Therapeutic potential of ciclesonide inahalation for COVID-19 pneumonia: Report of three cases.

No specific and effective anti-viral treatment has been approved for COVID-19 so far. Systemic corticosteroid has been sometimes administered to severe infectious diseases combined with the specific treatment. However, as lack of the specific anti-SARS-CoV-2 drug, systemic steroid treatment has not been recommended for COVID-19. We report here three cases of the COVID-19 pneumonia successfully treated with ciclesonide inhalation. Rationale of the treatment is to mitigate the local inflammation with inhaled steroid that stays in the lung and to inhibit proliferation of the virus by antiviral activity. Larger and further studies are warranted to confirm the result of these cases.

[Non-surgical management of small bowel diverticulitis with localized perforation:a case report].

A 40-year-old man presented to the emergency department with periumbilical pain and fever. A computed tomographic scan confirmed multiple jejunal diverticulum with localized extraluminal air and panniculitis around it, and jejunal diverticulitis with localized perforation was suspected. His symptoms were mild, and extraluminal air was localized;therefore, he was advised bowel rest and administered only antibiotics. The patient's symptoms resolved without surgical treatment, and at the time of writing this report, there had been no recurrence. Small bowel diverticulitis is rare, and careful analysis of imaging studies is necessary for establishing a diagnosis. This was a rare case where small bowel diverticulitis was resolved without surgical treatment.

[Practical Utilization of Home Care Support System and Influence of Home Care on the Regional Core Hospital].

The home care support system, newly established in 2014, is a system that always secures the hospitalization of pre-registered home care patients who need to be hospitalized. Ashigarakami Hospital has operated this system since April 2014. As of May 2018, a total of 215 people registered, and 156 people have died. Among the deceased patients, 77(49.4%)died at home, which was higher than the proportion of home deaths(13.0%)in the Japanese population dynamics survey in 2016. In patients who had malignant diseases, they could spend more than half of the period from their introduction to the system up to death being treated at home. Even in the case of death at a hospital, the duration of the last hospitalization was 18 days on average(median of 12 days). In most cases, patients were treated at home until shortly before death.

Cancer treatment and management for elderly patients 80 years of age or older with malignant solid tumors.

OBJECTIVE: We retrospectively analyzed the backgrounds, treatment and nursing care for 96 patients aged 80 years or more with malignant tumors. Twenty of them were hospitalized on an emergency basis. Sixty patients were male and 36 were female, with a median age of 83 years (range: 80-94 years). Twenty-seven had a PS of 3 or 4, and 41 were rated as not independent based on analysis of autonomy at hospitalization. Forty-seven patients had clinical stage III or IV malignancies. The proportions of patients with disease complications were 33.3% for neurological disease, 21.9% for respiratory disease, 70.8% for cardiovascular disease including hypertension, and 36.5% for metabolic disease. Thirty-nine patients underwent surgical or endoscopic resection of their tumors. Twenty-three patients received chemotherapy: hormonal treatment in 14, local injection of cytotoxic agent(s) in 6 and systemic anti-cancer therapy in 3. Thirty-nine patients received supportive care only. Forty-three patients newly required nursing care or an increased level of care at discharge. The median survival time was 10.9 and 15.3 months for stage III/IV and 0/I/II patients, respectively. In conclusion, most elderly patients with malignant tumors require full supportive care, including social nursing care, from the time of cancer diagnosis.

Abdominal Migraine in a Middle-aged Woman.

A 52-year-old woman presented with recurrent, severe abdominal pain. Laboratory tests and imaging were insignificant, and treatment for functional dyspepsia was ineffective. The poorly localized, dull, and severe abdominal pain, associated with anorexia, nausea, and vomiting, was consistent with abdominal migraine. The symptoms were relieved by loxoprofen and lomerizine, which are used in the treatment of migraine. We herein report a case of abdominal migraine in a middle-aged woman. Abdominal migraine should be considered as a cause of abdominal pain as it might easily be relieved by appropriate treatment.

Gallbladder herniation into the lesser sac through the foramen of Winslow: report of a case.

We report a case of gallbladder hernia into the lesser sac through the foramen of Winslow. The patient was a 90-year-old woman, admitted to hospital with obstructive jaundice. Computed tomography (CT) showed a left-deviated and remarkably enlarged gallbladder dragging the liver, and a dilated intrahepatic bile duct. The deviated gallbladder was thought to compress the common bile duct, causing the obstruction. Laparoscopic examination revealed gallbladder herniation into the lesser sac without a floating gallbladder; thus, we performed laparoscopic cholecystectomy. Herniation of the gallbladder is the rarest of all internal hernias and most reported cases have involved a floating gallbladder. The case we report here is therefore considered especially unusual.