Objective: The utility of topotecan monotherapy for relapsed small-cell lung cancer (SCLC) after failure of amrubicin monotherapy has not been evaluated. We aimed to investigate the efficacy and safety of topotecan monotherapy in patients with relapsed SCLC after amrubicin monotherapy.Patients and Methods: We retrospectively analyzed data from 16 patients with relapsed SCLC who were treated with topotecan monotherapy after amrubicin monotherapy at our hospital.Results: The response rate, progression-free survival, and overall survival were 0%, 32.5 days (95% confidence interval [CI] = 18–51), and 112 days (95% CI = 55–267), respectively. The most common adverse events (grade ≥3) were leukopenia (31.3%) and thrombocytopenia (31.3%), followed by anemia, anorexia, edema, and lung infections.Conclusion: The efficacy of topotecan monotherapy for relapsed SCLC after amrubicin monotherapy is inconclusive. Therefore, further studies are warranted.

A 38-year-old man was admitted to our hospital with fever and skin rash, and he was diagnosed as having dermatomyositis. He was treated with anti-inflammatory steroid and immunosuppressive agents. On hospital day 48, chest computed tomography (CT) revealed a nodule measuring approximately 2 cm in size in the lower lobe of the right lung (S9). Bacterial and/or fungal infection was suspected, but there was no response to antibiotic or antifungal treatment. A week later, repeat chest CT revealed the tumor now measuring approximately 6 cm in size in the lower lobe of the right lung. We performed bronchoscopy, and bacteriological examination of the transbronchial biopsy specimen revealed pulmonary tuberculosis. Interferongamma release assay (IGRA) before the initiation of immunosuppressive treatment was negative, so we did not administer treatment for latent tuberculosis infection. He was, however, treated with isoniazid, rifampicin, ethambutol, and pyrazinamide for 9 months, following which radiological features improved gradually. Here we describe in detail this rare case of a negative IGRA result before immunosuppressive therapy in a relatively young Japanese man who went on to develop active tuberculosis with a rapidly-growing pulmonary lesion during hospitalization.

A 68-year-old man was admitted to our hospital with complaints of fatigue, polyuria, and loss of appetite, and was diagnosed with diabetic ketosis. Chest and abdominal computed tomography (CT) showed a pulmonary tumor on the right S3 and multiple liver tumors. Blood chemistry revealed elevated levels of amylase and hepatobiliary enzymes. Pathological examination of a biopsy specimen from the liver tumor showed a small cell carcinoma. Based on the imaging and pathological findings, we made a diagnosis of extensive disease small-cell lung cancer (ED-SCLC), cT1aN3M1b (HEP, ADR). Treatment with carboplatin and etoposide evoked partial response and the serum level of amylase decreased. Immunohistochemical staining of liver biopsy specimen was positive for amylase, leading to a diagnosis of SCLC with amylase production. About 22 months after the diagnosis of SCLC, he was admitted to our hospital with fatigue, muscular weakness, edema, and hyperpigmentation. Laboratory findings showed elevated serum levels of hepatobiliary enzymes, adrenocorticotropic hormone (ACTH), and cortisol, and a decreased serum potassium level. Urinary potassium level was elevated. Pituitary magnetic resonance imaging showed a normal morphology. We made a diagnosis of SCLC complicated by Cushing’s syndrome. We report this rare case of SCLC with amylase and ACTH production, which was detected in the course of treatment of SCLC.

BACKGROUND/AIMS: To compare the diagnostic yield of 20-gauge forward-bevel core biopsy needle (CBN) and 22-gauge needle for endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) of solid pancreatic masses. METHODS: The use of 20-gauge CBN was prospectively evaluated for 50 patients who underwent EUS-FNA from June 2016 to December 2016. Data were compared with those obtained by a retrospective study of 50 consecutive patients who underwent EUS-FNA using standard 22-gauge needles between December 2016 and April 2017. At least two punctures were performed for each patient; the sample from the first pass was used for cytology with or without histology and that from the second pass was used for histology. Sample quantity was evaluated using the sample obtained from the second pass. RESULTS: There was no significant difference in the diagnostic accuracy rate between the first and second passes (20-gauge CBN: 96% [48/50]; standard 22-gauge needle: 88% [44/50]). Samples >10× power fields in length were obtained from 90% (43/48) and 60% (30/50) of patients using the 20-gauge CBN and standard 22-gauge needle, respectively (p=0.01). Technical failure occurred for two patients with the 20-gauge CBN. CONCLUSIONS: Diagnostic accuracy of the 20-gauge CBN was comparable to that of the 22-gauge needle. However, two passes with the 20-gauge CBN yielded a correct diagnosis for 100% of patients when technically feasible. Moreover, the 20-gauge CBN yielded core tissue for 90% patients, which was a performance superior to that of the 22-gauge needle.
Biopsy ; Biopsy, Fine-Needle ; Diagnosis ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Humans ; Needles ; Pancreas ; Prospective Studies ; Punctures ; Retrospective Studies ; Ultrasonography

Objective: Currently, the creation of a pharmaceutical risk management plan (RMP) for new drug information is obliged to pharmaceutical companies.  The created RMP is published on the Pharmaceuticals and Medical Devices Agency (PMDA) website.  RMP is a useful information source to ensure drug safety by healthcare professionals, including pharmacists.  “Risk minimization activities” of the RMP are especially important elements for healthcare professionals because they describe measures to minimize risk to patients.  We conducted a cross-sectional survey of the description of the contents of “risk minimization activities” in the RMP.
Methods: The RMP of 177 drugs that had been published in February 22, 2016 were investigated.
Results: Total risks enumerated for the study drugs were 1,678.  “Routine risk minimization activities” constituted 92.0% of total risks.  The most listed item on “routine risk minimization activities” was “attention on the product labeling of the drug package insert” (91.3%).  Differences in the expression level on “attention on the product labeling” were observed.  On the other hand, the most listed item of “additional risk minimization activities” was “the creation of documents for healthcare professionals” (38.3%) and “implementation of Early Post-marketing Phase Vigilance” (27.1%).
Conclusion: A clear understanding of RMP by healthcare professionals is important.  In the RMP, “risk minimization activities” (especially “additional risk minimization activities”) are the most important contents for healthcare professionals, because they include information of documents created by the pharmaceutical company for patient safety.  The level of description of the contents of RMP varies between drugs.  It is essential that these descriptions be uniform the expression level to be easily and accurately utilized by healthcare professionals.

Objective: Similarity in drug appearance is one of the major environmental factors influencing dispensing errors, such as picking the wrong medication (picking error).  The purpose of this study is to verify if the index values of appearance similarity calculated objectively for multiple-specification drugs are the factors of picking error.
Methods: Four variables (number of total prescription, deviation of prescriptions between the specifications, sheet size, and color similarity of the sheet surface) were calculated.  The number of total prescription and deviation of prescriptions were extracted from the dispensing system.  Sheet size and color similarity were calculated, respectively, from the area ratio and by the Histogram Intersection method using the press through package (PTP) sheet image.  To evaluate the relationship between the picking error rate and these four variables, univariate and multivariate analyses were performed.
Results: The number of total prescription and the deviation of prescriptions were not significant factors.  In contrast, sheet size and color similarity significantly influenced the picking error rates.
Conclusion: Similarity in appearance between multiple-specification drugs is a risk factor of picking error.  When the multiple-specification pair has the same sheet size or high color similarity, one needs to be caution of picking error.  Further, in the pharmaceutical industry, to reduce the risk of dispensing errors, it is desirable to carry out the devise to enhance the identity of each specification.

Objective: Similarity of drug names is one factor of dispensing incidents.  The aim of this study was to survey the relation between sensual similarities of drug names and the occurrence of taking errors for pharmacists who actually prepare medicine.
Methods: A pair of drugs (15 incident pairs and 104 control pairs) was displayed on a computer screen at random.  The subject’s task was to determine the sensual similarity of them.  Thirteen pharmacists who prepared these pairs and caused their incidents participated in the experiment.
Results: The result showed that the sensual similarity of drug names of incident pairs was found to be highly significant in comparison to one of the control pairs [p=0.026].  However, the similarity in incident pairs is not necessarily high.  It was suggested that the similarity of drug name was not the only factor of taking error.  Multiple linear regression analyses of the sensual similarity in control pairs were performed, in which 10 variables were reported as quantitative indicators of similarity of drug name and were able to be measured on the internet.  The correlation was good [R²=0.828].  However, this regression model was not useful when adjusting to incident pairs.  In incident pairs, the similarity value calculated by the regression model was lower than the measured sensual similarity.
Conclusion: The result suggested that measured sensual similarity includes other risk factors of taking error, such as appearance similarity and/or efficacy similarity and/or short distance arrangement.  It seemed that the pharmacist’s ability complicated the factor of taking error.

The purpose of this study was to analyze the socioeconomic factors influencing patient discharge destination and the length of their hospital stay. We investigated 83 consecutive stroke patients admitted to our rehabilitation ward between January 1 and December 31, 2008. The mean age was 68.1 years old, the mean length of stay was 86.1 days, and 57% were men. The outcome for this study was the patient discharge destination, defined as home or a nursing home type of facility. To examine the predictors of the discharge destination, we collected data including patient age, sex, total Functional Independence Measure (FIM) scores at discharge, ‘living alone’, ‘over 65 years old’, ‘requiring public assistance’, and ‘having a family member at home who requires nursing care’. In all, 69 patients were able to return home, and 14 patients were discharged to a nursing home type of facility. The home group showed a higher total FIM score (p<0.001). Logistic regression analysis showed that two factors, ‘living alone’ and ‘having a family member at home who requires nursing care’, adversely affected patient discharge to home. Also, the length of stay was longer among those patients who required public assistance (p<0.01). This study suggests that it is harder for patients to be discharged back to their homes who have these factors : ‘having a family member at home who requires nursing care’ and ‘living alone’. Additionally, having the patient characteristic of ‘requiring public assistance’ could prolong the length of hospital stay.

We report three cases of panic disorder treated with kampo formulae including shohangekabukuryoto. Case One was a 47-year-old driver. Sharp rises in blood pressure caused transient ischemic attacks in the brain. We suspected that anxiety over recurrent brain attacks stagnated his water and qi below the heart and caused phlegm heat, which lead to his panic disorder. His symptoms were cured with shohangekabukuryoto and the substance of orento. Case Two was a 49-year-old homemaker. Her domestic anxiety developed into a panic disorder. We suspected that her anxiety diminished the blood and the function of her liver, as well as her splenic sufficiency. Her attacks were cured with kamishoyosan, and with bukuryoingohangekobokuto which contains shohangekabukuryoto. Case Three was a 32-year-old homemaker. Overwork through her child-raising tasks developed into a panic disorder. We suspected that fatigue caused her splenic insufficiency and resulted in blood deficiency with the extra water below the heart. Shohangekabukuryoto and juzentaihoto were very effective, and resolved her attacks.These cases suggest that shohangekabukuryoto improved epigastric discomfort, dizziness and palpitation by justifying middle-jiao dysfunction, qi and water regurgitation. In each of the three cases, shohangekabukuryoto showed efficacy for panic disorder with other kampo formulae for respective signs and symptoms.
Panic Disorder ; Three ; Water ; Anxiety ; Cases