Useful anticoagulation therapy with heparin for Trousseau's syndrome in a terminally ill patient with rectal cancer： A case report

Trousseau syndrome is a clinical condition in which a thrombosis and embolism are caused by hypercoagulation associated with a malignant tumor. Here we report on a patient who developed a cerebral infarction during hospitalization in a palliative care unit due to advanced recurrent rectal cancer and was treated with anticoagulation therapy. A 50—year—old woman who experienced lung metastasis and bone metastases after rectal cancer surgery was hospitalized in a palliative care unit because increasing pain made home care difficult. Although her pain was relieved by drug therapy and irradiation, she developed a partial visual field defect and aphasia in succession when she received medical treatment because of respiratory discomfort due to advanced pulmonary metastases. Multiple cerebral infarctions were observed on a magnetic resonance imaging and blood tests revealed disseminated intravascular coagulation； therefore she was diagnosed with Trousseau syndrome. After the initiation of anticoagulation therapy, the aphasia improved. No adverse events were caused by treatment. All patients in the terminal phase should not be equally judged as not being candidates for anticoagulation therapy. It is necessary to examine each patient’s suitability by considering their prognosis and general condition as well as the significance and safety of the treatment.

Epidural catheter elongated through subcutaneous tunnel from the puncture site to the frontal abdominal wall in terminally ill cancer patients: a report of 3 cases

Continuous epidural injection of opioid/local anesthetic drugs can be a useful tool to alleviate intractable pain in cancer patients. The use of an epidural catheter, however, always faces with contamination and infection. In order to avoid contamination, an injection port is often implanted in the subcutaneous space and intermittent or continuous injection is employed. The injection port requires an additional cost and a little more time for implantation. Both the cost and the time-requiring procedure may be of problem in the terminally ill cancer patients. We present 3 cases of cancer patients with high risk of catheter contamination treated with continuous epidural injection using catheters elongated through subcutaneous tunnel from the epidural puncture site to the front side of abdominal wall. The risk factors of the patients were; subcutaneous emphysema due to intestinal perforation in a 81 yr male with bladder cancer, local abscess and MRSA infection in a 45 yr female with uterine cancer, and cutaneous tissue disruption in a 51 yr female with lung cancer and multiple metastasis. The duration of epidural analgesia were 22, 26, and 21 days until the patient's death, respectively. Although the risk of epidural catheter contamination and infection was extremely high in all three patients, continuous epidural injection for more than 3 weeks was possible with favorable analgesic effects. Use of an epidural catheter elongated through subcutaneous route from the puncture site to the frontal abdominal wall offers a practical and inexpensive way in patients with intractable pain at least for a few weeks. Palliat Care Res 2011; 6(2): 350-357