Larry A. Nathanson

Carcinoembryonic antigen-antibody complexes in a patient with colonic carcinoma and nephrotic syndrome

THE association of the nephrotic syndrome and neoplasms is an uncommon one.1 2 3 4 5 6 The role of the neoplasm in the development of the nephrotic syndrome can be attributed in some cases to obvio...

In vitro lymphocyte stimulation by a soluble antigen from malignant melanoma.

Abstract The lymphocytes of seven patients with malignant melanoma were stimulated when cultured in vitro with extracts of autologous tumor. One patient had a cystic neoplasm, which contained an el...

Metastatic basal cell carcinoma: Review, report of a case, and chemotherapy

Basal cell carcinomas very rarely metastasize. A review of the literature revealed 90 documented cases of metastasizing basal cell carcinoma. Metastases occur most frequently to the regional lymph nodes (68%), while other sites such as bone, lungs, and liver are less frequently involved (less than 20%). We wish to report a case of metastasizing basal cell carcinoma and our experience with chemotherapy. Chemotherapy has been utilized in only three of the previously reported cases. To date a total of seven different cytotoxic agents has been tried; all have been unsuccessful. At present the drug of choice for metastasizing basal cell carcinoma awaits reports of successful treatment of metastasizing lesions; nevertheless, since the appearance of metastases in basal cell carcinoma carries an ominous prognosis (median survival of only 10 months), chemotherapy should be offered to these patients.

Active specific immunotherapy with polyvalent melanoma cell vaccine for patients with in-transit melanoma metastases

This study was conducted to document the rate, duration, and type of objective response to active specific immunotherapy with a polyvalent melanoma cell vaccine (PMCV) for patients with in‐transit melanoma metastases and to identify any acute or chronic toxic effects of PMCV treatment.

The Incidence and Cost of Unexpected Hospital Use After Scheduled Outpatient Endoscopy

BACKGROUND Data on complications of gastrointestinal endoscopic procedures are limited. We evaluated prospectively the incidence and cost of hospital visits resulting from outpatient endoscopy. METHODS We developed an electronic medical record-based system to record automatically admissions to the emergency department (ED) within 14 days after endoscopy. Physicians evaluated all reported cases for relatedness of the ED visit to the prior endoscopy based on predetermined criteria. RESULTS We evaluated 6383 esophagogastroduodenoscopies (EGDs) and 11 632 colonoscopies (7392 for screening and surveillance). Among these, 419 ED visits and 266 hospitalizations occurred within 14 days after the procedure. One hundred thirty-four (32%) of the ED visits and 76 (29%) of the hospitalizations were procedure related, whereas 31 complications were recorded by standard physician reporting (P < .001). Procedure-related hospital visits occurred in 1.07%, 0.84%, and 0.95% of all EGDs, all colonoscopies, and screening colonoscopies, respectively. The mean costs were

Vinblastine, infusion, bleomycin, and cis‐dichlorodiammine‐platinum chemotherapy in metastatic melanoma

1403 per ED visit and

Using information technology to improve the quality and safety of emergency care

10 123 per hospitalization based on Medicare standardized rates. Across the overall screening/surveillance colonoscopy program, these episodes added

Carcinoembryonic antigen. Report of a screening study

48 per examination. CONCLUSIONS Using a novel automated system, we observed a 1% incidence of related hospital visits within 14 days of outpatient endoscopy, 2- to 3-fold higher than recent estimates. Most events were not captured by standard reporting, and strategies for automating adverse event reporting should be developed. The cost of unexpected hospital visits postendoscopy may be significant and should be taken into account in screening or surveillance programs.

Prospective pilot study of a tablet computer in an Emergency Department.

A chemotherapy regimen containing vinblastine‐bleomycin‐platinum has been studied in 42 patients with advanced malignant melanoma. Forty‐seven percent of evaluable and 43% of all patients experienced objective response. Complete responses were seen in visceral sites. Median duration of response has not been reached but will exceed 26 weeks. Toxicity is predominantly marrow suppressive, gastrointestinal, pulmonary, and mucocutaneous. Pulmonary toxicity was never severe when bleomycin dose was limited to less than 300 mg/m2 body surface area. Half of the patients relapsed with CNS metastases as a first presenting sign of recurrence. Because hospitalization is required in this program its dollar cost is high.

LUNG TUMORS: HOW THEY PRODUCE THEIR SYNDROMES*

With the 2010 federal health care reform passage, a renewed focus has emerged for the integration of electronic health records (EHRs) into the U.S. health care system. A consensus conference in October 2009 met to discuss the future research agenda with regard to using information technology (IT) to improve the future quality and safety of emergency department (ED) care. The literature is mixed as to how the use of computerized provider order entry (CPOE), clinical decision support (CDS), EHRs, and patient tracking systems has improved or degraded the safety and quality of ED care. Such mixed findings must be considered in the national push for rapid implementation of health IT. We present a research agenda addressing the major questions that are posed by the introduction of IT into ED care; these questions relate to interoperability, patient flow and integration into clinical work, real-time decision support, handoffs, safety-critical computing, and the interaction between IT systems and clinical workflows.