The coming millennium: enduring issues confronting Catholic health care.

Professor Singer and Ms. Johnson Lantz provide a cogent overview of Catholic health care in the United States and address the key issues affecting Catholic health care in the coming years. In particular, (1) clarity in canonical and ethical interpretation; (2) industry consolidation; and (3) "next generation" sponsorship and the impact of these issues are discussed in detail. The authors conclude that successful Catholic health care organizations must maintain strong mission and business fundamentals in an increasingly competitive reimbursement and regulatory environment.

Barium enema: detection of colonic lesions in a community population.

OBJECTIVE: The purposes of this study were to assess the prevalence of colonic lesions detected at barium enema in a community practice, to compare the findings at barium enema between patients who are asymptomatic and have no known risk factors for colorectal cancer (screening group) and patients who have symptoms of colonic disease or have known risk factors, and to determine if a questionnaire about symptoms and risk factors is an appropriate screening tool. SUBJECTS AND METHODS: A self-administered questionnaire about colorectal symptoms and risk factors was given to 1779 patients scheduled for barium enema examination. On the basis of their responses, patients were divided into three groups: screening group (asymptomatic, without risk factors), symptomatic, and asymptomatic with risk factors. Each patient underwent a fluoroscopic barium enema. We then compared the results (number, histologic type, size of lesion(s), location in the colon, and Patient's age) and risk factors among the three groups. RESULTS: At least one lesion within the colorectum was found in 166 (9%) of 1779 patients at combined proctosigmoidoscopy and barium enema. The prevalence of lesions in the 111 patients with at least one lesion above the rectum at barium enema was 4% (32 of 738) for the screening group, 8% (38 of 476) for asymptomatic patients with risk factors, and 7% (41 of 565) for symptomatic patients (p = .015 when comparing the prevalence in the screening group with the prevalences in the other two groups). Twenty-nine percent of all colonic lesions were found in the screening group. Among the asymptomatic patients, risk factors that included a history of colorectal polyps and advanced age were associated with a significantly higher prevalence of colonic polyps found at barium enema. In the symptomatic group, if patients with histories of polyps were excluded, we were unable to identify other risk factors that led to a significantly higher prevalence of polyps. CONCLUSION: Asymptomatic patients without known risk factors have a significantly lower prevalence of colonic polyps than either symptomatic patients or patients with risk factors alone. Despite this lower prevalence, 29% of all lesions in our series were in the screening group. Assessment of risk factors through a patient questionnaire was not helpful in identifying a group of patients with a higher prevalence of lesions--except for a history of polyps. Management decisions based on a patient questionnaire should be approached with caution. When low-risk patients are denied screening examinations, a significant number of lesions will be missed.

Intraoperative color Doppler sonography during renal artery revascularization.

Intraoperative color Doppler sonography is emerging as a useful procedure for evaluating renal arteries during transaortic renal endarterectomy or bypass grafting. Technical difficulties encountered during surgical renal revascularization, such as intimal defects or flaps, partial or complete thrombosis, and anastomotic stenosis of the renal artery, can be difficult to defect and evaluate. Intraoperative color Doppler sonography allows evaluation at a time when the problem is often correctable. We have been performing intraoperative sonographic studies of the renal artery for several years and have studied 151 vessels. In this pictorial essay, we present some of our observations on these cases.

Diagnostic imaging of urothelial cancer.

Technologic advances in diagnostic imaging offer new ways to evaluate urothelial tumors. Computed tomography, ultrasound, and magnetic resonance imaging each have potential to provide information previously unavailable without surgical intervention.

Radiology of cerebrospinal fluid rhinorrhea.

Fifty-one patients with cerebrospinal fluid rhinorrhea were evaluated at the Mayo Clinic from 1974 to 1977. The causes of the leak were fairly even distributed among postoperative, traumatic unrelated to previous surgery, and nontraumatic. The slightly fewer patients with a traumatic cause compared with those reported in most series reflects the referral patterns and surgical nature of the practice at the institution. Three-fourths of the patients had plain films of the skull, although the site of the leak was identified in only 21% of them. Two-thirds of the patients had tomography, which was helpful in 53%, especially in 10 of the 13 patients with traumatic nonpostoperative cerebrospinal fluid rhinorrhea. Posteroanterior tomography generally was more helpful than lateral tomography, except in leaks around the frontal sinuses. Radioisotope cisternography with intranasal pledgets helped localize the site of leak in 50% of patients and suggested the site of the leak in 25%. Radioisotope cisternography with pledgets often gave helpful positive results when the plain films and tomography were not helpful.