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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.
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Background: Factors requiring midazolam in addition to systemic opioids to control dyspnea in cancer patients have yet to be evaluated. Methods: We retrospectively analyzed data for cancer patients who received systemic opioids to relieve dyspnea from April 2019 to July 2021 in Wakayama Medical University Hospital, Japan. Patients were divided into an opioid-alone group and an opioid plus midazolam group, according to the treatment of dyspnea. Results: The total of 107 patients included 85 patients (79.4%) in the opioid alone group and 22 patients (20.6%) in the opioid plus midazolam group. Age<60 years (p=0.004) and male sex (p=0.034) was significantly associated with the addition of midazolam. Multivariate analysis found age <60 years (OR=5.34, 95%CI: 1.66–17.21; p=0.005) was associated with the addition of midazolam. Conclusion: Age <60 years is factor requiring midazolam in addition to systemic opioids to control dyspnea in cancer patients.
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Objective: To evaluate the efficacy of high-flow nasal cannula oxygen (HFNC) for dyspnea in patients with advanced disease. Methods: A literature search was conducted using MEDLINE, Cochrane Library, EMBASE, and Ichu-shi Web. Inclusion criteria were: 1) randomized controlled trials evaluating the effect of HFNC on dyspnea; 2) aged 18 years or older with advanced disease with hypoxemia; 3) control group was conventional oxygen therapy or noninvasive positive pressure ventilation. Exclusion criteria were: 1) patients in intensive care unit, 2) weaning from ventilator. Results: Six studies (4 from database searches, and 2 from hand searches) were included. In the 2 studies evaluating short-term intervention, one showed HFNC was more efficacious, and the other conventional oxygen was more efficacious. In the 2 studies evaluating long-term interventions: one showed HFNC was more efficacious, and the other showed no significant difference. In the 2 studies evaluating the intervention during exercise, one showed HFNC was more efficacious, and the other showed no significant difference. Conclusion: HFNC may be effective for dyspnea in patients with advanced disease associated with hypoxemia.
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Objective: To evaluate the efficacy of fan therapy for the relief of dyspnea in patients with chronic progressive disease. Methods: A systematic electronic database search of all available articles published before October 23, 2019 was conducted using Ichushi-Web of the Japan Medical Abstract Society databases, CENTRAL, EMBASE, and MEDLINE. In addition, a hand-search for updates was performed using PubMed on June 30, 2020 and December 7, 2021. The inclusion criteria were: 1) any RCTs comparing the effect of fan therapy with any other intervention, and 2) patients aged ≥18 years. Exclusion criteria were: 1) duplicate references, and 2) conference presentations. Results: We identified 110 studies, of which 10 met our criteria for inclusion. Finally, five studies were used in the meta-analysis. Fan therapy significantly improved dyspnea in patients with chronic progressive disease compared to control groups with a standardized mean difference of −1.43 (95% confidence interval: −2.70 to −0.17, I2=94%, p<0.0001). Conclusion: Fan therapy was found to be effective in reducing dyspnea in chronic progressive disease.
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In Japan, there are not many reports of using hydromorphone for patients with renal failure and occurring neurotoxicity such as disturbance of consciousness. This report includes two cases of consciousness disorder such as delirium when hydromorphone was started or increased in patients with renal dysfunction. In the case 1, delirium appeared when hydromorphone dosage was increased from 2.4 mg to 3.6 mg intravenously for cancer pain. After reduction of dosage, consciousness disorder was improved. In the case 2, delirium also appeared when oral hydromorphone started at 2 mg for cough and dyspnea. After discontinuation of hydromorphone, the disturbance of consciousness was improved. In both cases, hydromorphone improved cancer pain, cough, and dyspnea, but it was difficult to continue hydromorphone due to adverse events, and opioid switching was required. Although there are reports of neurotoxicity caused associated with the use of high-dose, long-term hydromorphone in patients with renal failure, neurotoxicity may be shown even with small doses and short-term administration.
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We previously reported that a case of yokukansan efficaciousness for weight gain due to overeating behavior following bariatric surgery. The reason is considered that yokukansan stabilized the patient's mental state. So, we proposed that administration of oriental medicines for mental state might be a new way of treating obesity. We investigated the efficacy of mazindol, bofutsushosan or yokukansan for obese patients. We retrospectively reviewed clinical data to identify patients administered mazindol, bofutsushosan or yokukansan for treatment of obesity. The inclusion criteria were patients tolerant to medicine for 3 months, and who could be administered yokukansan for anger. A total of 107 patients met these selection criteria. After 3 months of drug administration, significantly body weight reduction was observed in either the mazindol group or yokukansan group. We also selected and analyzed patients with diabetes mellitus to clarify the efficacy of these drugs for glucose metabolism. Reduction in HbA1c was not significant in the groups. These results suggest that mental health problems are very important for the treatment of obesity. And we suggest that oriental medicine is an effective treatment for mental health in obesity patients.
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As the treatment for peripheral facial paralysis, stellate ganglion block (SGB), steroid administration, a sugical operation, vitamine administration and acupuncture are acknowledged. The authors carried out a comparative study of two methods (acupuncture alone vs. the combination of acupuncture and SGB) on 41 cases with Bell's paralysis and 10 cases with Hant's syndrome. Acupuncture treatment, 15 minutes electrical stimulation, was done twice a week using Chinese needles. For the SGB group, SGB was done to the diseased side before each treatment using 5-10ml of 1% xylocaine. The results were rated on the basis of May's score. Marked effectiveness was seen rather more frequent among the fresh cases of the SGB group, but no significant differences were there. The fresh cases showed no significant differences between the two groups. The results confirmed the conviction that acupuncture is one of the effective methods for peripheral facial paralysis.
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Temporomandibular arthrosis, which is accompanied by pain in the jaw joint and surrounding tissue, as well as clicking and disorder of jaw opening or movement, is common in dentistry field. However current treatment often does not result in improvement. We carried out acupuncture treatment for temporomandibular arthrosis without organic disorders including psychogenic ones. 12 patients (one male and 11jfemales) referred from the department of dentistry and oral surgery of our hospital underwent acupuncture treatment once or twice a week. In each treatment, electro-acupuncture was performed for fifteen minutes through chinese needles applied to Fuchi, Eifu, Anmin, Kensei, Taiyo, Gekan, Kyosha, Ten-yo, Kensei and Gokoku. Remarkable results were obtaied in 4 of these cases, effective in 2 cases, rather-effective in 3, and non-effectiveI in 3 cases, a 75% effectivectiveness ratio.