The 38-years old woman was hospitalized due to peritonitis carcinomatosa after 8 months, since the operation for advanced gastric cancer. Although the dosage of domperidone suppository, metoclopramide injection and haloperidol injection was started to prevent her from vomiting, it was stopped because of the complication of extrapyramidal symptoms. Instead of previous prescription, the traditional Japanese medicine, ice candy of rikkunshito, was prepared and started to give her. After its dosage, the number of vomit was gradually decreased, and she was permitted to go back her home. Before a dosage of ice candy of rikkunshito, it was impossible for her to eat orally even if she felt hungry and had appetite, which caused a strong grief to her. Ice candy of rikkunshito is a smooth medicine and expected to prevent from vomiting while an intake of ice candy orally. Hence, it is considered that there is possibility to have effectiveness both physically and psychologically. After few days from going back home, she caused a consciousness impediment. Her last stay at home was only few hours. After one month since then, she died leaving her message,“I was tired out, but happy to stay at my home.”

Palliative care team（PCT）, nutrition support team（NST）and office of nutrition in our hospital developed a special soup service, which was served for ten patients faced with terminal cancer. The members of PCT, NST and the Cook served a special soup to ten patients. Nine of them could taste the soup without vomiting although they had anorexia. It was a good result. The number of days from the last day tasting the soup to death or hospital transfer was between 3 and 20 days（12.5 days on average）, and the number of times they could taste the soup was between 1 and 3（2.0 times on average）. Tasting the soup supports the strength of living, and might bring an improvement in spiritual quality of life.

An inflammatory fibroid polyp (IFP) is a mesenchymal tumor of the gastrointestinal tract. IFPs in the small intestine are the most frequently detected with symptoms, such as abdominal pain and tarry stool due to intussusception. Accordingly, few studies have reported jejunal IFP as a cause of occult gastrointestinal bleeding (OGIB) diagnosed via both of capsule endoscopy (CE) and double-balloon enteroscopy (DBE). A 68-year-old woman presented with a progression of anemia and a positive fecal occult blood test result. Esophagogastroduodenoscopy and total colonoscopy findings were unremarkable. CE revealed a tumor with bleeding in the jejunum. DBE also revealed a jejunal polypoid tumor. Bleeding from the tumor seemed to have caused anemia. The patient underwent partial laparoscopic resection of the jejunum, including resection of the tumor. The tumor was histopathologically diagnosed as IFP. To our knowledge, this is the first reported case of laparoscopic resection of jejunal IFP with OGIB diagnosed via CE and DBE preoperatively.
Abdominal Pain ; Aged ; Anemia ; Capsule Endoscopy* ; Colonoscopy ; Double-Balloon Enteroscopy* ; Endoscopy, Digestive System ; Female ; Gastrointestinal Tract ; Hemorrhage* ; Humans ; Intestine, Small ; Intussusception ; Jejunum ; Laparoscopy ; Leiomyoma* ; Occult Blood ; Polyps*

PURPOSE: Sonic hedgehog (Shh) signaling and epithelial-mesenchymal transition (EMT) are both known to relate to cancer progression. The purpose of this study was to investigate the role of Shh signaling and EMT in renal cell carcinoma (RCC). MATERIALS AND METHODS: Cell proliferation was assayed in RCC cell lines in the presence or absence of a Shh signaling stimulator, recombinant Shh (r-Shh) protein, or a Shh signaling inhibitor, cyclopamine. Real-time reverse transcription-polymerase chain reaction (RT-PCR) was performed to study the expression of EMT markers (E-cadherin, N-cadherin, and vimentin) and osteonectin. The expression of Ki-67, Gli-1, osteonectin, and EMT markers in nephrectomy specimens from RCC patients was also measured by immunohistochemical (IHC) staining. RESULTS: RCC cells showed enhanced cell proliferation by r-Shh protein, whereas cell proliferation was suppressed by the addition of cyclopamine in RenCa cells. Real-time RT-PCR showed that r-Shh suppressed the expression of E-cadherin and that this suppression was partly blocked by cyclopamine alone in RenCa cells. In the IHC results, osteonectin significantly correlated with vein sinus invasion (p=0.0218), and the expression of vimentin significantly correlated with lymphatic invasion (p=0.0392). CONCLUSIONS: Shh signaling and EMT play roles in RCC progression, and the Shh signaling inhibitor cyclopamine might be a possible molecular targeted therapeutic strategy for RCC.
Cadherins ; Carcinoma, Renal Cell ; Cell Line ; Cell Proliferation ; Epithelial-Mesenchymal Transition ; Hedgehogs ; Humans ; Nephrectomy ; Osteonectin ; Polymethacrylic Acids ; Veins ; Veratrum Alkaloids ; Vimentin

Recently, the palliative care team (PCT) at our hospital has included dentists. Among a total of 127 cancer patientsand required PCT intervention from 2009 to 2014, 17 patients (13.3%) had oral symptoms. Therefore, the PCT held discussions in order to determine the optimal way to treat each patient. Various symptoms, including oral pain, dry mouth, taste disturbance, furred tongue, excessive amounts of saliva, appetite loss, and trismus were treated by the dentists. As a result, the oral findings improved in all patients, while the oral symptoms improved in 16 of the 17 patients (94%). Thanks to the fact that dentists have joined the PCT, oral symptoms are effectively relieved, and PCT members now have an increased interest in oral cavity complications. Furthermore, conducting thorough examinations of the oral cavity by the PCT not only results in an improved QOL, but it has also increased the interest in the oral cavity on the part of the PCT. Therefore, more effective palliative care is expected to be achieved by promoting increased cooperation with more clinical departments.