Pain management of malignant psoas syndrome with tapentadol and lumbar plexus blockade：A case report

Malignant psoas syndrome（MPS）is one of challenging cancer pain states, which is often refractory to conventional analgesic therapy. We report a case of a 67 years-old female patient suffering from left MPS caused by lumbar paravertebral malignant lymphoma. Tapentadol, a dual action analgesic, has relatively low affinity to mu-opioid receptor and provoke noradrenergic reuptake inhibition simultaneously. Neuropathic component is predominant in MPS. Tapentadol is reported to be a drug of choice for the treatment of neuropathic pain. Psoas compartment blockade is a choice of interventions to relieve severe thigh pain caused by a lesion of lumbar plexus which exists in a compartment between psoas and quadratus lumborum muscles. Pain and numbness in the affected left thigh region of the patient were well managed by opioid switching from oxycodone to tapentadol and supplemental psoas compartment blocks with a local anesthetic and dexamethasone. The activity of daily life and quality of life of the patient were dramatically improved. Tapentadol with psoas compartment blockade may be efficacious for the management of MPS.

Low serum secretory immunoglobulin A level and sense of coherence score at an early gestational stage as indicators for subsequent threatened premature birth

<p><b>OBJECTIVES</b>The purpose of this study was to assess the validity of the candidate indicators secretory immunoglobulin A (s-IgA) and sense of coherence (SOC) as predictors of threatened premature birth.</p><p><b>METHODS</b>This was a panel study conducted on women in their first and latter half of pregnancy during survey period. The survey period was from December 2005 to June 2006 and from December 2007 to June 2008. The women enrolled in the study were asked to complete the survey questionnaire and provide blood samples for the determinations of physiological indicators. The questionnaire consisted of questions related to the stress perception scale (SPS), SOC score as an indicator of modifiers of stress, demographic data, complications in a previous pregnancy, and the course of the current pregnancy. We used s-IgA and high-sensitivity C-reactive protein as a physiological stress indicator and a marker of infection, respectively. Seventy-two eligible subjects were included in the analysis.</p><p><b>RESULTS</b>Twenty-eight (38.9%) subjects had undergone treatment for threatened premature birth, and 44 (61.1%) subjects had not. In the logistic analysis, we set the course of pregnancy as a dependent variable, and age, birth history, smoking habits, a history of miscarriage, premature birth or threatened premature birth, SPS, SOC, and s-IgA in the first half of pregnancy as independent variables. We found that low serum s-IgA levels and low SOC scores in the first half of pregnancy were associated with threatened premature birth.</p><p><b>CONCLUSIONS</b>Our results suggest that low serum s-IgA level and SOC score at an early gestational stage are significant indicators for a threatened premature birth.</p>

Relationship between Sense of Coherence in Final Stage of Pregnancy and Postpartum Stress Reactions

Objective: In this study, we evaluated postpartum stress using a postpartum depression scale and by measuring the level of a stress-related substance, to clarify the relationship between the stress-coping capabilities of women in the final stage of pregnancy and their postpartum stress reactions. Methods: Between April 2004 and October 2004, 54 women participated in a questionnaire survey and the measurement of their secretory immunoglobulin A (s-IgA) level as a stress-related substance two times in the final stage of their pregnancy (prepartum) and in their early puerperium (postpartum) was carried out. The questionnaire used in the prepartum stage included the following parameters: “basic features”, “Sense of Coherence (SOC)” and “Japanese version of the self-assessment depression scale” of Zung. The questionnaire employed in the postpartum stage included the following parameters: “course of delivery”, “Self-evaluation of delivery experience”, and “Postpartum depression scale”. Results: The depression score was higher and the s-IgA level was lower in the low-SOC score group than in the high-SOC score group, indicating that stress reactions were more intense in the low-SOC score group. Conclusion: It was revealed that stress reactions were more intense for women with a low SOC score. Moreover, the finding of a relationship between the low SOC score in the prepartum stage and depressive tendency suggests that women who are likely to develop depressive tendency can be predicted in the prepartum stage, and the significance of measuring SOC in the prepartum stage is thus suggested.

Relationship between sense of coherence in final stage of pregnancy and postpartum stress reactions

<p><b>OBJECTIVE</b>In this study, we evaluated postpartum stress using a postpartum depression scale and by measuring the level of a stress-related substance, to clarify the relationship between the stresscoping capabilities of women in the final stage of pregnancy and their postpartum stress reactions.</p><p><b>METHODS</b>Between April 2004 and October 2004, 54 women participated in a question naire survey and the measurement of their secretory immunoglobulin A (s-IgA) level as a stress-related substance two times in the final stage of their pregnancy (prepartum) and in their early puerperium (postpartum) was carried out. The questionnaire used in the prepartum stage included the following parameters: "basic features", "Sense of Coherence (SOC)" and "Japanese version of the self-assessment depression scale" of Zung. The questionnaire employed in the postpartum stage included the following parameters: "course of delivery", "Self-evaluation of delivery experience", and "Postpartum depression scale".</p><p><b>RESULTS</b>The depression score was higher and the s-IgA level was lower in the low-SOC score group than in the high-SOC score group, indicating that stress reactions were more intense in the low-SOC score group.</p><p><b>CONCLUSION</b>It was revealed that stress reactions were more intense for women with a low SOC score. Moreover, the finding of a relationship between the low SOC score in the prepartum stage and depressive tendency suggests that women who are likely to develop depressive tendency can be predicted in the prepartum stage, and the significance of measuring SOC in the prepartum stage is thus suggested.</p>