A Case of G-CSF-producing Duodenal Cancer That Steroid Was Remarkably Effective to Alleviate Symptoms at the End of Life

Introduction: G-CSF producing tumors often cause various symptoms at the end of life, such as fever, fatigue, and fluid retention as a result of high cytokine status. Case: The patient was an 80-year-old woman. She was referred to our hospital because of anorexia and urine volume reduction. After a detailed examination, she was diagnosed with duodenal cancer. Although she decided not to receive anticancer treatment because of her old age and poor general condition, she felt a great distress with abdominal distension by large ascites. Furthermore, peripheral blood smear examination showed remarkably increased levels of normal neutrophils. We suspected G-CSF producing tumor and, hence, dexamethasone administration was initiated to suppress cytokine release. As a result, renal dysfunction and urine volume were improved, and ascites accumulation was not observed again since initial paracentesis. The number of neutrophils also declined, and the patient was in a good condition, even though it lasted for a short time. Conclusion: In patients with high cytokine status caused by G-CSF producing tumor, steroids may be useful for pain relief.

The significance and problems of medical interview training with standardized patients in clinical training after objective structured clinical examinations / 医学教育

1) To examine the significance and problems of medical interview training, self-administered questionnaires were completed by 90 students who took part in medical interview training with simulated patients in clinical training after objective structured clinical examinations.2) Most students thought that medical interview training was meaningful and thanked the simulated patients for their useful comments. On the other hand, some students felt that to improve their interviewing skills stricter feedback from simulated patients and instructors might be needed.3) Our results suggest that repeated training in medical interviewing in clinical training after objective structured clinical examinations is an effective method for teaching communication skills. However, in the future the scenarios should be improved and the frequency of medical interview training should be increased.