The Impact of Visitor Restrictions During COVID-19 Pandemic on Bereaved Family Members of Patients in Palliative Care Units.

COVID-19 pandemic has impacted the families of patients in Palliative Care Units because of the visitor restrictions which were introduced to reduce the risk of infection. This study investigates how the bereaved families of the patients who died in end-of-life care during the pandemic evaluate the visitor restrictions and how the lack of direct communication with the patient affected them. We conducted a quantitative survey using an anonymous self-administered questionnaire. Participants were the bereaved families of patients who died in a Palliative Care Unit from April 2020 to March 2021. Their perspectives on the negative impact of COVID-19 pandemic on visitations, visitor restrictions, the quality of medical care in the month before the death of the patient, and online visitations were recorded in the survey. The results show that most participants experienced a negative impact on visitations. However, most respondents felt that the restrictions were unavoidable. According to visitor permissions in patients' last days, bereaved families were satisfied with the medical care provided for the patient and the amount of time spent with the patient in his/her last days. The importance of direct meetings during the last days of the patients' life for their family members was presented. We suggest further research to find measures which enable visitation in palliative care units, as caregiving from family and friends and maintaining COVID safety regulations are equally significant in end-of-life care.

[A Retrospective Investigation of Cases in Which a Contract Was Not Concluded after a Referral for Home Care].

Cases in which the contract was not concluded after a request for home visit care was received were retrospectively surveyed. Seventy-nine new requests for home visit care were received over a period of 6 months from January 1 to June 30, 2018. Of them, a contract was not concluded in 18 cases(22.8%). Among the cases in which no agreement was reached, 9 patients were male and 9 were female, mean age was 84.6, and the patients' afflictions included dementia, orthopedic disease, malignant tumor, incurable neurological disease, heart disease, and cerebrovascular disease. Reasons for not reaching an agreement for home care included that the patient him- or herself did not feel the need for home care because the patient's condition worsened soon after the referral, for financial reasons, the patient had a strong aversion to letting outsiders into his or her home, a desire to continue outpatient treatment, the patient's home was beyond the area that could be visited, the patient's primary physician determined that home visits were possible after the referral was received, and because the patient wanted to continue treatment with a specialist.

[Computed tomography (CT) assessment of the postoperative change of pericardial fat pad used in pulmonary surgery].

The purpose of this study is to clarify the postoperative change of pericardial fat pad used in pulmonary resection to reinforce bronchial suture or bronchial stump. 5 cases who received chest computed tomography (CT) examination 2 times or more after the operation (once within one week after the operation) were enrolled. For evaluation, scoring system from 1 to 4 according to the percentage of remaining pericardial fat pad was applied(1 point: 0∼19%, 2 point: 20∼49%, 3 point: 50∼79%, 4 point: 80∼100%). At 1 to 2 months after the operation, almost all cases were 3 or 4 point. However, the scores declined to 1 or 2 point 5 months after the operation in almost all cases. It is likely that the pericardial fat pad remains to be effective in protecting bronchial stump or anastomosis 1 to 2 months after the operation.

[Examination of a relapsing pattern of cases of completely resected non-small cell lung cancer].

PURPOSE: The purpose of this research was to understand the clinical discovery of a relapse, relapse time, and the presentation of the first relapse of non-small cell lung cancer(NSCLC)by examining cases of relapse after complete resection of NSCLC. Objective and method. Cases of relapse after complete resection of NSCLC in our hospital were examined. RESULTS: Fifteen cases were evaluated. In half of these cases, relapse was discovered owing to increased tumor marker values. Of the patients, 60%had a relapse within 2 years after resection and 20%had a relapse 5 years after resection. The first relapse was a local recurrence in 9 cases, lung metastasis in 5 cases, and distant metastasis outside the thoracic cavity in 3 cases. CONCLUSION: The effectiveness of the tumor marker as a diagnostic parameter of relapse in NSCLC was demonstrated. Discovering distant metastases at the early postoperative period and relapse 5 years after resection are important.

[Examination of clinical presentation in terminal-phase lung cancer patients at a single palliative care unit].

OBJECTIVE: To study the clinical presentation of lung cancer patients at our palliative care unit (PCU). DESIGN: We examined the clinical presentation of lung cancer patients at our PCU and compared it with the clinical presentation of patients with malignant tumors besides those indicative of lung cancer. RESULTS: The PCU occupancy ratio of lung cancer patients to inpatients was 24%, which was dependent on the type of carcinoma. Lung cancer patients in need of oxygen inhalation and/or terminal sedation were more in number than those with other types of malignant tumors. On the other hand, few patients needed treatment. Dyspnea is the major reason for the terminal sedation of lung cancer patients. CONCLUSION: Severe dyspnea appeared to be the typical clinical presentation of terminal-phase lung cancer patients.

[Pulmonary resection for lung cancer in a patient with an anomalous course of the right apical pulmonary vein].

We carried out right upper lobectomy and mediastinal node dissection for a 67-year-old man with lung adenocaricinoma in the right upper lobe. Intraoperatively, we found the middle lobe vein, V2, and V3 in front of the pulmonary hilum, and did not found a part of the right apical pulmonary vein. We found a part of the right apical pulmonary vein placed between the right main pulmonary artery and the right upper lobe bronchus, after cutting the pulmonary artery branches to the right upper lobe. We should keep on mind the possibility of anomalous course of pulmonary vein when pulmonary surgery is planned. And, if this abnormality is doubted with the preoperative chest computed tomogrphy (CT) scan, threedimensional CT( 3D-CT) scan of the pulmonary vein is useful.

[Examination and care for cancer patients with difficult-to-assess pain - feed back on patients who received consultation from our palliative care team].

OBJECTIVE: The care of cancer patients whose pain is difficult to assess is examined. METHODS: Cancer patients who received a consultation because pain assessment by our palliative care team between September 2008 and November 2010 proved difficult, were evaluated retrospectively. RESULTS: The corresponding cases were five cases(5. 6% of all cases who received consultation). The cause of the difficulty in the assessment of pain was due to dementia in two cases, mental retardation in one case, the patient's personality in another case, and the patient's believing in a third case. Useful observable items have been pointed out for difficult pain evaluation are of the patient, including expression and behavior. And the importance of chose consideration of the causes of difficult assessment of pain have also been pointed out. CONCLUSION: Careful care according to the cause of the difficult assessment of pain and individual communication ability proved important.

[Eosinophilic pleural effusion possibly induced by fibrin sealant].

A 74-year-old man underwent right upper lobectomy for the lung cancer and bullectomy of right lower lobe. Fibrin sealant was used for sealing the excision line. The increase of the pleural effusion with increasing C-reactive protein( CRP) and eosinophilia was noted at the 17th day after the operation. The pleural effusion was transparent and yellowish colored suggesting transudatory liquid. The eosinophil in the pleural effusion was as high as 14%. The drainage of the pleural effusion was performed for 2 days resulting in disappearing the abnormal accumulation without any additional treatment. The cause of pleural effusion was supposed to be fibrin sealant by a positive result of the drug lymphocyte stimulation test.

[Intralobar pulmonary sequestration treated by resection of the sequestrated segment].

Segmentectomy including the sequestrated segment and lobectomy are generally performed for intralobar pulmonary sequestration. We report a case of intralobar pulmonary sequestration of Pryce type III treated by resection of only the sequestrated segment. A 57-year-old man presented with a 5 x 3 cm mass shadow overlapping a cardiac shadow on the left lower lung field on chest radiograph at medical examination. The mass was not connected with the bronchial tree, and was supplied by an aberrant artery arising from the thoracic descending aorta. The mass was suspected to exist in the normal visceral pleura from chest images. The mass was suspected to be an intralobar pulmonary sequestration from the abovementioned findings, and we performed an operation. At the beginning of the procedure, after dissecting the aberrant artery, only the sequestrated segment was performed.

[Neurogenic tumors originated from vagus nerve and intercostal nerve simultaneously; report of a case].

A 60-years-old man was presented with the posterior mediastinal tumor by chest computed tomography (CT) that had been taken for the examination of another disease. A well circumscribed mass of 9 x 6 x 5 cm in diameter between the body of the thoracic vertebra and pericardium and a well circumscribed mass of 2 x 2 x 0.8 cm in diameter in the 9th intercostal space were noted by chest CT. von Recklinghausen's disease was suspected by the presence of a lot of brown spots and subcutaneous small nodules in the whole body, and both was speculated as neurogenic tumors. Both tumors were removed by the operation, and the pathologic diagnosis of the neurofibroma was obtained.

[Retrospective investigation of clinical presentation of lung cancer patients before and after treatment discontinuation].

INTRODUCTION: There is no clear answer as to how long we should continue aggressive treatment for progressive lung cancer. PURPOSE: An ideal way to conduct and discontinue aggressive treatment was examined from the viewpoint of quality of life and the remaining lifespan after treatment discontinuation. MATERIAL & METHODS: We began systemic chemotherapy and/or radiotherapy from January 2003 to December 2007, based on our pathological diagnosis of lung cancer. Then, in 30 patients who thereafter stopped aggressive treatment, we retrospectively investigated the content and period of aggressive treatment, and clinical presentation before and after they discontinued their treatment. In addition, the factors important for quality of life and the prognosis after the treatment discontinuation were analyzed. RESULT: For quality of life and the remaining lifespan after the treatment discontinuation, it was found important to avoid serious adverse effects of treatment and watch out for performance status decrease during the treatment period. Then, after the treatment discontinuation, it was thought to be important to pay attention not only to the cancer progression but also the complications arising from other diseases including pneumonia.

[Inflammatory myofibroblast tumor after surgery for primary lung cancer; report of a case].

Inflammatory myofibroblast tumor of the lung is a rare disease, and is difficult todistinguish from lung cancer. We report a case of inflammatory myofibroblast tumor which was found and resected postsurgery for lung cancer. The patient underwent right middle and lower lobectomy due to squamous cell carcinoma in right S6 of the lung. A nodular density of 15 mm in diameter was found in the right apex on computed tomography (CT) 1 year and 11 months after surgery. The right apical mass was resected by partial resection of the residual lobe and inflammatory myofibroblast tumor was diagnosed pathologically. It was a case for which recurrence or 2nd primary lung cancer was strongly suspected from the radiological findings and its rapid growth.

[Lung abscess which ruptured during the medical treatment of lung abscess; report of a case].

63-year-old man was admitted to our hospital with fever and cough for about 2 months. Laboratory data showed marked inflammatory changes, and chest computed tomography (CT) scans revealed right-sided hydrothorax, atelectasis of the right middle lobe, and a cystic mass in the right middle lobe. We diagnosed the patients as having lung abscess and empyema. Following the intravenous antibiotic chemotherapy, symptoms and laboratory data showed the improvement, however, on the 11th hospital day, he developed high fever again. A chest CT showed pneumopyothorax suggesting the rupture of lung abscess. Since the chest tube drainage was ineffective, open chest surgery was performed. Curettage of both thoracic and abscess cavity with closure of air leakage successfully cured the pyothorax.

[Clinical evaluation of lung cancer patients with only best supportive care].

Eighteen cases with only symptomatically treated lung cancer admitted to our hospital from May 2002 to October 2006 were retrospectively investigated clinically. The patients consisted of 10 males and 8 females, aged 50-9 8 years old (mean age 78.1 yo). Clinical stage distribution revealed a higher incidence in the advanced stages. The performance status according to the ECOG classification was predominantly grade 2-4. The average survival time was 5.9 4 months. The cell type was the major prognosticator followed by clinical stage and age. There was a tendency to die early in any case that had a poor whole-body state, such as weight reduction and a feeling of whole body fatigue. There was a tendency for the at home period to be short in cases that required control of pleural effusion, and the survival period was short.

[Pseudotumor by asymptomatic pulmonary infarction diagnosed by video-assisted thoracic surgery].

Two cases of asymptomatic pulmonary infarction were diagnosed by open lung biopsy with video-assisted thoracic surgery (VATS). Case 1: A pulmonary nodule in right S8b was pointed out in a 62-year-old man undergoing hemodialysis on chest x-ray film and CT. Case 2: A 50-year-old woman had undergone left mastectomy for mammary cancer 3 years previously and total hip replacement 1 year before. Chest X-ray film and CT revealed a pulmonary nodule in the left lower lung field and it was suspected to be metastasis of the mammary cancer. Both cases underwent open lung biopsy by VATS, and asymptomatic pulmonary infarction was revealed. When chest X-ray film shows a nodule in the lower-peripheral lung field in patients with risk factors, pulmonary infarction should be considered.

[Non-Hodgkin malignant lymphoma of rib origin: report of a case].

A 69-year-old man with left chest and back pain was found to have an osteolytic mass (4.2 x 3.8 cm) in the left 8th rib by chest X-ray and computed tomography (CT) in August 2003. There were no abnormal findings in the abdomen, lung, mediastinum or bone except the left 8th rib. Although the spontaneous disappearance of pleural effusion and the elevated CRP suggested the possibility of myelitis, the malignancy of the rib could not be ruled out, and the surgery was performed in September 2003. The mass was resected en bloc together with the involved 8th rib. The histological diagnosis was primary non-Hodgkin lymphoma (diffuse, medium-sized to large B-cell lymphoma).

Trans-arterial infusion chemotherapy for recurrence of pleural dissemination after thymectomy.

We present a report of trans-arterial infusion chemotherapy through the intercostal arteries and subphrenic artery for pleural dissemination of recurrent thymoma after thymectomy. The disseminated tumor did not enlarge for more than a year after this treatment, and there were no side effects. Trans-arterial infusion chemotherapy appears to be a preferable procedure for pleural dissemination of thymoma.

[Bronchioloalveolar carcinoma with acute respiratory failure due to hemoptysis; report of a case].

A 69-year-old male was admitted to our hospital for hemoptysis and dyspnea. Because of his deteriorating respiratory distress, he was intubated and controlled by respirator for 3 days. He was diagnosed with adenocarcinoma of the lung by the sputum examination and chest computed tomography (CT) revealed an infiltration shadow in the peripheral superior ventral segment (S3) of the right upper lobe. He underwent right upper lobectomy with video-assisted thoracic surgery. Microscopic findings of the resected specimen measuring 10 x 10 x 7 cm revealed mucin-producing bronchioloalveolar carcinoma (BAC) with metastases in lymph nodes and the same lobe (S2b). We reported a rare case of BAC with hemoptysis.

[A case of infected emphysematous bulla successfully treated with percutaneous thoracic drainage].

We present a case of infected emphysematous bulla successfully treated by percutaneous drainage. A 39-year-old man was admitted to our hospital because of fever and right lateral chest pain. A chest radiograph and CT revealed a cystic lesion with an air fluid level in the upper lobe of the right lung. The infected emphysematous bulla was not improved by the administration of antibiotics. On day 6 of hospitalization, a drainage tube (Aspiration Kit: 6 Fr) was inserted percutaneously into the bulla under fluoroscopic guidance. The infection subsided on the next day, and the patient was discharged following a week of drainage without complications.

[Advanced lung cancer of performance status 3 successfully treated by gefitinib--a case report].

The prognosis in cases of advanced lung cancer with poor performance status is poor. We report here a patient with advanced non-small cell lung cancer of performance status 3 who had severe cancer-induced pain, which was not controlable with morphine and radiation therapy. The cancer was successfully treated by oral administration of gefitinib (250 mg/day) without serious adverse effects of worsening of quality of life. Not only was the tumor controlled but rapid relief of severe cancer-induced pain was achieved.