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A 53-year-old man initially presented with costalgia and was diagnosed with MM, based on the pathological findings. IgE monoclonal protein was detected by Serum protein electrophoresis (SPEP) and, surprisingly, IgE was elevated to 7,950,000 IU/ml. Monitoring the disease response during treatment, we employed quantification of serum M protein at SPEP, because IgE levels were found to be inaccurate and erratic. The patient was treated with CyBorD. He found injection site reactions to be very burdensome, due to extreme skin changes. The diameter of the hyperpigmentation area was 8 cm. To reduce the severity of this reaction, we used an air sandwich technique, and succeeded in ameliorating the skin changes.

Daily subcutaneous injection of teriparatide, which consists of 34 amino acids of N-terminal of parathyroid hormone, has been investigated as a therapy for osteoporosis. It has been used since 2010 in Japan. Since teriparatide markedly stimulates bone formation, its daily injection increases bone volume mainly at the cancellous bone and significantly reduces vertebral and non-vertebral fracture risk. Because of the limitation (2 years) of the use in the life span, sequential treatment following teriparatide is needed. When combined with an antiresorptive agent, teriparatide showed additive increase in bone mineral density. However, it remains uncertain which agent is the best for the combination and what schedule is the most effective. Since teriparatide reduces back pain and stimulates bone repair, it is suitable for patients with back pain or with severe osteoporosis.

Background: Subcutaneous opioid is one way of managing postoperative pain in patients undergoing anticoagulant therapy. We have evaluated the safety and the efficacy of postoperative pain management using subcutaneous fentanyl and ketamine after abdominal gynecologic surgery., Methods: Written informed consent was obtained from 50 ASA physical status 1 or 2 female patients aged between 20 and 65. Patients were randomized to one of 5 groups. Group 1, 2 and 3 received 25, 35 and 50 microg x h(-1) subcutaneous fentanyl infusion, respectively. Group 4 received 25 microg x h(-1) fentanyl and 2 mg x h(-1) ketamine subcutaneously; group 5 received 25 microg x h(-1) fentanyl and 4 mg x h(-1) ketamine subcutaneously. General anesthesia was administered to all patients. Two hours after induction, subcutaneous infusion of fentanyl and ketamine was started in the patients and discontinued 24 hours after the operation. All patients were assessed twice, at 4 hours and at 24 hours after operation. Blood gas analysis was performed. Number of analgesic administration required during the 24 hours after operation was recorded. Groups 1, 2, 3 and groups 1, 4, 5 were evaluated as one group, respectively. Group differences were analyzed by variance analysis. Differences of analgesic administration were analyzed with Kruskal-Wallis test., Results: As to anesthetic requirement during the 24 hours after operation, there were no significant differences among treatment groups. With respect to blood gas analysis, only individuals receiving subcutaneous 25 microg x h(-1) fentanyl and 4 mg x h(-1) ketamine maintained high PaO2 4 hours after the operation (P<0.05)., Conclusions: We recommend administration of 25 microg x h(-1) fentanyl and 4 mg x h(-1) ketamine subcutaneously, which maintains high Pao2 and requires less analgesic.

Background: Continuous subcutaneous infusion (CSI) of analgesics may be an alternative for pain control in patients without an epidural catheter. The aim of this study was to investigate the efficacy of CSI using pentazocine in lower abdominal surgery with inhalation anesthesia or with total intravenous anesthesia., Methods: One hundred forty-seven patients scheduled for gynecological abdominal surgery were analyzed retrospectively. Anesthesia was induced with propofol and was maintained with propofol infusion or isoflurane-nitrous oxide inhalation. All patients received 30-75 mg of pentazocine before incision. At the end of surgery, CSI of pentazocine was begun at a rate of 0.5 ml x hr(-1) x Given regimen was pentazocine 240-390 mg and droperidol 5 mg with 1% lidocaine, and the total amount of dose was 40 ml., Results: Over 80% of patients were assessed to have effective pain relief and minimum side effects. Patients were classified into two groups by anesthetics during anesthesia; propofol, pentazocine, ketamine group (PPK group, n = 61); nitrous oxide, isoflurane, pentazocine group (GOI group, n=88). There were no differences between the two groups regarding postoperative pain relief, while total dose of pentazocine used during anesthesia were lower in GOI group than PPK group., Conclusions: In patients undergoing lower abdominal surgery, CSI of pentazocine provided effective postoperative pain relief and effectiveness did not depend on anesthetics during anesthesia.

Recently, it is gradually getting easier to change a life-style of the patients with cancer-pains from the conventional hospitalized way to the home healthcare system, because of the progress in technique of reducing pains and symptoms and because of prevalence of visiting nurse system. Home healthcare system or hospice is aimed at the improvement of the quality of life (QOL) of the patients. We had 3 patients who died at home after home healthcare service and whose cancer-pains were well controlled till their death at home by continuous subcutaneous injections of opioids (painkiller) when these patients could not take oral medications any more. Therefore, in order to determine the factors that enable the patients to live the terminal stage of their life at home until death by controlling their cancer-pain with continuous subcutaneous injections of opioid, we examined 3 patients who died of cancer at home under a good pain control. The subjects of the present study were 3 patients, who initially had oral or rectal medication of opioid for their pain control, eventually switched to subcutaneous injection of opioid and then died at home under a good pain control between April 1998 and December 2000. We collected all the information through nursing diaries, regarding painkiller care, and interaction of the patients, their family members and other people, and discussed the factors which enabled to maintain a good pain control in these patients at home by continuous subcutaneous injection of painkiller (opioid). As a result, the following 7 items were notified as the factors common in these 3 patients. 1) The patients themselves understood the diagnosis of their diseases and symptoms and could openly discuss the issues such as "how the patient and his/her family would like to live his/her life from now on" among family members, and also between family and medical associates. 2). The patients received detailed explanation of continuous subcutaneous injection at the time of admission to the hospital and chose to receive the continuous subcutaneous injection with their own will. 3) The patients had no other painful symptoms except cancer pains or had them well controlled if they had any, and had much stronger desire to live their life at home than above all. The family member agreed with the patients and respected their choice. 4) The family members had enough nursing capability, so they could properly handle medications and medical equipment as well as they could take care of the patients. 5) Both primary care physicians and visiting nurses had enough knowledge of home healthcare service for painkiller, and were able to frequently interact with the patients and their family in order to reduce their pains. 6) Visiting nurses supported the family by 24 hr-system and assisted the family in nursing the patients at home without worry. 7) Pharmacists also participated in the home healthcare system, thus, they could smoothly provide and manage opioids without any trouble.

Thirteen patients with renal cell carcinoma who had proven bony metastases were treated with multimodal treatment including surgery, radiotherapy and immunotherapy in the form of subcutaneous continuous injection of by natural type interferon-alpha (INF). The mode of administration of IFN was as follows: IFN, 2,5000 x 10(4) unit dissolved in 60 ml saline, was continuously injected (0.5 ml/hr) via a subcutaneous route as one course of the treatment and was given two courses in two weeks preoperatively. Postoperatively, IFN was given every week and the number of courses totally amounted to 15. In some cases IFN was given thereafter either every week or every other week. In four patients whose serum concentration of IFN was measured during and after administration of continuous IFN, the concentration of IFN rose after injection and showed 40.5 IU/ml in average 24 hours later. The concentration was kept measurable in six to eight days long and the maximum concentration was 167 IU/ml. In IFN-treated patients nine survived including two CRs, two NCs, five PDs and four deaths. The five year survival rate was 53%. Continuous subcutaneous injection of IFN in combination with surgery and/or radiotherapy is effective in the treatment of bony metastasis from renal cell carcinoma.

A continuous subcutaneous infusion of peplomycin was performed on 15 patients with cervical cancer. Eight patients received 5 mg of peplomycin a day and 7 patients received 2.5 mg a day. The peplomycin concentrating in the serum after infusion for 24 hours thus were 0.094 microgram/ml and 0.056 microgram/ml, respectively. The concentration of peplomycin in the tumor was found to be higher than in normal cervical tissue, and in the lymph nodes it was equal or higher than in the serum. Histological changes were minimum. A Grade IIa determination, however, was found in one patient, which may have been due to the total dose and/or the time of the examination. No pulmonary toxicity developed in any patients.