Four cases in which octreotide treatment relieved symptoms of gastrointestinal bleeding in end―stage cancer patients

<b>Background：</b>Although octreotide is effective in the relief of symptoms of gastrointestinal obstruction, it is also effective for gastrointestinal bleeding. It has been reported that octreotide reduced the splanchnic blood flow, and reduced the bleeding from esophageal varices, peptic ulcer and the tumor of gastrointestinal tract. We experienced four cases of end―stage cancer patients admitted to a palliative care unit whose symptoms of gastrointestinal bleeding were alleviated by octreotide（300μg／day）. <b>Case：</b>Case 1；A 75―year―old woman with gastric cancer developed melena and received octreotide. After octreotide was discontinued, melena and hematemesis recurred. Octreotide was restarted subsequently, and hematemesis resolved. Case 2；An 87―year―old woman with gastric cancer received octreotide for increase of bloody drainage from a stomach tube. She had epigastric pain and emotional distress from the blood. These symptoms were alleviated following the administration of octreotide. Cases 3 and 4；A 76―year―old man with gastric cancer and a 62―year―old man with bile duct cancer received octreotide for massive vomiting of blood. After the administration of octreotide, there was no reoccurrence of hematemesis in both patients. <b>Conclusion：</b>Octreotide may alleviate symptoms of gastrointestinal bleeding in end―stage cancer patients.

A small amount of ketamine with oxycodone induced an acute hyperactive delirium due to voriconazole, a CYP3A4 inhibitor, in a case of multiple myeloma with cancer pain

This is a report on a case of delirium due to a small amount of ketamine with voriconazole. A 58 year old male was treated for multiple myeloma and hip pain due to an extramedullary tumor following the administration of oxycodone, and voriconazole was administrated for his suspected mycotic pneumonia. His pain was refractory, so we started the administration of a small dose of ketamine (4 mg/hr) for analgesia, added to oxycodone. About 30 hours later, the delirium appeared but he complained of worsening hip pain, so we added 2 mg of ketamine rapidly. Immediately after the additional administration of ketamine, his delirium became more serious. We think the reason why a small amount of ketamine induced delirium is an interaction of ketamine and voriconazole. Ketamine is metabolized to norketamine, which is thought to be more harmless than ketamine, by cytochrome P 450 (CYP) (a part of by CYP3A4) and voriconazole is an inhibitor of CYP3A4. In cases of patients treated with voriconazole, ketamine should be more carefully administrated.