A 61-year-old woman underwent a regular echocardiography in October 2008 in which a mass of 1 cm in diameter was pointed out in the left ventricle apex. It did not dcrease, in spite of anticoagulation therapy, and therefore we performed surgery. The tumor was confirmed on the septal side of the cardiac apex by intraoperative cholangioscopy, and it was excised through the mitral valve. It was diagnosed as myxoma on immediate intraoperative pathological examination, and we confirmed that there was no tumor remnants on the resected stump histologically. The patient was discharged on the 13th day after the operation and 2 years later she was alive without recurrence of the tumor. This is the 25th case of left ventricular myxoma in Japan. In these reports, an initial resection of the tumor in the left ventricle was performed in 23 cases and the approach methods were described in 20 cases. The evaluation of the resected stump, regardless of remaining tumor, was described in only 3 cases. There were no reports of relapse after the operation. There are many reports which emphasize the usefulness of echocardiography, which is very helpful not only in the diagnosis, but also in periodic evaluations after the operation.

Salivary gland carcinoma such as adenoid cystic carcinoma (AdCC) is characterized by slow growth, diffuse invasion and lung metastasis, which determine the patient's prognosis. It is important to clarify an attractant molecule leading tumor cells to migrate. We examined the effects of stromal cell-derived factor (SDF) -1, a chemokine, on salivary gland carcinoma cell clone HSG and its subclone HSG-AZA3. SDF-1 promoted the invasion and migration of HSG and HSG-AZA3 cells dose-dependently. Immunocytostaining and RT-PCR indicated that HSG and HSG-AZA3 cells expressed SDF-1 receptor, CXCR4, both in protein and mRNA level, respectively. CXCR4 was present on the cell surface of HSG cells, and was downregulated by SDF-1 addition. Finally, we confirmed that CXCR4 was expressed in the tissue of AdCC. Our study suggests that SDF-1 and CXCR4 play a role in the migration of carcinoma of salivary gland origin.

Recently, in order to make chemotherapy, safer and more effective various forms of intervention by pharmacists are needed. In this paper, we report our experience in intervening in the administration of gefitinib to a patient with dysphagia. Chemotherapy with an intravenous drip injection to the 58 year-old woman admitted to our hospital for non-small cell lung cancer (NSCLC) was withdrawn due to severe pancytopenia after the first cycle of pharamcotherapy. Then, as an altermative, oral medication, of gefitinib was suggested by medical doctors. However, the oral administration was inappropriate to the condition of the patient. She was unable to keep taking gefitinib pills because she had been suffering from a progressive swallowing disturbance due to progressive non-small cell lung cancer. Thus, we proposed another oral administration method in which gefitinib was resuspended in thickening agents. This method made it possible for the patient to take gefitinib without any adverse events until the day before the patient died.
Patients ; Chemotherapy-Oncologic Procedure ; Non-small cell lung cancer ; Deglutition Disorders ; Needs

Purpose: The aim of this study was to clarify the factors contributing to the evaluation of perceived care in inpatient palliative care services from the aspect of informal caregiver after their loss of the patient to cancer. Method: A questionnaire was mailed to 9,684 bereaved subjects who had lost family members at one of 103 palliative care units in Japan to evaluate their sociodemographic characteristics and the evaluation of perceived care. An institution survey was performed to collect organization-related variables. The evaluation of perceived care was rated by the Care Evalutaion Scale (CES), the Good Death Inventory (GDI) and single item of overall satisfation. Result: A total of 5,810 responses were analyzed (response rate＝60％). Uni-variate and multivariate analysis was performed to clarify the determinants of each scale. Significant determinants of the score in the evaluation of care identified were: the rate of private room (100％), independent facility, palliative care physician being night-time duty, the number of nurses at night (＞0.1 per bed), sending a letter to every bereaved family, holding a memorial services for every bereaved family and having a religious background. Conclusion: In conclusion, the evaluation of palliative care from the aspect of informal caregiver was influenced by various organization-related variables.

To raise a level of safety and to enhance the effectiveness of complicated drug therapy, various drug monitoring programs have been implemented in these days. In the present study, we examined whether pharmaceutical care plans proposed by pharmacists contributed to drug therapy.The number of pharmaceutical proposals from pharmacists, which were adopted and put into poactice in the clinical stages, has increased annually and totaled 1,014 cases in the past four years. The number of proposals related to cancer chemotherapy increased remarkably. Moreover, most of the cancer-related proposals conserned drug dosage, suggesting that the pharmaceutical care by pharmacists may contribute to the safety management of drugs in drug therapy. Additionally, in the other clinical cases than cancer chemotherapy cases, there was an increase in the number of proposals based on patient's conditions and clinical examination data, which suggests frequent participation of pharmacists in drug therapy. Furthermore, it was found that 62.6% of the all pharmaceutical proposals were made by wards-resident pharmacists. This suggests that an increase in the numbrt of wards-resident pharmacists will contribute to more effective and safer drug therapy in the future.
pharmacotherapeutic ; Safety ; seconds ; Clinical ; Drug Monitoring

With increasing global life expectancy, the significance of geriatric assessment parameters has increased. Sarcopenia is a crucial assessment parameter and is defined as the age-related loss of muscle mass and strength. Sarcopenia is widely acknowledged as a risk factor for postoperative complications in diverse advanced malignancies and has a detrimental effect on the long-term prognosis. While most studies have primarily concentrated on the correlation between sarcopenia and advanced cancer, more recent investigations have focused on the relationship between sarcopenia and early-stage cancer. Endoscopic submucosal dissection (ESD), which is less invasive than surgical intervention, is extensively employed in the management of early-stage cancer, although it is associated with complications such as bleeding and perforation. In recent years, several reports have revealed the adverse consequences of sarcopenia in patients with early-stage cancer undergoing ESD. This literature review briefly summarizes the recent studies on the association between sarcopenia and ESD.

Objectives: We developed the multimodal program Nutrition and Exercise Treatment for Advanced Cancer (NEXTAC program). The aim of our study is to show algorithm of the home-based resistance training prescription and its compliance. Methods: We recruited 30 patients aged≥70 years scheduled to receive first-line chemotherapy for advanced pancreatic or non-small-cell lung cancer. Three educational sessions were planned in 8-week study period. Our resistance training consists of 3 or 5 of following 5 exercises components: (1) sit-to-stand, (2) calf raise, (3) knee extension, (4) knee raise, (5) side leg raise. Physiotherapist chose optimal prescription according to the modified Borg-scale. We assessed patient compliance, and safety. Results: Median proportion of days in which patients performed full or modified exercise program was 91%. Adverse events possibly related to the NEXTAC program were observed in 5 patients and included muscle pain (grade 1 in 2 patients), arthralgia (grade 1 in one patient), dyspnea on exertion (grade 1 in one patient), and plantar aponeurositis (grade 1 in one patient). Patient physical function and physical activity were maintained during the study period. Conclusion: Our resistance training showed excellent compliance and safety in elderly patients with newly diagnosed pancreatic and non-small-cell lung cancer receiving concurrent chemotherapy. Although this study was not designed to show the efficacy of the resistance training, our data indicate a potential protective effect on physical function and physical activity.