ABSTRACT
Ureteral stents are used to relieve acute or chronic urinary tract obstructions and may be complicated by stent encrustation. The development of encrustation is related to indwelling time, stent composition, bacterial biofilm formation, malabsorptive disorders, metabolic disorders (hypercalcemia, hyperuricosuria, pH imbalance), and cancer. Without intervention, encrustation may lead to luminal obstruction, infection, stent fracture, or ureteral avulsion during removal. Rarely, forced removal of an encrusted stent may cause the encrustation to remain in the urinary tract which can lead to further complications. Diagnosis of a retained encrustation includes evaluation with X-ray, ultrasound, and CT. Management strategies of retained encrustations are not standardized but may include removal with flexible ureteroscopy. In the following case, we present a 58-year-old male with retained encrustation material following non-forced stent removal that was not readily observed on initial imaging. CT demonstrated a curved, tubular radiodensity representing calcified encrustation material, and the diagnosis of retained encrustation was confirmed after successful removal with flexible ureteroscopy. We concluded that ureteral stent encrustation can remain in the urinary collecting system following stent removal, although this complication is rare and not well studied.
ABSTRACT
Giant ovarian cysts (>10 cm) are rare due to the widespread use of routine imaging. However, in the absence of compressive symptoms, giant cysts remain a diagnostic challenge, especially in patients with larger body habitus. Complications of benign ovarian cysts are infrequent but can include torsion of the adnexa. Bilateral torsion is a rare emergency that can threaten a patient's future fertility. In this case, we report on a 24-year-old female with bilateral torsion due to a triad of adnexal masses including a 30 cm mucinous cystadenoma, a 10 cm mature teratoma, and an 8 cm paratubal cyst. Controlled fluid aspiration was performed prior to en bloc resection of the cystadenoma due to the emergent nature of the case and lack of malignant features.
ABSTRACT
Background: The 5 year survival rate of esophageal cancer is under 20%. Studies have shown that early palliative treatments can improve patient quality of life and lower depressed mood without expediting mortality. Despite these benefits, few studies have analyzed factors associated with the national variation among patients who received palliative treatment for esophageal cancer. Methods: This is a retrospective study of adults diagnosed with stage IV esophageal cancer between 2004 and 2018 in the National Cancer Database (NCDB) who received palliative treatment or not (n = 43,599). Cross tabulation and binary logistic regression were performed and evaluated using SPSS. Exclusion criteria included concurrent tumors, patients under age 18, and missing data. Results: Of the 43,599 patients, 26.1% of patients received palliative interventions (n = 11,371). The majority of palliative treatment patients lived less than 6 months after diagnosis (54%) and received radiation (35.7%) or chemotherapy (34.5%) with palliative intent. The patients who received palliative treatment tended to be non-Hispanic (96.6%), white (87.2%), male (83.3%) patients between age 61 and 75 (43.8%) at a comprehensive community cancer program (38.7%) with adenocarcinoma histology (71.8%). Palliative treatment patients most commonly relied on Medicare as their primary payor (45.9%) and had a median household income over $48,000 (54.5%). Conclusion: We identified trends among stage IV esophageal cancer patients receiving palliative treatments. Patients receiving palliative treatments tended to be white, non-Hispanic men. Compared to patients who did not receive palliating treatments, this cohort was more likely to receive treatment at a comprehensive, academic, or integrated network facility.
