End-Stage Cancer Patients Diagnosed with a Femoral Pathological Fracture on Admission to Palliative Care Units.

Background: Femoral pathological fractures (PFs) due to bone metastasis result in exacerbation of pain, gait disturbance, and reduced general condition. Surgery may be considered depending on the situation, but is not suggested often, and treatment is difficult toward the end of life. Objective: Terminal cancer patients with a femoral PF admitted to a palliative care unit (PCU) were retrospectively evaluated. Measurement: Seven cancer patients diagnosed with a femoral PF at a PCU on admission, in Japan, were examined for clinical background, physical symptoms, and psychiatric symptoms. In addition, the responses of the patients' families and medical staff were examined. This study was approved by the ethics board of our hospital. Results: A total of 28.6% of patients were hospitalized from home, and the trigger for PF could not be confirmed in 85.7% of patients. In all cases, surgery was not recommended, given the poor prognosis. Opioid drugs were used for pain in all patients, and 85.7% of patients were able to relieve their symptoms. Delirium was observed in 71.4% of cases, and treatment with antipsychotics was required in all cases. Family grief also emerged as a problem, and the staff was burdened; hence, we addressed this at the death conference. Conclusions: Even for femoral PFs in cancer patients with a limited prognosis, it is necessary to perform tests and control pain. In addition, it is important to support the mental distress of patients and their families in a short period; medical staff should be trained to support the families after the patients' death.

[An autopsy of G-CSF-producing anaplastic carcinoma of the pancreas with impaired accumulation on FDG-PET after S-1 chemotherapy].

This paper presents a woman in her 70's with G-CSF producing anaplastic carcinoma of the pancreas(Stage IVb)who underwent chemotherapy by S-1 alone. On FDG-PET after the first course, accumulation of FDG was impaired remarkably. After the second course, the patient died of carcinomatous pleuritis and peritonitis on the 88th day after initiation of treatment. G-CSF producing anaplastic carcinoma of the pancreas is extremely rare and there are no reports with regard to response evaluation by FDG-PET. Thus, this case has significant clinical value.

[A case of successful treatment of granulocyte colony-stimulating factor producing hepatocellular carcinoma accompanying type B hepatitis with tegafur-uracil].

A 37-year-old man underwent lobectomy of the right liver for granulocyte colony-stimulating factor (G-CSF) producing hepatocellular carcinoma accompanying type B hepatitis. Within two months after the surgery, lung metastases were revealed and administration of sorafenib was begun, however, the lung metastases continued to enlarge. Changing the patient's medication to tegafur-uracil provided remarkable reduction of the lung metastases. The patient is alive two years after diagnosis and receives outpatient chemotherapy. We concluded that this case is valuable with regard to the extreme rarity of G-CSF producing hepatocellular carcinoma and its successful treatment in this case.

Endoscopic resection of Peutz-Jeghers polyps throughout the small intestine at double-balloon enteroscopy without laparotomy.

BACKGROUND: Small-bowel enteroscopy with the double-balloon method was developed to improve access to the small intestine. This study evaluated the usefulness of this method for the resection of small-intestinal Peutz-Jeghers polyps. METHODS: Two patients with Peutz-Jeghers syndrome underwent nonsurgical double-balloon enteroscopic resection of polyps throughout the small intestine. OBSERVATIONS: Multiple polyps in the jejunum were successfully resected via the oral route, as were the polyps in the ileum via the anal route. All 18 polyps (10-60 mm in size) were resected without subsequent bleeding or perforation. Histopathologically, 3 large polyps (>30 mm diameter) were hamartomas with adenomatous components. CONCLUSIONS: Double-balloon enteroscopy was safe and useful for the diagnosis and the treatment of Peutz-Jeghers polyps throughout the small intestine. Double-balloon enteroscopic polypectomy might preclude complications of Peutz-Jeghers syndrome, including intussusception, bleeding, and tumorogenesis, thereby obviating the need for multiple laparotomies.