Introduction: Among various predicting tools of survival developed for terminally ill cancer patients, Palliative Prognostic Score (PaP) is used very frequently. The target diseases of PaP are solid malignancies other than renal cancer; thus hematological malignancies are not included in them. Objective: To demonstrate that it is appropriate and useful to apply PaP to patients with terminally ill hematological malignancies. Methods: We used PaP to predict the survival of 18 patients with terminally ill hematological malignancies hospitalized in our hospice ward and compared the prediction accuracy with that of the previous studies. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 21-day survival probability were 91.7%, 83.3%, 91.7%, 83.3%, and 88.9%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 30-day survival probability were 72.7%, 85.7%, 88.9%, 66.7%, and 77.8%, respectively. Conclusion: Our results suggest that it may be possible to apply PaP to patients with terminally ill hematological malignancies.

In a 73-year-old man, ventricular septal rupture and tricuspid papillary muscle rupture were complicated with inferior acute myocardial infarction (AMI). Twenty-five days after AMI, radical operation was performed. VSR was found 1.5cm diameter at the inferior septum and directly closed using teflon felt strip. Infarctectomized inferior LV free wall was closed with woven Dacron patch which was cut from Cooley low porosity aortic tube graft and sutured with bovine pericardium facing to LV cavity. A part of anterior tricuspid papillary muscle was found to be ruptured. Tricuspid valve replacement was performed with Carpentier-Edwards valve. One and half year postoperatively, the patient has been doing well without heart failure. To our knowledge, this is the first case of VSR complicated with tricuspid papillary muscle rupture following AMI.

A case of idiopathic enlargement of the right atrium (IERA) is described. A 28-year-old woman was admitted to our hospital because of cardiomegaly and a mass in the right atrium. She had had cardiomegaly for at least 8 years. Echocardiography showed an enlarged right atrium and a large mass. Cardiac catheterization demonstrated normal hemodynamic data. Based on these findings, we diagnosed this case as IERA and the right atrial mass was suspected to be myxoma. At operation, a markedly enlarged right atrium was found. The right atrial wall was paper-thin. Through right atriotomy, a giant round thrombus (5×4×4cm) was found. The tricuspid valve showed a normal configuration. After extirpation of the thrombus, the right atrial wall was excised and plicated. The postoperative course was uneventful. IERA is extremely rare and heart failure and sudden death have been reported. Therefore, symptomatic or complicated cases should be treated surgically.

Objective: This study investigated prognostic factors of short survival in patients with malignant pleural mesothelioma (MPM) upon the time of their admission to the Palliative Care Unit (PCU). Method: We conducted a retrospective review of the medical records of 12 patients with MPM, who died at the PCU of our hospital from January 2016 to April 2018. According to the classification of survival period by previous predictor model, these patients were classified into three Groups, Group A: less than 13 days, Group B: between 14 and 55 days, and Group C: more than 56 days. Results: The number of patients was 5 in Group A, 5 in Group B, and 2 in Group C, respectively. Hemoptysis was seen in 40% of patients of Group A only and oxygen inhalation was necessary for all the patients of Group A. Dysphagia and bilateral pleural involvement were seen in 80% of Group A and in 60% of Group B. Pneumonia was seen in 60% of Group A and in 20% of Group B. The above four factors were not seen in Group C. Conclusion: This preliminary study suggests that hemoptysis, dysphagia, bilateral pleural involvement, pneumonia, and oxygen inhalation are possibly prognostic factors of short survival of patients with MPM upon their admission to PCU.