ABSTRACT
Meningeal dissemination is rare in the clinical course of ovarian carcinoma, and its prognosis is poor. Although it is treated by the intrathecal administration of methotrexate (MTX) and/or total brain irradiation, these treatments are usually ineffective. We report a 58-year-old woman with stage IIIc ovarian cancer who had received nine courses of adjuvant chemotherapy after surgery. But her carbohydrate antigen (CA) 125 serum level had increased further (38.9 U/ml) after five courses of biweekly paclitaxel (Taxol; Bristol-Myers Squibb, Tokyo, Japan; BT) maintenance therapy. Fainting occurred, with a few seconds of unconsciousness, as did severe headaches. However, results of head computed tomography (CT), head magnetic resonance imaging, and electroencephalogram were normal. Lumbar puncture (LP) was performed. The opening pressure was 30 cmH2O or greater. Meningeal dissemination of the ovarian cancer was diagnosed, as adenocarcinoma cells were found by cerebrospinal fluid (CSF) cytology. We started chemotherapy with intrathecal injections of MTX and hydrocortisone acetate. Establishing a diagnosis of carcinomatous meningitis may be difficult. Clinical signs and biological data are not conclusive. In this patient, CSF cytology was very effective in establishing the diagnosis, and the intrathecal administration of MTX and hydrocortisone was very effective.
Subject(s)
Adenocarcinoma/drug therapy , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Meningeal Carcinomatosis/drug therapy , Ovarian Neoplasms/pathology , Adenocarcinoma/cerebrospinal fluid , Adenocarcinoma/secondary , Electroencephalography , Female , Humans , Hydrocortisone/administration & dosage , Hydrocortisone/analogs & derivatives , Injections, Spinal , Magnetic Resonance Imaging , Meningeal Carcinomatosis/cerebrospinal fluid , Meningeal Carcinomatosis/secondary , Methotrexate/administration & dosage , Middle Aged , Neoplasm Staging , Spinal Puncture , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Erythropoietin/metabolism , Paraneoplastic Endocrine Syndromes , Female , Humans , Hysterectomy , Leiomyoma/diagnosis , Leiomyoma/metabolism , Leiomyoma/therapy , Middle Aged , Paraneoplastic Endocrine Syndromes/diagnosis , Paraneoplastic Endocrine Syndromes/etiology , Paraneoplastic Endocrine Syndromes/physiopathology , Paraneoplastic Endocrine Syndromes/therapy , Polycythemia/etiology , Uterine Neoplasms/diagnosis , Uterine Neoplasms/metabolism , Uterine Neoplasms/therapyABSTRACT
The large majority of gynecologic malignancies are comprised of uterine cervical cancer, endometrial cancer and ovarian cancer. Prognostic factors for each disease are based on various clinical pathological features, including clinical stage, tumor size, and lymph node metastatis for uterine cervical cancer. In addition to these factors, recent studies have investigated the role of various molecules including tumor markers and Hb level, apoptosis-related molecules as well as various genetic abnormalities as prognostic factor or indicators for uterine cervical cancer. This molecular background of uterine cervical cancer will shape future directions in the increasingly individualized basis of treatment.
Subject(s)
Biomarkers, Tumor/blood , Lymph Nodes/pathology , Uterine Cervical Neoplasms/mortality , Uterine Cervical Neoplasms/pathology , Antigens, Neoplasm/blood , ErbB Receptors/blood , Female , Humans , Lymphatic Metastasis , Papillomavirus Infections/complications , Papillomavirus Infections/pathology , Prognosis , Serpins/blood , Survival Rate , Uterine Cervical Neoplasms/virologyABSTRACT
BACKGROUND: To reduce the severity of post procedure pain associated with uterine artery embolization (UAE) for leiomyomata, we used continuous infusion of low concentration ropivacaine through an epidural catheter. METHODS: Thirteen patients for UAE were evaluated. In a patient without indication for epidural anesthesia, the pain was controlled with intermittent morphine infusion. Other patients had post procedure pain managed with 10 ml bolus of 1% lidocaine and continuous infusion of 0.2% ropivacaine at 5 ml x hr-1 for 16 hours. RESULTS: The patient complained of severe pain just after UAE and required epidural lidocaine. Then, we started to infuse lidocaine or ropivacaine just before starting UAE. Among these cases, 9 patients required extra pain control using NSAIDs as a rescue. Only three patients required no medication except epidural analgesia. CONCLUSIONS: Continuous infusion of 0.2% ropivacaine at a rate of 5 ml x hr-1 is not enough for pain management after UAE.
