ABSTRACT
BACKGROUND:Fentanyl transdermal system has analgesic effect similar to oral sustained-release morphine and has been widely used in advanced cancer pain management in several years. However, recent literatures about some serious adverse events associated with fentanyl transdermal system have been published, and the long-term safety of fentanyl transdermal system treatment is stil chalenged. OBJECTIVE:To observe the long-term clinical efficacy and safety of fentanyl transdermal system for pain management in patients with advanced cancer. METHODS:A total of 309 patients with advanced cancer pain were enroled, including 166 females and 143 males. The age ranged from 26-72 years old. Patients received oral sustained-release morphine for 2 weeks, and then were subject to fentanyl transdermal system for pain management at the 3rd week until the 12th week. A prospective study with self-contrast method was conducted to compare the analgesic effects of these two drugs, as wel as patient's acceptability, adverse events and toxicity in the administration course. RESULTS AND CONCLUSION: Stable pain relief was harvested throughout the oral administration of both sustained-release morphine and fentanyl transdermal system therapy. During the use of oral sustained-release morphine, adverse reactions appearing in sequence were constipation, nausea, fatigue and anorexia. After converting to fentanyl transdermal system, the symptoms of constipation (χ2=5.22,P=0.02) and nausea (χ2=4.38, P=0.04) significantly reduced, and vomiting was abated but showed no significant difference (χ2=2.7,P=0.10). 2.3% of patients had skin reactions to the patches, and regressed after replacing the patch area. Skin reactions were aleviated at 2-10 weeks after oral administration of fentanyl transdermal system. Some uncommon adverse events including headache, diarrhea, dyspnoea, excessive sweating or other symptoms often occurred at the time of the initial dosage increase. Preference or strong preference for fentanyl transdermal system in comparison to previous oral sustained-release morphine was reported by 91% of patients. These results demonstrate that fentanyl transdermal patches can provide stable pain relief for advanced cancer patients with good acceptability, and mitigate the incidence of adverse events due to oral drugs.
ABSTRACT
Objective To evaluate the efficacy and safety of management of kidney calculi in non-uronephrosis by percutaneous nephrolithotripsy (PCNL) under ultrasound guidance. Methods From July 2005 to June 2008, 97 cases of kidney calculi in non-uronephrosis were performed by percutaneous nephrolithotripsy. A tube was first inserted into the pelvis through cystoscope, and saline was instilled to dilate collecting system. Antegrade percutaneous access was obtained under ultrasound guidance. A combination of pneumatic and ultrasonic lithotrite was used to disintegrate and remove stone under direct vision. Clinical data including operation time, complications and stone free rate were analyzed retrospectively. Results The perutaneous renal access was successfully established under ultrasound guidance in all patients, immediate phase Ⅰ lithotripsy was performed in 95 cases and delayed phase Ⅱ lithotripsy in 2 cases. Operation time was 70-180 min, average time was (96±23 ) min. The average blood loss was 60 ml (20-500 ml), 4 cases had transfusion during the PCNL and average 400 ml. Minor pyrexia ( < 39℃) was seen in 24 cases,whereas serious pyrexia was noted in 3 cases. Conservatively administered with appropriate antibiotics, the fever disapeared in 27 cases within 5 days postoperatively. Severe complications did not occur during nephrolithotripsy. Stones were cleared completely in 78 out of 97 cases (80.4%)during immediate phase Ⅰ lithotripsy, residual stone fragment was found in 19 cases. Conclusion The management of kidney calculi in non-uronephrosis by PCNL appears to be efficacious and safe under ultrasound guidance.