Duplication of the inferior vena cava (DIVC) is an uncommon embryological anatomic phenomenon.We report a 63-year-old woman with extensive right leg deep vein thrombosis who required an IVC filter due to contraindications for anticoagulation, but was found to have DIVC which required the placement of two IVC filters with good result. This report will review and summarise past reports of DIVC management to provide a guide for future clinicians, and review the embryological development, diagnosis and IVC filter placement options as they are based on the type of anatomic malformation encountered.
Introduction: While patients with hypercalcemia can be treated with various treatment options including volume expansion, loop diuretics, calcitonin, bisphosphonate, sensipar; hypercalcemia can be resistant to these measures. Case Description: In this report, we present two elderly patients with hypercalcemia resistant to traditional therapy. Both had parathyroid tumor. Early diagnosis could not be established. Both patients required hemodialysis. Hypercalcemia was controlled in the 74-year old who successfully underwent surgery with normalization of calcium level. The 79-year old was not considered a surgical candidate and was transitioned to hospice. Discussion & Conclusion: Primary hyperparathyroidism is an important cause of hypercalcemia. In order to reduce morbidity and mortality, its diagnosis must be established earlier on. These case reports prepared with residents/junior faculty will benefit other trainees with the diagnosis and management of refractory hypercalcemia and highlight a teaching point that prompt diagnosis of primary hyperparathyroidism can have a major positive impact on the overall management of hypercalcemia.
e15629 Background: Enzalutamide, a second-generation androgen receptor inhibitor widely used in the treatment of prostate cancer, is often discontinued due to adverse events. A meta-analysis of randomized controlled trials was performed to examine the overall tolerability of enzalutamide in prostate cancer in comparison with controls. Methods: Databases including PubMed (up to December 2019) and Google scholar (up to December 2019) were searched to identify all phase II and III randomized controlled trials that compared enzalutamide with placebo (with or without other anti androgen drugs) along with reported data regarding drug discontinuation due to adverse events with enzalutamide and placebo. A random- or fixed-effects model was used to determine summary incidences, relative risks (RR), and 95% confidence intervals depending on the heterogeneity of included studies. Results: A total of 7 RCTs were eligible for analysis which included 7,343 patients (enzalutamide: n = 4116, control: n = 3227). The summary incidence of tolerability measured as discontinuation rate due to adverse events was 7.3% (95% CI: 6.1-8.7%) with enzalutamide and 5.7% (95% CI: 4.3-7.5%) with placebo or first-generation antiandrogens including bicalutamide, nilutamide or flutamide. The tolerability of enzalutamide varied with stage of prostate cancer with significantly higher incidence of discontinuation (9.8%, 95% CI: 8.0-11.9%) in non-metastatic prostate cancer group than metastatic prostate cancer group (6.7%, 95% CI: 5.8-7.6%). In comparison with controls, enzalutamide did not significantly affect the tolerability with an RR of 1.25 (95% CI: 0.95-1.66, P = 0.12). In addition, enzalutamide did not significantly affect the tolerability with an RR of 1.11 (95% CI: 0.80-1.53, P = 0.54) when compared to placebo. Conclusions: Enzalutamide may be comparable to placebo or first-generation antiandrogens in the tolerability for prostate cancer patients. Cautions should be taken to avoid unnecessary discontinuation.
e18828 Background: Patients with cancer receiving treatment can have symptoms related to their disease or treatment. Early recognition and appropriate intervention of these symptoms can lead to fewer emergency room visits and fewer hospitalizations with significant reduction in healthcare costs. Earlier treatment of symptoms leads to more adherence to treatment. We present data regarding reduction in healthcare costs after implementation of remote patient monitoring in our community oncology practice with 13 oncology practice sites and 29 medical oncologists in Jacksonville, Florida. Methods: We implemented RPM through a smartphone application at all our practice sites starting September 1,2021. We collected data regarding number of patients on active therapy who required inpatient admissions during the 3-month period from 9/1/2021 to 11/30/21 . We documented the number of admissions during this 3-month period in 2020, prior to implementation of RPM followed by number of admissions during the same period of time in 2021 after the implementation of RPM. The numerical difference in admissions was then multiplied by average cost of hospitalization for adult cancer patients to calculate the healthcare cost savings. Results: During the 3-month period in 2020 without RPM, there were 234 inpatient admissions. During the same time frame in 2021, after implementation of RPM, there were 199 admissions. The implementation of RPM, showed a 15 % reduction in number of inpatient admissions. Average cost of inpatient stay for a cancer patient is $22,100 as per the data from healthcare cost and utilization project. This would translate to $773,500 over 3-month period and approximately $3 million annual healthcare cost savings. The annual cost of implementation of RPM in our practice was $350,000 which includes cost of smartphone application and the required clinical staff. Conclusions: Remote patient monitoring through smartphone application can be effectively implemented in community oncology practice with significant reduction in healthcare costs. Not only does it save money, it helps improve patient experience and adherence to treatment. We will continue to collect data to see if the trend continues.
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