We report on a case of Hailey-Hailey disease successfully treated with Sokeikakketsuto. This case was a 70-year-old woman. Her mother, grandmother and elder sister had the same symptoms. From 2004 August, she noticed erythematous exudative lesions with itching on both sides of her inguinal area. By September, she was diagnosed with Hailey-Hailey disease histologically. We treated using a topical corticosteroid at first. This had little effect, so we considered treatment using Kampo medicines. We diagnosed a kidney Yin-deficiency from a fissure of her tongue, thirstiness, numbness in the region below the umbilicus and night sweat, thus and selected Rokumigan. We then diagnosed deficiency of Qi from her general malaise, so chose Hochuekkito. The pathology of Hailey-Hailey disease exists mainly in the epidermis which covers most of the body's surface area. And this indicates the presence of pathogenic wind factor. We considered the presence of dampness as a disease-inducing factor because of her exudation, and the presence of the heat from her erythema. So we also selected Eppikajutsuto as an anti wind-wetness-heat drug. Her general condition was very much improved with these administrations, but her skin lesions improved very little. So we stopped Eppikajutsuto, and Sokeikakketsuto administration was started instead. After this change of drug, her skin lesions were improved remarkably.

Case: We report the case of a female in her sixties with inoperable gastric cancer in which continuous bleeding from the cancer resulted in severe anemia and the need for frequent repetitive blood transfusions. In order to control the hemorrhage, radiation therapy of 30 Gy/10 fractions to the cancer was conducted. Her tarry stool soon stopped, her hemoglobin level increased and transfusion became unnecessary. One month later, gastric rebleeding derived from the marginal area of the radiation field occurred. Additional radiation therapy of 24 Gy/8 fractions was given and successful hemostasis was obtained. The patient has been well without transfusion for four months. Conclusion: It is difficult to control bleeding from advanced gastric cancer if the tumor cannot be resected. Endoscopic hemostasis is not always applicable. Interventional radiotherapy (IVR) can be indicated for arterial bleeding. However, the indication of this treatment is controversial in cases of continuous venous bleeding, as seen in our case. Successful hemostasis by radiation therapy was obtained without severe complications in our case. Therefore, it is conceivable that radiation therapy to resistant venous bleeding from unresectable advanced gastric cancer upon careful consideration of complications is a useful treatment modality.

STUDY DESIGN: Retrospective and comparative study. PURPOSE: We assessed surgical treatment outcomes in patients with thoracic myelopathy due to ossification of the ligamentum flavum (OLF), and OLF combined with ossification of the posterior longitudinal ligament (OPLL) or vertebral fracture (VF) at the same level. OVERVIEW OF LITERATURE: OLF and OPLL cause severe thoracic myelopathy. Osteoporotic VF commonly occurs at the thoracolumbar junction. There have been no investigations of thoracic myelopathy due to OLF and VF. METHODS: Forty patients were divided among three groups: the OLF group (n=23): myelopathy due to OLF, the OLF+OPLL group (n=12): myelopathy due to OLF and OPLL, and the OLF+VF group (n=5): myelopathy due to OLF and VF. We recorded OLF, OPLL, and VF sites and operative procedures. Each patient’s neurological status, according to the Japanese Orthopaedic Association (JOA) score, and walking ability were evaluated pre- and postoperatively. RESULTS: Patients in the OLF+OPLL group were significantly younger than those in the other two groups. The preoperative JOA score was significantly lower in the OLF+VF than OLF group. The final JOA score was significantly lower in the OLF+VF than OLF and OLF+OPLL groups. The JOA score recovery rate was significantly lower in the OLF+VF than OLF group. Final walking ability was significantly worse in the OLF+OPLL and OLF+VF groups than in the OLF group and significantly worse in the OLF+VF than OLF+OPLL group. CONCLUSIONS: Thoracic myelopathy due to OLF+VF occurs primarily in older females, who also exhibit worse preoperative and postoperative neurological status, and worse walking ability, than patients with thoracic myelopathy due to OLF or OLF+OPLL.

Stiff-person syndrome (SPS) is an extremely rare disease that is characterised by progressive rigidity and muscle spasms affecting the axial and limb muscles and is difficult to diagnose. In SPS, autoantibodies such as anti-GAD antibody or anti-amphiphysin antibody may be proved, and it is speculated that SPS is GABAergic neurons disorder with the central nervous system due to these antibodies. We report a case of advanced breast cancer with a paraneoplastic SPS. Case: A 52-year-old woman was diagnosed with advanced breast cancer with bilateral multiple lung metastases, bilateral cancerous pleurisy, multiple liver metastases, cancerous peritonitis, and bilateral ovarian metastases. Anti-cancer treatment was not indicated due to poor condition, and oxygenation and pleural drainage and ascites drainage were performed in the palliative care unit. A series of symptoms due to muscle rigidity progressed rapidly which initially manifested as dysphagia, then stiffness of the upper extremities and locomotive disability. So she was diagnosed as paraneoplastic SPS by a neurologist. Despite the partial efficacy of diazepam, it was difficult to increase dosage due to sedation.

The purpose of this study was to examine the impact of COVID-19 on home care at the end of life and the satisfaction of bereaved families. A questionnaire survey was conducted on 100 bereaved families of terminal cancer patients who were receiving home care. The effects of the COVID-19 on at-home medical treatment and the rate of satisfaction of bereaved families were examined. The response rate for this survey was 72.0%. Of the respondents, 52.8% of the bereaved families answered that the COVID-19 had an effect on their decision to choose home care. The rate of satisfaction of bereaved families was 98.6%. Even for terminal cancer patients who chose home care in the era of COVID-19 at our hospital, we were able to achieve high level of satisfaction for bereaved families.