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.

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 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.

　　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 source of the herbal mixture named Jiin-koka-to is Wan bing hui chun. Jiin-koka-to has been used mainly as a decoction for the treatment of bronchitis and tuberculosis. The cases of bronchial asthma treated with Jiin-koka-to in this report had similar symptoms: abnormal sensations in the throat and irritation. We investigated the efficacy of Jiin-koka-to in 11 asthma patients having both symptoms. Improvements were observed in all patients; these improvements included reduction of peripheral eosinophil count and serum IgE, loss in quantity of prednisolone, increment of peak expiratory flow rate, and cessation or decrease of asthma attacks. Thus, it is possible that Jiin-koka-to is a controller rather than a reliever in the treatment of bronchial asthma. Abnormal sensations in the throat and irritation might be one of the indications for Jiin-koka-to.

We prescribed Seisho-ekki-to for three bronchial asthma patients, with poor control of their attacks. Markers used to assess the efficacy of this formulation were sensations in the throat, palpitation and spontaneous sweating. All these markers improved rapidly, with Seisho-ekki-to administration. All three patients and several factors in common, namely; being middle-aged, having attacks that arise throughout the year, epigastric discomfort, fullness of the upper abdomen and pulsation near the umbilicus. Furthermore, a cessation or significant decrease in numbers of asthma attacks seen was brought about with Seisho-ekki-to medication. Up until now, Seisho-ekki-to has usually been used to treat summer heat syndrome. It appears, however, that Seisho-ekki-to may also be applied in the control of bronchial asthma, in the middle-aged.

Shishi-hakuhi-to was prescribed for four patients with panic disorder and sleep disturbance who requested the extract. As indications for the usage of this formulation, discomfort and restlessness of the chest for which Gardeniae Fructus has proved efficacious against, were used. Symptoms such as palpitation, chest discomfort, hot flash, anxiety and insomnia improved promptly with Shishi-hakuhi-to administration. The four patients had several common points, that is, menopause, hot flash and dysesthesia, but no agoraphobia. So far, Shishi-hakuhi-to had been used for liver dysfunction and dermatological diseases. Our results suggest that Shishi-hakuhi-to might be useful for cases with psychiatric diseases such as panic disorder.

Choyo-to, which has long been used for acute and chronic intestinal disease, dermatological disorders and pulmonary abscess, is attributed to the writings of 7th Century physician Sun Simiao, known as the “Qian-jinyao-fang”. We have also successfully treated nine different patients suffering from various diseases, using Choyo-to. In most of these cases, patients complained of constipation. Thus far, our modern experience suggests that Choyo-to may be indicated for not only right-side pain upon naval palpitation, pressure sensation at the ileocecum and excessive strain of abdominal muscles, but also for cases of dry skin, edematous skin and tendency of normal tongue color.