Intrathecal morphine delivery at prepontine cistern to control refractory cancer-related pain: a case report of extensive metastatic and refractory cancer pain

BACKGROUND

Extensive metastatic and refractory cancer pain is common, and exhibits a dissatisfactory response to the conventional intrathecal infusion of opioid analgesics.

CASE PRESENTATION

The present study reports a case of an extensive metastatic esophageal cancer patient with severe intractable pain, who underwent translumbar subarachnoid puncture with intrathecal catheterization to the prepontine cistern. After continuous infusion of low-dose morphine, the pain was well-controlled with a decrease in the numeric rating scale (NRS) of pain score from 9 to 0, and the few adverse reactions to the treatment disappeared at a low dose of morphine.

CONCLUSIONS

The patient achieved a good quality of life during the one-month follow-up period.

Magnetic resonance imaging study of hippocampus structural alterations in post-traumatic stress disorder: a brief review (translated version)

Post-traumatic stress disorder is a disabling condition that may affect individuals who have been exposed to severe emotional or physically life-threatening traumatic events. The majority of neuroimaging studies of post-traumatic stress disorder have focused on potential abnormalities in the hippocampus, a brain area that plays a critical role in memory processing and biological response to stress. Most of the imaging studies have found smaller volume of the hippocampus as measured with magnetic resonance imaging in patients with post-traumatic stress disorder while others failed to reveal hippocampal volume loss. We reviewed magnetic resonance imaging researches which focused on the hippocampal structural alteration of post-traumatic stress disorder in different populations (adults and children), with different research design (cross-sectional and longitudinal), and using different volume measure protocols (hippocampal total volume and subfield volume).

Cytokine expression during acute graft-versus-host disease after allogeneic peripheral stem cell transplantation

Acute graft-versus-host disease (aGVHD) is one of the major problems following allogeneic peripheral blood stem cell transplantation (allo-PBSCT). In order to investigate the pathogenesis of human aGVHD, we analyzed cytokine gene expression and cytokine secretion by peripheral blood mononuclear cells (PBMC) in 30 patients who underwent allo-PBSCT. In this study, reverse transcription-polymerase chain reaction (RT-PCR) was used to explore the mRNA expression of interleukin (IL)-2, interferon (IFN)-gamma, IL-4, IL-10 and IL-12 in the PBMC of allo-PBSCT patients with aGVHD and in controls. The concentrations of these cytokines and of IL-18 were also measured by means of ELISA in medium obtained from cultured leukocytes after stimulation with PHA or LPS. Compared with the normal allo-PBSCT group (n=14), IL-2 and IFN-gamma were detected more frequently in aGVHD group (n=16). IL-12 and IL-18 were elevated, while IL-10 level decreased in the same group. There is no difference in IL-4 gene expression between patients with or without aGVHD, but the concentration of IL-4 for patients with grade II-IV aGVHD decreased. These data suggest that IL-2, IFN-gamma, IL-12 and IL-18 play important roles in the development of aGVHD in humans.

Ecology and prevention of a shellfish-associated hepatitis A epidemic in Shanghai, China

During a shellfish-borne hepatitis A outbreak in Shanghai during the first quarter of 1988, 300,000 cases were reported in two months. Using cell culture and experimental infection of marmosets, hepatitis A virus (HAV) was isolated from clams collected from the market and the sea bed during the epidemic. A dose-response curve correlating the quantity of clams consumed to the attack rate of hepatitis A was well documented. The occurrence of the epidemic was associated with a good harvest of clams in a new area, serious pollution of this area with sewage and importation of the clams in large quantities into Shanghai where most young adults were susceptible. Clams can apparently be decontaminated by using a continuous water flow. In this way, HAV titres can be reduced by 90% in one day and by 99.9% in two weeks. An attenuated live HAV vaccine which has been developed in China has been shown to be safe and immunogenic and may be used for prevention of such epidemics in the future.