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Hepatopulmonary syndrome is the clinical relationship between hepatic dysfunction and the existence of pulmonary vascular dilatations which can result in a range of arterial oxygenation abnormalities.[1,2] The first published description [...]

Objective. Although the Health Care Financing Administration (HCFA) uses Medicare hospital mortality data as a measure of hospital quality of care, concerns have been raised regarding the validity of this concept. A problem that has not been fully evaluated in these data is the potential confounding effect of illness severity factors associated with referral selection and hospital mortality on comparisons of risk-adjusted hospital mortality. We address this issue. Data Sources and Study Setting. We analyzed the 1988 Medicare hospitalization data file (MEDPAR). We selected data on patients treated at the two Mayo Clinic-associated hospitals in Rochester, Minnesota, and a group of seven other hospitals that treat many patients from large geographic areas. These hospitals have had observed mortality rates substantially lower than those predicted by the HCFA model for the period 1987-1990. Study Design. Using the multiple logistic regression model applied by HCFA to the 1988 data, we evaluated the relationship between distance from patient residence to the admitting hospital and risk-adjusted hospital mortality. Principal Findings. Among patients admitted to Mayo Rochester-affiliated hospitals, residence outside Olmsted County, Minnesota was independently associated with a 33 percent lower 30-day mortality rate (p |is less than~ .001) than that associated with residence in Olmsted County. When patients at Mayo hospitals were stratified by residence (Olmsted County versus non-Olmsted County), the observed mortality was similar to that predicted for community patients (9.6 percent versus 10.2 percent, p = .26), whereas hospital mortality for referral patients was substantially lower than predicted (5.0 percent versus 7.5 percent, p = |is less than~ .001). After incorporation of the HCFA risk adjustment methods, distance from patient residence to the hospitals was also independently associated with mortality among the Mayo Rochester-affiliated hospitals and seven other referral center hospitals. Conclusions. The HCFA Medicare hospital mortality model should be used with extreme caution to evaluate hospital quality of care for national referral centers because of residual confounding due to severity of illness factors associated with geographic referral that are inadequately captured in the extant prediction model., The Health Care Financing Administration (HCFA) has been publishing observed and risk-adjusted estimates of hospital mortality rates for Medicare beneficiaries each year since 1986 based on the concept that these [...]

We retrospectively studied 22 patients with hepatopulmonary syndrome (HPS) evaluated at the Mayo Medical Center from 1984 to 1991. All patients had hepatic cirrhosis with clinical evidence of portal hypertension; [...]

Photodynamic therapy has been used since 1980 at our institution for the management of cancer of the tracheobronchial tree. We identified 13 patients (14 cancers) who were thought to be [...]

Pulmonary function and gas exchange were prospectively studied in 95 patients before and 9 to 15 months following liver transplantation. Pretransplant, the most common PF abnormality was impaired efficiency of [...]

Laser therapy can be used in the curative treatment of cancer. It is most effective, however, in the palliative treatment (intended to reduce pain and discomfort) of incurable tumors. The use of hematoporphyrin derivative with the laser treatment (HpD-PT) protocol shows actual curative potential. The method is based on the observation that the hematoporphyrin derivative, which is a complex mixture of natural dyes, is better retained by cancer cells than by normal cells. These dye molecules, when exposed to light, become involved in a photodynamic reaction that can kill the cancerous cells. In combination with an endoscope to precisely view the target area, phototherapy with hematoporphyrin derivative has been utilized in the therapy of patients with solid tumors. The treatment, however, is restricted to the degree that the light is able to penetrate the tumor mass. Animal research has suggested that corticoids and certain chemotherapeutic agents may also be useful in increasing the necrosis, or localized tumor-killing potential of hematoporphyrin derivative phototherapy on solid tumors. The present study examines the value of bleomycin sulfate (an antineoplastic agent) when combined with (HpD-PT) in mouse cancer model system. A virus-induced mouse mammary tumor was subjected to bleomycin treatment alone, and in a HPD-PT treated group. Suitable control groups were also examined. Bleomycin was found to be ineffective at increasing the level of tissue necrosis that resulted from HpD-Pt treatment alone; i.e., there was no synergic effect. (Consumer Summary produced by Reliance Medical Information, Inc.)

Intrapulmonary vascular dilatations (IPVD) are extrahepatic complications of acute and chronic liver disorders that can result in severe hypoxemia. Contrast-enhanced (CE) echocardiography provides a noninvasive method to detect right-to-left shunting [...]

Previous studies have described significant elevations in the concentrations of secretory immunoglobulin A (sIgA) in bronchial washings obtained from cancerous lungs. To date, there have been no prospective investigations examining [...]

CPA Online, the computer network of the Australian Society of Certified Practising Accountants (ASCPA), is to celebrate its second birthday in 10/97. No one knows now what it will be in the future, although some changes are being made, but it now provides ASCPA with a way to get timely and relevant information to all members and also gives them fellowship. Those in remote locations appreciate that greatly. The service is different for each person who uses it because users can choose areas of information and the level of detail they want 24 hours daily, 7 days of the week.

Byline: Denis Cortese and Robert Smoldt Navigating the healthcare labyrinth while you're sick is like trying to traverse Boston's streets when you're late for a meeting-an exercise rife with frustration [...]

Hematoporphyrin derivative (HpD) is selectively retained by a number of different tumors. Tissue that has retained HpD may be identified by fluorescence, and this property has been used to endoscopically detect tumors in the trachea, bronchi, and bladder. The technique might also be used to identify colorectal tumors, but little is known about the affinity of gastrointestinal cancers for this compound. Although the retention of HpD in colorectal tumors in experimental animals has been verified, it is important do determine that the same process occurs in human tissue. To answer this question, surgical specimens of colorectal cancers were examined with fluorescence videodensitometry. Ten patients were injected with between 2 and 5 milligrams per kilogram of body weight of hematoporphyrin derivative, 3 or 72 hours before surgery. After surgery, the specimens were photographed under ultraviolet light with a 35mm camera. The negatives were then analyzed with a video camera and computer that were capable of quantifying the density of various points on the photographic negative. In all ten specimens, the tumor had a stronger fluorescence than the surrounding tissues. Of the ten specimens, nine were adenocarcinomas, and one was a cloacogenic small cell cancer. This small cell cancer had the lowest level of fluorescence. The average fluorescence was about six times that of the surrounding tissues. In this study, the fluorescence of tumor tissue was greater for the injection 72 hours prior to surgery than for the injection three hours before. Although this study has not evaluated the numerous factors which might contribute to HpD affinity, such as tumor vascularity, histological type, pigmentation, and lipid content, the demonstration of selective retention by colorectal tumors is promising for the development of newer diagnostic methods. (Consumer Summary produced by Reliance Medical Information, Inc.)

The flexible fiberoptic bronchoscope is currently the standard tool for localization of radiographically occult cardnomas of the tracheobronchial tree. It allows direct inspection of proximal airways and can establish the [...]