Morphine is the only opioid that has been found effective for the relief of dyspnea in cancer patients. However, efficacy has not been fully demonstrated for other opioids such as fentanyl. Here, we report a case of lung cancer in which the use of fentanyl was effective for the relief of dyspnea. The patient was an 88-year-old man who had cT4N2M0, cStage IIIB lung cancer with right bronchial involvement and mediastinal lymph node metastases. Although the patient complained of dyspnea, he was not given morphine due to underlying renal dysfunction. He instead received oxygen therapy, and treatment with oral steroids and oxycodone. As oral administration became more difficult with subsequent lung cancer progression, the patient underwent opioid switching from oxycodone to subcutaneous injections of fentanyl. Dyspnea was not exacerbated following the switching, and was thereafter effectively managed by increasing the fentanyl dose and using rescue medication. Fentanyl is suggested to be a possible therapeutic option for dyspnea in cases where the use of morphine is difficult.

Purpose: To investigate the characteristics of sudden abdominal condition change that occur in a palliative care unit, we evaluated the association between these conditions and family acceptance at time of death. Methods: We retrospectively investigated the medical records of 30 terminally ill cancer patients who died of sudden abdominal condition change in our unit between January 2010 and March 2013. We focused particularly on the course of sudden change, symptom relief, explanation of the condition, and family acceptance at time of death. Results: The average time from onset of sudden change in abdominal condition until death was 20.6 hours and the median was 13 hours. Of the 30 total cases, 23 occurred in less than 24 hours. Frequent symptoms during the sudden change were abdominal pain in 28 patients, decreased blood pressure in 21, lowering of consciousness in 12 and disturbed behavior/excitement in 10. Impending symptoms were observed in 18 patients. For patients with good acceptance by family at time of death (21 patients), symptom relief was significantly better, frequency of disturbed behavior/excitement was significantly less, and prior specific explanation was significantly frequent, compared to the poor acceptance group (9 patients). The good acceptance group tended to be have a longer hospital stay, as well as longer time between sudden change and death. Conclusions: Death by sudden abdominal condition change came within 24 hours in a majority of cases. We consider that prior detailed explanation and improving symptom relief helps improve family acceptance.

Purpose: We evaluated the significance of support for leaving the palliative care unit temporarily in end-stage terminally ill cancer patients. Methods: We retrospectively investigated the medical records of 27 terminally ill cancer patients who died within 15 days after leaving our palliative care unit temporarily, between January 2011 and December 2012, and distributed a questionnaire to their bereaved family. Results: The age of the patients ranged from 29 to 91 years. Ten patients left the unit without stay and 17 left overnight. The destination of 24 patients was their home, while three had other destinations. For 11 patients, the main purpose of leaving the unit was to finish business, and for 9, was to see their houses once again. After returning to the hospital, the comments of 15 patients were affirmative, and those of 6 were negative. Questionnaire responses were obtained from 18 persons. Families reported anxiety regarding and difficulty with adaptation to the sudden change when the patients left the unit, apparatus support, patient transfer, and patient care. Conclusions: It was useful for the terminally ill cancer patients and their families to receive support when leaving the palliative care unit temporarily. Strategies to cope with the sudden change at the time of leaving the unit could help families feel reassured and secure.

Purpose: To investigate the indications for use of the Japanese version of the Liverpool Care Pathway (LCP), we evaluated the conditions of patients using and those not using the LCP. Methods: We retrospectively investigated the medical records of 71 LCP patients and 60 non－LCP patients who died in our palliative care unit between March and December 2013. Results: There was no significant difference in patients’ background between the LCP and non－LCP groups. For patients in the non－LCP group, sudden changes in condition were significantly more frequent and deep continuous sedation was used significantly less than in the LCP group. In the LCP group, the average duration on the LCP was 4.0 days, and the beginning criterion was met by three－point or more of all the patients. The initial assessment was achieved except for one case. In the non－LCP group, reasons for not using the LCP were a sudden change in condition (35 patients), a rapid change in medical condition (14), and a risk of falling (4). Conclusions: The LCP met the beginning criterion and was started at suitable time in the LCP group. The LCP is not useful for all patients; it cannot be used for a patient with sudden or rapid changes in condition, or at a risk of falling.

We examined three cases where Kampo medicine had effects on palindromic rheumatism. All the patients are men with arthralgia accompanied by redness, fever, and swelling. All cases are RF negative. Cases 2 and 3 are brothers. Case 1: A 58-year-old patient with recurrent arthralgia on shoulders, hands, and legs for 30 years. Eppi-ka-jutsu-to was administrated for arthralgia. When discomfort of the hypochondrium (Kyokyokuman) was noted, the administration of Sho-Saiko-to reduced the symptom.
Case 2: A 40-year-old patient with recurrent arthralgia on shoulders, hands and legs for nine years. Eppi-ka-jutsu-to was administrated for arthralgia. When discomfort of the hypochondrium (Kyokyokuman) and contraction of the abdominal muscles (Fukuhikokyu) was noted, the administration of Eppi-ka-jutsu-to-go-Shigyaku-san-ryo was replaced, which reduced the symptoms.
Case 3: A 46-year-old patient with recurrent arthralgia on knees and fingers, and pain in hip joints. Eppi-ka-jutsu-to was administrated for arthralgia. When discomfort of the hypochondrium (Kyokyokuman) and contraction of the abdominal muscles (Fukuhikokyu) were noted, the administration of Shigyaku-san reduced the symptoms.
All cases were typical palindromic rheumatism, and Eppi-ka-jutsu-to was effective to a certain degree. Kampo diagnosis of Saiko (Saiko-sho) was made and additional Saiko-drugs (Saiko-zai) reduced the frequency, the degree, and the length of the period of symptoms.

Medicine, Kampo ; Metabolic ; Therapeutic procedure ; Syndrome

In recent years, physical inactivity among children or adolescents has been a major public health concern. Although a number of studies have examined the effect of physical inactivity on depressive symptoms in adults, only few studies have examined this effect on children. Therefore, the purpose of this study was to examine the effect of physical activity on the development of depressive symptoms in children by using longitudinal data. The study participants were students in grades 4 to 8 in the Koshu City. Their physical activity and depressive symptoms were examined in 2008 by a questionnaire. One year later, their depressive symptoms were examined again. Students who had depressive symptoms at the baseline were excluded. Physical activity at the baseline was categorized into 3 groups as independent variables. The development of depressive symptoms was used as the dependent variable. Multivariate logistic regression analyses were performed to examine the relationship. At the baseline, 1532 students completed the questionnaire. Of them, 1379 students (727 boys and 652 girls) did not have depressive symptoms. One year later, 1319 students (95.6%) completed the questionnaires on depressive symptoms. Of them, 41 (6.0%) boys and 68 (10.6%) girls had developed depressive symptoms during the study period. High physical activity was significantly associated with decreased incidence of depressive symptoms compared to low physical activity only in boys (odds ratio: 0.37, 95% confidence interval: 0.12-0.95). Our results suggest that high physical activity significantly affects the depressive symptoms in boys.

We evaluated the association between respiratory symptoms and hydration volume during last 1 week of life in terminal cancer patients using retrospective study. The subjects were 138 terminally patients with malignancies. Patients were classified into two groups: the low hydration group (group L, n=85) who received 1,000 ml or less of artificial hydration per day in 1 week before death and high hydration group (group H, n=53) who received over 1,000 ml per day. We compared appearance of dyspnea and bronchial secretion on group L with group H. 64.1% of group H had dyspnea, and 52.8% had bronchial secretion. These fractions are significantly higher than group L (32.9%, 15.3%). In the results of multiple regression analysis, lung involvement (odds ratio: 3.55), hydration over 1,000 ml per day (3.54), and administration of opioid (0.40) were significantly related dyspnea. Lung involvement (7.29), hydration over 1,000 ml per day (4.43), and oral intake (0.31) were significantly related bronchial secretion. Our results provide preliminary evidence that excessive artificial hydration therapies influence the respiratory symptoms in terminal cancer patients. 1,000 ml of hydration may be used as a rough indication in terminal stage.

Purpose：We evaluated that the current state from which a palliative care unit receives emergency admission of cancer patients at home. Methods：We retrospectively investigated the medical records of 393 cancer patients who hospitalized in our unit between January 2013 and December 2014. The patients were shared with a group of two, schedule admission (schedule group) and emergency admission (emergency group), and it was compared with a result on discharge and with a hospitalization period. We investigated admission process, the date and time of admission, and reason for admission in emergency group. Results：The number of patients was 224 of schedule group and 169 of emergency group. The mortality rates were 81% in schedule group and 78% in emergency group (not significant). An emergency group for an average of 24.3 days was shorter for 9 days than schedule groups in a hospitalization period of dead leaving patients (p<0.05). In emergency group, admission process included 128 completed-interviews with the hospitalization, 11 incompleted-interviews before admission and 30 first visits, and 129 patients (76％) admitted within the weekday daytime. Many patients had a complaint of severe pain, appetite loss and oral absorption difficulty, and so much. Conclusions：An emergency group admitted the various processes and the much symptom. There were a lot of cases of early hospital death, but also admitted return at home, and our unit played the role of emergency admission.