The purpose of this study was to clarify the effects of bicycle ergometer training and prostaglandin E₁ (PGE₁) for patients with intermittent claudication. Subjects were divided into four groups : the medication group (M), the PGE₁ group (P), the exercise group (E) and the PGE₁ and exercise group (PE). The P group was injected with 10μg of PGE₁, the E group performed bicycle ergometer exercise 3 times a week for 6 weeks, and the PE group was injected with PGE₁ and performed exercises. The maximal walking distance (MWD) was evaluated by a treadmill test. Muscle oxygenation level was measured by near-infrared spectroscopy and recovery half time (T_1/2) was calculated. MWD was significantly improved for P (142%), E (216%) and PE (240%) groups. T_1/2 was significantly improved in the E and PE groups. This study indicates that improvement of MWD was a result of development of muscle perfusion in lower limbs and PGE₁ injection may support exercise therapy.

Introduction: There has been no case report in which hyperpigmentation developed on the skin area where a transdermal fentanyl patch was applied in a patient. Case report: A 43-year-old man with recurrence of postoperative rectal cancer was treated by cetuximab plus irinotecan and panitumumab plus FOLFIRI. For cancer pain, transdermal fentanyl patch (Fentos®) was administered, and radiation from behind was performed. Hyperpigmentation then appeared on the chest and the abdominal skin sites where the patches were applied. The hyperpigmentation nearly disappeared four months after the fentanyl patch was discontinued. Discussion: The cause of the pigmentation was possibly due to post inflammatory hyperpigmentation secondary to contact dermatitis. It was desirable to conduct patch test and skin biopsy for making an accurate diagnosis. Conclusion: We should pay a careful attention to hyperpigmentation of the skin where a transdermal fentanyl patch is applied.