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.

Two Cases of Splanchnic Nerve Block With Epidural Anesthesia in Patients Unable to Maintain Prone Position Due to Pancreatic Pain.

Splanchnic nerve block is considered to be effective for abdominal visceral pain, and is performed for the purpose of controlling abdominal pain and back pain caused by upper abdominal cancer. The patients in this case report were candidates for splanchnic nerve block owing to cancer-associated pain. However, because they could not assume the prone position that is required for the block owing to their pain, combined epidural anesthesia was used, resulting in successful implementation of the splanchnic nerve block. Patients who are candidates for splanchnic nerve block often have advanced cancer, and it is hence often difficult to secure and maintain the position required for the procedure owing to their severe pain. The two patients presented here suggest the possibility that epidural anesthesia might be useful as an adjunct in such cases.

A case of phantom pain and stump pain that was effectively controlled by ultrasound-guided ulnar and median peripheral nerve blocks.

Phantom limb pain and stump pain are often intractable, and their incidences are relatively high. We report a case of a patient with phantom limb and stump pain of the finger, who was successfully treated by peripheral nerve blocks. The patient was a male truck driver in his fifties, who had his left annular finger amputated in an accident 2 years previously. Owing to poor pain control at the stump of his finger, he was referred to our department. The initial examination revealed pain about numerical rating scale (NRS) 6/10 in the left annular finger transection as well as allodynia. Although some pain relief had been observed with postoperative medication, he still had persistent resting pain of about NRS 4/10. Therefore, blocks of the ulnar nerve and median nerve were performed. After the blocks were performed, the pain improved to NRS 1 to 2/10, and pain upon movement also almost disappeared. Peripheral nerve blocks can be a useful treatment modality for phantom limb pain and stump pain in the fingers, as in this case.

Two cases of low back pain of unknown etiology diagnosed as multiple myeloma.

We report two cases of patients complaining of lumbar back pain of unknown etiology which were finally diagnosed as multiple myeloma. The first case was a woman in her 80s with a chief complaint of lumbar back pain. The second case was a male in his 70s. He also consulted our institution because his pain did not subside despite receiving increased doses of oral medication and nerve blocks from his previous doctor. Both patients presented with compression fractures on plain radiography, and additionally with cytopenia, hyperproteinemia, and hypoalbuminemia in blood tests. Further tests were conducted due to suspected multiple myeloma, revealing a punched-out legion in the skull and elevated levels of ß2 microglobulin and Immunoglobulin G. Subsequently, both patients were transferred to the hematology department. In these two cases, we had predicted the presence of multiple myeloma from the results of initial testing and subsequently successfully provided definitive diagnoses following additional examinations.

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.

[The efficacy of ultrasound-guided infraorbital nerve block with hockey stick typed probe].

We report a case of ultrasound-guided infraorbital nerve block with a hockey stick typed probe in plane approach. Individual difference of infraorbital anatomy makes it difficult to puncture the infraorbital for a man, and the risks include bleeding, double vision and paranasal sinus puncture. The advantage of ultrasound-guided nerve block has been reported. Compared with conventional land mark method approach, ultrasound technique is thought to be easy to perform, more quickly and safely without any complications. From our results, we have demonstrated that ultrasound-guided infraorbital nerve block assisted by hockey stick typed probe could become one of the safe methods for this purpose.

Cytokine marker measurement in human neuroblastoma cells with supersensitive and multiplex assay: MUSTag technology.

BACKGROUND: Recently, various sets of protein -biomarkers have been discovered in important diseases such as cancers, brain stroke and heart attack. However, clinical validation is difficult and time-consuming by individual assays or because of very low concentrations at early stages of the diseases. We have developed assay technology through an innovative modification of the immuno-PCR method for the super-sensitive and multiplex detection of target biomarkers. METHODS: In the assay technology, each different oligo-tag simultaneously detects multiplex protein targets with extremely high-level sensitivity in a dose-dependent manner by qRT-PCR (maximum: three plexes). In this study, we measured specific secreted protein concentrations in the culture supernatant of a 24-h culture of transfected SH-SY5Y cells with MUSTag. RESULTS: There was a significant increase in the protein level of tumor necrosis factor (TNF)-α measured with extremely high-level sensitivity (≥10 pg/mL). Compared with negative controls, the levels of TNF-α increased from 16.9 to 28.1 pg/mL (p = 0.011). CONCLUSION: We suggest that our assay technology might be of clinical value in treating patients with cancer, cerebral ischemia, or patients who need a prompt and predictive diagnosis for adequate treatment.

[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.

[Ultrasound guided T2 intercostal nerve block: a comparison with stellate ganglion block under the blind technique and ultrasound guided technique].

BACKGROUND: The aim of this study is to compare the efficacy of stellate ganglion block, performed by ultrasound guided technique and blind technique, and ultrasound guided T2 intercostal nerve block. METHODS: In the present study, we evaluated the changes in upper arm skin temperature, and the development of Horner syndrome after stellate ganglion block (blind technique and ultrasound guided technique) and ultrasound guided T2 intercostal nerve block in 12, 11 and 10 patients scheduled for each block. Stellate ganglion blocks (blind technique) were performed via an anterior paratracheal approach at C6 using 1% mepivacaine 5 ml. Ultrasound guided stellate ganglion blocks were performed using 8-5 MHz, curved array transducer, and 1% mepivacaine 5 ml is injected to the longus colli muscle at C6 by the out of plane technique. Ultrasound guided intercostal nerve blocks were performed using 13-6 MHz, linear array transducer, and 0.75% ropivacaine 5 ml at T2. Patients were examined before and after the procedure. RESULTS: There were no significant differences in the increase of skin temperature and the development of Horner syndrome between the groups. CONCLUSIONS: Compared to stellate ganglion block (blind technique), ultrasound guided stellate ganglion block and T2 ultrasound-guided intercostal nerve block provided a similar efficacy.

[Ultrasound-guided and fluoroscopy-assisted selective cervical nerve root blocks].

BACKGROUND: In this article, we describe 14 case reports of using ultrasound guidance to facilitate blockade of the cervical nerve root. METHODS: A total of 14 ultrasound-guided selective cervical nerve root blocks using fluoroscopy were performed in 10 patients. The target point was the spinal nerve root between the anterior and posterior tubercles of the most lateral aspect of the transverse process C3-7, and C8 nerve root on the first rib. The key landmark was the C7 vertebra because of the absence of the anterior tubercle. RESULTS: All of the ultrasound-guided needles were placed accurately. There were no intravascular injections under real-time fluoroscopy. There were no complications. CONCLUSIONS: We conclude that ultrasound guidance might be useful for cervical nerve root blocks by improving nerve and vascular localization, and injections under real-time fluoroscopy might make this block safer by identification of the intravascular injection.

Referred pain distribution of the cervical zygapophyseal joints and cervical dorsal rami.

The purpose of this study was to determine the distribution of referred pain from the cervical zygapophyseal joints (C0/1 to C7/Th1) and the cervical dorsal rami (C3 to C7). The subjects were 61 patients who had occipital, neck, and shoulder pain of suspected zygapophyseal origin in whom pain was reproduced by injection of contrast medium into the joints or by electrical stimulation of the dorsal rami. Under fluoroscopic control, the zygapophyseal joints from C0/1 to C7/Th1 were stimulated by the injection of contrast medium and while electrical stimulation of the cervical zygapophyseal dorsal rami at segments C3 to C7 was performed during facet denervation. If injection or electrical stimulation reproduced the patient's usual pain, the distribution of referred pain was determined and the sites of referred pain were divided into 10 areas. A total of 181 joints and 62 segments were studied. Each joint and dorsal ramus produced referred pain with a characteristic distribution. The main distribution of referred pain was as follows. Pain in the occipital region was referred from C2/3 and C3, while pain in the upper posterolateral cervical region was referred from C0/1, C1/2, and C2/3. Pain in the upper posterior cervical region was referred from C2/3, C3/4, and C3, that in the middle posterior cervical region from C3/4, C4/5, and C4, and that in the lower posterior cervical region from C4/5, C5/6, C4, and C5. In addition, pain in the suprascapular region was referred from C4/5, C5/6, and C4, that in the superior angle of the scapula from C6/7, C6, and C7, and that in the mid-scapular region from C7/Th1 and C7.