Purpose: Paracentesis is one of the most effective techniques to manage malignant ascites in cancer patients. Some patients require frequent repeated drainage because of a rapid reaccumulation of ascites. The indwelling catheter technique is proposed to avoid the procedure risks and complications. Case report: We report a case of 73-year-old male diagnosed pancreatic cancer. The central venous catheter was used for management of his malignant ascites. One liter of ascetic fluid was removed every day for 21 days until death. To prevent a clogging of the catheter, multiple side-holes were opened to the catheter in advance of the paracentesis, and medical cyanoacrylate adhesive (Aron Alpha®) was applied around the indwelling catheter to avoid the leakage of ascites. Conclusion: We propose the use of the central venous catheter for the drainage of ascites, because the technique is less invasive and inexpensive, and also can reduce such complications as a clogging of the catheter and fluid leakage.

Purpose: Pruritus is a rare symptom among advanced cancer patients. This rarity results in limited knowledge about its mechanisms and treatments. Moreover, many previous studies have proposed pharmacological interventions to alleviate pruritus of not malignant disease but chronic liver disease (e.g. primary biliary cirrhosis). Recently, the antipruritic activity of paroxetine has been reported in various systemic disease. Case report: We report a case of 72-year-old female diagnosed hepatocellular carcinoma with liver cirrhosis. On admission, although jaundice was detected on her conjunctiva and skin with high serum total bilirubin level 3.4mg/dL (direct bilirubin 2.3mg/dL), she did not complain of pruritus. Gradually, she suffered from pruritus with no exanthema on her entire skin and perceived no beneficial effect from H1-antihistamine and topical steroid administrations (symptom score 7/10). Significant antipruritic effect was achieved immediately with oral paroxetine 10mg on day 13. On day 14, she scored pruritus on whole body at 0/10, and this antipururitic effect was observed for 2 weeks after administration until her death. No adverse effects were reported. Conclusion: Paroxetine is an antidepressant agent classified selective serotonin reuptake inhibitors. The antipruritic activity of paroxetine is possible due to the involvement of changing itch signal from peripheral serotoninergic receptor to central nervous system and inhibiting the enzyme activation (CYP2D6) of endogeneous opioids as pruritogens. We have observed the beneficial effect of paroxetine to alleviate pruritus due to malignant jaundice.

Purpose; Transdermal fentanyl (TF) has less systemic adverse effects as compared to morphine. However, few patients with cancer related pain obtain insufficient analgesic response despite the dose escalation of TF. The aims of this study were to describe patients with poor analgesic response and to evaluate the efficacy of opioid rotation from TF to oral morphine. Case reports; We conducted a retrospective chart review and analyzed six patients managed with opioid rotation in detail. Before opioid rotation, an average dose of TF was 204μg/hr. A significant decrease in pain score was found in all patients who switched to oral morphine, and five patients were treated with the combination of TF and oral morphine. Conclusion; These results may indicate that patients who are treated with relative high dose TF (over 200μg/hr) tended to response to poor analgesic, and opioid rotation is beneficial to restore the analgesic effects. We speculate that this clinical phenomenon is associated with opioid tolerance.

Most palliative care units in Japan allow patients to have their own pets visit them and also allow visits by therapy dogs, even though allowing animals into a hospital is not usually permitted. To determine which units allow patients to meet with their pets or have therapy dogs visit, questionnaires were sent 193 palliative care units, and the replies were obtained from the 149 units (77%). From the responses, it was determined that 135 units allowed patients to meet their pets on unit property, 36 units allowed patients to keep their pets with them, 121 units allowed patients to meet their pets in their hospital rooms, and 22 units adopted therapy dogs as animal-assisted therapies. Units established by religious organizations were more likely to allow patients to keep pets than non-religious organizations, and units established earlier more often allowed patients to meet up with their own pets than more recently established units. However, the use of animal therapy was equally likely in all units, regardless of religious affiliation or the age of the establishment. It is clear that being hospitable to patients' needs, and desires can be found in the newer palliative care units.