[Etiology and management of venous pain during intravenous administration of oxaliplatin].

In Japan, XELOX (capecitabine plus oxaliplatin) was approved for the treatment of advanced/recurrent colorectal cancer in September 2009. However, patients treated with XELOX sometimes experience intense, sporadic venous pain during administration of oxaliplatin through peripheral vein. To investigate the etiology and management of this event, we measured the titratable acidity, osmotic pressure, and pH of 5% dextrose in water (D5W) containing oxaliplatin with or without dexamethasone. The dexamethasone-containing solution was then tested for its efficacy in venous pain relief. D5W containing oxaliplatin had a pH of approximately 4. 8, whereas the titratable acidity and osmotic pressure were 0. 1 mEq/L and 300-320 mOsm/L, respectively, suggesting that the venous pain was partly attributable to the pH.When 1. 65-6. 6 mg of dexamethasone was added to this solution, the pH of the resulting solution was increased to 6. 5-7. 6. Moreover, pain was relieved in patients administered oxaliplatin with dexamethasone in D5W. When adjusted for pH by the addition of 1. 65-3. 3 mg of dexamethasone, oxaliplatin in D5W is associated with less venous pain without decreasing oxaliplatin content although it is not generally recommended to dissolve oxaliplatin in a basic solution since it is unstable under alkaline conditions.

[A case of unresectable advanced pancreatic cancer treated by gemcitabine-based chemotherapy following cancer pain alleviation by low-dose matrix-type transdermal fentanyl].

Cancer pain often makes patient's performance status worsen and is one of the difficulties in anti-cancer therapy. We report a case of unresectable advanced pancreatic cancer with cancer pain, which was treated by matrix-type transdermal fentanyl following slow-releasing oxycodone, which caused severe constipation. Rotation to matrix-type transdermal fentanyl (Durotep MT 2.1 mg) releaved severe constipation as well as cancer pain. The patient could take gemcitabine-based chemotherapy. Low-dose matrix-type transdermal fentanyl (Durotep MT 2.1 mg) is useful for opioid rotation from low-dose morphine or oxycodone with uncontrolled side effects, and it contributes to continuation of anti-cancer therapy.

Individual differences in rate-limiting reactions during metabolism of irinotecan hydrochloride.

UNLABELLED: Irinotecan hydrochloride (CPT-11) is converted to SN-38 by carboxylesterase, SN-38 is conjugated by UDP-glucuronosyl- transferase (UGT) to SN-38G. Individual differences in enzyme activity influence the efficacy of this anticancer agent and the adverse reactions it induces. In this study, individual differences in the metabolism of this drug were determined by calculating its c 1 on version (CPT-11 to SN-38) and conjugation ratios (SN-38 to SN-38G) from blood concentrations of CPT-11, SN-38, and SN-38G at immediately and 60 min after a 90-min intravenous infusion of CPT-11. Changes in conversion and conjugation during long-term infusion of CPT-11 were also investigated. The median conversion and conjugation ratios were 0.0155 and 2.812, respectively (n=48). Based on these values, the patients were classified into four types: low-low type (10.4%), low-high type (31.2%), high-low type (31.2%), and high high type (27.1%). Prolongation of infusion time resulted in an increase in the conversion ratio in the low-high type and an increase in the conjugation ratio in the high-low type. These changes, however, were very slight in the high-high type. Thus, a longer infusion time made it possible to increase the number of doses in the low-high type and minimize adverse reactions in the high-low type. CONCLUSION: In patients found to have a low SN-38 conversion ratio or SN-38G conjugation ratio based on simple assessment of data obtained by 2-point blood sampling, modification of infusion time may allow pharmacokinetic changes that confer a clinical benefit.

[Mohs paste for unresectable local lesion of breast cancer].

A 45-year-old woman with a local recurrence on her left chest wall discharged massive exudates. At every gauze exchange, blood was still oozing out. After using Mohs paste twice, the surface had been fixed chemically and dried up, so she did not have to exchange gauze, and there was no more bleeding. A 55-year-old woman was suffering massive exudates and offensive smell from her right primary breast cancer that formed a massive bulge with a deep ulcer in the center. Because her serum hemoglobin declined to 4.4 g/mL due to continuous bleeding, she needed to undergo blood transfusion. After using Mohs paste twice, the bleeding stopped almost completely. Now she uses Mohs paste by herself at home at her convenience. A 69 year-old woman suffered from an offensive odor and continuous bleeding from a local recurrence in the skin of her abdomen. A single use of Mohs paste relieved her from bleeding and the smell. Three patients had experienced no adverse events except mild pain and their QOL improved considerably. Mohs paste is in the hope of improving the QOL for the breast cancer patients with local advanced, unresectable skin lesions.

Reduced genome of the thioautotrophic intracellular symbiont in a deep-sea clam, Calyptogena okutanii.

Although dense animal communities at hydrothermal vents and cold seeps rely on symbioses with chemoautotrophic bacteria [1, 2], knowledge of the mechanisms underlying these chemosynthetic symbioses is still fragmentary because of the difficulty in culturing the symbionts and the hosts in the laboratory. Deep-sea Calyptogena clams harbor thioautotrophic bacterial symbionts in their gill epithelial cells [1, 2]. They have vestigial digestive tracts and nutritionally depend on their symbionts [3], which are vertically transmitted via eggs [4]. To clarify the symbionts' metabolic roles in the symbiosis and adaptations to intracellular conditions, we present the complete genome sequence of the symbiont of Calyptogena okutanii. The genome is a circular chromosome of 1,022,154 bp with 31.6% guanine + cytosine (G + C) content, and is the smallest reported genome in autotrophic bacteria. It encodes 939 protein-coding genes, including those for thioautotrophy and for the syntheses of almost all amino acids and various cofactors. However, transporters for these substances to the host cell are apparently absent. Genes that are unnecessary for an intracellular lifestyle, as well as some essential genes (e.g., ftsZ for cytokinesis), appear to have been lost from the symbiont genome. Reductive evolution of the genome might be ongoing in the vertically transmitted Calyptogena symbionts.

[Palliative care team support services by the hospital for home palliation].

At Osaka National Hospital, we opened a palliative care team (PCT) since July 2004. The PCT advises the symptom management of cancer patients and supports patients' decision making. By March 2006, 355 consecutive cancer patients referred to the PCT, including 221 patients with psychiatric symptoms. The duration of the treatments for psychiatric symptoms were extended longer than for physical symptoms (physical symptoms: 47.7 days, depression: 60.4, delirium: 56.0, adjustment disorders: 57.4; p < 0.05). The reasons for this prolongation are that psychiatric symptoms (especially delirium) are often overlooked, and that home doctors and visiting nurses often hesitate to take on the home medical care because of unfamiliarity with them. The management of psychiatric symptoms at home is important for appropriate end-of-life care. The PCT and regional doctors have to work closely in cooperating with the successive palliation when the patient is transformed to home medical care.