Purpose: Morphine is often administrated through a nosogastric catheter in palliative medicine. As adhesion to the catheter and its stoppage is problematic, adhesion of morphine granules in a nosogastric-tube was investigated. Methods: We investigated it in three following conditions. (1)four morphine products, which were three morphine granules (Pacif®, MS-twicelon® and Kadian®) and a morphine fine granule (Morphes®). (2)four different suspensions of composition, which were water, milk, enteral nutrition liquid and jellied suspension liquid. (3)two sizes of nosogastric catheter (10.5Fr and 13.5Fr). Each morphine product at a dose of 30mg was diluted by each suspension of 20mL in a cup, and injected into each size of nosogastric catheters using a syringe. And the catheter was flushed by the same suspension of 20mL. We counted the granule that adhered to the cup, the syringe and the catheter. Results: As for Pacif® and MS-twicelon®, jellied suspension liquid significantly decreased the number of morphine granules adhered than any of the other suspensions (One-Way Factorial ANOVA and Scheffe's F test: p<0.05) in both sizes of catheters. Only jellied suspension liquid made Kadian® pass the both catheters, but they were obstructed by Kadian® diluted in the other suspensions. Morphes® diluted in water had a tendency to adhere compared to those in milk, enteral nutrition liquid or jellied suspension liquid. Additionally, using the jellied suspension liquid, the maximum dosing of Pacif®, MS-twicelon® and Kadian® were 240mg, 90mg and 60mg, respectively. Conclusion: When administering morphine granules through a nasogastric-tube, using jellied suspension liquid is recommended. Palliat Care Res 2008; 3(2): 101-107

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Bone metastases occur in patients who have developed prostate cancer, and severely compromise the patient's quality of life. Here, we evaluated the quality of life in our inpatients diagnosed with prostate cancer with multiple bone metastases and bone pain. In our study, we evaluated pain using a pain diary, investigated the palliative effects of opioid dose, and assessed the quality of life using SF-36. The administration of chemotherapy and zoledronic acid (ZA) resulted in pain palliation, an anti tumor effect and improvements in the quality of life. We suggest that the administration of ZA might be an effective clinical strategy for multimodality advanced solid cancer therapy. We conclude that a 'combined' examination, in which a pain diary evaluating pain is considered in association with an SF-36 assessment evaluating quality of life is crucial to patient care. Palliat Care Res 2008 ; 3(2) : 308-315

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We performed combination therapy with modified oxaliplatin/l-LV/5-FU (mFOLFOX) in a patient with recurrent colorectal cancer who had peritonitis carcinomatosis. In this patient, mFOLFOX therapy resulted in disappearance of ascites and a decrease in carbohydrate antigen 19-9 (CA19-9), and improved quality of life (QOL) of the patient. This 62-year-old man was diagnosed with ascending colon cancer and metastatic cancer of the liver. Right hemicolectomy and right hepatic lobectomy were performed. We had started to treat with TS-1 in ambulatory care, however, he had peritonitis carcinomatosis with massive ascite reservoir on CT and peritoneal dissemination after a half year postoperatively. Furthermore, his ECOG Performance Status (PS) was rated as level 3. Therefore, we performed puncture of ascites and palliative mFOLFOX6 therapy. After ten courses, ascites and abdominal induration had disappeared and PS recovered to level 1. At present, CPT-11/l-LV/5-FU (FOLFIRI) are being administered for peripheral neuropathy and metastatic tumor associated with mFOLFOX6. The patient is spending his daily life satisfactory after FOLFIRI without abdominal swelling or ascites, and thus mFOLFOX6 may be an option for palliative therapy against massive ascites in patients with advanced colorectal cancer. The usefulness of palliative mFOLFOX6 therapy for patients with massive ascites should be evaluated in a well-designed clinical trial. Palliat Care Res 2008; 3(2): 316-320

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A 42-year-old man with primary tongue cancer was admitted to our palliative care center for the control of pain due to multiple bone metastases. On 30th day after admission, he was suffering from pneumonia. And on 37th day, chest radiograph demonstrated pericardial emphysema, which developed to the pericardial abscess. Chest Computed Tomography showed lymph nodes metastases around the left main bronchus, and revealed that there was a fistula between the left main bronchus and the pericardium. The patient was faced to the difficulty in taking spine position because of excessive excretion of the sputum. Pericardiocentesis was then performed percutaneously and a tube for the drainage was placed. After the placement of drain tube, he restored good night sleep in the spine position and the complaints were reduced. Palliat Care Res 2008; 3(2): 321-325

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Repeated needle thoracocentesis, tube thoracotomy, or pleurodesis are generally performed as a palliative treatment for malignant pleural effusion. However, these methods have an unsatisfactory success rate, require lengthy hospital stays, and induce pain and various inconvenience accompanying frequent treatment or catheterization, indicating unsatisfactory palliative care. Here, we experienced a case of malignant pleural effusion treated by pleuroperitoneal shunt. The patient was suffering from lung cancer in his eighties. Although the patient wished to be treated at home, uncontrollable pleural effusion forced him to remain in the hospital. By inserting Denver pleuroperitoneal shunt (Denver Biomaterials, Inc., Denver, CO, USA), he could return home. This method may be an effective treatment option in palliative care, particularly palliative home care, for patients with malignant pleural effusions. Palliat Care Res 2008; 3(2): 326-330

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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

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Percutaneous transesophageal gastro-tubing (PTEG) is considered a safe and effective treatment technique for drainage or feeding in patients with malignant bowel obstruction. We report six cases with malignant bowel obstruction due to recurrent gastric cancer whose bowel symptoms were satisfactory improved with PTEG. Ileus tubes were inserted in three of the six patients for decompression of the alimentary tract, a feeding tube was inserted in one patient for enteral feeding, and double elementary diet tubes (W-ED tube) were inserted in other two for decompression and enteral feeding. The median indwelling duration was 52days (rang; 24-460days). Home enteral nutrition was possible for the three patients with feeding tube and W-ED tube. Regarding decompression of alimentary tract, PTEG relieved the symptoms of all patients. One patient suffered from dermatitis around the inserted part of ileus tube because of the leakage of gastro-intestinal juice, and the ileus tube was removed. In two cases, the inserted tubes were exchanged because of the tube obstruction. PTEG made possible to use various types of tube depending on the state of the disease. From our experience, it is suggested that PTEG technique is an effective and useful procedure of choice for long-term drainage or feeding in patients with malignant bowel obstruction. Palliat Care Res 2008; 3(2): 335-342

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Mistake in Japanese Sentence had been corrected

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