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.
The feasibility and efficacy of adriamycin or epirubicin in combination with cyclophosphamide followed by weekly paclitaxel (AC/EC-weekly PAC) as adjuvant chemotherapy for breast cancer was investigated.
The feasibility of treatment containing bevacizumab (BV) for elderly patients is not well established. We investigated the safety of treatment containing BV for advanced or metastatic colorectal cancer in elderly patients. From June 2008 to December 2010, 22 patients were treated with BV in our hospital. We classified them into three groups: less than 65 years (group A: 8 patients), 66-75 years (group B: 9 patients), and more than 76 years (group C: 5 patients). Then, we compared the adverse events involving BV. The patient median age was 71. 5 (range 45-84)years old; 10 patients were treated in first-line therapy and 12 patients in second-line therapy or beyond. The number of patients with hypertension was one (12. 5%) in group A, 3 (33. 3%)in group B, and 3 (60%) in group C. Treatment was continued in 4 patients, and discontinued in 18. The reasons for discontinuing BV treatment were tumor progression in 14 patients, toxicities in 3 patients, and degradation of performance state in one patient. BV-associated adverse events had a tendency to become severe with aging, and patients for whom BV treatment was discontinued because of toxicities were all in group C. Severe adverse events of rectal bleeding, cerebral hemorrhage and cerebral infarction were observed in three patients. These patients had risk factors for BV-associated adverse events such as hypertension or a history of radiation therapy, besides the risk factor of age. It is suggested that BV-associated adverse events are highly frequent and severe in elderly patients. Especially in patients over 76 years old, risk factors such as hypertension and severe adverse events were observed. The administration of BV for elderly patients should be considered very carefully.
Chemotherapy with bevacizumab(BV)has been one of the standard treatments for patients with metastatic colorectal cancer. However, emergent treatments are sometimes required because of severe adverse events associated with it. We experienced a case of massive rectal hemorrhage during BV treatment, and interventional radiology(IVR)successfully controlled it. An 81-year-old male visited our hospital, suffering from local recurrence of rectal cancer. He underwent colostomy for fecal diversion, and chemoradiation therapy was performed. Systemic chemotherapy with XELOX+BV was performed for the residual tumor. On the 27th day after the first administration of BV, the patient was hospitalized because of anal bleeding and a state of shock. The colonoscopic examination showed a dimple caused by tumor shrinkage, which was closed by clipping. However, a state of shock was caused by intermittent hemorrhages again afterwards. The hemorrhagic point was identified as the oral side of the dimple by angiography, and coil embolization led to immediate hemostasis. The colonoscopic examination revealed nothing abnormal besides the dimple. It is therefore suspected that the cause of rectal hemorrhage might be induced by BV. During combination chemotherapy with BV, bleeding is one of the severe adverse events requiring an emergent treatment regardless of BV dose. IVR may be an effective treatment when bleeding can not be controlled by endoscopic hemostasis. Therefore, we should construct a system for emergency hemostasis including IVR.
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