Objectives: To assess the long-term analgesic effect of repetitive transcranial stimulation (rTMS) on chronic phantom pain using high frequency stimulation and to measure the serum beta-endorphin level pre- and post-rTMS. Material and methods: The study included 27 patients with unilateral amputation; all patients had chronic phantom pain. The patients were classified into two groups. Seventeen patients received 10 minutes real rTMS over the hand area of motor cortex (20 Hz, 10 second trains, intensity 80% of motor threshold) every day for five consecutive days and 10 patients received sham stimulation. Pain was assessed using a visual analogue scale (VAS) and the Leeds assessment of neuropathic symptoms and signs (LANSS) scale, before and after the first, fifth sessions, one and two months after the last session. Quantitative determination of serum beta-endorphin before and after five sessions was measured. Results: There was no significant difference between true and sham groups in the duration of illness, VAS, LANSS scores and resting motor threshold in upper and lower limb amputation at the base line. VAS and LANS scores of the patients who received real rTMS decreased more over the course of the treatment through the different points of follow-up (after five sessions, one and two months) than those who received sham stimulation. Serum beta-endorphin was increased significantly after real stimulation with no changes in patients received shame. Serum beta-endorphin showed no significant correlation to Hamilton depression, anxiety, VAS and LANS scores in true or sham groups before or after five sessions for rTMS. Conclusion: These results confirm that five daily sessions of rTMS over motor cortex can produce long lasting pain relief in patients with phantom pain and it might be related to an elevation of serum beta-endorphin concentration.

Background: Various interventions including the superior hypogastric plexus block and ganglion impar block are commonly used for treatment of pelvic or perineal pain caused by cancer. The inferior hypogastric plexus block through the transsacral approach under fluoroscopy, using a local anesthetics/ steroid combination for the diagnosis and treatment of chronic pain conditions involving the lower pelvic viscera was first described by Schultz in 2007. Neurolysis of the inferior hypogastric plexus could be useful for pelvic and perineal pain caused by cancer. Objectives: Assessment of the feasibility, safety, and efficacy of using the newly introduced inferior hypogastric block by the transsacral approach for relief of cancer related pelvic and perineal pain Methods: Injection of 6-8 ml of phenol 10% bilaterally, by passing a spinal needle through the sacral foramen to do the inferior hypogastric block in 20 patients with cancer pain in the pelvis and /or perineum. We measured VAS, sleep score, activity score, psychological score, and oral morphine (MST) consumption pre and post-procedure. Results: Two patients of the twenty died during the follow-up period, so, they were excluded from the study. All patients presented with cancer related pelvic, perineal, or pelviperineal pain. The mean pain score was reduced from 7.22 (1.31) pre-procedural to 4.06 (1.73) post procedural (P0.05). as well the mean morphine sustained release tablets (MST 30mg) consumption was reduced from 106.67 (32.90) mg to 63.33 (43.52) mg after one week (P0.05). No complications or serious side effects were encountered during or after the block. Discussion and Conclusion: the approach provides a good alternative technique for the treatment of low pelvic and perineal cancer related pain. It requires more studies for evaluation and refinement of the technique using other radiological techniques.

Background: Various interventions including the superior hypogastric plexus block and ganglion impar block are commonly used for treatment of pelvic or perineal pain caused by cancer. The inferior hypogastric plexus block through the transsacral approach under fluoroscopy, using a local anesthetics/ steroid combination for the diagnosis and treatment of chronic pain conditions involving the lower pelvic viscera was first described by Schultz in 2007. Neurolysis of the inferior hypogastric plexus could be useful for pelvic and perineal pain caused by cancer. Objectives: Assessment of the feasibility, safety, and efficacy of using the newly introduced inferior hypogastric block by the transsacral approach for relief of cancer related pelvic and perineal pain Methods: Injection of 6-8 ml of phenol 10% bilaterally, by passing a spinal needle through the sacral foramen to do the inferior hypogastric block in 20 patients with cancer pain in the pelvis and /or perineum. We measured VAS, sleep score, activity score, psychological score, and oral morphine (MST) consumption pre and post-procedure. Results: Two patients of the twenty died during the follow-up period, so, they were excluded from the study. All patients presented with cancer related pelvic, perineal, or pelviperineal pain. The mean pain score was reduced from 7.22 (1.31) pre-procedural to 4.06 (1.73) post procedural (P0.05). as well the mean morphine sustained release tablets (MST 30mg) consumption was reduced from 106.67 (32.90) mg to 63.33 (43.52) mg after one week (P0.05). No complications or serious side effects were encountered during or after the block. Discussion and Conclusion: the approach provides a good alternative technique for the treatment of low pelvic and perineal cancer related pain. It requires more studies for evaluation and refinement of the technique using other radiological techniques.

Background: Various interventions including the superior hypogastric plexus block and ganglion impar block are commonly used for treatment of pelvic or perineal pain caused by cancer. The inferior hypogastric plexus block through the transsacral approach under fluoroscopy, using a local anesthetics/ steroid combination for the diagnosis and treatment of chronic pain conditions involving the lower pelvic viscera was first described by Schultz in 2007. Neurolysis of the inferior hypogastric plexus could be useful for pelvic and perineal pain caused by cancer. Objectives: Assessment of the feasibility, safety, and efficacy of using the newly introduced inferior hypogastric block by the transsacral approach for relief of cancer related pelvic and perineal pain Methods: Injection of 6-8 ml of phenol 10% bilaterally, by passing a spinal needle through the sacral foramen to do the inferior hypogastric block in 20 patients with cancer pain in the pelvis and /or perineum. We measured VAS, sleep score, activity score, psychological score, and oral morphine (MST) consumption pre and post-procedure. Results: Two patients of the twenty died during the follow-up period, so, they were excluded from the study. All patients presented with cancer related pelvic, perineal, or pelviperineal pain. The mean pain score was reduced from 7.22 (1.31) pre-procedural to 4.06 (1.73) post procedural (P0.05). as well the mean morphine sustained release tablets (MST 30mg) consumption was reduced from 106.67 (32.90) mg to 63.33 (43.52) mg after one week (P0.05). No complications or serious side effects were encountered during or after the block. Discussion and Conclusion: the approach provides a good alternative technique for the treatment of low pelvic and perineal cancer related pain. It requires more studies for evaluation and refinement of the technique using other radiological techniques.

Background: FMS-Like Tyrosine kinase 3 (FLT3) plays an important role in early stages of hematopoiesis. FLT3 stimulation enhances proliferation and reduces apoptosis. One potential mechanism of FLT3 involvement in leukemia is over expression of its wild type and its ligand. The FLT3 protein is highly expressed in most patients with AML. In patients with ALL, FLT3 protein is highly expressed in up to 50% of leukemic blasts. Here, we aimed to evaluate the frequency of FLT3 protein expression in pediatric patients with ALL at South Egypt Cancer Institute, Assiut University, Egypt. Method: FLT3 surface protein expression on leukemic blasts was detected by flowcytometry of 101 denovo pediatric acute lymphoblastic leukemia patients. High FLT3 expression considered when ≥20% of malignant cells expressed CD135 and low FLT3 expression considered when 20% of malignant cells expressed CD135. Relation between FLT3 expression and other clinical and laboratory findings were studies. Results: High FLT3 expression was found in 47.5% of patients {39/74(52.7%) of precursor B-ALL and 9/27(33.3%) of precursor T-ALL}. High FLT3 level was significantly expressed in patients with the low risk age group (p0.001), patients who had no mediastinal mass, patients without lymphomatous features at presentation and patients with no CNS involvement at presentation (p0.001). 75% of patients with high FLT3 expression had TLC 50.000×109 (p=0.004). Conclusion: High FLT3 protein expression may be more commonly associated to favorable criteria of our ALL patients.