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Thirty-five patients with extensive abdominal or pelvic cancer who suffered uncontrolled, diffuse, extensive, and incapacitating pain were treated with a combination of neurolytic celiac plexus block (CPB), inferior mesenteric plexus block (IMPB), and superior hypogastric plexus block (SHGPB). The combination of neurolytic CPB, IMPB, and SHGPB was performed with alcohol, mainly using a transintervetebral disc approach. The combination neurolysis produced effective immediate pain relief in all the patients (visual analog scale (VAS), reduced from 8.8 +/- 0.2 to 0). This pain relief persisted during the first 3 months (VAS, 2.3 +/- 0.5) or until death. Morphine consumption was significantly decreased for the first 1 month (from 96 +/- 29 mg to 31 +/- 10 mg per day) after the neurolysis and thereafter continued to be lower than before the surgery, though not significantly so. No serious complications were observed to have been caused by the neurolytic procedure on the three sympathetic plexuses. Our preliminary clinical results suggest that the combination of neurolytic CPB, IMPB, and SHGPB improves the quality of life of patients who have incapacitating cancer pain, by reducing both the intensity of the pain and their opioid consumption, without serious complications. This combination procedure may provide a new therapeutic option for pain relief in patients with advanced cancer.

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A 37-year-old man with beta-thalassemia intermedia (betaTI), a rare disease caused by partial or complete deficiency of beta-globin chain synthesis, fell into a hemolytic crisis. Severe anemia persisted despite frequent transfusions. Therefore, he was scheduled for splenectomy to alleviate the anemia. The preoperative laboratory data showed marked anemia and liver dysfunction. Echocardiography revealed hyperkinetic left ventricular motion and increased cardiac index (CI), indicating a compensatory hyperdynamic circulation induced by persistent, severe anemia. Our strategy during general anesthesia was to keep the hyperkinetic cardiovascular system steady. Hence, the hemodynamic parameters including the CI were measured using a Swan-Ganz catheter, and other physiological parameters were monitored perioperatively. Anesthesia was maintained with balanced anesthesia: isoflurane at low concentrations and fentanyl to avoid cardiovascular depression. Throughout the operation, vital signs were kept stable and the lactate/pyruvate ratio was unchanged, indicating that anaerobic metabolism did not increase. We report successful anesthetic management with attention to hemodynamic changes in a patient with betaTI.

To study the contribution of tissue components to the mechanical properties of veins, pressure-volume relationships were obtained with the cylindrical segments of isolated dog external jugular veins at several levels of longitudinal extension. At each length, the transmural pressure of the segment was raised up to 20 cmH2O and then reduced to 0 cmH2O by increasing and decreasing the intraluminal volume at a constant rate. The longitudinal extension of the venous segments caused a significant reduction in the incremental volume elasticity within the pressure range of 0-2 cmH2O (E0-2) as well as a significant increase of the incremental volume elasticity within 10-20 cmH2O (E10-20). The pressure-volume relationships of venous segments were also constructed in the same way after treatment with 1 mg/ml collagenase for 30 min, 0.1 mg/ml elastase for 5 min, or 1 mg/ml hyaluronidase for 60 min. Treatment with collagenase or elastase produced a significant increase of the E0-2. The treatment, however, caused no effect on E10-20. Treatment with hyaluronidase induced no effect on these mechanical parameters but produced a significant attenuation of the extension-induced decrease in E0-2. Activation of the venous smooth muscles induced by norepinephrine (10(-4) M) or high-potassium Krebs solution caused a significant decrease of E0-2 as well as a significant increase of E10-20. A complete relaxation of the smooth muscles elicited by Ca(2+)-free Krebs solution containing ethylene glycol-bis(beta-aminoethyl ether)-N,N,N',N'-tetraacetic acid (2 mM) caused an increase of E0-2. Mechanical rubbing of the endothelium caused no significant effect on E0-2 and E10-20.(ABSTRACT TRUNCATED AT 250 WORDS)