BACKGROUND Fistula formation is a severe adverse event related to antiangiogenetic agents such as bevacizumab and inferior mesenteric arteriovenous fistula(IMAVF) is a result of acquired factor, especially colon surge...BACKGROUND Fistula formation is a severe adverse event related to antiangiogenetic agents such as bevacizumab and inferior mesenteric arteriovenous fistula(IMAVF) is a result of acquired factor, especially colon surgery. However, IMAVF occurs very rarely and there are few reports in patients during chemotherapy. We report a case of a patient who developed IMAVF during treatment with bevacizumab in metastatic colorectal cancer(mCRC) after colon surgery.CASE SUMMARY An 81-year-old man was diagnosed with descending colon cancer and underwent left hemicolectomy without any complications. He was definitely diagnosed with high-risk stage 2 and received tegafur-uracil plus leucovorin as adjuvant chemotherapy. Three years and 6 mo after the operation, the cancer relapsed with peritoneal dissemination. The patient underwent CyberKnife radiosurgery targeting the recurrent tumor and received chemotherapy with S-1 plus bevacizumab. At 1 year after chemotherapy, he complained of severe diarrhea, which is suspected drug-induced colitis. As diarrhea worsened despite the termination of treatment, he underwent colonoscopy and computed tomography (CT) scans that revealed edematous change from sigmoid to rectosigmoid colon. CT scans also revealed an aneurysm adjacent to the inferior mesenteric vein and multidetector CT angiography showed the IMAVF. Elective angiography confirmed the diagnosis of an IMAVF and it was successfully treated by arterial embolization. The patient resumed chemotherapy with only S-1 6 mo after embolization.CONCLUSION Clinicians should keep in mind the probability of severe diarrhea arose from IMAVF in mCRC patients treated with bevacizumab.展开更多
Purpose: To clarify the effect of percutaneous vertebroplasty for vertebral compression fracture by assessing the changes of radiographic and CT image findings. Materials and Methods: A retrospective radiological anal...Purpose: To clarify the effect of percutaneous vertebroplasty for vertebral compression fracture by assessing the changes of radiographic and CT image findings. Materials and Methods: A retrospective radiological analysis comprising 101 vertebrae of 48 patients who underwent percutaneous vertebroplasty for painful osteoporotic vertebral compression fracture was conducted. Whole spine radiographs and CT images were compared in patients preoperatively and 6 months postoperativey. Sagittal Cobb angles in three regions, sagittal vertical axis, and pelvic tilt were measured using whole spine lateral radiographs. CT findings due to the vertebral compression fracture, its healing process, and complications were evaluated. Results: On radiographs, sagittal alignment had an average gain of no more than 2.5° in each region. Sagittal vertical axis and pelvic tilt did not show significant change. Out of 68 vertebrae that demonstrated cortical disruption on preoperative CT, 37 (54%) demonstrated fusion of disrupted cortex on postoperative CT. Conclusion: No significant difference was observed between preoperative and postoperative spinal sagittal alignment on radiographs. However, CT did reveal healing process through fusion of disrupted cortex, intervertebral bridging, and increased density of cancellous bone. It is suggested that cement in the space of fracture may play a role in both mechanical stability and bone union.展开更多
文摘BACKGROUND Fistula formation is a severe adverse event related to antiangiogenetic agents such as bevacizumab and inferior mesenteric arteriovenous fistula(IMAVF) is a result of acquired factor, especially colon surgery. However, IMAVF occurs very rarely and there are few reports in patients during chemotherapy. We report a case of a patient who developed IMAVF during treatment with bevacizumab in metastatic colorectal cancer(mCRC) after colon surgery.CASE SUMMARY An 81-year-old man was diagnosed with descending colon cancer and underwent left hemicolectomy without any complications. He was definitely diagnosed with high-risk stage 2 and received tegafur-uracil plus leucovorin as adjuvant chemotherapy. Three years and 6 mo after the operation, the cancer relapsed with peritoneal dissemination. The patient underwent CyberKnife radiosurgery targeting the recurrent tumor and received chemotherapy with S-1 plus bevacizumab. At 1 year after chemotherapy, he complained of severe diarrhea, which is suspected drug-induced colitis. As diarrhea worsened despite the termination of treatment, he underwent colonoscopy and computed tomography (CT) scans that revealed edematous change from sigmoid to rectosigmoid colon. CT scans also revealed an aneurysm adjacent to the inferior mesenteric vein and multidetector CT angiography showed the IMAVF. Elective angiography confirmed the diagnosis of an IMAVF and it was successfully treated by arterial embolization. The patient resumed chemotherapy with only S-1 6 mo after embolization.CONCLUSION Clinicians should keep in mind the probability of severe diarrhea arose from IMAVF in mCRC patients treated with bevacizumab.
文摘Purpose: To clarify the effect of percutaneous vertebroplasty for vertebral compression fracture by assessing the changes of radiographic and CT image findings. Materials and Methods: A retrospective radiological analysis comprising 101 vertebrae of 48 patients who underwent percutaneous vertebroplasty for painful osteoporotic vertebral compression fracture was conducted. Whole spine radiographs and CT images were compared in patients preoperatively and 6 months postoperativey. Sagittal Cobb angles in three regions, sagittal vertical axis, and pelvic tilt were measured using whole spine lateral radiographs. CT findings due to the vertebral compression fracture, its healing process, and complications were evaluated. Results: On radiographs, sagittal alignment had an average gain of no more than 2.5° in each region. Sagittal vertical axis and pelvic tilt did not show significant change. Out of 68 vertebrae that demonstrated cortical disruption on preoperative CT, 37 (54%) demonstrated fusion of disrupted cortex on postoperative CT. Conclusion: No significant difference was observed between preoperative and postoperative spinal sagittal alignment on radiographs. However, CT did reveal healing process through fusion of disrupted cortex, intervertebral bridging, and increased density of cancellous bone. It is suggested that cement in the space of fracture may play a role in both mechanical stability and bone union.
