Intrathecal baclofen (ITB) therapy is used to treat patients with spasticity. The pump that delivers baclofen to the intrathecal space of the thoracolumbar spine is generally implanted under the skin or fascia of the anterolateral abdomen. Here we present a case in which the pump was implanted in an alternative site, under the skin of the anteromedial thigh. The patient was a 61-year-old man who was 148 cm tall. He had spastic paraplegia (ASIA Impairment Scale grade B) caused by severe scoliosis related to dystrophic neurofibromatosis. No safety space for pump implantation existed in his abdomen because of a stoma, scars, and adhesions that resulted from surgeries for ileus and abdominal aortic aneurysms. The catheter ran from the lumbar spine to the anteromedial thigh via the point between the iliac crest and the great trochanter. The catheter and pump caused no trouble over 1 year of follow-up. This case demonstrates that the thigh can be an alternative site for ITB pump implantation in some patients with abdominal wall problems. This surgical modification may not be indicated for some patients with ambulators or frequent hip motion, who are at risk of catheter problems or pump migration.

Intrathecal baclofen (ITB) therapy is used to treat patients with spasticity. The pump that delivers baclofen to the intrathecal space of the thoracolumbar spine is generally implanted under the skin or fascia of the anterolateral abdomen. Here we present a case in which the pump was implanted in an alternative site, under the skin of the anteromedial thigh. The patient was a 61-year-old man who was 148 cm tall. He had spastic paraplegia (ASIA Impairment Scale grade B) caused by severe scoliosis related to dystrophic neurofibromatosis. No safety space for pump implantation existed in his abdomen because of a stoma, scars, and adhesions that resulted from surgeries for ileus and abdominal aortic aneurysms. The catheter ran from the lumbar spine to the anteromedial thigh via the point between the iliac crest and the great trochanter. The catheter and pump caused no trouble over 1 year of follow-up. This case demonstrates that the thigh can be an alternative site for ITB pump implantation in some patients with abdominal wall problems. This surgical modification may not be indicated for some patients with ambulators or frequent hip motion, who are at risk of catheter problems or pump migration.

We performed combination therapy with modified oxaliplatin/l-LV/5-FU (mFOLFOX) in a patient with recurrent colorectal cancer who had peritonitis carcinomatosis. In this patient, mFOLFOX therapy resulted in disappearance of ascites and a decrease in carbohydrate antigen 19-9 (CA19-9), and improved quality of life (QOL) of the patient. This 62-year-old man was diagnosed with ascending colon cancer and metastatic cancer of the liver. Right hemicolectomy and right hepatic lobectomy were performed. We had started to treat with TS-1 in ambulatory care, however, he had peritonitis carcinomatosis with massive ascite reservoir on CT and peritoneal dissemination after a half year postoperatively. Furthermore, his ECOG Performance Status (PS) was rated as level 3. Therefore, we performed puncture of ascites and palliative mFOLFOX6 therapy. After ten courses, ascites and abdominal induration had disappeared and PS recovered to level 1. At present, CPT-11/l-LV/5-FU (FOLFIRI) are being administered for peripheral neuropathy and metastatic tumor associated with mFOLFOX6. The patient is spending his daily life satisfactory after FOLFIRI without abdominal swelling or ascites, and thus mFOLFOX6 may be an option for palliative therapy against massive ascites in patients with advanced colorectal cancer. The usefulness of palliative mFOLFOX6 therapy for patients with massive ascites should be evaluated in a well-designed clinical trial.Palliat Care Res 2008; 3(2): 316-320