Purpose: We report a case with portal vein stenosis that showed unexpected drowsiness induced by oral administration of low dose opioid, suggesting elevation of opioid level in blood. Case report: A 60-year-old woman developed portal vein stenosis caused by postoperative local recurrence and lymph node metastasis after operation of lower bile duct carcinoma. Her doctor administrated 10mg/day of oral controlled-release oxycodone tablet to her and she became drowsy. Therefore, we started powdered form of oral sustained release morphine with 10mg/day and reduced the dose to 5 mg/day; however, her drowsiness persisted. Finally, the symptom was remarkably improved when the administration was changed to a transdermal fentanyl patch (12.5μg/h). Conclusion: Adequate observation is required for cases with reduction in portal blood flow at the time of oral opioid administration. Because oral opioid can escape from first pass effect of the liver and opioid level in blood will be increasing. Furthermore, it is suggested that change in administration method from oral route to percutaneous one may be effective for improvement of adverse effects involving increased opioid-level in blood. Palliat Care Res 2008; 3(2): 331-334

Introduction: We are reporting on our experience with a case involving chronic diarrhea that had been continuing for 14 years following anticancer treatment, in which diarrhea and the nutritional status of the patient were unintentionally improved by administered antihistamine. Subject: A 48-year-old female. Fourteen years ago, surgery, chemotherapy, and total pelvic radiotherapy were carried out for cervical cancer, immediately after which diarrhea continued. A laparotomy was performed 11 years ago for Ileus, and radiation enterocolitis was diagnosed upon pathological examination 8 years ago. One month ago, she experienced swelling of the lower limbs after acute cellulitis and visited our outpatient palliative care. Leaking edema due to low nutrition remained following the remission of lymphedema. Ten days prior to re-examination, a maximum dosage of 20 mg/day of olopatadine was prescribed by another department against urticaria, and at the same time, remission of her diarrhea was observed. Oral administration of folic acid and vitamin was completed by continuing small doses, leading to a rise in CK and disappearance of the edema. Discussion: It may be believed that chronic diarrhea was relieved by olopatadine administered for another purpose due to the inhibitory action of 5-hydroxytryptamine 2A receptor, which is a subfamily of serotinin having histamine 1 inhibitory action and the action to increase the bowel movements.

Introduction: We report a case of acute-phase reaction of denosumab which was difficult to exclude aggravation of original cancer pain. Case: A 65 year-old man with severe pain from right back to upper abdomen due to mid thoracic vertebral metastases of small cell lung cancer was consulted to palliative care team. Denosumab 120 mg was administered subcutaneously three times every four weeks. On the next day of first administration, pyrexia occurred. At all three administrations, pain worsened for four days after the next day of administration. The pain was worsened from numerical rating scale 2 to 6. Same phenomenon was observed each time denosumab was administered for three consecutive times. Although the area of pain overlapped with that of original vertebral metastases, the repetition of the pain exacerbation soon after the denosumab administration suggested acute-phase reaction. Conclusion: Pain aggravation caused by acute phase reaction of denosumab might be overlooked in patients with cancer pain. More investigation is needed for details of acute-phase reaction caused by denosumab.