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Opioid-induced constipation (OIC) is the most common side effect of opioid. OIC influences the quality of life of pa-tients suffering from cancer pain. However, given that the drug is often overlooked and underappreciated, most of the time, the patients would avoid or abandon using opioid and, as a result, they continuously suffer from cancer pain. Therefore, OIC prevention and man-agement must be made before opioid use. The consensus on the diagnosis of OIC has only been reached recently. Thus, a unified defini-tion of OIC must be developed to exchange therapeutic option among departments in hospitals and compare treatment outcome. The di-agnosis of OIC is discussed, and the management of OIC, including medicinal and non-medicinal treatment, is summarized. Mean-while, the initial program for prevention and treatment of OIC is established to make OIC management more convenient for clinical physicians. Much work is still needed to establish a consensus on OIC diagnosis and a suitable program for prevention and treatment of OIC.
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Cancer pain is an inherently subjective feeling. As such, a patient's report of pain is the basis of assessment. Self-re-ported questionnaires are extensively used in clinical practice and research. Single-item unidimensional rating scales are often used to assess pain intensity. Numerical rating scale is recommended by the European Palliative Care Research Collaborative. Multidimension-al measurements, such as brief pain inventory and short-form McGill pain questionnaire (revised version), can also be used for more comprehensive pain assessments than other questionnaires. Furthermore, specific tools can be applied when cancer-related break-through pain or neuropathic pain is assessed. For patients with cognitive function impairments, face rating scale is a useful tool to screen pain. Multidimensional measurements should also be used for further evaluation. In cancer pain evaluation, the development of simple and practical computer-administered questionnaires is a new trend. Repeated cancer pain assessment is strongly recommended regardless of the applied scale.
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Objective: To analyze the clinical characteristics of opioid overdose in naloxone-antagonized advanced cancer pa-tients. Methods:Fifteen patients with moderate to severe cancer pain were diagnosed with opioid overdose. Five of the patients were treated with transdermal fentanyl, six with prolonged-release morphine sulfate tablets, and four with prolonged-release oxycodone hy-drochloride tablets. Naloxone was immediately administered upon discovery of opioid overdose. The reasons behind opioid overdose as well as the naloxone efficacy and patient prognosis were investigated. Results:In the patients of the group, the equivalent dosage of morphine, the treatment dosage is 10 mg/d to 640 mg/d, and the median dosage is 360 mg/d. The therapeutic dose of naloxone is 0.2 mg to 0.8 mg, and the median dosage is 0.4 mg. After naloxone use, the pupils of the patients were recovered in the first few min-utes, and respiratory depression improved within 10 min to 30 min. However, blood pressure recovery was slow for at least 1 hour. Two fever-afflicted patients were diagnosed with transdermal fentanyl overdose and impaired liver function, which exhibited rapid deteriora-tion immediately before the opioid overdose. Seven patients with poor pain control were diagnosed with opioid overdose during drug ti-tration. These patients were given poor prognosis, and their median overall survival time was 1.9 months. Conclusion: Opioid over-dose, which is shown to be common in advanced cancer patients, can be safely and effectively treated by naloxone. Early diagnosis and treatment of this condition would significantly improve the quality of pain control for the patient.
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Naloxone is a synthetic pan-opioid receptor competitive antagonist of the opioid receptors inside and outside the cen-tral nervous system. After systemic administration, it reverses almost all opioid effects. Systemically administered naloxone is used to reverse the life-threatening opioid toxicity. A number of studies have analyzed the importance of oral naloxone as a peripheral opioid an-tagonist in cancer patients. Naloxone has shown satisfactory efficacy for opioid-induced constipation (OIC). Ultra-low dose of naloxone has been reported to enhance the anti-nociceptive effect of morphine and reduce morphine consumption. We summarize the results from current studies of naloxone administration in cancer pain management.
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ObjectiveTo summarize the diagnosis,treatment and prognosis of testicular tumor.MethodsThe clinical and followed data of 91 cases of testicular tumor were retrospectively studied. Results In 91 patients, was in 18-40 years old 70.3 ％ (64/91) and 91.2 ％ (83/91) cases were germ cell tumor. 18-40years old germ cell tumor was 75.6 ％ (28/37), there was no case below 17 years old, the older than 60 years was 2.7 ％(1/37). The percentage of below 5 years and 18-40 years was 16.1％ (5/31) and 67.7 ％ (21/31),respectively.The interstitial tissue tumor developed in each age section,the number was least.The mixed tumor cases of 18-40 years percent was 93.3 ％(14/15).The early symptom of testicular tumor was indolent swelling in one side testis or testis nodus.Combined therapy,including radical orchiectomy,retroperitoneal lymph node dissection, chemotherapy and radiotherapy, were taken. The one year, three years and five years survival rate were 97.3 ％, 91.8 ％, 91.8 ％, respectively. The percentage of Ⅰ, Ⅱ, Ⅲ stage survived 5 years was 83.6 ％, 52.3 ％, 33.3 ％. ConclusionThe peak age of testicular tumor patients was 18-40 years old.The different pathological type is distributed in different ages,and the prognosis is related to pathology and stage. The survival time of germ cell tumor or early stage tumor is longer.
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Objective To evaluate effectiveness and side effects, as well as its safety, of Oxy-Codone hydrochloride controlled-release tablets (Oxycontin) for the elderly patients with moderate to severe cancerous pain. Methods From March 2005 to February 2009,106 elderly patients ( aged more than 60 years) suffered from moderate to severe cancerous pain were treated with Oxycontin,at initial dose of 10 mg/12 h. For the patients using making them pain-free or pain relieved mostly. Every patient was treated for 4 weeks at least. Severity of pain,sleeping status, appetite, fatigue, mental status, daily life, scores of understanding and cooperation, and side effects were .observed.Results The minimal effective dose of Oxycontin was 10 mg/d for the elderly patients with cancerous pain. Twenty-three patients (21.7%) were treated with it at dose of ≥200 mg/d,30 patients (28. 2% )at dose of 100 - 180 mg/d,and 53 patients (50. 0% ) at dose of 10 -90 mg/d. Pain was relieved in 97. 16% of the patients after treatment, with common side effects of constipation, nausea, vomiting;and drug treatment was needed for 24. 53% (26/106) of the patients with more common constipation. Conclusions Oxycontin is effective,tolerable,less side-effects for the elderly patients with moderate to severe cancerous pain, and can improve their quality of life.
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With the emerging of EGFR-targeting antibody, there is a new choice for malignant tumors. Several studies indicate that cetuximab combined with chemotherapy have a role in the first-line treatment of metastatic colorectal and lung cancer, with a 10% to 20% absolute increase in response rates reported. But, cosily price and partly responsive rate restrict the reasonable use of the drug. If the predictive biomarker works, clinician can identify patients who can benefit from the regimen and relieve the economic and toxic burden of null patients and avoid wasting time and money. The study progress of the biomarkers related to EGFR-targeting antibody was reviewed.
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To study the relationship between the expression of the DMBT1 gene in colon carcinoma and its clinical significance. Expression of the DMBT1 gene in colon carcinoma was measured by reverse transcriptase polymerase chain reaction (PT PCR). RT PCR amplification demonstrated that 13 of 36 (36 1%) cases showed an apparent reduction in DMBT1 mRNA in tumor tissues compared with paired normal tissues. Furthermore, the expression of the DMBT1 gene mRNA was reduced in the tumor tissues with lymph nodes metastasis, depth invasion and Dukes`s classification ( P
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Objective To evaluate the significance of clinical physical examination, breast ultrasonography, and mammography in the diagnosis of breast cancer in Chinese, to compare their sensitivity, specificity and accuracy, and to elucidate the significance of combined application of the 3 methods. Methods A total of 112 patients suspected to have breast cancer as a result of mass screening (38 cases) and OPD examination (74 cases), were subjected to clinical physical examination, breast ultrasonography and mammography, and biopsy specimens were obtained from all the cases by puncture or surgery, then the final diagnosis was confirmed by pathological examination. The diagnosis made from clinical physical examination, breast ultrasonography or mammography was compared with pathological findings, and the sensitivity, specificity, accuracy, positive predictive value, and Kappa index of the 3 methods were then calculated. Results 61 cases of breast cancer and 51 cases of benign breast disease were identified. The diagnostic sensitivity of clinical physical examination, ultrasonography and mammography was respectively 68.85%, 88.52% and 72.13%, the specificity was respectively 88.23%, 21.57% and 56.86%, while the accuracy was respectively 77.68%, 58.04% and 65.18%. The combined use of ultrasonography and mammography yielded the highest sensitivity of 98.36% (P
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Objective:To explore the variation of tumor cell proteins correlated with cell proliferation and chemo-resis-tance after repeated treatment with chemotherapy drugs.Methods:The human lung cancer cell line(LPET-a-2)was repeat-edly treated with chemotherapy drugs:doxorubicin,etoposide,cisplatin and the combination of the3drugs,and each drug was given at2concentrations.The treatment intervals were recorded.ErbB-2,c-myc,MDR1,MRP,LRP,ref-1and NF-?B were tested by flow cytometry.The cells expressing each protein,the mean and total quantity of each protein after each treat-ment were calculated by different drugs at different concentrations.Results:The levels of every protein decreased along with the time of culture.In high-dose group,every item decreased along with the time of treatment.In low-dose group,there was no rule for the item variation with some decreased and some increased.Conclusion:Low-dose anticancer drugs are easier to induce cell proliferation and chemo-resistance than high-dose one,which suggests that adequate chemotherapy should be given in clinical practice.
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Objective:To investigate the influence of different routes of administration on vaccine efficiency of peptide-pulsed dendritic cells(DC).Methods:Immunization of syngeneic C57BL/6 mice with bone marrow-derived murine DC pulsed with SIINFEKL, a MHC class Ⅰ-restricted peptide from chicken ovalbumin(OVA) sited at 257-264 amino acid residuals were performed via subcutaneous(s.c.), intramuscular(i.m.), intravenous(i.v.), and intraperitoneal(i.p.) administration, respectively. Seven days later the mice were sacrificed and the splenocytes were prepared to analyze antigen-specific CTL lysis for target cells and IFN-?-producting CD8+T lymphocytes using in vivo CTL assay and intracellular cytokine staining(ICS), respectively.Results:The results from in vivo CTL assay showed that the CTL lysis activities were 37.3%?7.3%, 10.8%?2.3%, 56.9%?3.6% and 61.0%?4.2% via s.c., i.m., i.v., and i.p. administration, respectively. Similarly, ICS showed that IFN-?-producting cells in total CD8+T lymphocytes were 0.43%?0.09%, 0.85%?0.12%, 0.76%?0.14% and 0.15%?0.04%, respectively.Conclusion:Different routes of administration has an obvious influence on vaccine efficiency of peptide-pulsed DC. The i.p. immunization with DC elicites the strongest CTL lysis activity, i.v. immunization is next, and s.c., in particular i.m. is the worst, suggesting that i.p. administration may be a safe and effective route for immunization with peptide-pulsed DC against cancers in a mice model.
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Purpose:To evaluate the efficacy and safety of combination chemotherapy of gemcitabine(GEM) and cisplatin(DDP) for anthracycine(ANT)-resistant advanced breast cancer(ABC). (GEM 1 200 mg/m 2 on day1 and 8,DDP 30mg/m 2 on day 3 to 5 in cycles of 21 days) Methods:From January 2000 to April 2003,fifty patients with ANT-resistant ABC were treated with combination chemotherapy of GEM and DDP. The median number of cycles was 3(range 2-4). Results:The overall response rate was 42.6%,The median time to progression was 4.5 months. The main side effect included gastrointestinal and hematologic toxicities,related grade 3 to 4 clinical adverse effect was nausea and vomiting in 12 cases (24%),anemia in 2 cases (4), leukopenia in 7 cases (14%),neutropenia in 4 cases (8%) and thrombocytopenia in 16 cases (32%).Conclusions:GEM and DDP combination is active in ANT-resistant ABC with an acceptable toxicity pattern and may well represent an interesting therapeutic choice after ANT regimen.
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By using 99m Tc-resin meal method, we measured the gastric emptying time (GET) in patients with chronic atrophic gastritis (CAG) and gastric carcinoma(GCa). Change in gastric movement in CAG and GCa patients was discussed in this report. The results of present study showed that, GET 1/2 in control group (n = 36) was 37.3?16.0 min; mild CAG (n = 21) 35.0?10.5min. In moderate and severe CAG group (n = 13), GET was 68.3?35.3 min before pentagastrin treatment, and 37.1?6.5 min after pentagastrin treatment. In gastric autrum carcinoma (n = 8) it was 80.9?47.9 min, and in cardiac carcinoma (n = 3) 26.9?7.2min. Significant differentiation existed between moderate or severe CAG and gastric autrum carcinoma groups. Labelled meal v-photography was a physiological examination. Anatomic foundation of prolonged GET 1/2 in moderate and severe CAG was possibly related with atrophy of gastric muscles. Prolonged GET 1/2 could be a promoting factor of development of grastric carcinoma. In order to prevent the development of gastric carcinoma, great attention should be given to those patients with moderate to severe CAG.
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25 patients with endoscopy confirmed active duodenal ulcer were treated with Xi Lei San or ci-metidine. Biopsy specimens were taken before and 3 weeks after treatment. Specimens were stained separately with HE, AB (pH2.5), PAS, and AB(pH2.5)/PAS. According to the morphological characteristics, the epithelium was divided into intestinal, gastric and transitional types. The percentage of the length and density of cells of all types were measured. The results were obtained as follows: during early phase of healing (3 weeks), goblet cells recovered most markedly in the epithelium close to the lesion. Transitional epithelium could relatively easily be observed.The Xi Lei San and cimetidine produced similar morphological changes. Endoscopically, even after the ulcer was healed, gastric and transitional epithelial cells could still be seen. Hypoplasia was observed in most of epithelial villi.
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Objective To study the features of mammography,breast ultrasonography(US)and physical examination(PE)on 0-Ⅰstage(early stage)breast cancer,and to approach a diagnostic measure for early stage breast cancer(EBC).Methods Physical examination,ultrasonography and mammography were performed in 28 patients with pathologically proved breast cancer in 0-Ⅰ stage,and the data were analyzed.Results The accuracy of PE for 0-Ⅰstage of EBC was 57.1%(16/28),and the accuracy by US or mammography was 85.7%(24/28)and 89.3%(25/28),respectively.As the main clinical symptom of 0-Ⅰ stage EBC,breast lumps were found in 14 of 16 PE positive cases(87.5%).The main feature of EBC by mammography was the finding of a lump(14/25,56%).The low echo of a solid space occupying lesion was the main US feature of EBC(18/24,75%).The diagnostic accuracy of mammography for 0 stage EBC was 100.0%(8/8),while only 50%(4/8)by both US and PE.Malignant calcification was the main feature of o stage breast cancer in mammography.The diagnostic accuracy of US,mammography and PE for I stage EBC was 100.0%(20/20),and was 85.0%(17/20)and 40%(8/20),respectively.US was advantagious in detecting cancer in young patient with compact breast.Conclusion Early stage breast cancer often displayed atypical features in PE,US and mammography,which are important for the early-diagnosis of breast cancer,and false negative findings are inevitable in examination.Therefore,the diagnosis of early stage breast cancer should be made with.The findings of PE,US and mammography should be analyzed comprehensively,however,when one of examinations gives a positive finding,the diagnosis of breast cancer should be suspected,and further examination should be carried out to make an early diagnosis.
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Objective To study both therapeutic and adverse effects of photodynamic therapy for cutaneous malignant tumors.Methods The IEAu-3 gold vapor laser(wavelength 627.8nm),manufactured by the Institute of Electronics,Chinese Academy of Sciences,and diode laser(wavelength 630nm),manufactured by DIOMED Ltd.(GB),were employed as the light source.Power density of the both kinds of laser was 100-150mW/cm2,and energy density was 150-300J/cm2.Haematoporphyrin derivative(HpD)was used as pohotosensitizer at dosage of 5mg/kg.The patients' foci were radiated 12-72h after HpD administration.The patients received 1 to 4 courses of photodynamic therapy.The size of patients' focus was measured before and after treatment and the therapeutic effect was appraised 4 weeks later.Results Evaluation of the therapeutic effect in 30 patients showed that 15 patients(50.0%)responded completely(CR),10 patients(33.3%)responded partially(PR),and 5 patients(16.6%)showed no response(NR).No patients showed progression of the lesion(PD).The total response case(CR+PR)was 25.No adverse effect was found in this group.Conclusions Photodynamic therapy is an effective and safe modality for cutaneous malignant tumor especially for basal cell skin cancer and squamous cell skin cancer.
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Objective To investigate the 50% inhibition concentration(IC50)of haematoporphyrin derivative(HpD)and hematoporphyrin monomethyl ether(HMME)at the saturated light dose and 50% inhibition energy density(IED50)at saturated photosensitizer dose in order to find out their photocytotoxicity features.Methods Cell culture and MTT technology were utilized to inspect photosensitizers' photocytotoxicity to the endothelial cells of mouse lung vessel.Exponentially growing cells were incubated with varying concentrations of the photosensitizers in DMEM medium(low glucose)in 96-well microliter plate for 4h.The plate was then exposed to copper vapor laser at 510.6nm and 578.2nm wavelength,respectively,for a period of time.Incubation was continued for another 24h in darkness,and the number of surviving cell was analyzed by MTT assay.Results The findings suggested that the IC50 of HMME was 1.31 and 1.24 times of that of HpD in 510.6nm and 578.2nm wavelengths at saturated light dose,respectively.IED50 of HPD was 1.18 and 1.17 times of that of HMME in 510.6nm and 578.2nm wavelengths at saturated photosensitizer dose,respectively.Conclusion HpD has stronger photocytotoxicity than HMME under 510.6nm and 578.2nm wavelength exposure,and the photocytotoxicity is closely related to light dose and wavelength.