High-Dose Fentanyl Patch for Cancer Pain of a Patient with Cholangiocarcinoma

We describe here a patient who obtained a good analgesic effect with high-dose fentanyl patches for controlling cancer pain. A 52-year-old man was referred to our hospital because of severe cancer pain that was 7/10 on a numeric rating scale (NRS). He had been diagnosed with locally advanced cholangiocarcinoma 3 months previously. We prescribed weak opioids and an antidepressant, but his pain was not relieved. We introduced strong opioids (transdermal fentanyl patches for the background pain and a short-acting opioid for the breakthrough pain) and his pain was tolerable on 250 microg/hr of fentanyl patches for 3 months. With time, however, his pain intensity became worse and this reached up to 8/10 to 9/10 on the NRS. Percutaneous transhepatic biliary drainage was performed, which did not relieve his pain. We increased gradually the dose of transdermal fentanyl to 1,050 microg/hr (20 patches). At this dose, the patient was mentally alert, with good pain control (NRS 2/10 to 3/10) and no exacerbation of side effects. To the best of our knowledge, we report here on the highest dose of transdermal fentanyl that has been successfully used for treating a patient suffering from visceral cancer pain.

A Case of Mixed Type Renal Tubular Acidosis with Primary Sjogren`s Syndrome / 대한신장학회지

56-year old woman was hospitalized for severe weakness and generalized bone pain, so she was immediately evaluated for the multiple bone lesions under the impression of malignancy with bone metastasis at the department of oncology. No underlying malignancy was found and the patient was referred to the division of nephrology, where patient was diagnosed as mixed type renal tubular acidosis (RTA) with clinical features of both type 1 and type 2 RTA. Type 2 RTA was diagnosed by high fractional excretion of bicarbonate over 15% and multiple bone lesions, and type 1 RTA was diagnosed by the presence of nephrocalcinosis and sustained high urine pH over 7.0 in spite of severe metabolic acidosis (pH <7.2) with low serum bicarbonate level. She also had findings characteristic of primary Sjogrens syndrome. The treatment started with sodium bicarbonate, vitamin D, calcium and analgesics. In the following seven months, acidosis and symptoms such as bone pain were improved gradually.