Catamenial pneumothorax (CP) is defined as a form of thoracic endometriosis syndrome (TES) and the clinical manifestations and management of this disease are not consensual. Successful treatment depends on how closely pulmonary specialists and gynecologists work together. Such being the circumstances, we reviewed our experience with CP in terms of treatment and follow-up. We treated surgically many patients with pneumothorax during the period from 1989 to 2014, of which eight cases had endometriosis on the diaphragm, lung or pleura histologically. The median age at the time of operation was 37 (range, 17 to 41). CP was right-sided in seven of the eight patients (87.5%). Six patients underwent an examination with diagnostic laparoscopy and five had positive findings. The median period of follow-up after surgery was 33.5 months (range, 4 to 129 months). Two patients had no recurrence without hormonal therapy. Six other patients experienced a recurrence of pneumothorax, although two patients received dienogest after surgery. The use of only dienogest or both GnRHa and dienogest prevented recurrence in all patients. CP is a critical condition that requires prompt action, so after surgical treatment, the choice of hormonal therapy with a high rate of patient compliance are needed. No recurrence occurred in young patients who had only surgical treatment, suggesting that there were some associations between age and recurrence. Since we succeeded in preventing recurrence after using GnRHa in all cases, we recommend GnRHa or dienogest following GnRHa for the first choice of hormonal therapy after surgery. However, treatment with only dienogest could achieve successful results with no recurrence, so more case studies need to be done to make the best treatment choice for each case.

　　Adhesion formation after abdominal surgery is a commonly recognized entity. Many studies have shown that women giving birth by cesarean section are at the risk of developing complications related to the postoperative formation of adhesions including ileus, bowel obstructions, impaired fertility, and chronic abdominal pain. Among several adhesion barriers, one that has been tested in randomized, controlled trials is the hyaluronic cid-carboxymethylcellulose (HA/CMC) membrane (Seprafilm®: Genzyme, Cambridge, MA, USA). This bioresorbable membrane serves as a mechanical barrier between surgically damaged tissues and resorbs afterwards. At our institution, we have used HA/CMC in cesarean sections. We report our experience with this patient population using placement of HA/CMC.　　This study enrolled 45 women who had undergone cesarean sections twice or more who had received HA/CMC during the previous cesarean section between January 2013 and November 2014. The incidence of adhesions to the area of abdominal wall incisions and uterine surface, intestinal obstructive symptoms, and adverse events were studied. The incidence of adhesions to midline incisions was 4.4% (n＝2). The filmy adhesion by major omentum was detected in these two cases. The incidence of adhesions to uterine surface was 2.2% (n＝1). The moderate thickness adhesion was detected at the left side of the vesico-uterine peritoneal incision by pelvic peritoneum which did not affect the operative procedure. No symptoms related to intestinal obstructions such as abdominal pains, nausea and vomiting were observed. No adverse events were observed. These three cases had fever which had nothing to do with HA/CMC applications but was attributable respectively to influenza infection, mastitis, phlebitis associated with a needle procedure.　　HA/CMC was considered a useful adhesion barrier membrane for use in cesarean sections as an adjunct intended to reduce the incidence of postoperative adhesions between the abdominal wall and the underlying viscera such as omentum, small bowel, and between the uterus and surrounding structures.

Objective: To clarify the relationship between the awareness of pharmacists regarding instructions on the use of inhaled corticosteroids and the instructions conveyed.
Design: Fact-finding-survey using self-administered questionnaires.
Methods: The survey items consisted of age, years of clinical experience, number of prescriptions from asthmatics per month (“number of prescriptions”), items to concern when giving instructions (“items to concern”) time required to give instructions on inhaler usage (“time required”), and the pharmacists’ awareness regarding instructions on the inhaler usage (“awareness items”).  There were six awareness items for which responses were solicited on a four-grade scale.  Respondents were divided into two groups: a “high awareness” group giving responses of “completely agree” (or “completely disagree” for diametrically opposed items) and a “low awareness” group giving other responses.  T test was used to compare the average of age, years of clinical experience, number of prescriptions, concern degree, and time required between 2 groups.
Results: This showed the higher consciousness that “instructions on inhaler usage are important issue relating to the patient’s asthma therapy” was significantly-high degree of concern and time required.  Also, the consciousness that “instructions on inhaler usage are a specialized activity performed by pharmacists” was related to age, years of clinical experience and level of concern degree.  Additionally, this suggested the pharmacists giving negative responses with respect to the notions that “the effect of instructions on inhaler usage is not worth the trouble” and “patients have insufficient desire to master of inhaler usage” had a higher degree of concern.
Conclusions: For significance and importance of instructions on inhaler usage, there was confirmed to be relationship between pharmacists’ awareness and the information conveyed and time spent on the instructions.  This suggested that it was important to improve awareness of instructions on inhaler usage in both the clinical and educational setting.

In palliative care setting, betamethasone is commonly used to relieve various symptoms such as general malaise, loss of appetite, fatigue and pain. In patients administered steroids, the psychic adverse effects should be cared as well as the physical adverse effects. Profile of Mood States (POMS) is a tool to evaluate a temporary mood and an affective state of a patient. The contracted version of POMS shortens intervention time by reducing question items. We administered betamethasone 3mg/day to the patient with digestive symptoms by bowel obstruction and the symptoms improved. Four months later, as the patient complained anxiety, irritation and insomnia, we prescribe predonisolone switching from equivalent dose of betamethasone. In this case we experienced that psychic symptoms improved without worsening digestive symptom since three days after the drug change. We evaluated a mood and an affective state before and after the drug change by using POMS contracted version. Palliat Care Res 2010; 5(2): 332-337