A case of blepharophimosis due to facial edema caused by malignancy-related superior vena cava syndrome, effectively treated with double dose of Goreisan,a traditional Japanese (Kampo) prescription

Introduction: Double dose of Goreisan was effective in a case of blepharophimosis due to facial edema caused by malignancy-related superior vena cava syndrome. Case: A 60-year old male patient diagnosed with squamous cell carcinoma of the tongue underwent brachytherapy, surgery, and several types of chemotherapy before cervical lymph node metastases developed. Cyberknife therapy was performed to reduce the volume of lymph node metastases, only to develop abscess and cause malignancy-related superior vena cava syndrome, leading to facial edema accompanied by blepharophimosis. Intravenous furosemide was not effective, so double dose of Goreisan, a traditional Chinese prescription was applied and the edema and blepharophimosis subsided immediately, thus enhanced the patient’s quality of life. Conclusion: Goreisan can be an effective option for cases of malignancy-related superior vena cava syndrome refractory to chemotherapy and/or radiotherapy.

Hospital-wide "opioid surveillance" audit led by palliative care team pharmacists to monitor pain management with opioids

Background: Previous surveys have demonstrated that a significant proportion of inpatients did not receive adequate pain management at an acute care hospital in Japan. Aim: The aim of this study was to evaluate the usefulness of a hospital-wide audit for assessing pain management with opioids according to the electronic medical records (EMRs) Methods: The subjects of this audit were inpatients receiving strong opioids who had not been consulted by the pallia. tive care team (PCT). The PCT held a weekly pharmacist-led conference to evaluate the adequacy and appropriateness of analgesics, including opioids, as well as drugs administered for adverse effects according to information collected by the PCT pharmacists. The PCT subsequently recorded the advisory comments in the EMRs. Each week, the PCT monitored whether the suggestions had been accepted by primary physicians and whether the pain and/or adverse effects had improved. Results: Among a total of 4,978 cases evaluated during the 3-year survey period, 888 (17.8％) had inadequate pain and/or adverse effect management. Symptoms improved in 82.3％ of cases for which PCT proposals were accepted. Conclusion: The results suggest that this hospital-wide audit may be useful for improving pain management with opioids at an acute care hospital.