Experience using radio frequency laptops to access the electronic medical record in exam rooms.

Kaiser Permanente, Northwest, evaluated the use of laptop computers to access our existing comprehensive Electronic Medical Record in exam rooms via a wireless radiofrequency (RF) network. Eleven of 22 clinicians who were offered the laptops successfully adopted their use in the exam room. These clinicians were able to increase their exam room time with the patient by almost 4 minutes (25%), apparently without lengthening their overall work day. Patient response to exam room computing was overwhelmingly positive. The RF network response time was similar to the hardwired network. Problems cited by some laptop users and many of the eleven non-adopters included battery issues, different equipment layout and function, and inadequate training. IT support needs for the RF laptops were two to four times greater than for hardwired desktops. Addressing the reliability and training issues should increase clinician acceptance, making a successful general roll-out for exam room computing more likely.

Cerebellar toxicity following high-dose cytosine arabinoside.

A patient with acute cerebellar toxicity following systemic high-dose cytosine arabinoside (ara-C) 3 g/m2/12 h for secondary acute nonlymphocytic leukemia is reported. Initial symptoms of ataxia and dysarthria emerged at 30 g/m2 cumulative dose and persisted without improvement over a ten-week period. Recurrence and worsening of cerebellar symptoms followed further consolidation treatment with high-dose ara-C. Subsequent autopsy showed extensive Purkinje's cell damage in the lateral cerebellar hemispheres. Persistent severe toxicity can occur at total doses less than those generally recognized.

Carcinoid tumors of the ileum.

Thirty patients with carcinoid tumors of the ileum over a recent 10-year period have been analyzed. Seventeen patients were symptomatic and 13 others were found to have tumors incidentally at autopsy or celiotomy. Patients with symptoms almost invariably had metastatic disease, yet preoperative diagnosis was rarely achieved. Arteriography in five patients with intestinal angina demonstrated encasement, kinking, and irregularity of mesenteric branches due to nodal metastasis. In five patients, each with liver metastasis, the classic carcinoid syndrome developed. Multiple primary carcinoid tumors were found in 9 of 30 patients (30 percent); 14 had an associated second malignant neoplasm (47 percent), most frequently colorectal carcinoma. En block surgical excision was the only effective therapy. Despite a prolonged natural history, the 5-year actuarial survival rate from the date of diagnosis was only 31 percent.