Masatsugu Yano

Assessment of cancer pain in a patient with communication difficulties: a case report

BackgroundThe number of patients who have difficulty with mutual understanding has been increasing recently due to an aging society. This emerging issue needs to be addressed. We report an instructive case of a patient who had communication difficulties due to dementia and sequelae of alcoholic encephalopathy.Case presentationA 66-year-old man of Mongolian race presented with coronary arteriosclerosis, spinal canal stenosis, transverse colon cancer, and alcoholic encephalopathy. We had been requested to remove wires that had been used for the closure of his chest in a coronary artery bypass grafting procedure. However, on admission, a tortured expression and abdominal distention were observed, along with emaciation. We diagnosed terminal stage cancer, and palliative care was offered. An abdominal computed tomographic scan revealed rectal cancer with stenosis and invasion to the adjacent tissues. A metallic stent was inserted, leading to reduction of the abdominal distention and an improvement of tachycardia. However, the patient’s tortured expression was not completely relieved; therefore, an assessment of cancer pain was considered. The Abbey Pain Scale was applied. On the basis of the patient’s score, analgesics and an opioid, among other medications, were administered. These led to relief of the patient’s tortured expression and reduced his Abbey Pain Scale score. Following this, the patient’s vital signs continued to be stable, and he was transferred to the referral institution.ConclusionsManagement of cancer pain in elderly patients with mutual understanding difficulties must be performed carefully. In the case of our patient, staff at the referral institution informed us of the patient’s latent torture, and we applied the Abbey Pain Scale. There was some confusion and uncertainty regarding clinical management throughout the patient’s care; however, his condition eventually stabilized. We believe the application of the Abbey Pain Scale assists in the relief of cancer pain. However, accumulation of further cases and experiences to verify this assessment is required.

A CASE OF THYROID HEMANGIOMA

甲状腺に発生する血管腫は非常に稀で，本邦での報告例もわずかに13例を数えるのみである1)～11)．今回当科では，画像所見などから甲状腺癌を疑った甲状腺血管腫の1例を経験したので報告する．症例は79歳，男性．嚥下障害を主訴に近医を受診した．頸部超音波検査で甲状腺右葉に腫瘤を指摘され，当科紹介となった．甲状腺右葉下極に30mm大の不整形腫瘍を認め，内部エコーは等～やや低エコーで不均一であった．穿刺吸引細胞診の結果はクラスIであったが，画像上悪性の可能性も否定できず，甲状腺右葉切除術を施行した．摘出腫瘤の割面は白色スポンジ様であり，病理組織検査で，甲状腺血管腫と診断された．