[Considering the Role of Home Care Support Clinics at a Pre-Discharge Conference].

In this study, we considered the role of home care support clinics for patients who wanted to go back to their homes from a hospice, duringa pre-discharge conference. The subjects of our study were 8 patients, of which 7 of them had cancer. Two patients died after the conference. These patients were discharged from the hospice three days after the conference and caregivers from the home care support clinics visited their homes 24 hours after their discharge. The clinic has a role to fulfill in terms of medical treatment and support, based on their life style and power of caregiving. We considered an advancedmeetingwith family or caregiver benefits in the conference. Further, the clinic has a role of establishinga relationship with each multi-disciplinary care unit and cooperate with them as soon as possible when needed.

[Usefulness of Peripherally Inserted Central Venous Catheters for Cancer Patients in Palliative Care Settings].

Peripherally inserted central venous catheters(PICCs)are widely used given they have lower incidence of serious complications than central venous catheters. We evaluated the safety and usefulness of ultrasound-guided PICC placement for cancer patients in palliative care settings. We attempted to insert PICCs in 42 patients, and the insertion was successful in 40 (95.2%)patients. Complications occurred in 9(22.5%)patients, but none were severe. In 30 cases, PICCs were used for infusion and drug delivery until cancer death. The duration of catheterization was 25(1-126)days. Our results suggest that ultrasound-guided PICC represents a safe and usefultoolfor cancer patients in palliative care settings.

[Aiming at the Spread of Palliative Care in Community Health Care-Consideration of Human Resource Development from the Viewpoint of the Home Physician and Support Hospital].

Palliative care for cancer patients requires information sharing, including prognoses, to fulfill the wishes of the patient and patient's family as well as to avoid wasting time. It is necessary to recognize the importance of the pre-discharge conference and home medical care to realize the wishes of the patient and the patient's family.

[End-of-Life Decision Making Support in Palliative Homecare].

Advance care planning is important in end-of-life decision making in home-based palliative care for both cancer patients and non-cancer patients.

[Clinical Utility of Tapentadol].

Tapentadol(TP)is a new strong opioid analgesicthat has both m-opioid receptor(MOR)effects and norepinephrine reuptake inhibitor(NRI)effects. In comparison with the existing strong opioid analgesics, the mechanism of action suitable for palliation of neuropathic pain is expected to be better for TP. The analgesic effect and side effects of this drug were tested in 10 cases of exacerbation of neuropathic pain at our hospital, and the sedative response rate was 70%. The main side effects were somnolence 44.4%, nausea 33.4%, and constipation 11.1%. The side effects on the digestive system were considered minimal. Although it is speculated that opioids would be useful as an outpatient treatment, few case reports are available regarding their use for cancer pain; therefore, further investigation is necessary. Generally, numerous social issues that would increase the likelihood of drug adherence failure must be addressed in order to expand the use of strong opioid analgesics such as TP. Both the patients and the healthcare worker should be involved when addressing these issues in Japan, and the measures should include instructions for appropriate reporting and for using such drugs.

[A case of drug-induced interstitial pneumonitis after chemotherapy with UFT and leucovorin for multiple lung metastases of rectal cancer].

The patient was a 70-year-old male who had multiple lung metastases of rectal cancer. He was administered UFT(300mg/ day)and LV(75mg/day)after Hartmann operation for rectal cancer. He complained of fever and difficulty breathing after 2 courses of these medicines, and was admitted for UFT-and LV-induced interstitial pneumonitis. Treatment with methylpredni- solone(30mg/day)improved his symptoms and revealed radical findings. He was ready for discharge on the 10th day after treatment. Interstitial pneumonitis-induced UFT and LV is rare, but can lead to severe complications, which should be diagnosed and treated by corticosteroid as soon as possible.

[A case of irinotecan-induced interstitial pneumonia during treatment of recurrent colon cancer].

A 75-year-old man undergoing operations for rectal cancer was given adjuvant chemotherapy for 6 months. Fourteen months after surgery, peritoneal dissemination was found, so mFOLFOX6 therapy was started. After 34 courses of mFOLFOX6 therapy, peritoneal dissemination progressed. As a second-line treatment, we administered FOLFIRI therapy. The patient visited our emergency unit with the chief complaint of a fever thirteen days after the second course was completed. A chest imaging study showed diffuse infiltrative shadow and ground glass shadow bilaterally. Chemical interstitial pneumonia was suspected from his clinical findings. In the ICU, respiratory care by BiPAP and steroid pulse therapy(mPSL 1 g/day for three days)were performed. Steroid therapy improved his respiratory status and chest image findings, and he was able to leave the ICU on the seventh day. We continued steroid internal use treatment and he was discharged on the 70th day. The agent causing interstitial pneumonia was thought to be CPT-11 from the administration history. The incidence of interstitial pneumonia as an adverse event of CPT-11 is low, but it can be fatal without adequate attention. Steroid pulse therapy was validated for treatment, and it served to prolong life.

Localized malignant pleural mesothelioma showing a thoracic mass and metastasizing to the stomach.

Malignant mesothelioma typically shows either diffuse tumors or multiple pleura-based nodules. Localized malignant mesothelioma is rare. In this case report, a 70-year-old man with left chest wall tumor underwent tumor resection, and the lesion was pathologically diagnosed as biphasic malignant mesothelioma. Tumor recurrence was detected in the stomach due to vomiting of blood, and also spread to the mediastinal lymph node, and bone 3 months postoperatively. Total gastrectomy was performed and the histopathological diagnosis of metastasis of mesothelioma was made. In the previously reported cases, all of the localized malignant mesothelioma arose in the pleural space and there was no metastasis of localized malignant mesothelioma to the stomach. In the present case, gross and histological examinations were performed for both the primary lesion and gastric metastatic tumor. Though it was very difficult to distinguish mesothelioma from sarcoma and other chest wall tumors, immunochemical staining was able to facilitate making the diagnosis. This case suggests that localized malignant mesothelioma is capable of showing multiple forms and a variety of clinical courses. Localized malignant mesothelioma can arise primarily from the chest wall.

[Complete response in a case of advanced unresectable esophageal cancer treated by chemoradiation therapy and S-1+CDDP chemotherapy].

We report a 37-year-old woman who complained of chest discomfort as of August 2004, and was found to have advanced esophageal cancer in the upper thoracic area in December 2004.S he was diagnosed as Stage IVa (T4N1M0) because chest computed tomography (CT) indicated trachea invasion and lymph node metastasis. We diagnosed it to be a case of unresectable esophageal cancer, and she underwent chemoradiation therapy. CT showed regression of the main tumor and metastatic lymph nodes when the CRT course was completed. The main tumor disappeared macroscopically. We again considered an operation, but the CRT was so effective that the patient wished to continue CRT and underwent three courses. Endoscopy showed disappearance of the main tumor and Lugol's solution. Following this, 10 courses of the treatment with CDDP alone (CDDP 10 mg/weekly) were continued until the appearance of renal dysfunction. S-1 (100 mg/body/day)was started in September 2005. The treatment is currently ongoing, and no recurrence or metastases had occurred as of March 2009.

[A case of recurrent pancreatic cancer with lung metastasis responding to S-1 combined gemcitabine chemotherapy].

The patient was a 54-year-old male. In July 2004, he underwent resection of the pancreatic body tail region to treat pancreatic body tail cancer. On histopathological examination, the stump of the extirpated specimen was positive for tumor cells. After surgery, 10 courses of therapy with gemcitabine hydrochloride(GEM, 1, 000 mg/m(2), 3-week administration followed by 1-week discontinuation)were performed, and follow-up was continued. In February 2006, local relapse was detected. Chemotherapy with GEM was administered for 1 year and 9 months. However, in November 2007, an increase in the recurrent lesion size and right lung metastasis were noted. The regimen was switched to combination therapy with S-1 and GEM(S-1 60 mg/m(2) day, continuous administration on days 1 to 14 and 2-week discontinuation; and GEM 1, 000 mg/ m(2), administered on days 8 and 15). After the end of the 11th course, PET-CT revealed the disappearance of FDG accumulation in the recurrent and metastatic lesion sites. During the treatment period, there were no grade 3 or higher adverse reactions. The patient is being treated at the outpatient clinic (as of January 2009).