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Cooperative care between hospitals and community pharmacies is important to safe and effective pharmacotherapy for outpatients. We developed a protocol comprising three agreements about alternative drugs and dosing schedules with the aim of minimizing inquiries about prescriptions to doctors. The protocol was implemented under an agreement between core hospitals in Gifu City and community pharmacy members of the Gifu City Pharmaceutical Association from October 2019. Here, we examined the impact of this protocol on patient waiting time in pharmacies. Before introduction of the protocol, median patient waiting time for questionable prescriptions requiring an inquiry to a doctor was significantly longer than that for prescriptions not requiring an inquiry (23.0 min vs. 10.0 min, p<0.001). After introduction of the protocol, median time for prescriptions which were questionable but nevertheless under the protocol did not require an inquiry to a doctor was significantly reduced compared with those which were questionable and still did require an inquiry (15.0 min vs. 24.0 min, p=0.038). In conclusion, introduction of a protocol aimed at minimizing inquiries about prescriptions to doctors from a community pharmacy was useful in reducing the waiting time of patients, and also likely in decreasing the working times of medical doctors and pharmacists.

Some reports have shown that the prognosis of recurrent lung metastases after resection of pancreatic cancer is better than that for other organs. We report on 2 cases of long‒term survival after lung resection for lung metastases from pancreatic cancer. Case 1: A 73‒year‒old man underwent distal pancreatectomy for pancreatic body cancer. Adjuvant chemotherapy of S‒1 was administered for 6 months. At 3 years after surgery, 2 small metastatic nodules were detected in the right lung, and the patient underwent thoracoscopic right upper lobectomy. At 5 years and 9 months after the initial surgery, he is alive without recurrence. Case 2: An 81‒year‒old woman underwent pylorus‒preserving pancreatoduodenectomy for pancreatic head cancer. Adjuvant chemotherapy of S‒1 was administered for 4 months. At 1 year and 9 months after surgery, a metastatic nodule was detected in the left upper lung, and the patient underwent thoracoscopic left upper lobectomy. At 4 years and 6 months after initial surgery, radiation therapy was performed for localized bone metastasis. At 5 years and 1 month after the initial surgery, she is alive without other recurrences. In conclusion, recurrent lung metastases of pancreatic cancer with a small number of metastases may result in long‒term survival following resection.

A 74-year-old man was admitted for evaluation of a pancreatic tumor. Abdominal CT revealed a multilocular cystic tumor with thickened septal walls and an enhanced mural nodule in the head of the pancreas, as well as enlarged para-aortic lymph nodes. FDG-PET revealed FDG accumulation in the nodule and in the para-aortic nodes. The tumor was diagnosed as intraductal papillary mucinous carcinoma (IPMC) with para-aortic lymph node metastases. After 2 courses of chemotherapy with gemcitabine and nab-paclitaxel, the tumor decreased slightly in size, but the lymph nodes did not change. Surgery was then performed. Intraoperative pathology examination confirmed that the para-aortic lymph nodes had only inflammatory swelling. Accordingly, pylorus-preserving pancreaticoduodenectomy was performed. Histopathology examination revealed atypical cells without invasion, and IPMC (TisN0M0;stage 0) was diagnosed. It is thus important for selection of the appropriate treatment approach to determine if enlarged para-aortic lymph nodes are benign or malignant.

During recent years, obesity has emerged as a major public health problem in the world. It is generally agreed that non-surgical therapies do not solve the problem of morbid obesity (BMI > or =35 kg/m). Therefore, bariatric surgery has been frequently performed for treatments of morbid obesity in American and European countries. In 2008, more than 340,000 bariatric surgical operations (> or =90% laparoscopically) were done, and the typical procedures were laparoscopic Roux-en-Y gastric bypass, adjustable gastric banding and sleeve gastrectomy. Bariatric surgery certainly reduces weight and improves comorbidities and survival in morbidly obese patients. Recently, several bariatric procedures have been also introduced into Japan, and their excellent results in Japanese patients have been already reported.

Case 1 was a 71-year-old woman with a hepatocellular carcinoma (HCC), 45 mm in diameter, with liver cirrhosis. She received chemo-lipiodolization and radiofrequency ablation (RFA). As the AFP level remained high after the RFA, she was given continuous hepatic arterial infusion chemotherapy. After the treatment, the AFP level decreased to normal range. She is still alive without recurrence after 3 years and 1 month from the beginning of this treatment. Case 2 was a 80-year-old man who had two HCCs, 60 and 20 mm in diameter, respectively. He received RFA and continuous hepatic arterial infusion chemotherapy. He is still alive without recurrence 2 years and 10 months from the beginning of this treatment. Case 3 was a 67-year-old man who had an HCC, 52 mm in diameter, with liver cirrhosis. He received chemo-lipiodolization, RFA, and continuous hepatic arterial infusion chemotherapy. Two time recurrences were controlled by RFA, and he is still alive without recurrence 2 years and 5 months from the beginning of this treatment. We experienced three cirrhotic patients with advanced HCCs, who received a combination therapy of RFA and continuous hepatic arterial infusion chemotherapy. It is suggested that combination therapy can be one of the treatments for hepatocellular carcinoma, over 3 cm in diameter,with liver cirrhosis.