Introduction: We experienced a case in which an epidural block was useful in estimating the cause of low back pain in a patient suffering from esophageal cancer with liver and paraaortic lymph node metastases. Case: A 69-year-old male with a history of surgery for lumbar disc herniation (at the age of 20). He was diagnosed with esophageal cancer and during follow-up, he noticed low back pain, followed by epigastric pain. MRI revealed L1/2 and L2/3 intervertebral disc herniation. The thoracic epidural block was performed from Th8/9 under X-ray fluoroscopy to alleviate symptoms and identify the cause of low back pain. After confirming the analgesic effect, we conducted a splanchnic nerve block using neurolytic agent (anhydrous ethanol), resulting in total pain elimination. Subsequently, the patient passed away under good pain control without increasing the dose of analgesics. Conclusion: By confirming the effectiveness of epidural block at the thoracic level in advance, the complicated pain was thought to be derived from not lumber disc herniation, but the visceral nerves. An epidural block was useful for the selection of subsequent analgesic therapy.

OBJECTIVES: The purpose of this study is to evaluate the efficacy of annual zoledronic acid treatment in Japanese patients with nonmetastatic prostate cancer during androgen deprivation therapy (ADT). METHODS: This is a single institution 12-month study. Between 2016 and 2019, patients aged 70 years or older on ADT for nonmetastatic prostate cancer had bone mineral density (BMD) measured and 10-year probability of fracture calculated using fracture risk assessment tool (FRAX). Patients who showed osteopenia or had a 10-year hip fracture risk ≥ 3% or a 10-year probability of major osteoporotic fracture ≥ 20% were offered treatment with zoledronic acid 5 mg intravenously (ZA group). The patients who did not receive treatment were set as the control group. Lumbar and hip BMD were measured 6 and 12 months after treatment in the ZA group and 12 months after baseline in the control group. The yearly BMD change of both groups was compared. RESULTS: The mean ages of the ZA group (n = 26) and control group (n = 12) were 80.5 ± 9.1 and 76.1 ± 6.7 years, respectively. In the ZA group, lumbar and hip BMD changes at 12 months were +2.1% and +0.8%, respectively. In the control group, lumbar and hip BMD changes were −0.9% and −4.9%, respectively. There were statistically significant differences between the 2 groups in BMD percent changes (P < 0.05). CONCLUSIONS Without intervention, BMD tends to continue to decrease during ADT. Our findings suggest that administration of zoledronic acid enables maintenance of BMD in the older adults.

A 72-year-old woman was scheduled to undergo aortic valve replacement for aortic stenosis when she was diagnosed with heparin-induced thrombocytopenia type II after a decrease in platelets was detected. Although postponement was considered, the operation went ahead as scheduled because of unstable hemodynamics. Continuous intravenous infusion of argatroban (4 mg/kg/min) was initiated at the start of the operation, and nafamostat mesylate (30 mg/h) was initiated when cardiopulmonary bypass was started. Activated coagulation time was monitored, and the dose of argatroban was adjusted accordingly. Argatroban administration was terminated after removal of aortic cross-clamping, and cardiopulmonary bypass was stopped 1 h later. The operation was completed 7 h after stopping cardiopulmonary bypass due to difficulties in hemostasis. Operation time was 12 h 21 min, cardiopulmonary bypass time was 3 h 10 min, blood loss was 3444 mL, and blood transfusion volume was 6400 mL. The amount of argatroban administered was lower in our case than in previously reported cases, but blood loss after stopping cardiopulmonary bypass could not be reduced in our case.

Health support activities for residents were held three times during a period from June, 2016 to November, 2017. The residents registered in order to participate through 11 community pharmacies. Participant’s blood pressure values were measured at the venue of health support activities by pharmacists. The blood pressure values in 66 of the 106 participants were analyzed, excluding 40 participants receiving medical treatment. The rate of participants with hypertension, systolic blood pressure (SBP)≧140 mmHg or diastolic blood pressure (DBP)≧90 mmHg, was 32% (21／66). Of those with hypertension, 43% (9／21) had hypertension of a high risk level, SBP≧160 mmHg or DBP≧100 mmHg. Pharmacists provided lifestyle counseling and encouraged them to make changes in order to achieve tighter blood pressure control. The data of their blood pressure values were provided to community pharmacies for continuing support of their blood pressure control. With the pharmacist’s support, the median value of blood pressure of participants who had hypertension decreased in the second event. In addition, 50% (3／6) of participants who attended the second event with hypertension of high risk level, visited the hospital for a consultation with a doctor after getting pharmacist’s advice. These results indicate that greater access to community pharmacists improved blood pressure control of residents with hypertension. However, there were many residents who consider it difficult to use pharmacies without a prescription. Hence, friendly relationship to residents on their utilizing pharmacies is needed for providing them lifestyle counseling such as preventing hypertension by pharmacists.

Objective: Folate receptor α (FRα) is a membrane protein expressed in various solid tumors but has limited expression in normal cells. Therefore, FRα is an attractive target for cancer treatment. This study aimed to investigate the relationship between FRα expression and the clinicopathological characteristics and survivals of cervical cancer. Methods: This retrospective study included patients with cervical cancer who underwent primary surgery between 2000 and 2020 at our institution. Immunohistochemical staining of FRα was performed using an anti-folate-binding protein/FBP antibody. FRα-positive staining was defined as ≥5% of tumor staining and FRα-high as ≥50% tumor staining with ≥2+ intensity. The association between FRα expression and survival was assessed using multivariate Cox regression analysis, adjusting for established prognostic factors. Results: Overall, 123 patients were identified, and 140 tumor samples, including 17 paired primary and metastatic samples, were evaluated. As histological types, 67 patients had squamous cell carcinoma (SCC), and 56 patients had non-SCC. All primary tumors were FRα-positive. High FRα expression was observed in 25% of the cases and differed according to histology (SCC vs. non-SCC, 14.9% vs. 37.5%, p=0.004). FRα expression was significantly higher in metastatic tumors than in primary (170 [IQR, 140–205] vs. 125 [IQR, 110–150], p=0.0006). High FRα expression was significantly associated with worse overall survival (hazard ratio, 6.73; 95% confidence interval, 2.21–20.53; p=0.001). Conclusion In cervical cancer, FRα expression was elevated in metastatic tumors and high expression was associated with a worse prognosis. Our study supports the development of FRα-targeted therapy for advanced cervical cancer.