Introduction: The purpose of this study was to clarify factors related to recognition of the possibility of end-of-life care at home (hereafter referred to as end-of-life care) among middle-aged and elderly people living in heavy snowfall and depopulated areas.Methods: Residents aged 40~69 years in town B, prefecture A were surveyed by mail using a self-administered, unmarked questionnaire. Analysis methods were: (1) a reliability analysis of survey items, (2) basic statistics, (3) tests for differences in composition ratios, (4) tests of differences between the two groups for each item, and (5) binomial logistic regression analysis. Recognition of the possibility of end-of-life care was used as the objective variable, and sex, age, and 18 indicators significant in (3) and (4) were used as explanatory variables.Results: There were 63 in the positive group for end-of-life care, 239 in the negative group, and 120 in the unknown group (Response rate: 44.1%). Factors related to perception of the possibility of end-of-life care were positively related to "existence of a community hospital, " "positive image of end-of-life care, " and "trust in people in the community. "Conclusion: In depopulated areas, it is necessary to consider specific measures to promote the three factors that raise awareness of the possibility of end-of-life care.

We report a case in which feelings of abdominal distension and discomfort of the abdominal wall caused by malignant ascites were relieved by ultrasound-guided rectus sheath block. Case report: A 59-year-old man developed gastric cancer with malignant ascites and experienced feelings of abdominal distension, but no nausea, dyspnea, poor mobility, or limb edema. Symptom control was inadequate with diuretic therapy and abdominal paracentesis. Feelings of distension improved temporarily with ultrasound-guided rectus sheath block. A percutaneous catheter was then used to administer an infusion of 0.25% ropivacaine triweekly until his death 20 days later. Conclusion: Feelings of abdominal distension is one of various symptoms of severe ascites and is difficult to manage. Ultrasound-guided rectus sheath block can be used to relieve this symptom on a case-by-case basis.

We report a case whose left lower limb neuropathic pain accompanied by pelvic tumor invasion was remarkably eliminated by ultrasound-guided sciatic nerve block. Case report: The subject was a sixty year old male. Pharmacological therapy was given according to the WHO analgesic ladder, but his left lower limb pain failed to respond to drugs. His intractable lower limb neuropathic pain was alleviated by ultrasound-guided sciatic nerve block. Drug delivery can be achieved with a percutaneous catheter and a disposable infusion pump. Infusions were run at 5mlh^-1 with 0.1% ropivacaine. Conclusion: Neuropahic pain is sometimes hard to be controlled only by opioids or adjuvant analgesics, but there is a possibility of providing pain relief by combination use with nerve blocks. Interventional techniques can be highly effective but also have the potentiality to produce significant adverse effects. Many patients have factors which would be considered a near absolute contra-indication to the use of nerve blocks such as immuno-compromise or impairment of coagulation. Skillful application of peripheral neural blockade with ultrasound imaging broadens the options for providing optimal pain management. Palliat Care Res 2011; 6(1): 313-315