Objective: This study aimed to investigate the effect of nutritional status on estimated fentanyl absorption in cancer patients being treated with a fentanyl transdermal patch (FP), by measuring the residual fentanyl content in used patches. Methods: 24 adult Japanese inpatients receiving FP treatment for chronic cancer-related pain were enrolled. During FP application, the nutritional risk of the patients was measured using the Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Screening 2002 (NRS 2002), both of which are nutrition screening tools used widely in Japan. We then classified the patients into low-, medium-, and high-risk groups according to the nutritional risk measured by MUST, and compared the transdermal fentanyl delivery efficiency (FE) between that groups. Results: The FE, which is estimated by the residual fentanyl content in used FPs collected from the patients, was found to be decreased in the high-risk group. According to NRS 2002, the mean transdermal fentanyl delivery efficiency in the high-risk group was significantly lower than that in the low-risk group. Conclusion: These results showed that changes in nutritional status affect FE, and that poor nutritional status might decrease transdermal fentanyl absorption in cancer patients.

We describe a case of meningeal carcinomatosis of the internal auditory meatus presenting as sudden deafness accompanied by dizziness. A 54-year-old woman complained of acute right-side hearing loss in October 2014. The pure tone audiometry test revealed right-side hearing loss of 47.5 dB. She was treated with oral steroids. Her hearing as well as her symptoms of dizziness worsened and she was admitted for further examination. Her right and left-side hearing had worsened to 105.0 dB and 47.5 dB, respectively. A magnetic resonance imaging scan of the head revealed bilateral enhancement of the internal auditory canal and multiple brain metastases. The chest radiograph revealed a mass in the left lung. Adenocarcinoma of the lung was diagnosed. Lumbar puncture yielded no evidence of carcinoma cells in the cerebrospinal fluid, but an increased number of lymphocytes was confirmed. A diagnosis of multiple brain metastases and leptomeningeal metastasis from the adenocarcinoma of the lung was considered. Whole-brain radiation therapy (30 Gr/10 fractions) was administered. Progressive bilateral hearing loss is a rare first manifestation of meningeal carcinomatosis. It is quite important to consider the possibility of this condition when patients present with sudden deafness.
Adenocarcinoma ; Audiometry ; Brain ; Cerebrospinal Fluid ; Diagnosis ; Dizziness ; Ear, Inner ; Female ; Head ; Hearing ; Hearing Loss ; Hearing Loss, Bilateral ; Hearing Loss, Sudden ; Humans ; Lung ; Lymphocytes ; Magnetic Resonance Imaging ; Meningeal Carcinomatosis ; Middle Aged ; Neoplasm Metastasis ; Radiography, Thoracic ; Spinal Puncture ; Steroids ; Temporal Bone

We report an extremely rare case of primary squamous cell carcinoma of the stomach. A 69-year-old man was admitted to our hospital with a 2-month history of dysphagia and tarry stools. Endoscopic examination revealed a cauliflower-shaped protruding mass along the lesser curvature of the gastric cardia. Biopsy of the lesion revealed squamous cell carcinoma of the stomach. Computed tomography revealed a thickened stomach wall and a mass protruding into the gastric lumen. Total gastrectomy with splenectomy, distal pancreatectomy, and Roux-en-Y reconstruction was performed, together with a lower thoracic esophagectomy via a left thoracotomy. Histopathological examination of the specimen revealed well-differentiated squamous cell carcinoma of the stomach. Postoperative follow-up was uneventful for the first 18 months. However, multiple liver metastases and para-aortic lymph node metastasis developed subsequently. Despite systemic combination chemotherapy, the patient died because of progression of the recurrent tumors. Here, we review the characteristics of 56 cases of gastric squamous cell carcinoma reported in Japan.
Aged ; Biopsy ; Carcinoma, Squamous Cell* ; Cardia ; Deglutition Disorders ; Drug Therapy, Combination ; Esophagectomy ; Follow-Up Studies ; Gastrectomy ; Humans ; Japan* ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Pancreatectomy ; Splenectomy ; Stomach Neoplasms ; Stomach* ; Thoracotomy

Purpose: The objective of this study was to investigate whether body fat rate (BFR) and triceps skinfold thickness (TSF) are associated with estimated fentanyl absorption in patients treated with the fentanyl transdermal matrix patch for moderate to severe cancer pain, by measuring the residual content of fentanyl in used matrix patches. Methods: Adult Japanese inpatients experiencing chronic cancer-related pain and receiving treatment for the first time with a transdermal fentanyl matrix patch (Durotep®MT patch) were included in the present study. During the initial application period, BFR was measured using a body fat scale, and TSF was measured by an experienced nurse with an adipometer. One patch was collected from each patient. The residual fentanyl content in used matrix patch was determined by high-performance liquid chromatography. The transdermal fentanyl delivery efficiency was estimated based on the fentanyl content of the used matrix patches. Results: Fifteen adult patients (5 males and 10 females) were included in this study. Nine patches with a release rate of 12.5μg/h and 6 patches with a release rate of 25μg/h were collected. The application site was the chest or upper arm. BFR and TSF both showed a significant positive correlation with delivery efficiency. Conclusion: In malnourished or low-body fat patients receiving DMP, pain intensity should be more carefully monitored, and fentanyl dose adjustment may be required. Additional parameters, such as nutritional status including body fat change, the degree of dry skin, and plasma fentanyl concentration, also require detailed evaluation. Palliat Care Res 2010; 5(2): 206-212

Objective: The purpose of this survey is to identify the individuals responsible for providing drug information (DI) services in medical institutions across the nation and understand their work conditions. Method: This survey was conducted across medical institutions nationwide, each with at least 200 general hospital beds. The survey focused on personnel in charge of DI services at medical institutions. Results: Responses were collected from 181 facilities, representing a response rate of 13.7%. The median number of full-time equivalent DI personnel at each facility was 1.2 (ranging from 0.2 to 7 (n = 180)). Among the respondents, 90 (49.7%) individuals learned their DI responsibilities from their predecessors, 81 (44.8%) individuals learned through participation in academic societies (excluding the Japanese Society for Drug Information), and 61 (33.7%) individuals gained their knowledge from academic journals, with these methods listed in their order of prevalence. The most sought-after knowledge and skills for DI personnel included the knowledge of adverse drug reaction reporting system (134 (74.0%)), basic PC skills (130 (71.8%)), knowledge of medical fees (128 (70.7%)), and expertise in disease treatment methods (125 (69.1%)). Results and Conclusion: The findings of the survey revealed that several medical institutions with 200 or more beds have only one or two individuals in charge of DI duties. Apart from their core role in drug information, the DI staff members are expected to possess extensive knowledge concerning medical fees and related matters. However, they predominantly rely on their skills for DI operations. The tasks identified in the survey are tasks that are presently being performed by DI personnel at medical institutions. This underscores the pressing need for immediate attention to be given to acquiring the essential knowledge and education required for these tasks.