Management of advanced colon cancer in a community hospital--impact of age on clinical management and survival.

PURPOSE: Colon cancer is more common in the elderly than in younger and middle-aged people. Cancer clinical trials focus more on younger patients and the management of elderly patients with advanced disease is still unclear. METHODS: We studied all patients presenting with colon adenocarcinoma metastasis to liver at a community teaching hospital from Dec 2000 through Dec 2007 by a retrospective review of Tumor Registry data and patient chart review with focus on age, clinical management, decision making, and survival. Sixty-seven patients with a median age of 69 and a male to female ratio of 31:36 were identified. RESULTS: The patients with obstructive symptoms and Eastern Cooperative Oncology Group performance status on presentation though varied little by age, smaller proportion of elderly patients underwent resection of the primary bowel tumor in the presence of liver metastases with ten of 16 (63%) aged 80 or greater being managed without surgery. The percentage of patient's preference to physician's preference for patients not undergoing the primary bowel resection increased for older age group. Median survival decreased significantly with age (p < 0.05). CONCLUSIONS: Age-related clinical management, decision-making autonomy, and survival are apparent in this study, and there was an increasing trend of patient's involvement in decision making as the age increases and, thus, affecting the age-related clinical management.

A large spontaneous abdominal bruise in a 60-year-old woman: a case report.

OBJECTIVE: To report a case of severe abdominal bruising successfully diagnosed using systematic hemostatic investigations. CLINICAL PRESENTATION AND INTERVENTION: A 60-year-old woman developed a large spontaneous nontraumatic, painless bruise over the right lower abdominal wall. Computed tomographic scan of the abdomen showed a subcutaneous hematoma beneath the site of the obvious bruise diagnosed as a hematoma. Laboratory tests revealed an activated partial thromboplastin time of 53 s and a factor VIII level of <1%, consistent with the diagnosis of acquired hemophilia A. The patient was treated with steroids and immunosuppressants and her factor VIII levels gradually normalized. CONCLUSION: This case report showed that whenever there is spontaneous bruising, factor VIII deficiency should be considered as one of the important differential diagnosis.

Migration of the chest tube into the esophagus in a case of Boerhaave's syndrome.

Boerhaave's syndrome is the spontaneous transmural rupture of the esophagus. Patients can have a variety of manifestations. Boerhaave's syndrome has to be considered in acutely ill patients with no other explanations for their illness. Computed tomography scan of the chest is emerging as a useful tool for the evaluation of these patients. Surgical repair is the standard of care. Adequate drainage of the pleural fluid is necessary to prevent pulmonary complications. Esophageal perforation should be considered whenever thoracostomy tube drainage assumes an enteric character. When inserting the chest tube for draining pleural fluid, the trochar should not be used because of potential injury to the already perforated esophagus. Posterior placement of the chest tube should be avoided because the tube may migrate into the perforated esophagus. Because of the high incidence of mortality, prompt suspicion, diagnosis, and management are warranted. A careful history, detailed review of the imaging, and a high index of suspicion are key for prompt diagnosis.