Pain is one of the most common and intolerable cancer symptoms. It is therefore recommended that palliative care and pain management should be commenced even at the early stages of cancer. For most patients with cancer pain, the World Health Organization′s three-step analgesic ladder can provide adequate pain relief. We need to fully understand how to use the analgesic ladder, how to select opioids, how to titrate the daily dose of analgesics, how to set the rescue doses for breakthrough pain, how to switch opioids when intolerable adverse events appear, how to treat opioid-insensitive pain, such as neuropathic and bone pain, and how to select patients that should be treated with neural blockade. This review focuses on the pharmacological agents currently available for effectively treating cancer pain.
The deterioration in the circumstances of the economy and human resources for hospitals and medical industry is now broadly recognized. We succeeded in reducing the assessed loss of the Otolaryngology Department Outpatient Clinic, which resulted in a gain of over 75% profit through the cooperation of the doctors and office staff. It was assumed that the communication and knowledge management between doctors and office staff was important. While this project was planned by a doctor, it was found that creative suggestions and ideas from office staff as professionals also had a desirable effect. It appears that the resolution of problems by establishing procedures of good communication and knowledge management leads to better quality of medical treatment and would ultimately raise awareness, resulting in a better hospital and more desirable workplace.
A 63-year-old man visited our hospital because of a positive fecal occult blood test during mass screening. Total colonoscopy was performed, and a lateral spreading tumor (LST) about 30 mm in size was found at the cecum. The tumor was treated with en bloc resection by endoscopic submucosal dissection (ESD) using a hook knife. Pathological findings revealed that the tumor was a well-differentiated adenocarcinoma in adenoma, limited to the mucosa. He left our hospital 3 days after ESD without complications, such as perforation or delayed bleeding. If we are familiar with the characteristics of the endo-knives and know the location of the lesion, we can safely and accurately perform ESD.
Primary small bowel cancer is a relatively rare malignancy as compared with other malignancies of the gastrointestinal tract. It is difficult to diagnose small bowel cancer because small bowel enteroscopy or wireless capsule video enteroscopy are not applied routinely in most hospital. An emergency operation is generally performed in many cases because of acute abdomen. We experienced a case that we were able to diagnose as small bowel cancer before the oper-ation. The case was a 76-years-old woman. She had anemia and intermittent stomachache. She was diagnosed with small bowel cancer by small bowel enema. In surgical findings, the circular tumor was on the anal side, 90 cm from Treiz′s ligament. Partial resection of the small bowel was performed. The pathological fidings was adenocarcinoma of small intestine. The postoperative course was uneventful, and she was discharged on postoperative day 13.
We report a rare case of transmesenteric hiatus hernia in the mesentery of the transverse colon due to internal hernia. A 78-year-old woman, with history of surgery doe appendicitis, experienced epigastric pain and vomiting. Under the diagnosis of ileus, we conducted conservative long-tube therapy. However, the herniation did not remit, so surgery was conducted. An oval defect about 2 cm in diameter was present in the mesentery of the transverse colon. About 20 cm of the small intestine was invaginated through the defect. The small intestine was not necrotic and returned to its normal position. The postoperative course was uneventful. We did not consider the possibility of internal hernia, including mesenteric hiatus hernia. Thus we must carefully consider this potential etiology in elderly patients with intermittent abdominal discomfort of unknown origin.
A 70-year-old male was admitted to our hospital because of pneumothorax with idiopathic pulmonary fibrosis. Chest tube drainage did not affect the air leak, and the air leak had persisted for about 8 weeks. Complete recovery required surgical resection of the bulla responsible for the ongoing air leak. However, his condition was poor and it was considered that operation under general anesthesia would be difficult. Pleurodesis with autologous blood and with fibrin glue ended in failure. Finally we injected self-platelet rich plasma (PRP) through the chest tube. Two days after this procedure, the air leakage stopped and the chest tube was withdrawn. Regarding the mechanism of action of this PRP, organization of the healing is considered to be greater than the adhesion effect. We believe the treatment with PRP is potentially a new approach for intractable pneumothorax treatment.
A 46-year-old man demonstrated occult blood reaction in a stool sample on medical examination, and was later diagnosed with ulcerative colitis by colonoscopy. Histological examination of a biopsy specimen from the colon showed epithelioid cell granuloma. This case is presently considered to be suspected Crohn′s disease or indeterminate colitis. The patient is currently being treated with 5-ASA, and remission has been maintained.