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A 79-year-old man with unresectable advanced gastric cancer due to invasion to the pancreas and positive lavage cytology( T4b, N+, M1, CY1, cStage ⅣB; Japanese classification of gastric carcinoma, 15th edition)received standard chemotherapy, including 6 courses of S-1 plus cisplatin as first-line therapy and 2 courses of paclitaxel plus ramucirumab followed by 6 courses of paclitaxel monotherapy as second-line therapy. The primary lesion became PD with these treatments. Subsequently, nivolumab monotherapy was introduced as third-line therapy. After 9 courses, the primary tumor shrunk, and lavage cytology turned to negative on diagnostic laparoscopy. We judged that the tumor was resectable, and the patient underwent radical total gastrectomy and D2 lymphadenectomy as conversion surgery. The pathological stage was ypT3(SS), N0, M0, CY0, and the therapeutic effect was Grade 1b. R0 resection was accomplished. He has been alive without recurrence for 18 months after resection without adjuvant chemotherapy.

Microsatellite instability(MSI)testing is performed in cancer patients to determine the indication for chemotherapy with immune checkpoint inhibitors. We report on our scheme to ensure that Lynch syndrome patients are offered the opportunity for genetic counseling and genetic testing. Two hundred and eight cancer patients(107 males and 101 females, 20- 87 years, mean 63.3 years)underwent MSI testing at our hospital between February 2019 and November 2021. From February 2019 to December 2020, the MSI testing was performed with a consent document that included a commentary on Lynch syndrome, and the results were explained only by the attending cancer doctors. Eleven(8.6%)of the 136 cases had MSI-high, but none of them led to a visit to the genetic medicine department. The Genome Center in our hospital, which was operational from April 2020, undertook information sharing by multiple professions and established a system to provide appropriate support to cancer doctors. Consecutively, 72 MSI tests were performed between January and November 2021, and 2 patients(2.8%)with MSI-high(1 with endometrial cancer and 1 with colorectal cancer)were referred to the Department of Clinical Genetics for genetic counseling. Through genetic testing, both were diagnosed with Lynch syndrome, and information on future surveillance and health care for blood relatives was provided.

A 52-year-old female with stage Ⅳ, bilateral, HER2-positive, breast cancer as well as bilateral axillary lymph node(LN) metastasis and bilateral pulmonary metastasis was administered trastuzumab plus pertuzumab plus docetaxel as a standard chemotherapy. After this treatment the right breast cancer, right axillary LN metastasis, and bilateral pulmonary metastases contracted, while the left breast cancer and left axillary LN metastasis expanded. Trastuzumab emtansine was then administered, and the left axillary LN metastasis contracted, however, the left breast cancer expanded, resulting in marked breast engorgement. When trastuzumab deruxtecan(T-DXd)was administered, the left breast cancer contracted for the first time during the overall treatment process, and the signs of breast inflammation disappeared. Other lesions showed no recrudescence. T-DXd was administered seven times, and, at the stage of maximum contraction during the treatment period, a total left mastectomy and left axillary LN dissection were performed. Pathological examination then confirmed that tumor cells were no longer present in the left breast and left axillary LN. In this case T-DXd was highly effective for the local treatment of intractable, HER2-positive, breast cancer.

A 73-year-old man was presented with epigastric pain and indicated high CA19-9 levels, and computed tomography detected a tumor in the uncinate process of the pancreas infiltrated duodenum and superior mesenteric artery. The patient was diagnosed with borderline resectable pancreatic carcinoma and received neoadjuvant chemotherapy with gemcitabine and S-1. During neoadjuvant chemotherapy, the patient also received radiotherapy to control duodenal bleeding. After neoadjuvant chemotherapy, stable disease(SD)was proven on the Response Evaluation Criteria in Solid Tumors(RECIST), and subtotal stomach-preserving pancreaticoduodenectomy was performed. The pathological findings showed pancreatic adenosquamous carcinoma. After 7 days postoperatively, hepatic metastasis was detected, and after 78 days postoperatively, the patient died.

A 71-year-old female was referred to our hospital for abdominal distention and anorexia. Gastrointestinal endoscopy revealed wall thickening of the entire circumference. Abdominal CT scan showed diffuse thickening of the stomach, but there was no obvious metastasis. Scirrhous gastric cancer was strongly suspected, but endoscopic biopsies could not demonstrate malignant features. Staging laparoscopy was performed. There was a small amount of ascites and numerous peritoneal dissemination. She was diagnosed with gastric cancer pStage Ⅳ(pT4a, NX, H0, M1, P1, CY1)without HER2 positivity. We experienced a case of scirrhous gastric cancer in which staging laparoscopy was useful for histological diagnosis and staging.

Several types of SARS-Cov-2 vaccine have been quickly developed and officially approved for emergency use in accordance with the Pharmaceutical Act. Mass vaccination in workplaces in Japan was subsequently promoted, targeting health care workers and senior citizens. We overviewed the pathophysiology of COVID-19 and reviewed reports containing fatal outcomes, compensation programs, and remedial measures for health damage after vaccinations, in relation to their relevant legislations. The Immunization Act was amended prior to the mass vaccination to authorize the indemnity agreement between the government and pharmaceutical companies to compensate for losses based on health damages after vaccination. Pursuant to the Civil Code and the State Redress Act, employers reserve the right to obtain reimbursement when they are liable to pay compensation for damages inflicted on a third party. There are no provisions to exclude healthcare workers and occupational health staff who participated in practical procedures from lawsuits and liability. We propose legislative reformation and careful contracts with responsible organizations concerned with emergency vaccinations in order to confront forthcoming new or re-emerging infections beyond this pandemic.

We report a case of early asymptomatic acute promyelocytic leukemia (APL) with leukopenia as the only hematologic abnormality. A 55-year-old woman was referred to our hospital with leukopenia (white blood cell [WBC] count of 1,500/µl with 36% neutrophils), which was incidentally determined during an annual medical checkup. Two months before the presentation, her WBC was 3,400/µl with 60% neutrophils. A WBC count was 1,200/µl with 40% neutrophils. Immature myeloid cells were not observed. Her hemoglobin level and platelet count were normal. Moreover, no clinical or laboratory evidence was suggestive of disseminated intravascular coagulation or infection. The peripheral blood WT1 mRNA level was increased to 26,000 copies/µg RNA. The bone marrow aspirate smear revealed 40% myeloperoxidase-positive promyelocytes with occasional Auer rods and faggots; however, circulating leukemia cells were not revealed by cell morphology or flow cytometry analysis. Quantitative reverse-transcription polymerase chain reaction analysis revealed WT1 and PML-RARA fusion transcripts in both the peripheral blood and bone marrow samples. Thus, the determination of peripheral blood WT1 expression may be sufficiently sensitive for detecting a small number of circulating APL cells.

Many lactating women want to breastfeed their baby, but may be overly concerned regarding the drugs present in breast milk; this leads to unnecessary weaning. Moreover, lactating women may stop taking medications at their own discretion and may not receive adequate treatment. Therefore, pharmacists are required to provide appropriate information to lactating women. In 2020, we conducted a questionnaire survey on 1781 pharmacists with the aim of investigating the actual situation of the provision of drug information by pharmacists to lactating women. The results showed that the information source that pharmacists place more importance on is the package itself, rather than databases and books, which are considered to be appropriate sources of information on the use of medicines by lactating women. Besides, more than 90% of pharmacists answered that they would like to participate in the study session. These results indicate that it is important to set up information sources that can effectively be used at workplaces and to organize study sessions for pharmacists with the support of National Center of Child Health and Development and other bodies. By improving the environment, with the aim of further improving the level of pharmacists, pharmacists will be able to provide accurate information more appropriately.

We report a case of pseudo-prolongation of activated partial thromboplastin time (APTT), which was suspected to be caused by an animal-derived phospholipid. A 78-year-old woman was referred to our hospital because of an unexplained APTT prolongation. She had compensated alcoholic liver cirrhosis, with modestly decreased platelet count and normal prothrombin time, and no bleeding tendency. The APTT was 66 seconds in a test using phospholipid extracted from rabbit brain but was 34.9 seconds with synthetic phospholipids. The artifactual pseudo-prolongation of the APTT was seemingly attributable to the susceptibility of the test reagents to low factor XII levels. Thus, tests with different APTT reagents would be useful to physicians in the diagnosis of similar cases.

BCR-ABL tyrosine kinase inhibitors (TKIs) have significantly improved the prognosis of chronic myeloid leukemia (CML). Currently, five BCR-ABL TKIs are approved for use in patients with CML, but the long-term use of these TKIs is associated with various cardiovascular events. Typical cardiovascular adverse events include pulmonary hypertension caused by dasatinib and arterial occlusive diseases caused by nilotinib and ponatinib. Although mechanisms of cardiovascular adverse events of BCR-ABL TKIs in the treatment of CML have not been clarified, differences in their inhibitory activities on off-target kinases, including those involved in vascular function, may be related to individual safety profiles. Arterial occlusive diseases are common in patients with a history of cardiovascular disease and risk of atherosclerosis. Arterial occlusive diseases, such as ischemic heart disease, ischemic cerebral disease, and peripheral arterial occlusive disease, worsen the prognosis and quality of life of patients with CML. Therefore, appropriate management strategies are required. This paper outlines cardiovascular adverse events associated with TKI treatment, including arterial obstructive diseases, pulmonary arterial hypertension, and QT interval prolongation.

A 78-year-old man who underwent esophagectomy for middle thoracic esophageal squamous cell carcinoma(pT1bN0M0, pStage Ⅰ)was diagnosed with lymph node recurrence 12 months after the initial surgery. He received chemoradiotherapy(5- fluorouracil plus cisplatin); however, the treatment was terminated at the middle of the treatment course because of progressive disease. He received chemotherapy(docetaxel plus 5-fluorouracil plus cisplatin)as a second-line treatment, which was also canceled due to serious adverse events. Partial response was achieved after the second therapy; therefore, surgical excision was performed. Thirteen months after the second surgery, he was diagnosed with second local recurrence with invasion to the trachea. Another course of chemotherapy(docetaxel[2-weekly]plus 5-fluorouracil plus cisplatin)was administered, which also achieved a partial response. Thus, surgical excision with partial tracheal resection and mediastinal tracheostomy was performed. He has been alive without recurrence for 6 months after the final operation. In case of postoperative solitary lymph node recurrence of esophageal cancer, long-term survival can be expected with multidisciplinary treatment.

We retrospectively examined 106 cases of tapentadol use in Japan in August 2014 for cancer pain at our hospital.The advantage of the opioid medication tapentadol is that its introduction is suitable in patients undergoing anti-cancer treatment because of the low incidence of gastrointestinal symptoms, with glucuronidation involved in the metabolism, and lack of interactions with other drugs.However, depending on the dosage form and presence of swallowing disorders, the administration should be considered carefully.

A66 -year-old man was diagnosed with chronic myeloid leukemia(CML). Imatinib treatment had been initiated, and a major molecular response(MMR)was achieved. The patient had anemia and was diagnosed with descending colon cancer. The patient was surgically treated, and then received postoperative adjuvant chemotherapy with UFT/LV. However, imatinib was not administered during that period. The patient could undergo postoperative adjuvant chemotherapy for 6 months without acute exacerbation of the CML.

Case: A man in his 60s reported upper abdominal pain; close examination revealed a tumor in the body-tail of the pancreas that was suspected to be infiltrating the stomach. Multiple liver lesions(S3, S4)were also detected. Histological examination by EUS-FNA showed poorly-differentiated carcinoma; thus, this case was diagnosed with unresectable pancreatic cancer with liver metastases(cT3, cN1[No. 7], cM1[P0, H1], cStage Ⅳ: JPS 7th). After 2 kinds of systemic chemotherapy(9 courses of GEM plus nab-PTX and 9 courses of modified FOLFIRINOX), obvious distant metastases or local progression did not appear and conversion surgery was scheduled. Although a metastatic lesion was identified at S5 of the liver just before the surgery, it was assumed that an R0 resection could be achieved; therefore, the operation(distal pancreatectomy with combined proximal gastrectomy, left adrenalectomy, lymph node dissection, partial hepatectomy of S5, and cholecystectomy)was performed. Histopathological examination showed squamous metaplasia of the epithelial tissue combined with glandular formation. This case was, thus, diagnosed as adenosquamous carcinoma of pancreas. This patient was discharged 90 days after the operation. The patient is still alive 2 years and 2 months since the first diagnosis.

Aim: Although urinary incontinence (UI) in the elderly appears to be related to polypharmacy, it is unclear whether multiple medications elevate UI quantitatively or qualitatively. There have been few studies on the association of polypharmacy with each type of UI. The present survey aimed to clarify these issues., Method: The subjects were elderly home health care patients ≥65 years of age taking ≥5 prescription medications and not being treated with anti-cancer agent. The visiting nurses filled out a questionnaire based on their nursing and medication records. Types of UI were evaluated according to a UI checklist., Results: A total of 167 subjects (97 women, 70 men, mean age of 83.8 years) were eligible for the data analysis. Subjects talking 5-9 prescription medications accounted for 59.3%, while those talking≥10 counted for 40.7%. Men talking ≥10 medications showed a slight but non-significant increased risk of UI. In women, α-adrenergic antagonists and benzodiazepines significantly increased the risk of stress UI and urge UI, respectively. Furthermore, α-adrenergic antagonists reduced the risk of functional UI, whereas acetylcholinesterase inhibitors elevated it. α-adrenergic antagonists in combination with benzodiazepines also significantly increased the risk of stress UI and urge UI, while α-adrenergic antagonists with acetylcholinesterase inhibitors increased the risk of stress UI. In men, there were no prescription medications that were particularly related to UI., Conclusions: The present results suggest that there are gender differences in prescription medications-induced UI. It is likely that the causing medications are different depending on the type of UI, and the combination of them significantly increase the risk of UI.

Case 1 is a 68-year-old woman with locally recurrent rectal cancer(LRRC)developed 5 years after resection of primary rectal cancer. The tumor seized right lateral side in pelvic. We performed tumor excision after preoperative chemoradiation comprised external beam radiation with oral S-1(tegafur/gimeracil/oteracil). He has been relapse-free for 3 years 3months after surgery. Case 2 is a 74-year-old man with LRRC developed 2 years after resection of primary rectal cancer. The tumor was located dorsal to anastomosis site in pelvic. We performed abdominoperineal resection for LRRC after preoperative chemoradiation with oral S-1. He has been relapse-free for 2 years. It was suggested that preoperative radiotherapy combined with oral FU for local recurrence after rectal cancer may contribute to distant and local control.

A 67-year-oldman underwent lower anterior resection for rectal cancer andresection of liver metastatic tumor 5 years later. Seven years and 2 months after the initial surgery, a soft tissue mass was detected in the left diaphragm. Further retrospective review of CT scan images showedthat the diaphragmatic tumor was present just before the hepatectomy. Partial resection of the left diaphragm was performed, and no relapse has occurred since then for 2 years. Most cases of diaphragmatic metastasis are considered to arise from dissemination, but we considered this case as more likely to be hematogenous. When surgery is chosen to treat metastatic tumors of colorectal cancer, checking for other metastasis via preoperative imaging andperforming curative resection is important.

Regorafenib is an oral multikinase inhibitor; the CORRECTtrial evaluated its efficacy in patients with metastatic colorectal cancer following disease progression with standard therapies. However, regorafenib has toxicities that develop quickly. Few studies have reported the safe dose and usage of regorafenib to avoid these adverse events in Japanese patients. We examined the side effects and safe administration technique of regorafenib in this study. We administered regorafenib to 15 patients with metastatic colorectal cancer following disease progression with standard therapies. Between August 2013 and January 2014, 5 patients received 160 mg oral regorafenib once daily on days 1-21 of a 28 day course(group A). Between February 2014 and July 2015, 10 patients received initiating therapy with 120 mg regorafenib, with the intention of increasing the dose(group B). We retrospectively assessed side effects, number of dose courses, and total dose of regorafenib in both groups. The median dosing course was 5 coureses in group B, which was more than the 1 course in group A. The median total dose was 10,800 mg in group B, which is about 4 times as much as the 2,400 mg in group A. In group B, 7 out of 10 patients (70%)were successful in the dose escalation of regorafenib from 120 to 160 mg daily over 3-5 courses. The disease control rate was 40% in both groups. The rate of adverse events of Grade 3 or higher was 60% in group A, compared to 40% in group B within 2 courses. The overall survival time was 308 days in group B, which was significantly longer than the 168 days in group A. Initiating therapy with 120 mg regorafenib with the intention of increasing the dose improves safety and allows an increase in dosing courses, as well as in the total dose of regorafenib and overall survival time.

This nationwide survey aimed to evaluate reduction of drug and medical costs due to prevention of serious adverse drug reactions through pharmaceutical inquires by community pharmacist, and investigate relation with iyaku bungyo (separation of dispensing from medical practice) rates. Using the national list of pharmacies, 10% of pharmacies were randomly selected by prefecture and asked to participate in an Internet-based survey. The survey period was 7 days, from July 21 to July 27, 2015. Of the 5575 pharmacies queried, 818 responded to the survey (response rate: 14.7%). The proportion of inquiries to total prescriptions was 2.6%. Among these, the proportion of prescriptions changed in response to inquiry was 74.9%. An estimated 103 million yen was saved by reducing drug costs, and 133 million yen was saved by reducing medical costs due to prevention of serious adverse drug reactions. Comparison of prescription change rates between pharmacies with high and low iyaku bungyo rates indicated that the proportion of prescriptions changed was significantly higher in pharmacies with high iyaku bungyo rates than in those with low iyaku bungyo rates (78.2% vs. 69.9%, p<0.01). The findings suggest that inquiries about prescriptions are useful in ensuring the safety of pharmacotherapy and reducing the cost of healthcare. They also suggest that iyaku bungyo promotes prescription changes through inquiries, leading to proper use of pharmaceutical products.

The diagnosis of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas includes radiographic (CT, MRI) and endoscopic evaluation (ERCP, EUS). The treatment strategy is outlined in the 2012 International Consensus Guidelines (ICG). Herein, we report a case initially not indicated for surgery. Four months after the initial diagnosis, the cystic lesion transformed into a solid mass-like lesion visible on CT. FDG-PET showed abnormal FDG uptake at the same location. Surgical resection was performed immediately, and the tumor was diagnosed as IPMN with inflammation. FDG-PET showed a false-positive diagnosis for the malignancy in this case of IPMN.

Skin metastases from esophageal cancer are comparatively rare but have poor prognosis. Here, we report a case of esophageal cancer metastases to the skin. A 70-year-old man was admitted to our hospital for nodules with ulceration in the nose, and biopsy revealed a metastatic carcinoma. FDG-PET indicated FDG accumulation in the skin, liver, and esophagus, while an endoscopic study of the upper gastrointestinal tract showed a type 3 tumor at the upper mid-thoracic esophagus. We diagnosed the patient with metastatic esophageal cancer and administered chemotherapy. Radiation therapy (40 Gy/20 Fr) was simultaneously administered for the tumor in the nose because the patient's quality of life (QOL) decreased daily owing to pain and bleeding caused by metastatic skin cancer. The radiation therapy reduced the size of the tumor in the nose, but the tumor had remained along with the presence of a scar 3 to 6 months after the start of radiation therapy. Radiation effectively promoted the QOL of our patient with skin metastases.

Purpose: Here, we investigated the efficacy of chemotherapy with trastuzumab for patients with advanced or recurrent gastric cancer., Materials and Methods: We investigated the progression free survival (PFS) and overall survival (OS) of advanced gastric cancer patients who received first-line chemotherapy with trastuzumab in our hospital., Result: After first-line chemotherapy, the median PFS and median OS of patients who received trastuzumab combined with capecitabine/cisplatin chemotherapy was not significantly longer than those of patients who received trastuzumab combined with S-1/cisplatin chemotherapy (PFS, 138 [95%CI: 118-187] vs 169 [95%CI: 83-251] days, p=0.9684; OS, 393 [95%CI: 240-469] vs 466 [95%CI: 256-482] days, p=0.4703). After second-line chemotherapy, the median PFS of patients who received trastuzumab plus irinotecan chemotherapy was not significantly longer than that of patients who received trastuzumab plus paclitaxel chemotherapy (PFS, 63 [95%CI: 52-266] vs 58 [95%CI: 26-184] days, p=0.5447).

We report the case of a 70-year-old man with unresectable advanced gastric cancer because of invasion to the pancreas and multiple liver metastases. He could have continued with fourth-line chemotherapy by controlling intermittent bleeding from the cancer by means of 2 rounds of radiotherapy and trans-arterial embolization. The serum hemoglobin level declined to 4.5 g/dL during second-line chemotherapy. As the venous bleeding from the cancer was difficult to control by endoscopic hemostasis, radiotherapy with 40 Gy/20 fractions was applied to the cancer. We were able to restart chemotherapy after the hemostasis, but 6 months later, the serum hemoglobin level declined to 6.1 g/dL. Additional radiotherapy of 20 Gy/10 fractions was delivered to the tumor, and successful hemostasis was achieved; the serum hemoglobin level reached 7.5 g/dL. However, a contrast-enhanced CT, which was performed 3 weeks later, demonstrated extravasation from the cancer into the gastric cavity. We conducted trans-arterial embolization, and the patient no longer required transfusion. We planned to restart chemotherapy soon, but after 1 month, he died of pneumonia.

A 67-year-old man had a gastric polyp diagnosed on screening. Atrophic changes in the upper gastric mucosa were seen on upper gastrointestinal endoscopy. In addition, endoscopy revealed in the middle area of the stomach wall a 10 mm polyp that was diagnosed as a carcinoid tumor through biopsy. Blood serum gastrin was elevated at 2,800 pg/mL.We diagnosed a Rindi Type 1 gastric carcinoid. The patient was planned to be treated with surgical laparoscopy assisted distal gastrectomy (LADG); however, the procedure was changed to intraoperative laparoscopy assisted total gastrectomy (LATG). Chromogranin-positive tumor pathological findings in the mucous membrane submucosa and in the muscularis mucosae endocrine cell micronest (ECM) were widespread. There was no obvious vascular invasion. After the surgery, the serum gastrin level normalized and the patient remains alive.

The prognosis of esophageal cancer patients who undergo non-curative resection is very poor. Here, we retrospectively analyzed the factors associated with non-curative resection. Thirty-five patients with cT3 or T4 thoracic esophageal cancer treated with neoadjuvant chemotherapy or chemoradiotherapy followed by esophageal resection were included in this study. Among the 35 patients, 27 underwent curative resection (R0 group), while 8 underwent non-curative resection (R1R2 group). A comparison of the clinicopathological factors between groups revealed no significant differences in presurgical factors. The pathological T factor was significantly deeper in the R1R2 group than in the R0 group (p=0.0086). Histopathological response tended to be higher in the R0 group (p=0.055). An accurate preoperative diagnosis of T factor is important.

A 78 -year-old man with rectal cancer underwent abdominoperineal resection of the rectum. In the postoperative period, the patient experienced wound infection, leading to an abdominal wall hernia. Two years following surgery, a rise in the serum CEA level was seen. A metastatic tumor was detected in the right lung on chest CT. VATS right lung inferior lobe segmental resection was performed. After lobectomy, the serum CEA level continued to increase. Another metastatic tumor was detected in the right lung on chest CT. Chemotherapy with capecitabine, oxaliplatin, and bevacizumab was commenced. The erosive part of the abdominal wall scar hernia extended during the nine weeks of chemotherapy. The chemotherapy was then discontinued. In the follow-up CT scan, a right pleural recurrence, local recurrence in the pelvis, and a liver metastasis were detected. Chemotherapy was re-introduced 3 years after surgery. The erosive part of the abdominal wall hernia again began to spread with chemotherapy recommencement. Four months after restarting chemotherapy, the hernia ruptured, with a loop of the small intestine protruding out of it. The patient covered this with a sheet of vinyl and was taken by the ambulance to our hospital. The erosive part of the abdominal wall hernia had split by 10 cm, and a loop of the small intestine was protruding. As ischemia of the small intestine was not observed, we replaced it into the abdominal cavity, and performed a temporary suture repair of the hernia sac. Following this, bevacizumab was discontinued, and the erosive part reduced. We performed a radical operation for abdominal wall scar hernia repair 11 weeks after the discontinuation of bevacizumab.

The safety and feasibility of chemotherapy for super-elderly patients (over 85 years old) has not been clarified yet. We report an extremely aged patient with recurrent rectal cancer that was successfully treated with capecitabine plus bevacizumab chemotherapy. An 85-year-old-woman underwent a Hartmann procedure for rectal cancer. Nine months after surgery, tumor markers were elevated. CT and MRI revealed liver metastases in S5 and S7. We administered capecitabine plus bevacizumab chemotherapy. Tumor makers were normalized after 2 courses, and the liver metastases disappeared after 6 courses. Although Grade 1 hypertension developed, no other adverse event occurred. Chemotherapy has been safely performed for 20 courses. The patient's PS score has been maintained at 0, and she has been under treatment as an outpatient. We suggest that capecitabine plus bevacizumab chemotherapy is an effective regimen for extremely aged patients with recurrent colorectal cancer.

It is sometimes difficult to differentiate between metastatic and primary liver tumors, when the liver tumor occurs simultaneously with a gastric cancer. We encountered a case of resected gastric cancer, which occurred concomitantly with intrahepatic cholangiocarcinoma after S-1 plus cisplatin chemotherapy, in a patient who was previously diagnosed with metastatic liver tumor before treatment. An 80-year-old man was admitted to our hospital because of epigastralgia. Endoscopic study of the upper gastrointestinal tract showed a type 3 tumor at the upper body of the stomach. A plain CT scan showed an irregular, low-density area, which was enhanced by contrast medium in the lateral segment of the liver. We performed an ultrasound- guided needle biopsy, because it was impossible to make a definitive diagnosis by dynamic CT, contrast-enhanced ultrasonography, and MRI. Immunohistochemical analysis for cytokeratin 7/20 resulted in 7 (+)/20 (-) for both the gastric cancer and the liver tumor. Therefore, we diagnosed the patient with gastric cancer, which occurred concomitantly with the metastatic liver tumor, and administered chemotherapy with S-1 plus cisplatin. After 3 courses of the regimen, a reduction in the size of mass was observed in the stomach and the liver. We subsequently performed left hepatectomy and total gastrectomy with lymph node dissection. Microscopic examination revealed the gastric cancer, which occurred simultaneously with the intrahepatic cholangiocarcinoma. The postoperative course was uneventful, and the patient remains well without recurrences.

Approximately 20% of patients develop some complications after gastrectomy. These complications should be treated appropriately to achieve a positive outcome. The records of 6 patients with postoperative intra-abdominal abscesses treated with interventional radiology (IVR) were analyzed. The cause of abscess was anastomotic leakage in 4 patients and contaminated surgery after gastric perforation in 2 patients. Intra-abdominal abscesses were detected on postoperative day 12 (median), and an IVR-guided drainage tube was inserted with a median interval of 1 day. The drainage tube was kept in place for 26 days (median), and patients were discharged 6.5 days (median) after drainage tube removal. No patients were converted to open surgery. Early IVR-guided drainage was essential and effective for intra-abdominal abscess treatment after gastrectomy.

We report the cases of 2 patients with advanced rectal cancer who achieved pathological complete response to treatment with preoperative therapy. Case 1 was a 72-year-old man diagnosed with cT3N1M0 advanced rectal cancer. Neoadjuvant chemoradiotherapy with S-1 (120 mg/day) and radiation (50 Gy/25 Fr) was administered. Eight weeks after the last chemoradiation therapy, we performed laparoscopic Hartmann's operation. Case 2 was a 59-year-old man diagnosed with cT4aN0M0 advanced rectal cancer. He was treated with XELOX plus bevacizumab as neoadjuvant chemotherapy. Four weeks after 4 courses of treatment, he underwent laparoscopic Mile's operation. Neoadjuvant therapy was performed without any complications, and a pathological complete response was achieved in both patients. These cases demonstrated that neoadjuvant therapy can be a promising option for locally advanced rectal cancer.

Successful aging is characterized by minimal age-associated loss of the physiological functions of sleep and circadian clock. Sleep health education is necessary to have normal, quality nighttime sleep and full daytime alertness. Elderly people show changes of sleep parameters, accompanied by increased napping. Many studies have reported that daytime sleepiness or napping in elderly people could have potentially serious effects such as dementia and life-style related diseases. The main topics of sleep health education for elderly people are as follows: Right knowledge of sleep mechanism, understanding the bad influence of excessive napping, the effects of light on the circadian rhythm and negative effects of caffeine, alcohol and television.

Background: The laryngeal tube (LT ; Smiths Medical, Minnesota, U. S. A) is an inflatable supraglottic device for emergency airway management such as during chest compression, the instability after insertion remains a problem., Methods: We investigated the effectiveness of three fixation methods of LT using a manikin and automated chest compressor., Results: After 10-minute chest compression, LT without fixation was shifted by 0.4 ± 0.1 cm, which was greater than with Durapore tape (0.2 ± 0.1 cm), Multipore tape (0.2 ± 0.1 cm), or a neck tape (0.1 ± 0.1 cm). The shift of the position was smaller with neck tape fixation compared to Durapore or Multipore tape fixation., Conclusions: A fixation neck tape may be useful in stabilizing the inserted position of LT during cardiopulmonary resuscitation.

This is the eighth investigation which has been carried out every 5 years since 1974 for the purpose of grasping the trend of X-ray devices and the radiographic condition. We gathered it up mainly on a radiographic condition, in this report. As for the chest radiography and double contrast gastrography, introduction of the flat panel detector (FPD) advanced in comparison with the last survey. Ratio of the imaging system at chest radiography was 65% for computed radiography (CR), 33% for FPD, 1% for screen/film (S/F), and 1% for others. The radiographic condition of FPD was current time product less than CR. Ratio of the imaging system at gastrography was 3% for CR, 48% for FPD, 34% for image intensifier-digital radiography (I.I.-DR), and 15% for S/F. The tube voltage and the exposure time were similar to the last survey time, but the tube current became lower. Through this survey, the change of the radiographic condition was seen in the radiography part where introduction of the FPD advanced. We think the continuous survey is necessary in future.

We investigated the clinicopathological findings of 13 patients with perforated colorectal cancer. In 6 patients, the primary region affected by the cancer was the sigmoid or rectosigmoid colon, and 9 out of 13 patients had perforations at the location of the tumor itself. The Hartmann operation was performed in 5 patients, and D2 or D3 lymph node dissection was performed in 6 patients. The final stages of the 13 patients were as follows: 1 patient with stage II cancer, 5 patients with stage III cancer, and 7 patients with stage IV cancer. Postoperative death occurred in 1 patient. Five out of 7 patients with curative operations had recurrences; 2 patients had peritoneal disseminations, 2 patients had lung metastases, and 1 patient had paraaortic lymph node metastases. Even if patients underwent a curative operation, a high frequency of recurrence, especially of peritoneal dissemination, was observed. Therefore, we conclude that a careful follow-up is required.

Purpose: The efficacy of chemotherapy for advanced or recurrent gastric cancer in patients who were aged over 75 years was investigated., Materials and Methods: Progression free survival (PFS) and overall survival (OS) of advanced gastric cancer patients who received first-line chemotherapy with TS-1 plus cisplatin or TS-1 in our hospital from 2009 to 2013 were determined. The patients were divided into two groups: H and L. H group patients were aged over 75 years, and L group patients were aged less than 75 years., Results: Median PFS and median OS of patients in the H and L groups who received TS-1 plus cisplatin chemotherapy were not significantly different. PFS was 77[range, 13-211] days and 139[range, 53-211]days for the H and L groups, respectively(p=0.141), while OS was 523[range, 22-1,030] days and 402 [range, 322-623] days, respectively (p=0.620). Similarly, median PFS and median OS of patients who received TS-1 chemotherapy were not significantly different between the H and L groups. PFS was 103[range, 51-156]days and 152.5[range, 85-278]days for the H and L groups, respectively (p=0.230), while OS was 414 [range, 224-714]days and 605[range, 452-1,077] days, respectively ( p=0.1337)., Conclusion: PFS and OS were not significantly different in younger patients with advanced gastric cancer who received TS-1 plus cisplatin or TS-1 chemotherapy compared to that in similarly treated elderly patients with advanced gastric cancer.

A 61-year-old man was referred to our hospital because of gastric pain and weight loss.Upper gastrointestinal endoscopy revealed a superficial depressed (Type 3) tumor with pyloric stenosis.The tumor was diagnosed as tubular adenocarcinoma by pathological examination.Abdominal computed tomography showed enlarged paraaortic and No. 8a lymph nodes.The patient underwent distal gastrectomy (D0)and Roux-en-Y reconstruction.After surgery, chemotherapy combined with molecular targeted therapy (S-1+cisplatin[CDDP]+trastuzumab), based on overexpression of the HER2 protein in the primary tumor as assessed by immunostaining, was administered.After the molecular targeted chemotherapy, the carcinoembryonic antigen (CEA )levels decreased to the normal range and the enlarged lymph nodes were remarkably decreased in size. The patient is currently alive without progressive disease.

A 64 -year-old woman was referred to our hospital with a diagnosis of advanced rectal cancer with metastases to the left supraclavicular lymph nodes and paraaortic lymph nodes. Alow anterior resection was performed because of the symptoms of ileus. Subsequently, chemotherapy consisting of XELOX with bevacizumab was initiated as the first-line regimen, over 6 courses. Asecond -line regimen of FOLFIRI with bevacizumab was selected due to multiple lung metastases and the progression to both left supraclavicular and paraaortic lymph nodes. During the first 3 courses, the patient had no harmful side effects. Although the patient received adequate prophylactic antiemetic therapy and supportive treatment, grade 4 delayed emesis induced by irinotecan (CPT-11) occurred at 7 days after the fourth course of FOLFIRI chemotherapy. The patient was given total parenteral nutrition, after which she recovered substantially from the emesis. Delayed emesis is occasionally seen with irinotecan therapy and can be efficiently managed with adequate prophylactic antiemetic therapy. However, delayed emesis occurring one week after administration is rarely observed. Delayed emesis and subsequent therapy affect the quality of life (QOL) of the patient and subsequent therapy therefore, adequate attention and prompt management are required for delayed emesis.

Patients with Klippel-Feil syndrome (KFS) frequently encounter difficult airway management due to skeletal abnormalities, including fusion of two or more vertebrae and short neck. We report successful tracheal intubation using the air-Q supraglottic airway device (air-Q). A 46-year-old woman (height, 149 cm; weight, 62 kg) with KFS was scheduled to undergo vertebral arch plasty for cervical spondylotic myelopathy. She could open her mouth sufficiently but could not tilt her head due to C1-3 fusion. Following administration of fentanyl 100 microg and propofol 120 mg, mask ventilation was achieved with jaw thrust maneuver. We then administered rocuronium 50 mg for immobilization and attempted tracheal intubation using the Pentax-AWS Airwayscope with a thin pediatric Intlock. However, we could not target the glottis, and ventilation via a size 3 i-gel or size 3.5 air-Q was unsuccessful. Using a size 2.5 air-Q, sufficient ventilation was finally achieved. We performed fiberoptic tracheal intubation through the air-Q using a tube with an internal diameter of 6.0-mm. We then exchanged the 6.0-mm tracheal tube with a 7.0-mm spiral tube using a 10 Fr tracheal tube introducer.

We report the successful awake tracheal intubation in a patient with hypopharyngeal cancer and gastroesophageal regurgitation with the TaperGuard Evac tracheal tube (TaperGuard) and Pentax-AWS Airwayscope (AWS). A 63-year-old man with hypopharyngeal cancer with invasion to the glottis was scheduled for total laryngectomy under general anesthesia. He had undergone thoracic esophagectomy and could not maintain supine position due to severe gastroesophageal regurgitation. To avoid vomiting after induction of anesthesia, we planned awake intubation in the sitting position with the AWS. After topical anesthesia with 8% lidocaine and infusion of fentanyl and continuous dexmedetomidine, the AWS was inserted into his mouth in the sitting position from the cranial side. The AWS allowed visualizing the glottis avoiding the cancer, leading to safe placement of the tracheal tube.

A regimen of capecitabine plus oxaliplatin(XELOX)has become one of the standard postoperative adjuvant chemotherapies for colon cancer. However, few tolerability studies have been conducted in Japan. In this study, we retrospectively examined treatment continuation and the adverse events that occurred during 8 courses of postoperative adjuvant chemotherapy with XELOX in 21 patients with colorectal cancer who had undergone curative resection. The completion rate for 8 courses of treatment with XELOX was 71.4%, while the median relative dose intensities of capecitabine and oxaliplatin were 85.0% and 75.0%, respectively. Although the incidence of subsequent Grade 3 or higher hand-foot syndrome was 14.3%, the rate of peripheral neuropathy was 0%. Our hospital had a high rate of XELOX treatment continuation, suggesting that XELOX adjuvant chemotherapy would be well tolerated in clinical practice as well.

Background: The i-gel (Intersurgical, Wokingham, U.K.) is a newly developed, non-inflatable supraglottic device characterized by its soft, gel-like, and transparent mask made of thermoplastic elastomer. Although i-gel can be useful in emergency airway management during chest compression, the instability after insertion remains a problem., Methods: We investigated the effectiveness of three fixation methods using a manikin and automated chest compressor., Results: After 5-minute chest compression, i-gel without fixation was shifted by 0.56 +/- 0.17 cm, which was greater than with Durapore tape (0.28 +/- 0.08 cm), Multipore tape (0.26 +/- 0.05 cm), or a fixation strap (0.04 +/- 0.05 cm). The shift of the position was smaller with strap fixation compared to Durapore or Multipore tape fixation., Conclusions: A fixation strap may be useful in stabilizing the inserted position of i-gel during cardiopulmonary resuscitation.

Therapeutic effects of obesity disease (obesity as a disease) are determined by the weight reduction, decrease of visceral fat and improvement of comorbidities. Evaluation criterion of therapeutic effect is determined a decrease of more than 3% weight reduction, because improvement of comorbidities in obesity, especially visceral obesity, is observed in the weight loss of more than 3%. In obesity more than 30 in BMI or morbid obesity, it is necessary to weight reduction more than 5%.