A 69-year-old woman was referred on suspicion of multiple bone metastases. She had undergone modified radical mastectomy for right breast cancer at age 40 years. Positron emission tomography revealed multiple bone metastases, and serum levels of CEA, CA15-3, and NCCST439 were elevated. The diagnosis was metastatic breast cancer. Pathological re-examination confirmed that the tumor cells were positive for estrogen receptor and progesterone receptor, and negative for HER2. Endocrine therapy with letrozole was initiated, followed by toremifene citrate as second-line therapy and exemestane as third-line therapy. Seventeen months later, she developed trouble walking because of lower-extremity edema, which was caused by a synovial cyst of the left hip joint. Although no other metastases were detected, S-1 was introduced (2 weeks followed by 1 week of rest) due to severe decline in quality of life. Six months after initiation of S-1, the synovial cyst disappeared and lower-extremity edema was improved. At 11 months after initiation of S-1, serum CA15-3 level had fallen to approximately within normal limits. As of now, although the tumor marker level has been rising gradually, no other metastases except for bone metastases have been detected and treatment is continuing.

Objective: This study aimed to evaluate the regular medications prescribed to elderly neurosurgical inpatients in community hospitals in Japan.Materials and Methods: Elderly patients (aged ≥ 65 years) who had been admitted to neurosurgery departments from April 2015 to March 2017 were enrolled in this study. We collected data on regular medications at the time of admission and discharge. Furthermore, we retrospectively analyzed factors associated with potentially inappropriate medications (PIMs). PIMs were defined as polypharmacy (≥ 6 medications used concurrently) or taking any of the unfavorable medications on the “list of drugs to be prescribed with special caution” in the “Guidelines for Medical Treatment and Its Safety in the Elderly 2015”.Results: We gathered data on over 1900 medications (mean number, 5.04) prescribed to 197 patients (mean age, 76.9 years). PIMs were observed in 51.3% of patients on admission. The most common prescriptions resulting in PIMs were benzodiazepine agents, followed by loop diuretics and H2 receptor antagonists. The multivariate analysis revealed that age (odds ratio, 1.08; p < 0.01) and the number of prescribers (odds ratio, 6.16; p < 0.01) were significantly related to PIMs on admission. PIM exposure at the time of discharge accounted for 39.1%, a 12.2% decrease.Conclusion: More than half of the elderly patients were prescribed PIMs on admission; however, this exposure decreased by 12.2% at the time of discharge. Hospitalization is an optimal opportunity for reconsidering the necessity of medications and for changing the prescriptions according to patients’ conditions.

We describe an extremely rare case of advanced pure primary ovarian squamous cell carcinoma (SCC), treated by adjuvant chemotherapy with dose-dense paclitaxel combined with carboplatin (dd-TC) plus the combination chemotherapy with irinotecan and cisplatin (CPT-P), with long-term recurrence-free survival. A 71-year-old woman complaining of lower abdominal pain was referred to our hospital and a 7-cm-diameter solid tumor was identified. She was diagnosed with a left ovarian tumor that was highly suspicious for malignancy based on ultrasonography, magnetic resonance imaging, and contrast-enhanced computed tomography. Bilateral salpingo-oophorectomy, low-anterior colon resection, and colostomy were performed. Intra- and post-operative histopathological diagnosis revealed International Federation of Gynecology and Obstetrics stage IIIc well-differentiated pure ovarian SCC. As adjuvant chemotherapy, 2 courses of dd-TC were administered, followed by 3 courses of CPT-P; the patient then underwent 4 additional courses of dd-TC. Both regimens were effective and there has been no recurrence or metastasis thus far in the 5 years since the operation.
Abdominal Pain ; Aged ; Carboplatin* ; Carcinoma, Squamous Cell* ; Chemotherapy, Adjuvant ; Cisplatin ; Colon ; Colostomy ; Diagnosis ; Drug Therapy, Combination ; Epithelial Cells* ; Female ; Gynecology ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Obstetrics ; Ovarian Neoplasms ; Paclitaxel* ; Recurrence ; Ultrasonography