The case was a man in his 80s, who had been in home care with primary hepatocellular carcinoma before hospitalization. He suffered nausea and appetite loss. However, hypercalcemia in laboratory data, brain metastasis on head CT and MRI, and intestinal obstruction or dilatation on abdominal CT, were not revealed. Upper gastrointestinal endoscopy detected no mechanical abnormality after admission to hospital and medical treatment with 3.75mg/day of mirtazapine was started. The dietary intake increased on the following day of the administration and nausea and appetite loss were improved, so the patient was discharged. In conclusion, low-dose mirtazapine was considered to be one of the effective therapeutic agents for nausea from unknown causes in cancer patients.

The initial case was a man in his 50s. He received 2 cans a day of ProSure^®, while undergoing radiation and chemotherapy with carboplatin and docetaxel for adenocarcinoma in the lung. His body weight rose from 62.4 kg on admission to 63.7 kg before discharge, CRP decreased from 3.08 mg/dl to 0.48 mg/dl, and albumin fell from 3.6 g/dl to 3.5 g/dl. The second case was a man in his 60s. He was diagnosed as having squamous cell carcinoma in the lung and administered with 2 cans a day of ProSure^® and antibiotics. One-and-a-half months later, he underwent chemotherapy with carboplatin and S-1 and radiation. His body weight stood at 47.0 kg on admission and 47.2 kg before discharge, CRP dropped from 15.45 mg/dl to 3.26 mg/dl, and albumin was retained at 2.6 g/dl to 2.7g/dl. The administration of ProSure^® brought about improvements in the nutritional status and anti-inflammatory effects in the patients with chemotherapy.

  The patient was a woman in her 80s, who was referred to the palliative care team in our hospital for pain due to bone metastases from lung cancer. Although gabapentin and ifenprodil tartrate were administrated in addition to opioids and loxoprofen sodium, and the dose of opioids was increased, pain was not relieved remarkably. A switch from gabapentin to pregabalin brought remarkable pain relief. Before the internal use of pregabalin, the patient was often seen lyiing in bed because of pain. However, by pregabalin, she began to walk, pushing her wheelchair and smile often. Her ability to perform the basic activities of daily living was improved. The switch from gabapentin to pregabalin was one effective option when an analgesic adjuvant for cancer pain was chosen.

Objective: To attain optimal blood concentration rapidly, it is needed to perform initial dose setting appropriately when vancomycin (VCM) used.  In order to design initial dose settings of VCM more currently, we compared the predictive performance of two types of VCM therapeutic drug monitoring (TDM) analysis software retrospectively.
Method: We utilized two TDM analysis software, SHIONOGI-VCM-TDM ver.2009 (VCM-TDM) and “Vancomycin MEEK TDM analysis software Ver. 2.0” (MEEK), based on patient’s background. 112 patients who received VCM and performed TDM were analyzed during the period from October 2011 through September 2012 and compared the actual trough level with the predictive trough level.  The predictive performance was evaluated by calculating ME (mean prediction error), MAE (mean absolute prediction error), and RMSE (root mean squared error).  Age, gender, and a renal function were evaluated as patient’s background.
Results: VCM-TDM gave good predictive performance for patients overall.  When classified patient’s background complexly (sex, age, and renal function), as for male patients, VCM-TDM showed good predictive performance except for the group over 65 years old and CCr over 85 mL/min.  For female patients, the difference of predictive performance was not accepted by all groups.
Conclusion: These results suggest, for male patients, we should use VCM-TDM for initial dose settings except for the group over 65 years old and over CCr 85 mL/min.  For the other patients, we consider that both of software can be used.  These new findings seem to contribute to proper dosage settings of VCM.

Liverpool Care Pathway (LCP) Japanese version was implemented to electronic medical chart (FUJITSU HOPE/EGMAIN-FX®). The processes were needed as follows; preparation of each templates (criteria for use of the LCP/initial assessment, ongoing assessment, and care after death), preparation of pathway/regimen, incorporation of the templates to the pathway and approval in our hospital clinical pathway committee. One problem we encountered was whether to choose an Excel or a template format for each assessment sheet, and the template format was selected as it presented us with a higher degree of convenience, since each field can be expanded into a table on the screen without scrolling and there is little limitation in the letters of the valiance records that can be used in the template format. The complexity of the three records, “the pathway”, “SOAP & focus” for recording opioid use, and “the progress sheet” for recording vital signs, in addition to the inability to expand enough to capture the same field and show changes in the daily pathway over time through night and day work shifts remain a challenge and need to be improved in the future.