Introduction: It is difficult in the treatment for the patients with refractory pruritus by conventional oral or external medication. Case report: A 72-year-old woman with pancreatic metastasis of primary lung cancer, who was treated by control-release oxycodone for cancer pain and endoscopic biliary drainage for obstructive jaundice. Although external medication and oral anti-allergic agents (mirtazapine and herbal medicine) were administered for pruritus, there was no improvement. The patient was diagnosed with refractory pruritus and pregabalin was administered. After the beginning of low dose, increase of dosage provided improvement at the third day of the administration. Finally, numerical rating scale improved from 8/10 in previous treatment to 0-1/10 in following treatment, and the symptom was relieved. Discussion: A few previous research of effectiveness on pregabalin for pruritus have been reported from abroad. The improvement for refractory pruritus was provided by pregabalin. Conclusion: We conclude that pregabalin is a one of the options for effective treatment for refractory pruritus.

　　Purpose: To elucidate the degree of self-conctribution of each member of a palliative care team and the palliative effect patients. Patients and Methods:The degree of self-contribution to intervened patients and the degree of improvements in the symptoms items listed in a Japanese version of the Support Team Assessment Schedule (STAS-J) were examined prospectively. Results: The degree of self-contribution was often higher in doctors, nurses, clinical psychotherapists and pharmacists, and lower in nutritionists. It was related to age, gender, site of primary disease and the duration of intervention. The symptom items which showed improvement were such items as pain, nausea, vomiting, appetite loss and insomnia, but delirium and depression worsened. The degree of self-contribution and the degree of improvement in symptom were correlated in seven items in the case of pharmacists but only in one in the case of other professionals. Discussion: The degree of self-conribution varied and was not always high even after the intervention of the care team. It was considered that the fact that the number of related items was larger in pharmacists than in any other professionals was probably because the pharmacists could assess the symptoms and propose drugs from an objective point of view, although character might be mostly involved. Conslusion: It is to be hoped that every one engaged in palliative care will do what is one’s forte and apply each one’s individuality properly in the future.

  The patient was a woman in her 70s, who had been diagnosed as having a malignant fibrous histiocytoma in the right axilla with invasion to the intrathoracic space at a local hospital. The growth of cytokine-producing tumor was suspected, and thrombocytopenia caused by bleeding and jaundice by blood transfusion were disclosed. When she was admitted to our palliative care unit, the platelet count was 19,000/μl and total bilirubin was 6.4mg/dl. Furthermore, several predictive fools showed the prognosis for survival was poor. After transferal to our hospital, the patient was treated mainly with medication. No blood transfusion was given. In the clinical course, the platelet count and total bilirubin level were restored to normalcy. The patient lived on for another five months or over. The contributing factors, in prolonging her life longer than predicted were probably as follows; (1) spontaneous recovery of thrombocytopenia without bleeding, (2) improvement of jaundice caused by the blood transfusion, and (3) foods taken orally even in small amounts. There are patients whose prognosis varies substantially in the fields of the palliative care. It is important to work out proper medical treatment and care plans according to symptoms and the status of patients.

　　Objective: To elucidate the appearance of skin moisturization (cold and clammy skin) indying period and related factors. Methods: Patients were observed prospectively with skin moisturization using the clinical pathway for end-of-life care (Liverpool Care Pathway Japanese version [LCP]) by nurses in the palliative care unit. Results: Of 213 patients placed on LCP, 48 (22.5%) indicated skin moisturization, which was observed mostly in summer and in the morning. It appeared 45.8 hours before death on the average. By multivariate analysis, the administration of non-steroidal anti-inflammatory drugs (NSAIDs) was an independent related factor. Conclusions: Compared to our previous retrospective study, the appearance of skin moisturization was higher in frequency and earlier in the dying period, and the administration of NSAIDs was an independent related factor.

　　The first patient was a 33-year-old man with a history of fatty liver disease. Dynamic computerized tomography of a lesion in liver segment IV showed faint staining in the arterial phase and high signal intensity in the portal venous and equilibrium phases. The second patient was a 57-year-old woman also with a history of fatty liver disease. Magnetic resonance imaging (MRI) of a lesion in segment II in T1 out of phase revealed geographic morphology and high signal intensity. Furthermore, Gd-EOB-DTPA-enhanced MRI showed accumulation in the lesion in the hepatobiliary phase. In both cases, an aberrant left gastric vein and focal fat sparing area was diagnosed. Venous inflow to the liver other than via the portal vein may cause fatty degeneration of liver parenchymal cells or focal fat sparing due to imbalanced intrahepatic blood flow. In the present cases, imaging revealed a focal fat sparing area with an aberrant left gastric vein. Focal fat sparing area with aberrant inflow vessel identified in the background of fatty liver does not require biopsy or surgery. Therefore, further detailed evaluation of such images is warranted.

  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.

This paper presents the case of a man in his 70's with local advanced bladder cancer with hospital-developed Fournier's gangrene. The patient was hospitalized at the palliative care unit, and drainage with incision of the scrotum for symptom relief was performed to relieve severe pain. The patient experienced pain only during changing of the wound's dressing and no pain at rest after the operation. Furthermore, he reached his birthday and spent time in peace with his family. Fournier's gangrene is the necrotizing fasciitis of perineal and anal lesions, in which inflammation progresses rapidly in wide lesions, and it is associated with a high mortality rate. For Fournier's gangrene in a terminally ill patient, current agreement might depend on the patient's goal of treatment. The drainage provided for spiritual care of the patient and his family as well as pain relief. In conclusion, local drainage for Fournier's gangrene can be feasible as a choice of palliative treatment. Palliat Care Res 2011; 6(2): 340-343

Recently, QOL has become an important consideration when giving medical treatment. The development of treatments for urinary incontinence, a condition which greatly affects QOL, however, has been late in coming, because there are few critical symptoms. We experienced three cases of urinary incontinence successfully treated with ryokyojutsukanto. Case 1 was a 63-year-old woman. She had developed stress urinary incontinence (SUI) from about 30 years of age. As she came to be aware of lumbago and numbness of legs, she sought Kampo treatment. Tokishakuyakusangoninjinto was ineffective, but her all symptoms were improved with ryokyojutsukanto. Case 2 was a 46-year-old woman. She had become aware of incontinence after delivery of her first child (at 27 years of age), and she received Kampo treatment for lumbago and her incontinence. Tokishakuyakusankabushi was slightly effective for her lumbago, but ineffective for her incontinence. These symptoms were improved after a change to ryokyojutsukanto. Case 3 was a 70-year-old woman. She developed a bladder/bowel disturbance, and mixed urinary incontinence (MUI) caused by conus syndrome with a compression fracture of Th12 vertebral body. With ryokyojutsukanto, her fecal incontinence disappeared, and her lumbago and urinary incontinence showed a tendency toward improvement.
Urinary Incontinence ; Low Back Pain ; symptoms <1> ; Human Females ; therapeutic aspects

We report two cases of numbness and pain of neuropathy due to ANCA (antineutrophil cytoplasmic antibody)-associated vasculitis successfully treated with Ogikeishigomotsuto. The first case was a 57-year-old female who complained of high fever, painful skin eruptions of the lower limbs, and proteinuria. Although the severe pain was reduced with steroid therapy, neuropathy-related numbness and pain remained widespread in her lower limbs. After we prescribed Ogikeishigomotsuto, most of her pain disappeared while her degree of numbness diminished by almost half in two weeks. In addition, her steroid therapy could be tapered off without adverse effect. The second case was an 82-year-old female with fever and myalgia. Although myalgia of the upper arm disappeared with steroid treatment, walking became difficult due to numbness from the lower legs, to the soles of her feet. With Ogikeishigomotsuto administration, she became better able to walk because her legs had warmed up, and the range of her numbness had decreased. These cases suggest that Ogikeishigomotsuto may be effective against numbness and neuropathic pain due to ANCA-associated vasculitis.
Numbness ; Pain ; Peripheral neuropathy ; Antineutrophil cytoplasmic antibody measurement ; Vasculitis