Refractory Diarrhea Associated with Carcinoid Syndrome Improved after Opioid Switching from Fentanyl to Morphine

Background: In the case of refractory diarrhea that cannot be treated with loperamide only, drugs such as octreotide and serotonin receptor antagonists are generally recommended. We have reported a case of refractory diarrhea associated with carcinoid syndrome in which symptoms improved only with opioid switching, without octreotide. Case: We experienced a case of a 28-year-old female with cervical cancer. She was diagnosed with recurrence after cervical cancer surgery and presented with pain and diarrhea. Her diarrhea did not improve sufficiently after taking loperamide. She was admitted to the palliative care hospital for symptom control due to persistent diarrhea and right lower extremity pain associated with bone metastasis. We diagnosed the cause of her diarrhea as carcinoid syndrome by some laboratory examination. For pain management, we switched opioids from transdermal fentanyl to continuous subcutaneous infusion of morphine. It resulted in pain relief and improvement in the frequency of diarrhea, and she was able to be discharged home. Conclusion: In cases of refractory diarrhea and in patients who need opioids, there is one option to use morphine. If it is effective, it may simply resolve both pain and diarrhea and reduce the use of multiple medications.

Palliative care using noninvasive ventilation（NIV）in a patient with lung cancer and interstitial pneumonia

<b>Case：</b>A 57 year-old man, who had received home oxygen therapy and noninvasive ventilation（NIV）as outpatient, was admitted to our hospital because he felt shortness of breath. He could not eat meals because he was required to receive NIV in all days. He therefore was admitted to our palliative care unit（PCU）on a permanent basis in order to improve the quality of his life. In the PCU, he could take a bath, eat meals and appreciate local folk songs while receiving NIV. Complications were only desaturation and feeling shortness of breath while bathing or eating. <b>Conclusions：</b>NIV may be a useful device for the patients with terminal respiratory failure.

Efficacy and safety of peripherally inserted central catheters in patients receiving chemotherapy

<b>Background</b>: On receiving chemotherapy, extravasation of drugs is a severe problem. The extravasations occur more commonly in patients who are elderly, have a poor performance status, have diabetes mellitus complications or have repeatedly received chemotherapy. Also, cancer patients usually require repeated venous punctures for this treatment. <b>Purpose and methods</b>: For the purpose of evaluating the efficacy and safety of peripherally inserted central catheters (PICCs) for intravenous chemotherapy, we retrospectively reviewed all the cancer patients for whom PICC were inserted for chemotherapy from April 2008 to December 2010. Patients' background, duration of PICC insertion and complications were evaluated in this study. <b>Results</b>: Ten patients (male 4, female 6) were reviewed in this study. The median age was 59 years (17∼69). A total of 13 PICCs were inserted in 10 patients. The most common underlying disease was abdominal rhabdomyosarcoma (n=3, 30%) followed by lung cancer (n=2, 20%) and hematologic tumor (n=2, 20%). The average catheter span was 46 days. Catheter-related infections were seen in 2 cases (15.4%). No phlebitis or thrombosis usually associated with venous route was detected in PICC used for chemotherapy. <b>Conclusions</b>: PICC might reduce patients' discomfort such as repeated venous punctures or complications associated with chemotherapy. We suggest that PICC would be one of the effective tools in chemotherapy. Palliat Care Res 2011; 6(2): 233-236