Oren-to extract alone was administered to 28 patients who had pain in the tongue but without organic lesions, and who had either a “hypofunctioning constitution” or a “normal functioning constitution”. The patients were predominantly women in their 50's. Treatment was continued for at least two months. The results were excellent in nine, good in 15, and unchanged in four. No side-effects attributable to Oren-to were observed. When the effect was compared in patients with and without dryness of the mouth, no significant difference was found. Thus it was shown that Oren-to was effective in the treatment of pain in the tongue in patients with either 'hypofunctioning constitution“ or ”normal functioning constitution“, regardless of whether they ”had dryness of the mouth or not. It seems that this preparation is also effective for the treatment of pain in the tongue in patients with psychosomatic disease who have a “hypofunctioning constitution” or “normal functioning constitution”. We discuss our study focusing on this condition.

Purpose：Methadone is an opioid used in Japan for the treatment of cancer pain. A thorough consideration of complex pharmacokinetics with individual differences and of serious adverse effects is necessary before switching to methadone; therefore, methadone is not yet widely used. We examined the analgesic and adverse effects of methadone through clinical cases and considered the clinical significance of methadone as an opioid analgesic for the treatment of cancer pain. Methods：The clinical course of 44 patients with cancer pain who were switched to methadone from other opioids was analyzed. Results：Out of the 44 cases investigated, 37 cases （84.1％） were successful. In the successful cases, pain intensity before and after methadone administration was reduced from an average of 7.5 to 2.8, respectively, on the numerical rating scale. Strong drowsiness （six cases） and nausea （three cases） were observed as adverse effects. However, no serious effects, such as QT prolongation and respiratory depression, were recognized. Conclusion：For patients with refractory cancer pain who require a high opioid dose, methadone is considered to be one of the alternatives in pain therapeutics.

Background: Methadone can only be administered orally in Japan. However, it is unclear how to treat pain when patients become unable to take methadone orally because of the progression of the disease. Aims: To assess retrospectively end-of-life pain control management after patients become unable to take methadone orally. Methods: Twenty-eight patients with cancer pain undergoing treatment with oral methadone died at a palliative care unit between April 2013 and September 2014. All patients died of cancer and were unable to swallow before death. We assessed pain control approaches after the patients became unable to take methadone orally. Results: Twenty-one patients survived 1 day or longer after becoming unable to swallow. Methadone was switched to another opioid because of pain. Of these 21 patients, 10 patients survived for 1 week or longer after being switched to another opioid. At this point, methadone would be mostly eliminated from the blood circulation. Among these 10 patients, seven patients were treated with subcutaneous morphine, and three patients were excluded because their pain could not be evaluated. The conversion ratio from final oral methadone dosage to oral morphine equivalent dose of opioids used on the seventh day was 6.1. Conclusion: Even when patients become unable to ingest methadone, switching to other opioids may not always be necessary because of the long half-life of methadone when pain is absent at the end of life. If necessary, pain could be managed by switching to other opioids with a conversion ratio of 6.1.

A 77-year-old man was hospitalized for a proximal anastomotic aneurysm 9 years after surgery for an abdominal aortic aneurysm. The aneurysm was located 3cm distal to the renal artery. The maximum diameter was 55mm. His medical history included a reoperation for the proximal anastomotic aneurysm and cerebral infarction. Endovascular stent grafting was performed because it was possible anatomically. Postoperatively, no endoleak nor migration were found. At present, the patient is being followed up regularly in the outpatient department. Endovascular stent graft placement can be an effective method for reoperation cases of an abdominal aortic aneurysm, and if it is possible anatomically, it should be attempted.

A 67-year-old man was referred to our department for surgical treatment of ischemic cardiomyopathy. Chest X-ray showed cardiomegaly with a cardiothoracic ratio of 62% and pulmonary congestion. CAG revealed multiple obstructive lesions in the left coronary artery system. LVG and UCG showed ventricular dilatation and dysfunction. ECG showed complete left bundle branch block with a QRS duration of 180ms. He underwent autologous bone marrow cell implantation and biventricular pacing concomitant with coronary artery bypass grafting. He is doing well after 15 months without any complications. Combination with therapeutic angiogenesis and cardiac resynchronization therapy may contribute to the development of new regenerative strategy for patients with severe ischemic cardiomyopathy.

We present a rare case of a patient who underwent complete microendoscopic excision of an osteoid osteoma, which induced radiculopathy without nerve root compression. A 20-year-old man presented severe right groin pain that was temporarily relieved by nonsteroidal anti-inflammatory drugs. A computed tomography (CT) scan showed typical features of a nidus located in the inferior cortex of the right L3 pedicle. We performed surgery using a posterior microendoscopic approach. We drilled vertically along the line of the cortex of the caudal pedicle using a high-speed drill. After identifying the tumor, en bloc resection of the nidus was achieved. Immediately after surgery, pain in the right groin disappeared. A CT scan showed that most of the right L3 pedicle remained. This minimally invasive technique preserves spinal structures, including the facet and pedicle, and is a viable option for the treatment of spinal osteoid osteomas located close to vital structures.
Groin ; Humans ; Osteoma, Osteoid* ; Radiculopathy ; Spine* ; Tomography, X-Ray Computed ; Young Adult

Introduction: Paroxysmal atrial fibrillation (Paf) occurred in an inpatient who has been prescribed methadone for cancer pain in our palliative care unit, but oral administration of aprindine (antiarrhythmic agent) succeeded in defibrillation and methadone administration could be continued. Case: A 75-year-old man had developed multiple bone metastases after resection of thyroid cancer. Due to refractory cancer pain, switching from oxycodone to methadone was performed. Pain relief was achieved with methadone 40 mg/day and without QT interval prolongation. After methadone administration about 9 months, there suddenly became loss of appetite in the morning of one day. ECG examination revealed Paf onset. Aprindine 20 mg was orally administered for the purpose of defibrillation. After about 2 hours sinus rhythm was gained and later without recurrence. Conclusion: This case was considered to have the coincidental complication of paroxysmal atrial fibrillation in the course of methadone administration. If administration of antiarrhythmic agents is performed in a patient whom has been prescribed methadone, it is feared to lead to result in QT interval prolongation due to drug interactions. It is important to carefully select an agent that rarely leads to QT prolongation.

OBJECTIVESWith greater concern for efficient resource allocation and profiling of medical care, a case-mix classification was applied for the per-diem payment system in Japan. Many questions remain, one of which is the role of comorbidity and complication (CC) in grouping logic. We examined the association of the number of CC with the length of hospital stay (LOS) and hospital mortality as well as the proportion of LOS high outliers in 19 major diagnostic categories (MDCs).

METHODSThis study was a secondary data analysis embedded in a government research project, including anonymous claims and clinical data during a 4-month period from July 2002. Every 19 MDC, LOS, hospital mortality or proportion of LOS high outliers was compared by the number of CC and presence of any procedures.

RESULTSFrom 82 special function hospitals, 241,268 patients were enrolled in this study. Among all patients, 50.5% were identified without any CCs, 32.4% with one or two, 13.4% with three or four, and 3.7% with over five CCs. The overall mean LOS was 22.15 days and hospital mortality 26.05 cases per 1,000 admissions. In any MDC, LOS and the proportion of outliers increased as the number of CC rose. The mortality rate increased prominently in the respiratory system and the hematology system.

CONCLUSIONSThis study demonstrated that the occurrence of more CC caused longer LOS and higher mortality in some major disease categories. Further study will clarify the association of the weighted CC with resource use through controlling procedures specific for MDC.

We present the case of a 76-year-old man who underwent preoperative endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) for obstructive jaundice caused by pancreatic head cancer. The patient had obstructive jaundice and cholangitis during neoadjuvant chemotherapy. Transpapillary biliary drainage using endoscopic retrograde cholangiopancreatography was attempted; however, it was unsuccessful because of duodenal tumor invasion. Therefore, EUS-HGS was performed. Jaundice and cholangitis improved promptly after EUS-HGS, and stent obstruction and migration were not observed before surgery. The stent was safely removed during surgery, and no postoperative complications occurred. Most studies of EUS-HGS for preoperative biliary drainage have been small and retrospective, and few have examined the safety of intraoperative stent removal. The fistula in our patient was promptly identified and the stent was safely removed despite the relatively limited field of view during robot-assisted laparoscopy.The promising findings of our case report can be used to inform EUS-based surgical strategies for biliary drainage with obstructive jaundice.