Implementation of Do Not Attempt Resuscitate Orders in a Japanese Nursing Home

Objective: To investigate whether do not attempt resuscitation (DNAR) orders can be implemented in a standard nursing home in Japan, where routine DNAR orders are not yet common in many facilities including hospitals. Method: Ninety-eight residents in a 100-bed nursing home were evaluated. All of the eligible residents and/or their family members were asked whether they wanted to receive resuscitation, including mechanical ventilation. Result: The residents were 54 to 101 years of age (mean 83.3), with 27 males and 71 females. After administering the questionnaire, 92 (94%) patients did not want resuscitation and mechanical ventilation. Conclusion: In a nursing home, it was possible to obtain advance directives by which most residents/families rejected resuscitation and mechanical ventilation. This could avoid unnecessary and undesirable resuscitation procedures

A case of obstructive sleep apnea syndrome caused by malignant melanoma in the nasal cavity and paranasal sinus

A 71 year-old obese woman complained of obstructive sleep apnea syndrome (OSAS) related symptoms. The apnea-hypopnea index (AHI) was 73.5/hour. She presented with nasal bleeding to an ENT doctor. A mass on the nasal septum was seen and biopsy was performed. Histological confirmation showed malignant melanoma. The tumor stage proved to be cT4aN2M1 (stage IV) due to multiple metastatic lesions. After palliative irradiation, the nasal tumor was reduced in size and her symptoms of OSAS were improved. The second AHI revealed 13.5/hour. This case was considered to be OSAS caused by a tumor obstructing the nasal cavity. This might suggest the necessity of routine work-up of the upper airway in cases of patients with sleep disorder. Otherwise, OSAS caused by such obstruction might be missed. We report a very rare case with secondary OSAS caused by malignant melanoma in the nasal cavity and paranasal sinus

Successful treatment of non-small cell lung cancer with gefitinib after erlotinib-induced severe eyelid erosion: Two case reports

Gefitinib and erlotinib are first-generation, small, molecular inhibitors of the epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI). Even as these drugs have led to a paradigm shift in the treatment of advanced non-small cell lung cancer (NSCLC), drug-induced adverse effects are commonly seen. We experienced two cases of NSCLC patients who developed erlotinib-induced eyelid erosion and were then successfully treated with gefitinib, without recurrence of toxicity or disease progression. As far as we had investigated, this is the first report documenting the successful cases treated with gefitinib after erlotinib-related severe eyelid erosion

Non-HIV pneumocystis pneumonia

Human immunodeficiency virus (HIV)-uninfected Pneumocystis jirovecii pneumonia (non-HIV PCP) can develop in patients with autoimmune diseases, malignancies, and other diseases, and it can lead to potentially lethal respiratory dysfunction showing a high mortality (1–3). Over the past decade, a paradigm shift in the treatment of autoimmune disease such as rheumatoid arthritis (RA) (4, 5) and inflammatory bowel diseases (IBD) has been brought about by the introduction of biologics (6–8). While the emergence of innovative biologic agents targeted at specific molecules and pathways in the immune system have altered the clinical course of autoimmune disease patients and improved their quality of lives and social outcomes, increasing incidence of non-HIV PCP have been noticed (4–8). In the field of solid organ transplant recipients and malignancies, the emergence of new generation of immunosuppressive agents, such as rituximab and cytotoxic agents could result in frequent occurrence of non-HIV PCP (9–13). Today, although every clinician could encounter PCP patients, there is no established standard treatment for non-HIV PCP. We review recent topics and some aspects to improve the treatment of non-HIV PCP