Hepatocellular Carcinoma: Surveillance, Diagnosis, Evaluation and Management.

Hepatocellular carcinoma (HCC) ranks fourth in cancer-related deaths worldwide. Semiannual surveillance of the disease for patients with cirrhosis or hepatitis B virus allows for early detection with more favorable outcomes. The current underuse of surveillance programs demonstrates the need for intervention at both the patient and provider level.

Locoregional Therapy for Intrahepatic Cholangiocarcinoma: The Role of Intra-Arterial Therapies.

Intrahepatic cholangiocarcinoma (ICC) is a rare disease with a rising incidence. While surgical resection is the only curative option, the disease process is often identified in advanced stages, as this malignancy often remains clinically silent in early development. Only one-third of patients are eligible for resection at the time of diagnosis.

Extrahepatic portomesenteric obstruction resulting in splanchnic hypertension and refractory ascites.

Portal hypertension is a commonly described etiology that typically stems from underlying cirrhosis. Interventional radiologists may offer several interventions in the multidisciplinary approach to managing these patients. However, it is important to ascertain the cause and type of hypertension before intervention to avoid poor outcomes.

Addressing Patient Bias Toward Health Care Workers: Recommendations for Medical Centers.

Some patients engage in behavior or use language that demeans clinicians on the basis of their social identity traits, such as race, ethnicity, sex, disability, gender presentation, and sexual orientation, and some patients even request reassignment of involved clinicians. Despite the importance and prevalence of this problem, many medical centers lack an organizational approach for addressing patient conduct. Policy development can be daunting because organizations may encounter various barriers, including reluctance of staff to have difficult conversations about race or other identity traits; uncertainty about what constitutes an appropriate response to the spectrum of demeaning behaviors and who should make this determination; what, if any, support should be offered to targeted clinicians; whether these incidents should be reported and to whom; and whether the medical center's response should differ depending on whether nurses, trainees, or other clinicians are involved.

90Y Radioembolization of Colorectal Hepatic Metastases Using Glass Microspheres: Safety and Survival Outcomes from a 531-Patient Multicenter Study.

Unlabelled: Hepatic metastases of colorectal carcinoma are a leading cause of cancer-related mortality. Most colorectal liver metastases become refractory to chemotherapy and biologic agents, at which point the median overall survival declines to 4-5 mo. Radioembolization with (90)Y has been used in the salvage setting with favorable outcomes.

Hospitalization-Associated Disability in Adults Admitted to a Safety-Net Hospital.

Background: Little is known about hospitalization-associated disability (HAD) in older adults who receive care in safety-net hospitals.

Objectives: To describe HAD and to examine its association with age in adults aged 55 and older hospitalized in a safety-net hospital.

Design: Secondary post hoc analysis of a prospective cohort from a discharge intervention trial, the Support from Hospital to Home for Elders.

Functional disability in late-middle-aged and older adults admitted to a safety-net hospital.

Objectives: To determine the prevalence of preadmission functional disability in late-middle-aged and older safety-net inpatients and to identify characteristics associated with functional disability by age.

Design: Cross-sectional analysis.

Setting: Safety-net hospital in San Francisco, California.

"Missing pieces"--functional, social, and environmental barriers to recovery for vulnerable older adults transitioning from hospital to home.

Objectives: To describe barriers to recovery at home for vulnerable older adults after leaving the hospital.

Design: Standard qualitative research techniques, including purposeful sampling of participants according to age, sex, race, and English proficiency, were used to ensure a wide breadth of experiences. All participants were interviewed in their native language (English, Spanish, or Chinese).

Percutaneous renal cryoablation complicated by hemorrhage.

The authors describe a case in which a patient underwent percutaneous cryoablation of a suspected right renal cell carcinoma complicated by bleeding. Urgent angiography revealed a lower renal pole arteriovenous (AV) fistula, correlating with the recent treatment site. This AV fistula was successfully treated with coil and Gelfoam embolization.

Interpretation of serologic tests in an HIV-infected patient with kidney disease.

Background: A 32-year-old African American man with HIV infection presented with hemoptysis, shortness of breath and renal insufficiency. Serologic testing revealed the presence of anti-glomerular basement membrane antibodies and equivocal levels of anti-myeloperoxidase antibodies.

Investigations: Physical examination, urine and blood analysis, kidney ultrasound, chest radiograph, sputum cultures, bronchoscopy and renal biopsy.