Pain relief in metastatic cancer other than breast and prostate gland following transsphenoidal hypophysectomy

1977 ◽  
Vol 47 (5) ◽  
pp. 659-662 ◽  
Author(s):  
George T. Tindall ◽  
Daniel W. Nixon ◽  
James H. Christy ◽  
Jimmy D. Neill
Keyword(s):  
Pain Relief ◽  
Metastatic Cancer ◽  
Prostate Gland ◽  
Critical Evaluation ◽  
Pituitary Hormones ◽  
Content Type ◽  
Advanced Carcinoma ◽  
Brain Peptides ◽  
Progression Of Disease ◽  
Fine Print

✓ Hypophysectomy was performed in six patients with advanced carcinoma other than from breast and prostate gland to alleviate pain. Two patients received significant and lasting relief of pain; one achieved relief but died from progression of disease 5 weeks after surgery; one patient, initially relieved, had recurrence of pain 3 months later; one had about 50% relief; and one received no benefit. Possible mechanisms for pain relief include changes in pituitary hormones, prostaglandins, and the newly isolated brain peptides, alpha and beta endorphin. These preliminary observations will require further critical evaluation in a larger series to determine the effectiveness of hypophysectomy in relieving pain in cancer other than from the breast and prostate. The results, nevertheless, do imply that a different approach to pain, namely endocrine manipulation, may be beneficial in certain cancer patients.

Transsphenoidal hypophysectomy for disseminated carcinoma of the prostate gland

1979 ◽  
Vol 50 (3) ◽  
pp. 275-282 ◽  
Author(s):  
George T. Tindall ◽  
Nettleton S. Payne ◽  
Daniel W. Nixon
Keyword(s):  
Pain Relief ◽  
Operative Procedure ◽  
Prostate Gland ◽  
Stage Iv ◽  
Early Postoperative Period ◽  
Significant Feature ◽  
Content Type ◽  
Carcinoma Of The Prostate ◽  
Microsurgical Approach ◽  
Fine Print

✓ Transsphenoidal microsurgical hypophysectomy was performed in 53 men with disseminated carcinoma (Stage IV) of the prostate gland. The mean age was 64.8 years. Forty-three of the 53 men had severe pain due to their disease. Significant pain relief was obtained following hypophysectomy, usually within 24 hours, in 39 (91%) of these 43 patients. Objective remission occurred in 16 (36%) of 45 patients in whom the follow-up review was adequate to make this decision. Although dramatic, pain relief was not permanent in every patient. Four patients died in the early postoperative period, and in one, death was directly related to the operative procedure. Significant complications included partial diabetes insipidus in 40 cases (75.5%), and cerebrospinal fluid leaks in six (11.3%). The authors conclude that hypophysectomy is an appropriate operation in patients with disseminated carcinoma of the prostate gland, particularly when pain is a significant feature of the illness. Further, the transsphenoidal microsurgical approach appears to be the operative procedure of choice for performing hypophysectomy.

Safety and efficacy of stereotactic radiosurgery for tumors of the spine

2004 ◽  
pp. 413-418 ◽  
Author(s):  
Deborah L. Benzil ◽  
Mehran Saboori ◽  
Alon Y. Mogilner ◽  
Ronald Rocchio ◽  
Chitti R. Moorthy
Keyword(s):  
Spinal Cord ◽  
Single Dose ◽  
Pain Relief ◽  
Total Dose ◽  
Stereotactic Radiosurgery ◽  
Medical Center ◽  
Primary Tumors ◽  
Content Type ◽  
Increased Risk ◽  
Fine Print

Object. The extension of stereotactic radiosurgery treatment of tumors of the spine has the potential to benefit many patients. As in the early days of cranial stereotactic radiosurgery, however, dose-related efficacy and toxicity are not well understood. The authors report their initial experience with stereotactic radiosurgery of the spine with attention to dose, efficacy, and toxicity. Methods. All patients who underwent stereotactic radiosurgery of the spine were treated using the Novalis unit at Westchester Medical Center between December 2001 and January 2004 are included in a database consisting of demographics on disease, dose, outcome, and complications. A total of 31 patients (12 men, 19 women; mean age 61 years, median age 63 years) received treatment for 35 tumors. Tumor types included 26 metastases (12 lung, nine breast, five other) and nine primary tumors (four intradural, five extradural). Thoracic tumors were most common (17 metastases and four primary) followed by lumbar tumors (four metastases and four primary). Lesions were treated to the 85 to 90% isodose line with spinal cord doses being less than 50%. The dose per fraction and total dose were selected on the basis of previous treatment (particularly radiation exposure), size of lesion, and proximity to critical structures. Conclusions. Rapid and significant pain relief was achieved after stereotactic radiosurgery in 32 of 34 treated tumors. In patients treated for metastases, pain was relieved within 72 hours and remained reduced 3 months later. Pain relief was achieved with a single dose as low as 500 cGy. Spinal cord isodoses were less than 50% in all patients except those with intradural tumors (mean single dose to spinal cord 268 cGy and mean total dose to spinal cord 689 cGy). Two patients experienced transient radiculitis (both with a biological equivalent dose (BED) > 60 Gy). One patient who suffered multiple recurrences of a conus ependymoma had permanent neurological deterioration after initial improvement. Pathological evaluation of this lesion at surgery revealed radiation necrosis with some residual/recurrent tumor. No patient experienced other organ toxicity. Stereotactic radiosurgery of the spine is safe at the doses used and provides effective pain relief. In this study, BEDs greater than 60 Gy were associated with an increased risk of radiculitis.

Dose-dependent epidural leakage of polymethylmethacrylate after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures

2002 ◽  
Vol 96 (1) ◽  
pp. 56-61 ◽  
Author(s):  
Kyung Sik Ryu ◽  
Chun Kun Park ◽  
Moon Chan Kim ◽  
Joon Ki Kang
Keyword(s):  
Pain Relief ◽  
Epidural Space ◽  
Percutaneous Vertebroplasty ◽  
Vertebral Compression Fractures ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Content Type ◽  
Compression Fractures ◽  
Dose Dependent ◽  
Pmma Cement ◽  
Fine Print

Object. The use of polymethylmethacrylate (PMMA) cement by percutaneous injection in cases requiring vertebroplasty provides pain relief in the treatment of osteoporotic vertebral compression fractures. A retrospective study was performed to assess what caused PMMA cement to leak into the epidural space and to determine if this leakage caused any changes in its therapeutic benefits. Methods. Polymethylmethacrylate was injected into 347 vertebral compression fractures in 159 patients. The cement leaked into the epidural space in 92 (26.5%) of 347 treated vertebrae in 64 (40.3%) of the 159 patients, as demonstrated on postoperative computerized tomography scanning. Epidural leakage of PMMA cement occurred more often when injected above the level of T-7 (p = 0.001) than below. The larger the volume of PMMA injected the higher the incidence of epidural leakage (p = 0.03). Using an injector also increased epidural leakage (p = 0.045). The position of the needle tip within the vertebral body and the pattern of venous drainage did not affect epidural leakage of the cement. Leakage of PMMA into the epidural space reduced the pain relief expected after vertebroplasty. The immediate postoperative visual analog scale scores were higher (and therefore reflective of less pain relief) in patients in whom epidural PMMA leakage occurred (p = 0.009). Three months postoperatively, the authors found the highest number of patients presenting with pain relief, including those in the group with epidural leakage, and at this follow-up stage there were no significant differences between the two groups. Conclusions. The authors found that epidural leakage of PMMA after percutaneous vertebroplasty was dose dependent. The larger amount of injected PMMA, the higher the incidence of leakage. Injecting vertebral levels above T-7 also increased the incidence of epidural leakage. Epidural leakage of PMMA may attenuate only the immediate therapeutic effects of vertebroplasty.

Activation of the anterior cingulate cortex by thalamic stimulation in patients with chronic pain: a positron emission tomography study

2000 ◽  
Vol 92 (1) ◽  
pp. 64-69 ◽  
Author(s):  
Karen D. Davis ◽  
Ethan Taub ◽  
Frank Duffner ◽  
Andres M. Lozano ◽  
Ronald R. Tasker ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Chronic Pain ◽  
Pain Relief ◽  
Anterior Cingulate Cortex ◽  
Analgesic Effect ◽  
Anterior Cingulate ◽  
Emission Tomography ◽  
Content Type ◽  
Positron Emission ◽  
Fine Print

Object. Deep brain stimulation (DBS) of the sensory thalamus has been used to treat chronic, intractable pain. The goal of this study was to investigate the thalamocortical pathways activated during thalamic DBS.Methods. The authors compared positron emission tomography (PET) images obtained before, during, and after DBS in five patients with chronic pain. Two of the five patients reported significant DBS-induced pain relief during PET scanning, and the remaining three patients did not report any analgesic effect of DBS during scanning. The most robust effect associated with DBS was activation of the anterior cingulate cortex (ACC). An anterior ACC activation was sustained throughout the 40 minutes of DBS, whereas a more posteriorly located ACC activation occurred at a delay after onset of DBS, although these activations were not dependent on the degree of pain relief reported during DBS. However, implications specific to the analgesic effect of DBS require further study of a larger, more homogeneous patient population. Additional effects of thalamic DBS were detected in motor-related regions (the globus pallidus, cortical area 4, and the cerebellum) and visual and association cortical areas.Conclusions. The authors demonstrate that the ACC is activated during thalamic DBS in patients with chronic pain.

Gamma knife surgery with a dose of 75 to 76.8 Gray for trigeminal neuralgia

2004 ◽  
Vol 100 (5) ◽  
pp. 848-854 ◽  
Author(s):  
Ronald Brisman
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Recurrent Pain ◽  
Content Type ◽  
Kaplan Meier ◽  
Uniform Manner ◽  
Second Procedure ◽  
Fine Print

Object. The author presents a large series of patients with idiopathic trigeminal neuralgia (TN) who were treated with gamma knife surgery (GKS), at a maximum dose of 75 to 76.8 Gy, and followed up in a nearly uniform manner for up to 4.6 years. Methods. Two hundred ninety-three patients were treated and followed up for at least 6 months (range 0.4–4.6 years, median 1.9 years). At the final follow-up review, there was complete (100%) pain relief without medicines in 64 patients (21.8%), 90% or greater relief with or without small doses of medicines in 86 (29.4%), between 75 and 89% relief in 31 (10.6%), between 50 and 74% relief in 19 (6.5%), and less than 50% relief in 23 patients (7.8%). Recurrent pain requiring a second procedure occurred in 70 patients (23.9%). Kaplan—Meier analysis showed that 100%, 90% or greater, and 50% or greater pain relief was obtained and maintained for 3.5 to 4.1 years in 5.6 , 23.7, and 50.4% patients, respectively. Of 31 patients who described pain relief ranging from 75 to 89%, 80% of patients described it as good and 10% as excellent; of 17 patients who reported between 50 and 74% pain relief, 53% described it as good and none as excellent (p = 0.014). Dysesthesia scores greater than 5 (scale of 0–10, in which a score of 10 represents excruciating pain) occurred in four (3.2%) of 126 patients who had not undergone prior surgery; all these patients obtained either good or excellent relief from TN pain. There were 36 patients in whom the TN had atypical features; these patients were less likely to attain at least 50% or at least 90% pain relief compared with those without atypical TN features (p = 0.001). Conclusions. Gamma knife surgery is a safe and effective way to relieve TN. Patients who attain between 75 and 89% pain relief are much more likely to describe this outcome as good or excellent than those who attain between 50 and 74% pain relief.

The use of stereotaxic chemical hypophysectomy in the treatment of thalamic pain syndrome

1983 ◽  
Vol 59 (6) ◽  
pp. 1002-1006 ◽  
Author(s):  
Allan B. Levin ◽  
Lincoln F. Ramirez ◽  
Jordan Katz
Keyword(s):  
Pain Relief ◽  
Diabetes Insipidus ◽  
Pain Syndrome ◽  
Pituitary Hormones ◽  
The Body ◽  
Cerebral Stroke ◽  
Preoperative Pain ◽  
Content Type ◽  
Third Nerve Palsy ◽  
Thalamic Pain Syndrome

✓ Three patients with neurological injuries consistent with cerebral stroke subsequently developed pain over portions of the body contralateral to the injured hemisphere. Stereotaxic chemical hypophysectomy was used in the management of this pain after other surgical procedures and medical management had failed to provide relief. Postoperatively, all patients were treated for hypopituitarism. All developed transient diabetes insipidus, and one patient developed transient right third nerve palsy. No other complications were encountered. All three patients experienced significant pain relief within 48 hours of the procedure. By the date of discharge, two of the three patients reported complete, and the third greater than 80% pain relief. At the initial follow-up visit all patients were essentially pain-free. These patients have now been followed for 58, 39 and 19 months, and remain free of their original pain. During this time the intravenous administration of naloxone has failed to reproduce the preoperative pain. Pituitary function testing 1 year or more following operation demonstrated that none of the patients had an endocrinologically complete hypophysectomy. Recovery from transient diabetes insipidus was not associated with return of the original pain. The mechanism of action of stereotaxic chemical hypophysectomy in the relief of pain related to thalamic lesions remains unknown. The observation that naloxone failed to reproduce the preoperative pain casts doubt on the theory that augmentation of endogenous opiate release is the primary mechanism. Additional observations suggest that pain relief after hypophysectomy may be more directly the result of stimulation of a hypothalamic pain-suppressing mechanism than due to the elimination of pituitary hormones.

Acromegaly, diabetes insipidus, and visual loss caused by metastatic growth hormone—releasing hormone-producing malignant pancreatic endocrine tumor in the pituitary gland

1995 ◽  
Vol 83 (4) ◽  
pp. 719-723 ◽  
Author(s):  
Shigeru Genka ◽  
Hitoshi Soeda ◽  
Manabu Takahashi ◽  
Hideki Katakami ◽  
Naoko Sanno ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Pituitary Gland ◽  
Diabetes Insipidus ◽  
Metastatic Cancer ◽  
Growth Hormone Releasing Hormone ◽  
Serum Growth Hormone ◽  
Content Type ◽  
Releasing Hormone ◽  
Metastatic Growth ◽  
Fine Print

✓ The case of a 52-year-old woman with acromegaly, diabetes insipidus, and visual impairment caused by a metastatic growth hormone—releasing hormone (GRH)—produced pancreatic tumor is reported. Serum growth hormone (GH) and somatomedin C levels were elevated to 14 ng/ml (normal < 5 ng/ml), and 3.20 U/ml (normal < 1.88 U/ml), respectively. Paradoxical increases were observed in GH levels after glucose tolerance and thyrotropin—releasing hormone-stimulation tests. Biopsy of a pituitary tumor observed on computerized tomography scans and magnetic resonance studies revealed a metastatic cancer. When circulating GRH levels were measured, a marked increase in plasma GRH (1145 pg/ml; normal < 4—1 pg/ml) was observed. The patient died of cachexia due to metastases. Postmortem examination revealed that a primary tumor, a malignant endocrine lesion, was present in the pancreas, with metastatic tumors in the pituitary, lung, liver, and adrenal glands. Synthesis and production of GRH by the tumor was demonstrated by Northern blotting and immunohistochemical analysis. The pituitary gland showed hyperplastic, but not adenomatous changes. The authors stress the importance of both exploration for an ectopic source of GRH and the search for a GH-producing pituitary adenoma when unusual signs and symptoms are seen in patients with acromegaly.

Safety and efficacy of stereotactic radiosurgery for tumors of the spine

2004 ◽  
Vol 101 (Supplement3) ◽  
pp. 413-418 ◽  
Author(s):  
Deborah L. Benzil ◽  
Mehran Saboori ◽  
Alon Y. Mogilner ◽  
Ronald Rocchio ◽  
Chitti R. Moorthy
Keyword(s):  
Spinal Cord ◽  
Single Dose ◽  
Pain Relief ◽  
Total Dose ◽  
Stereotactic Radiosurgery ◽  
Medical Center ◽  
Primary Tumors ◽  
Content Type ◽  
Increased Risk ◽  
Fine Print

Object. The extension of stereotactic radiosurgery treatment of tumors of the spine has the potential to benefit many patients. As in the early days of cranial stereotactic radiosurgery, however, dose-related efficacy and toxicity are not well understood. The authors report their initial experience with stereotactic radiosurgery of the spine with attention to dose, efficacy, and toxicity. Methods. All patients who underwent stereotactic radiosurgery of the spine were treated using the Novalis unit at Westchester Medical Center between December 2001 and January 2004 are included in a database consisting of demographics on disease, dose, outcome, and complications. A total of 31 patients (12 men, 19 women; mean age 61 years, median age 63 years) received treatment for 35 tumors. Tumor types included 26 metastases (12 lung, nine breast, five other) and nine primary tumors (four intradural, five extradural). Thoracic tumors were most common (17 metastases and four primary) followed by lumbar tumors (four metastases and four primary). Lesions were treated to the 85 to 90% isodose line with spinal cord doses being less than 50%. The dose per fraction and total dose were selected on the basis of previous treatment (particularly radiation exposure), size of lesion, and proximity to critical structures. Conclusions. Rapid and significant pain relief was achieved after stereotactic radiosurgery in 32 of 34 treated tumors. In patients treated for metastases, pain was relieved within 72 hours and remained reduced 3 months later. Pain relief was achieved with a single dose as low as 500 cGy. Spinal cord isodoses were less than 50% in all patients except those with intradural tumors (mean single dose to spinal cord 268 cGy and mean total dose to spinal cord 689 cGy). Two patients experienced transient radiculitis (both with a biological equivalent dose (BED) > 60 Gy). One patient who suffered multiple recurrences of a conus ependymoma had permanent neurological deterioration after initial improvement. Pathological evaluation of this lesion at surgery revealed radiation necrosis with some residual/recurrent tumor. No patient experienced other organ toxicity. Stereotactic radiosurgery of the spine is safe at the doses used and provides effective pain relief. In this study, BEDs greater than 60 Gy were associated with an increased risk of radiculitis.

Percutaneous trial of stimulation for patient selection for implantable stimulating devices

1975 ◽  
Vol 43 (4) ◽  
pp. 440-444 ◽  
Author(s):  
Donald L. Erickson
Keyword(s):  
Pain Relief ◽  
Psychological Factors ◽  
Flexible Electrode ◽  
Suitable Candidate ◽  
Content Type ◽  
Careful Scrutiny ◽  
Adequate Pain Relief ◽  
The Social ◽  
Selection For ◽  
Fine Print

✓ The author describes a flexible electrode which can be inserted percutaneously for a period of several days in candidates for an implantable electrical stimulating device for pain relief. This allows the patient a trial of stimulation which closely mimics that of the intended implantable system. If this trial does not give adequate pain relief in a variety of situations, the patient is not considered to be a suitable candidate for an implantable device. The trial of stimulation in no way obviates the need for careful scrutiny of the social and psychological factors accompanying chronic pain problems.

Pudendal neuralgia due to solitary neurofibroma

1982 ◽  
Vol 56 (5) ◽  
pp. 732-733 ◽  
Author(s):  
Francesco Tognetti ◽  
Massimo Poppi ◽  
Giulio Gaist ◽  
Franco Servadei
Keyword(s):  
Pain Relief ◽  
Unusual Case ◽  
Clinical History ◽  
Pudendal Neuralgia ◽  
Content Type ◽  
Solitary Neurofibroma ◽  
Complete Pain Relief ◽  
Perineal Region ◽  
Fine Print

✓ An unusual case of pudendal neuralgia due to a solitary neurofibroma of the perineal region is described. The authors outline the long clinical history. There was complete pain relief after removal of the lesion.

Sign in / Sign up

Export Citation Format

Share Document