Caudal Neuraxial Blocks for Pain Relief From Pelvic Neuropathy Caused by Extensive Diffuse Large B-cell Lymphoma.

Central neuraxial blocks can be a vital therapeutic tool for neuropathic pain, but they are infrequently implemented for pain management in cancer patients. Upon a literature review, further data on the role or efficacy of central nerve blocks for neuropathic cancer pain would be beneficial. Additionally, evidence-based guidelines and practices are lacking regarding additional interventions for neuropathic pain relief, a common manifestation of cancer burden. Here, we report the case of a 29-year-old male patient who presented in the ED with intractable neuropathic pain from extensive diffuse large B-cell lymphoma. The patient demonstrated left lower extremity pain, fevers, chills, and tenderness with erythema over the site of his port-a-catheter on his chest. The patient was also hypotensive, despite IV fluid resuscitation. Recent imaging showed a hypermetabolic soft tissue mass in the left upper quadrant of the abdomen. There was also extensive cancer spread in the peripheral pelvis, presacral region, and within multiple sacral foramina, with a secondary perineural spread of the tumor. The patient previously positively responded to a caudal nerve block at an outpatient pain clinic. The patient was admitted to the ICU for three days, and following the resolution of sepsis, the patient received caudal and sciatic nerve blocks on admission day 8. Upon further imaging showing metastasis to the brain, the patient was discharged to inpatient hospice on hospitalization day 10 following a palliative conversation with the patient and family.

Black hip: a rare case treated by total hip replacement.

BACKGROUND AND OBJECTIVE: Ochronic arthropathy of hip (Black Hip) is a rare clinical manifestation of congenital disorder of amino acid metabolism characterized by a classic triad: (1) degenerative arthritis, (2) ochronotic pigmentation, and (3) urine that turns black on long standing or alkalinization. We report a case of ochronic arthropathy of the left hip joint that was successfully treated by total hip arthroplasty. DESIGN AND SETTINGS: This is a case study conducted at PES Medical College, Andhra Pradesh, India. PATIENTS AND METHODS: A 60-year-old female patient came with a history of progressive pain in her left hip joint for the last 8 months. She was diagnosed to be suffering from ochronic arthritis of left hip. RESULTS: After tissue confirmation she was operated with total hip replacement. At the end of 2 years, the patient was symptom free without any implant loosening. CONCLUSION: Ochronotic arthropathy is a rare metabolic disorder that can be underdiagnosed many a times. Early management is only symptomatic, and advanced cases need surgical intervention. Vitamin preparations are given because of the influence of vitamin C on tyrosine and phenylalanine metabolism. In the cases of severe degenerative arthritis of hip, total hip replacement may be considered as a surgical option.

Insights on chronic-relapsing opsoclonus-myoclonus from a pilot study of mycophenolate mofetil.

Opsoclonus-myoclonus syndrome is characterized by abnormal lymphocyte trafficking into brain. The authors hypothesized that mycophenolate mofetil, a lymphocyte proliferation inhibitor, might be therapeutic. The cerebrospinal fluid and blood immunophenotypes of 15 children with predominantly chronic-relapsing opsoclonus-myoclonus syndrome were compared before and after treatment by flow cytometry. Mycophenolate mofetil reduced the cerebrospinal fluid expansion of HLA-DR+ activated T cells (-40%); the frequency of other T-cell or natural killer cell subsets remained unchanged, but cerebrospinal fluid B cells increased significantly. Adrenocorticotropic hormone dose was lowered by 64% over an average of 1.5 years, yet 73% eventually relapsed despite therapeutic drug levels. Prior treatment with rituximab prevented relapse-associated increase in cerebrospinal fluid B cells, without hindering mycophenolate mofetil-induced reduction in T-cell activation. These data demonstrate resistant immunologic problems in chronic-relapsing opsoclonus-myoclonus syndrome. Mycophenolate mofetil did not prevent relapse. The novel effect of mycophenolate mofetil on chronically activated T cells may contribute to its efficacy in T-cell mediated neurological disorders.