Intrathecal neurolytic block in a patient with refractory cancer pain

We report the successful treatment of refractory cancer pain by bilateral intrathecal neurolysis using phenol–glycerol. A 60-year-old man had recurrent sigmoid cancer and metastases to the lumbar (L4–5) and sacral bones. He complained of refractory pain in the lower back and lower extremities despite high-dose opioid treatment based on the WHO ladder. On admission to our hospital, he received continuous intravenous infusion of morphine (7,000 mg/day) with ketamine (300 mg/day) and lidocaine (700 mg/day). Intravenous midazolam was required to treat extreme anxiety. Because of inadequate pain relief and severe drowsiness, intrathecal phenol–glycerol neurolytic block was performed twice at the L2/3 intervertebral space. His analgesia was greatly improved and high-dose intravenous opioid was retitrated and ceased. He remained comfortable and lucid at home for 2 months, until 2 days before his death at hospital. Intrathecal neurolytic block may be appropriate for some patients suffering from refractory pain that is resistant to conventional opioid analgesic treatment.     

Intrathecal phenol block in treatment of intractable pain of malignant disease

Canadian Journal of Anesthesia/Journal canadien d'anesthésie - We have reviewed the use of intrathecal phenol block for the relief of intractable pain in 37 patients suffering from...     

Intrathecal dissemination of meningiomas; a case report]

A case of the cytologically verified intrathecal dissemination of benign meningiomas was reported. A 36-year-old man was admitted to our hospital because trans-sphenoidal surgery was planned for the repair of CSF rhinorrhea caused by a recurrent pituitary adenoma. The CT scan demonstrated incidental multiple tumors spread throughout in the pontomedullary and ambient cisterns. The head and spinal MRI showed more than fifteen small tumors in the posterior fossa and the thoracic spinal canal. CSF cytology revealed benign fibroblastic or meningotheliomatous meningioma with whorl formation and psammoma body. Several comments were made on the mechanism of the intrathecal dissemination of the meningiomas.     

No sensory block with spinal bupivacaine a case report

Key words  spinal anaesthesia - bupivacaine - sympathetic - sensory and motor blocks     

Immunotactoid glomerulonephritis in a child with HIV infection: a case report

Renal disease is a common complication of human immunodeficiency virus (HIV) infection in adults. In children, however, HIV pathology of the gastrointestinal and respiratory tracts predominates, whereas renal disease is often an incidental finding. In this report, we describe a child with stage III HIV infection associated with immunotactoid glomerulonephritis (IT). The patient was referred for investigation of idiopathic nephrotic syndrome. Electron microscopy of his renal biopsy specimen revealed numerous electron-dense microtubular deposits, arranged in parallel fashion, consistent with a diagnosis of IT. He received highly active antiretroviral therapy (HAART) as well as corticosteroids and is currently in remission. To our knowledge, this is the first report of IT in a child.     

Chance fracture in a child: a case report with nonoperative treatment

The Chance fracture is an unusual lesion of the lumbar spine. Although 33 cases have been reported, only eight have occurred in adolescents and none in young children. We report here a case in a 6-year-old child.     

Appendix-ureteroplasty in a child: report of a case

The use of vermiform appendix as a tube to replace right ureteral segment has been reported, rarely in child. Herein is reported a case of right ischemic ureteral stenosis following a reimplantation of the ureter for high grade reflux secondary to posterior urethral valves with only one functioning kidney. A long ureteral defect was bridged successfully by appendix interposition and then reimplanted in the bladder at four years of age. The interest of ureteroappendiculoplasty provides temporary solution to repair long ureteral defect, in spite of uncertain future, especially in childhood.     

Dupuytren's disease in a child: a case report

Dupuytren's disease commonly affects men over the age of 40 years. It is very rare to find it in the paediatric age group. We describe a case of histologically proven Dupuytren's disease in a 10-year-old boy who presented with a nodule in his palm. Dupuytren's disease should be considered in the differential diagnosis of a nodule in hand or contracture of a finger joint in the paediatric age group.     

Intrascrotal hemangioma in a child: a case report

The patient was a boy two years and six months old. He was brought to our University Hospital with the chief complaint of scrotal mass for two years. On palpation, the mass was discriminated from the testis, epididymis and spermatic cord. The mass was followed by ultrasonography and we found two masses at the age of two years and six months. The tumors were surgically resected and they were 0.5 x 0.5 x 0.5 cm, 1.5 x 1.0 x 0.5 cm in size, respectively. Histopathological examination revealed venous and capillary hemangioma. We discuss this case, and review the literature.     

Aggressive pilomatrixoma in a child: a case report

Calcifying epitheliomas of Malherbe (pilomatrixomas) are benign calcifying tumours that arise from the hair matrix and present as a slow-growing dermal or subcutaneous mass most commonly located in the head and neck. Recurrences after tumour removal are rare. There have been reports in the past of invasive pilomatrixoma in the pre-auricular area (Krausen et al., 1974; Rothman et al., 1976; Sasaki et al., 1976; Arole et al., 1983), as well as other locations such as the right arm (Gromiko, 1927) and the upper back (Lopansri and Mihm, 1980). Two cases were also reported in adults by Weedon et al. in 1980. None of these tumours has occurred in children.     

Cavernous hemangioma with bone formation in a child: case report

A 13-year-old girl suffering from seizures who was found to have hemangioma calcificans in the frontal lobe was surgically treated. The favorable postoperative course of our patient as well as reported cases suggest early excision of the lesion if it is located in an accessible area. Histological examination confirmed ossification with marrow in the lesion. The literature regarding ossification in the brain is discussed briefly.     

Anaesthetic implications in a child with severe copper deficiency--a case report

Copper deficiency may present many systemic manifestations that can have challenging anesthetic implications. We here report the case of a child with severe copper deficiency and discuss the anesthetic management for an endoscopic nasal foreign body removal.     

Robot-assisted radical cystoprostatectomy in a small child with rhabdomyosarcoma: a case report

We report the first case of a robot-assisted radical cystoprostatectomy in a 22-month-old boy with embryonal rhabdomyosarcoma in his urinary bladder. Treatment according to international protocol CWS-2002 P (Cooperative Weichteilsarkom Studie) was given prior to surgery. The da Vinci S Surgical System from Intuitive Surgical (Sunnyvale, CA, USA) was used to laparoscopically remove the urinary bladder and prostate radically. The surgical procedure performed and the postoperative course were uneventful. This technique is safe and feasible also in small children. It seems to have advantages over open surgery and no disadvantages. We recommend this technique for further use.     

Intrathecal morphine and clonidine for control of intractable cancer pain. A case report

The use of intrathecal clonidine, in combination with intrathecal morphine, for the treatment of a patient with intractable cancer pain is reported. The addition of clonidine overcame the problem of tolerance to the analgesic effects of morphine alone. The patient was maintained pain free for three months, without complications, until his death. At autopsy, no evidence of neurotoxicity associated with the prolonged intrathecal administration of clonidine and morphine was found.     

Bifocal pyomyositis in a 3-year-old child with eczema: a case report

Pyomyositis is an infection of the skeletal muscles, resulting in a pus-filled abscess. Immunodeficiency of the patient is considered to play an important role in pathogenesis. We report a case of a 3-year-old child, who presented with multifocal pyomyositis in the gastrocnemius muscle, extending to the posterior muscles of the thigh. Even though there was no evidence of immunodeficiency, the presence of atopic eczema in the big toe of the affected limb could interfere with the immune system response, and therefore, could be associated with pyomyositis. The increasing incidence of pyomyositis in non-tropical areas and its severe complications requires an acute clinical awareness.     

Pulmonary blastoma in a child: report of a case

We describe herein the case of a 2-year-old girl found to have a pulmonary blastoma (PB). The child was admitted to our hospital with the chief complaints of coughing and left-sided chest pain. On admission, a chest X-ray revealed a large mass in the left lung, which measured 10 cm in diameter. Computed tomography and magnetic resonance imaging showed a marginally and heterogeneously enhanced tumor filling the left hemithorax. Pathologic findings of the fine-needle aspiration were suggestive of neuroblastoma. Subsequently, a left pneumonectomy with lymph node dissection was performed and histopathological examination confirmed that the tumor was a PB (type III). After the definitive diagnosis was made the patient received combination chemotherapy, and no evidence of recurrence has been seen in the 5 months since surgery. Received: September 4, 2000 / Accepted: March 6, 2001