A Case of Nerve Root Radiofrequency Thermocoagulation for Pain Due to Pleural Metastasis of Lung Cancer Leading to Improvement in the Patient's Quality of Life.

Advances in medicine have made long-term survival of cancer patients possible. Hence, it is now necessary to consider how to approach common symptoms, such as cancer-related pain, in these patients. In this study, we describe a lung cancer patient in whom relief of intractable thoracic pain caused by pleural metastasis was achieved through thoracic radiofrequency thermocoagulation (RF), improving his quality of life (QOL). The patient was a man in his 70s with right upper lobe lung cancer, left 9th -11th rib metastasis, and left thoracic pain associated with parietal pleural metastasis. The patient experienced insomnia and weight loss due to poor appetite caused by opioid analgesics and inadequate pain control. Therefore, RF was performed as interventional treatment, resulting in a decrease in the numerical rating scale score from 10/10 to 2/10, and an improvement in QOL. In cases wherein long-term survival is expected, a long-term treatment plan for chronic cancer-related pain, which has a tendency to become persistent, becomes necessary. RF for the nerve roots might be a viable option for pain caused by pleural metastasis in cancer survivors.

Saturated salt solution method: a useful cadaver embalming for surgical skills training.

This article evaluates the suitability of cadavers embalmed by the saturated salt solution (SSS) method for surgical skills training (SST). SST courses using cadavers have been performed to advance a surgeon's techniques without any risk to patients. One important factor for improving SST is the suitability of specimens, which depends on the embalming method. In addition, the infectious risk and cost involved in using cadavers are problems that need to be solved. Six cadavers were embalmed by 3 methods: formalin solution, Thiel solution (TS), and SSS methods. Bacterial and fungal culture tests and measurement of ranges of motion were conducted for each cadaver. Fourteen surgeons evaluated the 3 embalming methods and 9 SST instructors (7 trauma surgeons and 2 orthopedists) operated the cadavers by 21 procedures. In addition, ultrasonography, central venous catheterization, and incision with cauterization followed by autosuture stapling were performed in some cadavers. The SSS method had a sufficient antibiotic effect and produced cadavers with flexible joints and a high tissue quality suitable for SST. The surgeons evaluated the cadavers embalmed by the SSS method to be highly equal to those embalmed by the TS method. Ultrasound images were clear in the cadavers embalmed by both the methods. Central venous catheterization could be performed in a cadaver embalmed by the SSS method and then be affirmed by x-ray. Lungs and intestines could be incised with cauterization and autosuture stapling in the cadavers embalmed by TS and SSS methods. Cadavers embalmed by the SSS method are sufficiently useful for SST. This method is simple, carries a low infectious risk, and is relatively of low cost, enabling a wider use of cadavers for SST.

Simultaneous measurement of cytosolic and mitochondrial Ca(2+) during ischemia in mice whole-brain slice preparation and its application to drug evaluation.

We developed a conventional imaging method to measure Ca(2+) concentration in cytosol (using FuraRed as an indicator) and mitochondria (using Rhod-2 as an indicator), simultaneously, by alternative excitation with specific wave length. After confirming the availability of the method in Hela cells, we applied it to mouse whole-brain slice -preparation, which was exposed to oxygen- and glucose-deprived artificial cerebrospinal fluid (ischemic ACSF) for 12 min. The fluorescence (>570 nm) at the cerebral cortex and hippocampus due to FuraRed (excited by 480 ± 10 nm) decreased (indicating the increase in cytosolic Ca(2+)-concentration), while the fluorescence due to Rhod-2 (excited by 560 ± 10 nm) increased (indicating the increase in mitochondrial Ca(2+) concentration) during exposure to ischemic conditions. We found the characteristic protective effects of cyclosporine A (10(-6) M), a known blocker for mitochondrial permeability transition, and SEA0400 (10(-6) M), a blocker for Na(+)/Ca(2+) exchanger, on the abnormal Ca(2+) increase in cytosol. We confirmed that the present method will be useful for future pathological and pharmacological studies on ischemia-induced brain damage.

Repetitive cerebral blood flow measurements using laser speckle imaging in a transient cerebral ischemic mouse model.

Using laser speckle imaging (LSI), which can visualize quadratic distribution of blood flow, we measured blood flow changes in transient cerebral ischemic mice, and compared these results with data obtained using laser Doppler flowmetry (LDF). In addition, we examined the relationship between ischemic damage and blood flow change. ICR mice (n = 22) were subjected to transient middle cerebral artery occlusion using a 6-0 monofilament under general anesthesia. LSI was performed before -ischemia, during ischemia, and 30 min, 3 h, 24 h, 7 days, and 28 days after ischemia. LDF was monitored continuously from pre-ischemia to 10 min after ischemia commenced. The level of cerebral blood flow (CBF) measured by LSI was less than that using LDF. LSI was able to measure CBF quantitatively and repeatedly. Blood flow -measurements using LSI revealed that recovery of cerebral cortical blood flow after ischemia in mice without cortical infarction was earlier than that seen in mice with cortical infarction. This study indicates that LSI is a -useful technique for analyzing the relationship between -tissue damage and cerebral blood flow change following cerebral ischemia.

Cyclophilin-D inhibition in neuroprotection: dawn of a new era of mitochondrial medicine.

Traumatic brain injury and ischemia can result in marked neuronal degeneration and residual impairment of cerebral function. However, no effective pharmacological treatment directed at tissues of the central nervous system (CNS) for acute intervention has been developed. The detailed pathophysiological cascade leading to -neurodegeneration in these conditions has not been elucidated, but cellular calcium overload and mitochondrial dysfunction have been implicated in a wide range of animal models involving degeneration of the CNS. In particular, activation of the calcium-induced mitochondrial permeability transition (mPT) is considered to be a major cause of cell death inferred by the broad and potent neuroprotective effects of -pharmacological inhibitors of mPT, especially modulators of cyclophilin activity and, more specifically, genetic inactivation of the mitochondrial cyclophilin, cyclophilin D. Reviewed are evidence and challenges that could bring on the dawning of mitochondrial medicine aimed at safeguarding energy supply following acute injury to the CNS.

[Actual effectiveness of nerve block against neuropathic pain].

Evidence regarding the effectiveness of nerve block in treating neuropathic pain is scarce. However, in actual clinical situations, nerve block has been used as a treatment in combination with other methods, such as pharmacotherapy, psychotherapy, and physiotherapy. The goal of neuropathic pain treatment is not a complete recovery but some improvement in the activities of daily living (ADL) as well as the quality of life. There is no single effective, definitive treatment for the various causes of neuropathic pain; therefore, the active use of nerve block should be considered in patients who show a positive response to this treatment. This is because nerve block reduces pain and improves the patients' ADL. Nerve block also has the potential to be effective as an early treatment of and prophylaxis for neuropathic pain. Therefore, the use of nerve block should be considered from the onset of pain. In recent years, methods such as ultrasound-guided nerve block and thermocoagulation with pulsed radiofrequency have become more commonly used as safer and more accurate nerve block techniques. This article discusses the current clinical status of nerve block against neuropathic pain.

An atypical case of fulminant interstitial pneumonitis induced by carbamazepine.

Carbamazepine is a therapeutic anticonvulsant, used to manage pain. We often use it to treat trigeminal and post-herpes zoster neuralgias. Interstitial pneumonitis (IP) is a known adverse consequence of using carbamazepine, with bronchiolitis obliterans and organizing pneumonitis. (BOOP) drug-induced IP as typical examples. Here we described a patient with post-herpes zoster neuralgia, who suffered from drug-induced acute IP that differed from cases typically induced by carbamazepine.

Usefulness of galvanic skin reflex monitor in CT-guided thoracic sympathetic blockade for palmar hyperhidrosis.

Computed tomography (CT)-guided thoracic sympathetic blockade with ethanol was performed while monitoring sympathetic nerve activity, with an alternating current (AC) galvanic skin reflex (GSR) monitor, in a patient with palmar hyperhidrosis in whom endoscopic thoracic sympathectomy was impossible because of pleural adhesion. Sweating was suppressed after the thoracic sympathetic blockade, and the monitor showed a significant increase in skin resistance. The effect of sympathetic blockade could be evaluated directly and in real time using a GSR monitor.