Risk factors and management for massive bleeding of an acute hemorrhagic rectal ulcer.

An acute hemorrhagic rectal ulcer (AHRU) is considered to be a potentially life-threatening illness requiring urgent identification and management because of massive bleeding. It is therefore important to clarify the factors associated with the massive bleeding of an AHRU and the best management. The factors associated with the massive bleeding of 14 patients with AHRU were determined by comparing the clinicopathologic features, laboratory data, and treatment between four patients with more transfusions (> or = 12 U) and 10 patients with less transfusions (< or = 3 U). Patients with AHRU of the more transfusion group had lower performance status (PS), more diabetes mellitus, more comorbid diseases, and lower serum albumin concentrate than those of the less transfusion group. More surgical treatment and the administration of hemostatic agents were necessary for the patients with AHRU of the more transfusion group than for those of the less transfusion group, and the duration from bleeding to hemostasis in patients with AHRU of the more transfusion group was larger than that of the less transfusion group. Patients with AHRU of the more transfusion group had a longer duration of no oral food intake, total parenteral nutrition, and hospital stay from bleeding day than those of the less transfusion group. Thus, the factors associated with the massive bleeding of AHRU were identified.

Early conversion from oral morphine to transdermal fentanyl in patients with cancer pain.

BACKGROUND/AIMS: The aim of this study is to prove that an early conversion from oral morphine to transdermal fentanyl is an effective and safe treatment modality for patients with cancer pain. METHODOLOGY: Early conversion to transdermal fentanyl was evaluated for patients with cancer pain (VAS > or = 4) by administering 20-30 mg of morphine. RESULTS: The early conversion to transdermal fentanyl improved cancer pain in comparison to oral morphine. The mean VAS score improved to 2.6 +/- 2.8 after treatment, whereas the mean VAS score was 5.67 +/- 2.4 before treatment by transdermal fentanyl. Eighteen of 24 patients (75%) were responders due to an early conversion by the VAS score, and the mean VAS score after transdermal fentanyl was 1.2 +/- 0.9 in responders. Finally, 66.7% of all patients received from 2.5 mg to 5.0 mg of transdermal fentanyl. The VAS score before conversion from oral morphine to transdermal fentanyl showed a significant difference (responder vs. non-responder: 4.7 +/- 1.8 vs. 8.5 +/- 1.4, P<0.001). Rescue treatment for cancer pain was required for 16 series in 13 patients. Vomiting, nausea, constipation, and drowsiness were observed as adverse effects. However, the nausea symptoms significantly improved after treatment with transdermal fentanyl (P<0.05). CONCLUSIONS: Early conversion from oral morphine to transdermal fentanyl helped to effectively relieve cancer pain while improving the effects of morphine induced nausea.