Background: We experienced two cases where fentanyl relieved pregnant women of their cancer pain. Case 1: A pain in the lower back of a 30-year-old woman since the 30th week of her pregnancy for multiple myeloma. We started fentanyl continuous intravenous infusion on the first day of the 34th week and gradually increased the dosage to 32 μg/h. Elective cesarean section was performed on the 1st day of week 36. The child was born without problems. Case 2: A 34-year-old woman was diagnosed with stomach cancer in the 22nd week of her pregnancy. Fracture on the twelfth thoracic vertebra was also found. Continuous-subcutaneous-infusion of fentanyl was started and the dosage was escalated to 24 μg/h , which reduced her pain. Chemotherapy was effective for her cancer and did not affect the fetus. At week 34, elective cesarean section was carried out. Because the child presented cyanosis immediately after birth, tracheal intubation was performed, but extubated on the next day without problem. Conclusion: Fentanyl was found to be effective for reducing cancer pain in the two cases. Although the existence of causal relationship is unknown, cyanosis was observed in one case.

BACKGROUND/AIMS: Few reports have described the long-term treatment outcomes of the anti-tumor necrosis factor-α antibody for Japanese Crohn’s disease (CD) patients. The aim of this study was to evaluate them and clarify the clinical factors that affect the long-term prognosis of the anti-tumor necrosis factor-α treatments. METHODS: This was a retrospective, observational, single-center cohort study. Japanese CD patients treated with either infliximab or adalimumab as a first-line therapy were analyzed. The cumulative retention rates of the biologics, relapse-free survival, and surgery-free survival were analyzed using Kaplan-Meier methods. The clinical factors associated with the long-term outcomes were estimated by both the log-rank test and Cox proportional hazard model. RESULTS: The cumulative retention rate was significantly higher in the group with a concomitant elemental diet of ≥900 kcal/day, baseline C-reactive protein (CRP) levels < 2.6 mg/dL, and baseline serum albumin levels ≥3.5 g/dL, respectively. The baseline serum albumin levels were also associated with both relapse-free and surgery-free survival. The lack of concomitant use of an elemental diet ≥900 kcal/day was identified as the only independent risk factor for the withdrawal of the biologics. CONCLUSIONS: Baseline CRP levels and serum albumin levels could affect the long-term outcomes in CD patients. Concomitant elemental diet of ≥900 kcal/day could have a positive influence on clinical treatment course.
Adalimumab ; Antibodies ; Asian Continental Ancestry Group ; Biological Products ; C-Reactive Protein ; Cohort Studies ; Crohn Disease ; Food, Formulated ; Humans ; Infliximab ; Necrosis ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Serum Albumin