[Temporary Home Management of a Refractory Pleural Effusion with an Indwelling Catheter].

BACKGROUND: Pleurocentesis and pleurodesis are the common treatments for pleural effusion. However, most home-visit physicians usually hesitate to perform these treatments for patients confined at home. CASE: A 51-year-old woman developed breast cancer(ER+, HER2-)at the age of 39 years. She underwent a partial mastectomy of the right breast. Nine years later, metastatictumors in the lungs, and hilar and mediastinal lymph nodes were found. The patient was admitted to our hospital because of the progression of pleural effusion and dyspnea. On the day of admission, the aspiration catheter was placed in the left lung with continuous suction, but pleurodesis could not be performed as the left lung did not re-expand enough. As the patient requested to go home as soon as possible, she was discharged with the catheter in place. Three days after the discharge, the home-visit physician drained 340 mL of fluid through the catheter. Six days after the discharge, the patient was readmitted to the hospital with malaise and dyspnea, but no signs of complications associated with the indwelling catheter use were observed. The patient died 4 days after the readmission. CONCLUSION: This case suggests that draining fluid using an indwelling pleural catheter as a home-based healthcare measure is one of the simplest and safest options.

[Abnormal Nipple Discharge].

BACKGROUND: Breast carcinoma and precancer are thought to start in the lining of the milk duct or lobule. Ductography and fiberoptic ductoscopy have beenadvocated as the mainprocedures inpatien ts with nipple discharge. METHODS: We investigated the usefulness of microdochectomy(MD)by using indocyanine green(ICG)fluorescence imaging. ICG and indigo carmine were injected into the mammary duct. A periareolar incision was made, and a fluorescence image of the demarcated mammary duct segment was obtained. CONCLUSION: MD using indocyanine green fluorescence imaging is a useful procedure in guiding subsequent breast surgery in the treatment of nipple discharge.

Prevalence of myofascial pain syndrome in patients with incurable cancer.

BACKGROUND: Myofascial pain syndrome (MPS) is a condition that involves skeletal muscles. It is caused by overload or disuse of muscles and is characterized by extreme tenderness in the muscles with taut bands. Treatment for MPS is different from that for cancer-related pain. Cancer patients have many factors that cause restriction of body movement and posture. Although cancer patients appear to demonstrate risk factors for MPS, its prevalence has not been reported in patients with incurable cancer. This study was conducted to investigate the prevalence of MPS in patients with incurable cancer. METHODS: A retrospective chart review. The data for patients with incurable cancer who received palliative care at our department between September 2015 and March 2016 were investigated. We examined the prevalence of MPS, which was diagnosed on the basis of the Rivers criteria (RC) and Simons criteria (SC). We also examined the following factors associated with MPS: performance status (PS), use of medical devices, and primary cancer sites. The primary outcome was the prevalence of MPS based on RC. Secondary outcomes included the prevalence of MPS based on SC and the relationship between MPS and either PS or medical devices. RESULTS: Thirty-four patients with incurable cancer were identified. MPS based on RC or SC was detected in 10 (29%) and 20 (59%) patients, respectively. Twenty-two of 34 patients who complained of pain, 10 (45%) had MPS based on RC and 20 (90%) had MPS based on SC. Age and central venous port were risk factors for MPS by multivariate analysis. CONCLUSION: A very high prevalence of MPS was detected in our study population. MPS should be considered when patients with incurable cancer complain of pain.

[Evaluation of the Small Excision Using a Sonographically Visible Breast Biopsy Marker(HydroMARK®)].

In case an operation is necessary after an ST-VAB for microcalcification, a wide excision needs to be performed because of the loss of marking. The HydroMARK®breast biopsy marker can be visualized using an ultrasound or mammography and facilitates a small excision. Six months after the deployment, all markers were visualized using an ultrasound. Thus, Hydro MARK®can decrease the sample size(11 g)in open biopsies and correctly diagnose ADH. However, no HydroMARK®cases were diagnosed with ADH in large samples(44 g, 32 g). Five malignant histology cases underwent mastectomy, and the distance between the HydroMARK®and tumor was 300 mm. HydroMARK®appears to be a safe and effective marker after a stereotactic biopsy for calcification, which facilitates an exact small excision of lesion surgically.

[Radiotherapy and Eribulin Mesylate for Mediastinal Node Metastasis from Breast Cancer-A Case Report].

A69 -year-old woman was diagnosed as having local advanced breast cancer. She was treated with neoadjuvant chemotherapy( AC followed by paclitaxel)and followed up with left total mastectomy with axillary lymphadenectomy for breast cancer(pT3N1aM0, Stage ⅢA, ER positive, PgR positive, and HER2 negative). She received adjuvant therapy with chest wall irradiation and an aromatase inhibitor. Two years after the mastectomy, mediastinal lymph node and rib metastases and dissemination appeared. We changed the regimen to capecitabine. She continued the capecitabine therapy for 7 years and was found to have multiple lung metastasis. Therefore, we chose eribulin mesylate therapy. Ten days after eribulin mesylate (1.0mg/body)was first administered, she suddenly had difficulty breathing, and chest CT revealed left low lobe atelectasis. The superior mediastinal lymph node had grown rapidly and compressed the left main bronchus and superior vena cava. To reduce the lymph node size, we started radiotherapy(50 Gy/25 Fr)for the superior mediastinal area in addition to the eribulin mesylate therapy. After the radiotherapy, chest CT revealed a remarkable reduction of lymph node size and full pulmonary reexpansion. One year after the radiotherapy, she is continuing treatment without systemic progression.

Cancer Transitional Care for Terminally Ill Cancer Patients Can Reduce the Number of Emergency Admissions and Emergency Department Visits.

BACKGROUND: Emergency admissions and emergency department visits (EAs/EDVs) have been used as quality indicators of home care in terminally ill cancer patients. We established a cancer transitional care (CTC) program to monitor and manage terminally ill cancer patients receiving care at home. The purpose of this study was to evaluate the effectiveness of CTC by the frequency of EAs/EDVs. METHODS: In a retrospective chart review, we identified 133 patients with cancer admitted to our department, of whom 56 met study eligibility criteria. The CTC consisted of at least 1 or more following components: (1) a 24-hour hotline for general physicians or home care nurses to reach hospital-based physicians, (2) periodic phone calls from an expert hospital-based oncology nurse to home care medical staff, and (3) reports sent to our department from home care medical staff. The primary outcome variable was the frequency of EAs/EDVs. RESULTS: There were 32 EAs/EDVs and 69 planned admissions during the observation period. In the last 30 days of life, 16 patients (28.6%) had 1 EA/EDV and none had multiple EAs/EDVs. Compared with previous studies, our study found a similar or lower frequency of EAs/EDVs. CONCLUSION: Our findings suggest that the implementation of CTC reduces the number of EAs/EDVs by replacing them with planned admissions. Further prospective studies to evaluate CTC are warranted.

[A Case of Shock Due to nabPTX Administration Successfully Treated with Cytokine Adsorption Therapy].

The patient was a 71-year-old woman with ER(+), PgR(-), HER2(3+), and Ki-674 2% breast cancer. After surgery for left breast cancer(Bt+Ax), epirubicin, cyclophosphamide therapy was administered as postoperative adjuvant chemotherapy, and nabPTX plus trastuzumab therapy was started sequentially. The patient was hospitalized due to severe neutrope- nia(neutrophils 0/mm3)from nabPTX, but her condition stabilized after admission. However, the patient suddenly went into shock after 3 days and was thus transferred to the ICU. Her general condition was rapidly improved through cytokine adsorption therapy in the ICU. After 5 days, she was extubated and wheeled back to a general ward. She was discharged without problems in the succeeding months. In this case, FN or cardiovascular diseases was ruled out, and engraftment syndrome was considered given that cytokine adsorption therapy significantly improved the patient's condition. Considering the risk for severe neutropenia in nabPTX administration, clinicians should exercise caution when administering the drug.

[Strut Adjusted Volume Implant(SAVI) - An Interim Report of Patient Satisfaction and Outcomes].

BACKGROUND: Strut adjusted volume implant(SAVI)was approved by the Food and Drug Administration(FDA)for the treatment of breast cancer in 2006. MATERIAL AND METHODS: The phase II study was conducted to investigate the activity and safety of SAVI in breast cancer patients. Criteria for SAVI treatments were N0, T<2 cm, and age≥40. After patients underwent breast-conserving surgery, they received SAVI twice a day×5 days(34 Gy). The primary endpoint are feasibility and safety. Second endpoint are local recurrence rate and cosmesis. RESULTS: Three patients were enrolled and the median duration of administration is 18.7 days(17-20). Further, the most common treatment-related adverse events were thickening and redness of skin(grade 1/2), while there was no deformity of breast in each case. CONCLUSION: The current study demonstrated that SAVI is well tolerated treatment in breast cancer patients and may be convenient for use in patient treatment.

[A case of consciousness disorder induced by the syndrome of inappropriate secretion of antidiuretic hormone following cisplatin and 5-fluorouracil chemotherapy in a patient with esophageal cancer].

We report a case of consciousness disorder following the fourth course of chemotherapy with cisplatin (CDDP) and 5- fluorouracil (5-FU) in a patient with esophageal cancer. A 74-year-old man was admitted to our hospital to receive chemotherapy for esophageal cancer. Six days after chemotherapy, the patient showed impaired consciousness and his serum sodium concentration was found to be 125 mEq/L, but no edema or dehydration was noted. This hyponatremic state was diagnosed as CDDP-induced syndrome of inappropriate secretion of antidiuretic hormone (SIADH) on the basis of serum and urine hypo-osmolality. Accordingly, fluid intake was restricted and sodium supplements were administered, resulting in an appropriate increase in the serum sodium concentration to 132 mEq/L in 4 days.