A Case of Chronic Post-radiation Pain Syndrome Successfully Treated with Shimbuto

We report a patient, who had neuropathic pain after radiation, called “chronic post-radiation pain syndrome,” who was successfully treated by Shimbuto. The patient was a 83-year-old man, diagnosed with Stage IB non-small cell lung cancer of the left upper lobe. Although the lesion had a surgical indication, he selected radiotherapy, and stereotactic body radiotherapy was performed. A few months later, he experienced neuropathic pain in his anterolateral chest wall. Loxoprofen and acetaminophen had little effect; moreover, tramadol hydrochloride/acetaminophen combination tablets and pregabalin induced drowsiness and dizziness. He then wanted to take Kampo medicine (Japanese traditional medicine) and was observed to have susceptibility to gastrointestinal disorders and cold intolerance by Kampo diagnosis. We prescribed Shimbuto 5 g per day, along with pregabalin. After 2 months, the pain had almost disappeared and he could stop taking pregabalin. Shimbuto is usually prescribed to patients at a risk of gastrointestinal disorders, pain, numbness, and other symptoms induced by cold intolerance. Shimbuto includes the extract of processed aconite root, which is effective for pain and numbness; therefore, it might be a good option for treating neuropathic pain when we have difficulties with Western medicine.

Clinical significance of systematic retroperitoneal lymphadenectomy during interval debulking surgery in advanced ovarian cancer patients / 부인종양

OBJECTIVE: To investigate the clinical significance of systematic retroperitoneal lymphadenectomy during interval debulking surgery (IDS) in advanced epithelial ovarian cancer (EOC) patients. METHODS: We retrospectively reviewed the medical records of 124 advanced EOC patients and analyzed the details of neoadjuvant chemotherapy (NACT), IDS, postoperative treatment, and prognoses. RESULTS: Following IDS, 98 patients had no gross residual disease (NGRD), 15 had residual disease sized or =1 cm (suboptimal). Two-year overall survival (OS) and progression-free survival (PFS) rates were 88.8% and 39.8% in the NGRD group, 40.0% and 13.3% in the optimal group (p<0.001 vs. NGRD for both), and 36.3% and 0% in the suboptimal group, respectively. Five-year OS and 2-year PFS rates were 62% and 56.1% in the lymph node-negative (LN-) group and 26.2% and 24.5% in the lymph node-positive (LN+) group (p=0.0033 and p=0.0024 vs. LN-, respectively). Furthermore, survival in the LN+ group, despite surgical removal of positive nodes, was the same as that in the unknown LN status group, in which lymphadenectomy was not performed (p=0.616 and p=0.895, respectively). Multivariate analysis identified gross residual tumor during IDS (hazard ratio, 3.68; 95% confidence interval, 1.31 to 10.33 vs. NGRD) as the only independent predictor of poor OS. CONCLUSION: NGRD after IDS improved prognosis in advanced EOC patients treated with NACT-IDS. However, while systematic retroperitoneal lymphadenectomy during IDS may predict outcome, it does not confer therapeutic benefits.

A successful case of Denver shunt from the right chest cavity to right femoral vein in the patient with right massive pleural effusion

We experienced a case that right massive pleural effusion was successfully controlled with Denver shunt from the right chest cavity to right femoral vein. A 80-years-old woman had received hemodialysis due to chronic renal failure twice in a week. She was diagnosed as right breast cancer and underwent right breast conserving surgery at December, 2008. In postoperative follow-up duration, she had difficulty in breathing and visited to the emergency room in our hospital. She was diagnosed as respiratory failure due to right massive pleural effusion from the X-ray result and the blood gas analysis. There was no pleural effusion within the left chest space. No malignant cell was detected in the effusion. We thought that diuretics and shunt tube from the right chest cavity to the abdominal cavity would be ineffective because of her chronic renal failure, and for that reason, we placed the shunt tuve from the chest cavity to the right femoral vein. Respiratory failure and the quality of life were successfully improved for about 7 months by using it. Palliat Care Res 2011; 6(1): 301-307