e18688 Background: Sarcomas are a group of heterogenous tumors with diverse histopathological types. They account for less than 1% of adult solid tumors (1). The estimated new cases were 13,190 with 5,130 estimated deaths in 2022(2). Survival is largely determined by presence of metastasis on diagnosis, grade, site, and size of the tumor(3). Data over 19 years in our safety net hospital were analyzed including demographic data, disease characteristics and treatment modalities in association with overall survival. Methods: All patients diagnosed with sarcoma from 1998 to 2017 were included in the analysis. Patients were categorized by insurance status, stage, site, grade, pain on presentation, and treatment modalities. Survival analysis and Kaplan-Meier curves were conducted to examine the relation between patient demographics and survival. Results: Of 163 patients included in the analysis, 54% were insured and 46% were uninsured. Uninsured patients had a higher overall survival rate compared to insured patients (HR = 0.49, CI 0.38-0.90, p = 0.014). Regarding race, 55% of patients were white, 35.6% were black and 9.2% patients were identified as other races. There was no difference in overall survival between different ethnicities. Regarding gender, 61.3% were males and 38.7% were females with no statistically significant difference in survival. Compared to stage I, stage III were 2.28 times (CI 1.27-4.08, p = 0.005) and stage IV were 5.76 times (CI 3.16-10.05, p < 0.001) more likely to die. There was no statistically significant improvement in overall survival in patients who underwent chemotherapy or radiotherapy. However, surgical intervention was associated with improved survival and patients were three times more likely to survive (0.3, CI 0.18-0.5, p < 0.001). Analysis also showed no statistically significant difference in survival in patients presenting with pain. Conclusions: Insured patients have better outcomes overall than uninsured patients in sarcomas(4). Nevertheless, within safety-net-hospitals, all patients receive necessary treatment regardless of insurance status. We found that in our institution, insurance may factor in delaying treatment due to hurdles such as prior authorizations, co-pays and coverage disruptions(5). Conversely, uninsured patients can begin appropriate treatment without such delays which could explain difference in survival rates. Additional studies are needed to identify the possible effects of insurance and pinpoint its burden on survivorship. [Table: see text]
Introduction: Emphysematous gastritis is a rare and severe condition characterized by the presence of air and bacteria in the gastric wall. It usually presents with severe abdominal pain and diagnosed by presence of gas within the gastric wall on imaging. It has a high mortality rate of about 60-80%. Conservative management is the mainstay of treatment. Case Description/Methods: A 36-year-old male with a past medical history of alcohol use disorder and major depressive disorder presented with severe diffuse abdominal pain with post-prandial worsening, intractable nausea, and vomiting. This was preceded by binge drinking of alcohol. He reported poor appetite over one month associated with 17lb weight loss and early satiety. No history of liver disease, peptic ulcer disease, excessive NSAID or aspirin use. He was tachycardic and normotensive. No signs or symptoms of overt GI bleeds. Physical exam was negative for guarding or tenderness. Labs were remarkable for lactic acidosis of 3.6 mmol/L with an anion gap of 21. Lipase and LFTs were normal. CT abdomen showed gastric emphysema and mild diffuse circumferential thickening with fat deposition through the cecum and sigmoid colon, suggestive of emphysematous gastritis. General surgery was consulted but recommended no acute surgical intervention. He was started on a clear liquid diet, pantoprazole drip, empiric IV Piperacillin-Tazobactam, pain medications, and IV fluids. EGD showed moderate gastritis, no necrosis, mild duodenitis. Biopsy showed mild chronic gastritis. Patient improved clinically and repeat CT abdomen in 2 days showed improvement in gastric emphysema. He was discharged with a 7-day course of oral Amoxicillin-Clavulanate and indefinite pantoprazole 40mg BID (Figure). Discussion: Emphysematous gastritis starts with disruption of the integrity of gastric mucosa with secondary infection. Isolated organisms include Streptococci, S. Aureus Enterococci, Clostridium, Klebsiella, Pseudomonas, E.Coli, Enterobacter. Ischemia is an inciting event as seen in volvulus, SMA occlusion, acute gastric dilation. Mechanical causes include forceful emesis, gastric outlet obstruction, malignancy, and iatrogenic causes like gastrostomy or NG tube insertion, myotomy and biliary stents. Risk factors are alcohol use, NSAID and steroid use, cytotoxins, diabetes, abdominal surgery, and burns. Optimal conservative management with diet management, IV fluids, antibiotics has good outcomes as demonstrated by the above case and additional recent cases in literature.[3590] Figure 1. A-Gastric emphysema and mild diffuse circumferential thickening with fat deposition through the cecum and sigmoid colon, suggestive of emphysematous gastritis B-Significantly decreased air locules along the periphery of the proximal gastric mucosa.
Figure 1. Images of the patient's abdomen and right thigh (left) and left hip (right). The skin is extensively involved with painful retiform purpura and areas of superficial necrosis with associated hemorrhagic bullae.
Solitary extramedullary plasmacytoma (SEP) is a rare tumor due to the monoclonal proliferation of plasma cells without bone marrow involvement. Plasmacytomas are frequently encountered in bone or soft tissue but rarely occur in the gastrointestinal (GI) tract. They can present with a multitude of symptoms depending on their site. This report describes a case of SEP diagnosed as a duodenal ulcer (DU) during esophagogastroduodenoscopy (EGD) for iron deficiency anemia.
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