Use of hormone therapies in disseminated carcinomatosis of the bone marrow associated with hormone receptor-positive breast cancer.

Disseminated carcinomatosis of the bone marrow (DCBM) is diffusely invasive bone metastasis resulting from solid tumors. DCBM is often associated with disseminated intravascular coagulation (DIC) or hemolytic anemia. Generally, DCBM treatment includes cytotoxic chemotherapy for underlying solid tumors and management of hematological conditions if present. We report a case of DCBM accompanied with DIC in hormone receptor-positive breast cancer. Due to her life-threatening condition, we used hormone therapies, not cytotoxic chemotherapies, to treat her DCBM. With zoledronic acid, her DIC and general condition gradually improved and eventually she could return to her daily life. If DCBM occurs in hormone receptor-positive breast cancer, hormone therapy can be one of the treatment choices.

Pain Management of Malignant Psoas Syndrome Under Epidural Analgesia During Palliative Radiotherapy.

Malignant psoas syndrome is a rare malignant condition presenting as lumbosacral plexopathy and painful fixed flexion of the hip. Metastasis to the psoas muscle is observed, which damages the nerve bundles in the lumbosacral plexuses. The syndrome presents as refractory lower back pain with several other neurological symptoms. The pain is difficult to control because it is a mixture of nociceptive and neuropathic pain, which indicates that treatment requires a versatile approach. The authors report a case of severe back pain caused by metastasis to the psoas muscle of advanced gastric cancer in a patient who underwent palliative radiotherapy under epidural analgesia. Despite conventional analgesics and subcutaneous oxycodone, he had difficulties in maintaining supine position because of the back pain and had a problem to receive radiotherapy, which required him to stay still in the same position during the treatment. By epidural analgesia, he could remain in supine position and complete radiotherapy without increasing opioid administration. His back pain was improved after the radiotherapy. Epidural analgesia is an effective treatment choice for a patient who is unable to keep the position during palliative radiotherapy.

[Effect of lidocaine gargling on taste perception].

Because stomatitis is a painful condition, gargling with lidocaine is often prescribed before meals. However, because lidocaine inhibits nerve conduction, lidocaine gargling may affect taste perception. Therefore, we studied the effects of lidocaine gargle on taste. We prepared samples of the 5 basic tastes at equivalent concentration levels in terms of the taste quotient. We conducted sensory tests to judge whether the samples could be tasted, and the threshold concentrations (50% taste rate) were estimated from the taste rates. The sensory test was repeated after the subjects gargled with lidocaine, and the efficacy ratio was calculated by comparing the threshold concentrations. Although no interaction was observed between the lidocaine gargle and the threshold concentration levels in the logistic regression analysis, significant differences were observed in the primary effects of each standard, such as the concentration levels, flavor, and bitterness. When the efficacy ratios based on the threshold values were calculated, increases in the thresholds for flavor and bitterness were observed. The results of this study suggested that gargling with lidocaine before a meal increases the thresholds for the appreciation of flavor and bitterness. This increase in the threshold values due to lidocaine was associated not with the pharmacological effect of the drug but with its strong bitterness.