Ureteropelvic junction obstruction caused by metastatic cholangiocarcinoma

We describe the rare case of a 61-year-old female with right ureteropelvic junction (UPJ) obstruction caused by metastatic cholangiocarcinoma. Her past medical history was notable for cholangiocarcinoma treated with neoadjuvant chemoradiation and two orthotopic liver transplants six years earlier. Urology was consulted when she presented with flank pain and urinary tract infection. Diagnostic workup demonstrated right UPJ obstruction. She was managed acutely with percutaneous nephrostomy. She subsequently underwent robotic pyeloplasty and intrinsic obstruction of the UPJ was discovered. Histological examination revealed adenocarcinoma, consistent with systemic recurrence of the patient\u27s known cholangiocarcinoma

The Diminishing Dominion of Expert Opinion: Missouri’s Imposition of the Ultimate Issue Rule

In August 2017, the Missouri General Assembly amended its expert testimony statute, Section 490.065. The newly-enacted Section 490.065.2(3)(b) states, “In a criminal case, an expert witness shall not state an opinion about whether the defendant did or did not have a mental state or condition that constitutes an element of the crime charged or of a defense. Those matters are for the trier of fact alone.” Section 490.065.2(3)(b) is identical to Federal Rule of Evidence 704(b) (“Rule 704(b)”). This change is significant because issues in criminal cases, such as deliberation with respect to homicide and the affirmative defense of insanity, frequently implicate defendants’ mental states. In addition, Rule 704(b) and its state-law counterparts have drawn significant scholarly criticism as unduly restricting helpful expert testimony. For example, one scholar argues Rule 704(b) produces “counterproductive” and “troubling” results by “requir[ing] the jury, as the finder of fact, to reach a conclusion as to the defendant’s mental state without the benefit of the most useful testimony the expert could offer.