Nozomu Murakami

Resected pleomorphic carcinoma of the gallbladder.

Pleomorphic carcinoma is a rare lesion and the literature contains few reports of pleomorphic carcinoma of the gallbladder. The present study reports a rare case of primary pleomorphic carcinoma of the gallbladder for which we were able to perform curative surgery. A 77-year-old woman with dementia developed nausea and anorexia, and computed tomography demonstrated irregular thickening of the gallbladder wall. Drip infusion cholangiography and endoscopic retrograde cholangiopancreatography revealed no stenosis of the common and intrahepatic bile ducts. We suspected carcinoma of the gallbladder without lymph node metastasis and invasion to the common bile duct. We guessed it to be resectable and performed open laparotomy. At operation, the fundus of the gallbladder was adherent to the transverse colon, but no lymph node and distant metastases were detected. Therefore, we performed curative cholecystectomy with partial colectomy. Histopathology and immunostaining showed coexistence of an adenocarcinoma, squamous cell carcinoma and sarcomatous tumor of spindle-shaped cell, as well as transition zones between these tumors. We diagnosed stage I pleomorphic carcinoma of the gallbladder. No recurrence has been observed for one and a half years. The biological behavior of pleomorphic carcinoma of the gallbladder remains unknown. It will be necessary to accumulate more case reports of this tumor in order to define diagnostic criteria.

Evaluation of A Novel Information-Sharing Instrument for Home-Based Palliative Care: A Feasibility Study.

Aim: To examine the feasibility and usefulness of a novel region-based pathway: the Regional Referral Clinical Pathway for Home-Based Palliative Care. Method: This was a feasibility study to evaluate the frequency of variances and the perceived usefulness of pathway using in-depth interviews. All patients with cancer referred to the palliative care team between 2011 and 2013 and received home care services were enrolled. Result: A total of 44 patients were analyzed, and pathway was completed in all the patients. The target outcome was achieved in 61.4% while some variances occurred in 54.5%. Nine categories were identified as the usefulness of the pathway, such as reviewing and sharing information and promoting communication, education, motivation, and relationships. Conclusion: This novel pathway is feasible and seems to be useful.

Usefulness of a Collaborative Home Visit Program Between Hospital and Visiting Nurses

This study aimed to provide a basis for appropriate home care for cancer patients by clarifying the usefulness of home visits in a collaboration program between visiting and certified hospital nurses. This was a mixed-methods study. (1) A quantitative study was conducted, involving all patients referred to the palliative care team, and (2) a questionnaire survey was conducted, involving 40 visiting nurses. In the study (1), the subjects were all patients who were referred to a palliative care team before (October 2010 to March 2012; control group) and after (April 2012 to September 2013; collaborative home visit group) the initiation of collaborative home visits. After the patients underwent observation through December 2013, their data from charts, as of January 2014, were obtained. The proportion of home deaths increased by 3.8%, from 58.3% (n = 14) to 62.1% (n = 18), after the initiation of collaborative home visits; this increase was not significant (P = .78). However, in the survey (2), visiting nurses’ sense of difficulty in providing palliative home care was significantly reduced in comparison between those with and without experience of such visits (P = .013). Visiting nurses’ reduced sense of difficulty in providing palliative home care after collaboration during home visits suggests the usefulness of such collaboration for them. This program may contribute to increases in the proportion of home deaths by increasing the numbers of nurses newly engaged in palliative home care.

Stability of octreotide acetate decreases in a sodium bisulfate concentration-dependent manner: compatibility study with morphine and metoclopramide injections

Purpose Sodium bisulfate is known to affect the stability of octreotide. However, the critical concentration of sodium bisulfate is not known. Therefore, we assessed the critical concentration of sodium bisulfate needed to preserve the stability of octreotide using actual drugs containing sodium bisulfate. Methods Although morphine and metoclopramide preparations are considered to be compatible with octreotide, some of their products are known to contain sodium bisulfate. Thus, octreotide was mixed with preparations of sodium bisulfate solutions at serial concentrations and morphine and metoclopramide preparations containing sodium bisulfate, and octreotide stability was then evaluated using high performance liquid chromatography. Results Octreotide concentrations decreased significantly at a sodium bisulfate concentration of 0.1 mg/mL or higher after 10 days when octreotide was mixed with sodium bisulfate solutions at various concentrations. A significant decrease in octreotide concentrations also occurred when it was mixed with morphine and metoclopramide preparations containing sodium bisulfate and stored for 10 days; however, slight decreases were observed in the mixture with both preparations and were within the clinically acceptable range for morphine preparations. Conclusions These results indicate that the residual rate of octreotide decreases with time in a sodium bisulfate concentration-dependent manner when octreotide was mixed with morphine or metoclopramide. However, this incompatibility may be clinically acceptable when the final sodium bisulfate concentration is lower than 0.1 mg/mL and the mixed solution is used within 7 days.

The comparative study of a recostruction with gastric tube and free jejunal autograft for pharynx and/or cervical esophageal carcinoma.

下咽頭・頸部食道癌に対する2つの再建法を比較検討した.縦隔内リンパ節郭清を伴う胃管による再建法 (胃管群) の7例と縦隔内リンパ節郭清を伴わない遊離空腸移植による再建法 (空腸群) 14例を対象とした.空腸群では呼吸器系合併症を認めず, 縫合不全もなかったが, 胃管群では呼吸器系合併症2例, 縫合不全2例認めた.胃管群で郭清された縦隔内リンパ節には転移を認めなかったが, 頸部傍食道リンパ節への転移は胃管群で57.1%, 空腸群で42.9%であった.頸部リンパ節の郭清に重点をおくべきであることを示唆した.再発形式は遠隔転移を伴ったものにのみ縦隔内リンパ節への転移を認めた.空腸群の術後総頸動脈造影では吻合部の狭窄や血栓形成は認めなかった.胃管群での最長生存例は62か月に肺転移で死亡した1例であった.空腸群では現在5年以上生存例は2例である.両群間に遠隔成績の差はなかった.遊離空腸による再建法は安全でリスクの高い症例にも応用できる.