complaining of right chest pain. The chest X-ray showed a diaphragmatic mass. An exploratory thoracotomic biopsy revealed a primary MFH of the diaphragm. The patient was treated with combined chemotherapy consisting of ifosfamide and doxorubicin. A partial response was seen after 6 cycles of chemotherapy. However, she died of brain metastasis 12 months after the diagnosis.
Adult ; Aged ; Biopsy ; Brain ; Chest Pain ; Diagnosis ; Diaphragm* ; Doxorubicin ; Drug Therapy ; Extremities ; Female ; Head ; Histiocytoma, Benign Fibrous ; Histiocytoma, Malignant Fibrous* ; Humans ; Ifosfamide ; Neck ; Neoplasm Metastasis ; Sarcoma ; Thorax

Cervical disc herniation is a common disorder characterized by neck pain radiating to the arm and fingers as determined by the affected dermatome. This condition has a favorable prognosis, but pain can have a serious detrimental impact on daily activities. Epidural neuroplasty has been applied as a treatment option for cervical disc herniation; however, no study has addressed the clinical outcomes. This retrospective study evaluated the clinical outcomes of epidural neuroplasty on 128 patients for the treatment of cervical disc herniation. To measure pain-related disabilities over time, the changes of pain scores in neck and arm were evaluated using a numerical rating scale (NRS) and the neck disability index (NDI). Compared with preprocedural values, the pain NRS of neck and arm demonstrated significant improvement at day 1, and 1, 3, 6, and 12 months after the procedure (P < 0.001). Likewise, the NDI was significantly reduced at 3, 6, and 12 months after the procedure (P < 0.001). There were no serious complications. Cervical epidural neuroplasty shows good clinical outcomes in the treatment of cervical disc herniation and can be considered a treatment modality for cervical disc herniation refractory to conservative treatment.
Adult ; Aged ; Amides/administration & dosage ; Anesthetics, Local/administration & dosage ; Anti-Inflammatory Agents/administration & dosage ; Cervical Vertebrae/*radiography ; Dexamethasone/administration & dosage ; Disability Evaluation ; Epidural Space/radiography ; Female ; Follow-Up Studies ; Humans ; Hyaluronoglucosaminidase/therapeutic use ; Injections, Epidural ; Intervertebral Disc Displacement/radiography/*surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neck Pain/drug therapy ; Pain/drug therapy ; Pain Measurement ; Questionnaires ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome

The effects from cervical facet joint injections in those patients who have been complaining cervical zygapophyseal joint pain were compared. The patients were diagnosed originally as myofascial pain syndrome (MPS), cervical herniated nucleus pulposus (HNP), and whiplash-associated disorders (WAD). Patients with the zygapophyseal joints pain of C5-6 and C6-7 were classified by their pain origin as MPS, HNP, and WAD. All patients had been undergone cervical zygapophyseal joints injections with the mixture of lidocaine and triamcinolone unilaterally or bilaterally through the posterior approach under C-arm imaging guide. The therapeutic effects were compared with reduction of numeric rating scale (NRS) of pain before and immediately after blockade and symptom-free periods in each group after 12 months. Symptom durations before injections were 16.1+/-9.6, 4.6+/-1.9 and 4.1+/-1.1 months in each MPS, HNP, and WAD groups. The reductions of NRS immediately after the blockade among the three groups were not different. However, the symptom-free duration after blockade lasted longer in the HNP group than the other two groups. In patients with cervical zygapophyseal pain syndromes, the analgesic effect from cervical facet joint blocks lasted longer in cervical HNP than MPS or WAD.
Adolescent ; Adult ; Aged ; Anesthetics, Local/administration & dosage/therapeutic use ; Anti-Inflammatory Agents/administration & dosage/therapeutic use ; Comparative Study ; Female ; Humans ; Injections ; Lidocaine/administration & dosage/*therapeutic use ; Male ; Middle Aged ; Neck Pain/*drug therapy ; Research Support, Non-U.S. Gov't ; Shoulder Pain/*drug therapy ; Treatment Outcome ; Triamcinolone/administration & dosage/*therapeutic use ; Zygapophyseal Joint/drug effects/pathology

We reviewed 30 cases of superior vena cava syndrome in adult patients who were seen at the Yeungnam University Hospital from January 1985 to June 1990. The results were as follows: 1. The male-to-female ratio was 6.5:1, and the most patients were in the age group between the sixth and seventh decades. 2. The most common symptoms were dyspnea (87%) and followed by cough (63%), facial swelling (63%) and chest pain (44%) and the physical signs were dilated neck vein (97%), facial edema (93%) and facial flushing (45%) in order of frequency. 3. The simple chest x-ray findings were superior mediastinal widening (90%), right hilar mass (77%) and pleural effusion (31%). 4. Diagnosis was made by history and physical examination (100%), chest C-T scan (100%), simple chest x-ray (97%), bronchoscopy with biopsy (40%) and so on. 5. 21 cases of patients were confirmed by histology: 14 cases (46%) of bronchogenic ca, 4 cases (14%) of lymphoma, 3 cases (10%) of metastatic lung ca. Of bronchogenic ca, small cell ca was 7 cases (23%), squamous cell ca, 5 cases (17%), and unclassified cawas 2 cases (6%). 6. In response of treatment, the clinical improvement was achieved in 18 cases with radiotherapy alone, 1 case with chemotherapy only, and 6 cases with radio-chemotherapy.
Adult ; Biopsy ; Bronchoscopy ; Chest Pain ; Cough ; Diagnosis ; Drug Therapy ; Dyspnea ; Edema ; Epithelial Cells ; Flushing ; Humans ; Lung ; Lung Neoplasms ; Lymphoma ; Neck ; Physical Examination ; Pleural Effusion ; Radiotherapy ; Superior Vena Cava Syndrome* ; Thorax ; Veins ; Vena Cava, Superior*