1/3. Management of the pelvic recurrence of rectal cancer with radiofrequency thermoablation: a case report and review of the literature.INTRODUCTION: The results of rectal cancer surgery are limited by the development of local recurrence (LR) that represents a great challenge to the surgeon. In the presence of unfavourable conditions for performing a curative operation, various forms of palliative treatment are indicated to control the patient's symptoms and the disease's complications. Recently, radiofrequency thermoablation (RFTA) has become a complimentary alternative therapy for malignant inoperable liver tumours. The present paper reports the use of RFTA in the management of pelvic recurrence of rectal adenocarcinoma. CASE REPORT: Fourteen months after abdominoperineal resection, a 32-year-old woman began to complain of progressive pelvic and lumbar pain. A large pelvic mass was found and serum CEA was elevated (66.4 ng/ml) at that time. Due to the dimensions of the presacral tumour (8 x 5 x 4 cm3) and the associated refractory pain, the patient underwent RFTA of the recurrent disease. Under epidural anaesthesia, a computed tomography-guided percutaneous needle electrode was introduced into the tumour. Although the procedure provided immediate pain control, the patient developed an intestinal obstruction 3 months later. This complication required surgical treatment to release adherences from the necrosed tumour. CONCLUSION: Apart from this complication, RFTA allowed prolonged relief of the pelvic pain and improved quality of life. Faced with an unresectable pelvic recurrence, RFTA proved to be a viable option for controlling pain, although a relatively high cost and eventual complications may limit its use.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/3. Intraventricular morphine for intractable craniofacial pain.This case management report on a patient with advanced craniofacial neoplasm discusses the successful treatment of chronic pain by the cortical intraventricular narcotic administration. A previously treated patient with surgery and radiotherapy for carcinoma of the palate developed severe intractable pain despite high dose oral morphine therapy. Investigations revealed that neoplasm had reoccurred with extensive infiltration. Intraventricular morphine therapy was discussed and accepted by the patient and family. A ventricular shunt with an Ommaya reservoir was inserted under local anaesthesia. Preservative-free morphine sulphate in increasing doses of 0.25 to 1 mg was administered, once daily, which kept the patient in a pain-free state. The treatment was initiated in the hospital and continued at home till the demise of the patient on the 9th week. The home care was provided by the nurses of home nursing Foundation and singapore Cancer Society under physician supervision. There were no complications which had been reported in the literature, observed in the management of this patient.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/3. Transporting patients with overwhelming pain.The use of ketamine anaesthesia is described for the transport from home to hospital of patients in severe pain secondary to malignant disease. The technique is simple and highly effective and introduces a new role for anaesthetists and pain relief specialists.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |