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Analgesic medication for inoperable. Cancer of the uterus and the tolerance of the organism for morphin
176
AMERICAN
JOURNAt
OF
OBSTETRICS
AND
GYNECOLOC,Y
The author treated all 11 eases of visceral pain by presacral neurectomy with complete success. The somatic pain should be best relieved by intrathecal alcoholir injections or cordotomy. The lumbar puncture is ordinarily made in one of t,hts upper lumbar spaces. The motor fibers are not equally affecated. The etiology is discussed. It is stressed that when appropriate treatment fails to relieve pain the patient is entitled to comfort without becoming an addict to morphine. It is emphasized that there will be failure in pain relief unless the appropriate treatment is given. This necessitates an accurate diagnosis of the type of pain. H. CLOSE HESSELWXE. Bidet, A.: Analgesic Tolerance of the 341, 1937.
Medication Organism
for
for Inoperable. Morphin, Bull.
Cancer of the Uterus and Soe. d’ohst. et de gynee.
the 26:
In spite of the recent advances in the treatment of carcinoma of the uterus, a large proportion of women with such cancers suffer excruciating pain. The have only a momentary effect usual analgesics, such as aspirin and pyramidon, so that morphine must be used to secure any relief. Attempts are being made to avoid this by surgical, physiotherapeutic, and even biologic means, but they have not yet succeeded in replacing morphine. In a recent case of inoperable cancer Binet performed a resection of the superior hypogastric plexus with excellent results. Other operative procedures are chordotomy and lumbar ramisections. Cobra venom has also been suggested and tried by the author, but his patients did not obtain any relief from pain and cried for morphine. The chief drawback of morphine is the tolerance which patients develop. This occurs rapidly. The author reports a ease where a patient gave herself 60 hypodermic injections of 0.02 cm. of morphine every day. This is the equivalent of 120 ordinary hypodermic doses of morphine. 5. P. GREENHILL. Curtillet, gym%.
E. : The Treatment of et d’obst. 32: 306, 1937.
Pain
in
Cancer
of
the
Cervix,
Rev.
franq.
de
The author points out that morphine is generally employed to relieve the pain which is associated with cancer of the cervix. However, it is unsatisfactory because it weakens the patient, and produces a condition of stupor, it is temporary and costly, and the patient continues to suffer more or less between injections. Another medical measure to relieve this type of pain is cobra venom, but the failures with this substance are more frequent than the successes. Among the surgical procedures recommended to relieve this type of pain are the following: 1. Section of the posterior roots of the lumbar nerves. This operation is now seldom performed. 2. Section or resection of the sympathetics. The chief operations in this class are hypogastrie periarterial s.ympathectomy. 3. Medullary interventions of which cordotomy is the most common. The results are not very satisfactory. 4. Injections of alcohol. The author recommends that the first procedure to be tried is eubarachnoid injection of alcohol, because it is the simplest. If this fails, the superior hypogastric plexus should be resected if the patient’s condition permits. If, however, this operation cannot be done or if the pain is sacral or renal in origin, a cordotomy will have to be done. J. P. GREENHILL.
AMERICAN
JOURNAt
OF
OBSTETRICS
AND
GYNECOLOC,Y
The author treated all 11 eases of visceral pain by presacral neurectomy with complete success. The somatic pain should be best relieved by intrathecal alcoholir injections or cordotomy. The lumbar puncture is ordinarily made in one of t,hts upper lumbar spaces. The motor fibers are not equally affecated. The etiology is discussed. It is stressed that when appropriate treatment fails to relieve pain the patient is entitled to comfort without becoming an addict to morphine. It is emphasized that there will be failure in pain relief unless the appropriate treatment is given. This necessitates an accurate diagnosis of the type of pain. H. CLOSE HESSELWXE. Bidet, A.: Analgesic Tolerance of the 341, 1937.
Medication Organism
for
for Inoperable. Morphin, Bull.
Cancer of the Uterus and Soe. d’ohst. et de gynee.
the 26:
In spite of the recent advances in the treatment of carcinoma of the uterus, a large proportion of women with such cancers suffer excruciating pain. The have only a momentary effect usual analgesics, such as aspirin and pyramidon, so that morphine must be used to secure any relief. Attempts are being made to avoid this by surgical, physiotherapeutic, and even biologic means, but they have not yet succeeded in replacing morphine. In a recent case of inoperable cancer Binet performed a resection of the superior hypogastric plexus with excellent results. Other operative procedures are chordotomy and lumbar ramisections. Cobra venom has also been suggested and tried by the author, but his patients did not obtain any relief from pain and cried for morphine. The chief drawback of morphine is the tolerance which patients develop. This occurs rapidly. The author reports a ease where a patient gave herself 60 hypodermic injections of 0.02 cm. of morphine every day. This is the equivalent of 120 ordinary hypodermic doses of morphine. 5. P. GREENHILL. Curtillet, gym%.
E. : The Treatment of et d’obst. 32: 306, 1937.
Pain
in
Cancer
of
the
Cervix,
Rev.
franq.
de
The author points out that morphine is generally employed to relieve the pain which is associated with cancer of the cervix. However, it is unsatisfactory because it weakens the patient, and produces a condition of stupor, it is temporary and costly, and the patient continues to suffer more or less between injections. Another medical measure to relieve this type of pain is cobra venom, but the failures with this substance are more frequent than the successes. Among the surgical procedures recommended to relieve this type of pain are the following: 1. Section of the posterior roots of the lumbar nerves. This operation is now seldom performed. 2. Section or resection of the sympathetics. The chief operations in this class are hypogastrie periarterial s.ympathectomy. 3. Medullary interventions of which cordotomy is the most common. The results are not very satisfactory. 4. Injections of alcohol. The author recommends that the first procedure to be tried is eubarachnoid injection of alcohol, because it is the simplest. If this fails, the superior hypogastric plexus should be resected if the patient’s condition permits. If, however, this operation cannot be done or if the pain is sacral or renal in origin, a cordotomy will have to be done. J. P. GREENHILL.