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Background Gallbladder cancer (GBC) is one of the refractory diseases. Multidisciplinary approach including immunotherapy for such cancers has received much attention in recent years. Case presentation A 59-year-old man underwent an extended cholecystectomy for GBC (pathological stage II, T2 N0 M0, [per UICC 7th edition]) that was incidentally found during cholelithiasis surgery, and was then treated with adjuvant gemcitabine (GEM). Three months later, when a recurrence-suspected lesion was detected in segment 5 (S5) of his liver, we started adoptive immunotherapies with cytokine-activated killer (CAK) cell infusions, combined with chemotherapy. After a year of adjuvant immunochemotherapy, the S5 lesion disappeared on imaging, but lesions suspected metastatic recurrence again appeared in S7 and S8 at 4 years and 6 months post-surgery, for which GEM and cisplatin (CDDP) were administered as second-line chemotherapy. Immunochemotherapy produced stable disease (per RECIST) for 9 months, when tumor growth was detected; open microwave coagulo-necrotic therapy (MCN) was performed for these lesions. Three years after MCN, a solitary liver metastasis was detected in S4. MCN was conducted again, and peritoneal dissemination was found intraoperatively. A month after the second MCN, the patient’s carcinoembryonic antigen (CEA) level had increased. Therefore, GEM and tegafur-gimeracil-oteracil potassium (TS-1) were administered as third-line chemotherapy. We also switched the adoptive immunotherapy for tumor-associated antigen-pulsed dendritic cell-activated killer (DAK) cell immunotherapy. After nine courses of GEM and TS-1 administration, CEA had decreased to a normal level. At the time of reporting, 9 years and 6 months have passed since the initial surgery, and 18 months have passed since the peritoneal metastasis was detected. GEM and CDDP are currently administered as fourth-line chemotherapy because of re-increased CEA. Although an undeniable metastasis was found in his para-aortic lymph node, this patient visits our clinic regularly for immunotherapy. Conclusion We here report a rare case of long-term survival of recurrent GBC well controlled by multidisciplinary therapy. Immunotherapy may be a promising modality among multidisciplinary methods for advanced cancer.

Transient elevation of antiphospholipid antibody (APLA) is commonly observed in cases of viral infection; however, it is generally not associated with clinical thromboembolic events. In this report, we present a rare case of superior mesenteric artery (SMA) thrombosis associated with a transient elevation of APLA and discuss its relationship with fibromuscular dysplasia and adenomyosis of the uterus. Furthermore, we discuss the use of anticoagulant therapy in cases with transient elevation of APLA. In this case, a 46-year-old woman with no significant medical history was diagnosed with intestinal stenosis after SMA thrombosis that had been resolved with anticoagulant therapy. Laboratory examination showed elevated levels of anticardiolipin antibody. Resection of the stenosed ileum and hysterectomy for huge adenomyosis were performed. Anticardiolipin antibody level normalized 4 months after the operation. Anticoagulant therapy was withdrawn after anticardiolipin antibody normalized, and the patient has been free from thromboembolic events ever since. Transient elevation of APLA should be kept in mind in all patients with thromboembolic events, including those with no medical history of collagen diseases or infection. In the present case, association with fibromuscular dysplasia and adenomyosis of the uterus is suspected, but further investigation is required. Once the APLA level normalizes with the resolved thrombus, decision of withdrawing the anticoagulant therapy can be considered.

Physical function is considered to be associated with dysphagia: however, there is little data regarding the association between dysphagia and functional decline during hospitalization among older patients. The aim of the present study was to investigate the prevalence of dysphagia, and the association between dysphagia and functional status during hospitalization in older acute-care patients.A total of 103 older patients without present or prior history of diseases that could directly impair swallowing and cause dysphagia (45 men and 58 women; mean age 80.5 years) hospitalized in acute-care wards were included in the present study. Dysphagia or difficulty swallowing was assessed by using the 10-item Eating Assessment Tool. Functional and nutritional status, such as Barthel Index (BI), Mini-Nutritional Assessment short form, body mass index, calf circumference, handgrip strength and dysphagia, were analyzed to evaluate their relationships.Dysphagia, as assessed using the 10-item Eating Assessment Tool, was noted in 26.2% of the participants. Multivariate analysis showed that dysphagia, handgrip strength and BI on admission were independently associated with poor BI gain during hospitalization after adjustment for age, sex, causative disease for admission, premorbid ADL, length of hospital stay, Mini-Nutritional Assessment short form, handgrip strength and BI.Dysphagia, as assessed by the 10-item Eating Assessment Tool, was common in older patients. In addition, dysphagia was independently associated with poorer functional recovery during acute-care hospitalization of older patients. Geriatr Gerontol Int 2017; 17: 1610-1616.

Aim Physical function is considered to be associated with dysphagia: however, there is little data regarding the association between dysphagia and functional decline during hospitalization among older patients. The aim of the present study was to investigate the prevalence of dysphagia, and the association between dysphagia and functional status during hospitalization in older acute-care patients. Methods A total of 103 older patients without present or prior history of diseases that could directly impair swallowing and cause dysphagia (45 men and 58 women; mean age 80.5 years) hospitalized in acute-care wards were included in the present study. Dysphagia or difficulty swallowing was assessed by using the 10-item Eating Assessment Tool. Functional and nutritional status, such as Barthel Index (BI), Mini-Nutritional Assessment short form, body mass index, calf circumference, handgrip strength and dysphagia, were analyzed to evaluate their relationships. Results Dysphagia, as assessed using the 10-item Eating Assessment Tool, was noted in 26.2% of the participants. Multivariate analysis showed that dysphagia, handgrip strength and BI on admission were independently associated with poor BI gain during hospitalization after adjustment for age, sex, causative disease for admission, premorbid ADL, length of hospital stay, Mini-Nutritional Assessment short form, handgrip strength and BI. Conclusions Dysphagia, as assessed by the 10-item Eating Assessment Tool, was common in older patients. In addition, dysphagia was independently associated with poorer functional recovery during acute-care hospitalization of older patients. Geriatr Gerontol Int 2017; 17: 1610–1616.