Abstract: The present paper described the technique to evaluate digital resolution (DR), Visual Magnification (VM), onScreen Magnification (SM) and Useful magnification (US) in order to compare image quality and resolution for diagnostic purposes on computer assisted microscopes including Multi-Modal Miniature Microscopes-4M.The study was done on surgical pathology and cytological specimens comparing analog microscopic images versus digital Small Size Virtual Slides (SSVS) images. The SSVS were obtained with an 8 megapixel camera, in JPEG2000 format using a super-resolution algorithm of capture. The field of view-FOV images showed four times higher discrimination power, in spite of the low sampling density. The region of interest-ROI images, with a sampling density close to Shannon theory showed six times higher discrimination power. OnScreen magnification FOV achieved 640x and ROI 3200x augments that could never been reached using analog microscopy. The paper demonstrates that SSVS are ideal for hand-held microscopes or even mobile phones with ad-on capture systems.
Abstract: Query by image medical training. Optical Biopsy with confocal endoscopy (OB-CEM) 978-989-674-016-0 The use of Optical Biopsies-OB (in the present case Confocal endomicroscopy-CEM) is limited due to difficulties to interpret images. The OB-CEM are taken by endoscopists, not trained in microscopic morphology which is the domain of the surgical pathology. To gain diagnostic confidence the endoscopists could consult the images to a pathologist or could use the technique proposed in the paper. That is, to search for similar images on Internet to compare the diagnosis.
The present paper is a positioning paper of how to build a CEM-image metadata to be used by the multimedia standards ISO-15938-12:2008 and ISO-24800-3 in order to search on line using a âquery by imageâ. Metadata semantics based on Kudo colorectal crypt architecture was used for annotation or automatic image extraction. The training set was composed of 25 OB-CEM chromo-colonoscopy images taken with a FICE (Fujinon Intelligent Chromoendoscopy). Those parameters were, whenever possible, automatically extracted from the image and included in the metadata for image mining. Future developments will annotate histological images is such a way that the query could also retrieve the histological image
Abstract: BACKGROUND: Referrals from rural health centers to urban hospitals join waiting lists as outpatients for hospital admission and hospital treatment. This influences quality of life (QoL) of the rural population and retired people who require medical attention without traveling, provided no risks are involved. For this reason, a rural region of Spain has adopted a strategy to deliver telemedicine (TM) specialized care (Extremadura model) as a political decision. OBJECTIVES: The present study aimed at objectively assessing QoL on aspects of health and well-being for citizens benefiting from this system. METHODS: We performed a randomized study of 800 primary care patients referred for specialized care: 420 regular face-to-face hospital referrals and 380 referred to a hospital specialist at a distance by TM. The study used two questionnaires: a modified version of the classical SF-12v2 short form questionnaire for health and well-being and a specific author-elaborated questionnaire. The latter focused on major patient concerns such as (1) discomfort and pain relief, (2) swift diagnosis, (3) swift treatment, (4) swift decision on hospital admission or not, (5) avoidance of traveling, (6) avoidance of red tape, and (7) personal attention. QoL was assessed twice: before referral to a hospital specialist and 6 months after referral to the same. The results were statistically compared. RESULTS: Both groups showed comparable health status with added advantages for TM referrals such as (1) less traveling (p = 0.0001) and (2) faster diagnosis, health examination, and treatment (p = 0.0001). CONCLUSION: Telemedicine care by a hospital specialist through videoconferencing was comparable to hospital referral for face-to-face medicine. Teleconsultations managed by nurses had a positive impact on the QoL of rural patients. They did not have to travel and thus diagnoses and examinations to start treatment were initiated faster.
Abstract: As in other hospital departments, histopathology and morbid anatomy require automation and quality control. Usually the PIS (Pathology information system) automates samples, images and reports and progressively incorporates PI (Pathology informatics), D-PATH (digital pathology), e-PATH (electronic pathology), PPH (Patho-pharmacology), virtual autopsy and in general all types of translational research in the PMIS (pathology management information system).
Abstract: Context:In the present paper we introduce the innovative technique of literature mining to discover relevant cytologic findings to automatically detect regions of interest (ROI) in cytologic virtual slides that are being assessed remotely.Technology:Four types of technologies are included: (1) literature mining techniques; (2) optimization algorithms to select relevant literature; (3) small size virtual slide digitization process; (4) selection of ROIs for remote diagnosis; (5) JPIP server availability of virtual slide for distant diagnosis; and (6) Internet services.Design:The project was designed to ensure long distance diagnosis of cytologic specimens taken by a laboratory technician. The small size virtual slide is digitized and the ROI selected using literature mining.Results:The results had been tested in a rural area in Venezuela. Cytology specimens were examined by the expert via the Internet and the ROI is selected with 90% accurate diagnosis.Conclusions:Novel techniques in pathology such as literature mining and small size virtual slide or Web services have to be put in place in order to facilitate remote diagnosis.
Abstract: The ability to obtain information about the structure of tissue without taking a sample for pathology has opened the way for new diagnostic techniques. The present paper reviews all currently available techniques capable of producing an optical biopsy, with or without morphological images. Most of these techniques are carried out by physicians who are not specialized in pathology and therefore not trained to interpret the results as a pathologist would. In these cases, the use of telepathology or distant consultation techniques is essential.
Abstract: The ability to obtain information about the structure of tissue without taking a sample for pathology has opened the way for new diagnostic techniques. The present paper reviews all currently available techniques capable of producing an optical biopsy, with or without morphological images. Most of these techniques are carried out by physicians who are not specialized in pathology and therefore not trained to interpret the results as a pathologist would. In these cases, the use of telepathology or distant consultation techniques is essential.
Abstract: Technological advances in optical microscopy and the diagnostic capacity of a wide variety of optical techniques call for a reappraisal of the role of the pathologist. Today, neither microscopes nor tissue staining and processing are essential for diagnosis. However, in order to set the gold standard for these techniques, more publications on the morphology of in vivo biopsies and noninvasive optical biopsies are needed. This should be the responsibility of pathologists. The present article introduces the techniques of optical microscopy and non invasive microscopy and demonstrates their diagnostic capacity.
Abstract: Small Size Virtual Slide (SSVS) is a novel technique developed by us and consistent in low power slide scan with high resolution cameras that allow digital zooming. Implemented in the
TEXCAN-II® soft ware, it allows distant diagnosis on through intranet or Internet. Complete virtual slide seen online provides a level of diagnosis comparable with regular microscopy, in a fast
and reliable way, minimizing storage requirements.
In the present paper the SSVS technique was assess on fi ft een cytology and pathology specimens evaluated by ten pathologists, that have never done distant diagnosis or try telepathology systems, obtaining a ROC diagnostic curve of 0.95.
Abstract: A drug e-prescription demonstrator was created in compliance with existing legislation as well as security and privacy standards. A professional ID-card was built on a high security chip (ISTEC E4 High; EAL-5) with a Hash hardware accelerator for a digital signature placed in a single chip USB token. Commercial software products as well as development kits of the new hardware designed in the project were used to build an authentication, authorisation and electronic signature demonstrator. The degree of legal compliance was evaluated. The tested novel single chip USB token was highly efficient but limited by its 1.1 interface speed ( 12 Mbit/s). The chip, initialised with a banking-mask, inefficiently managed space for the health-care chain of trust. The public key and privilege management infrastructure was not able to handle health-care attributes in the appropriate extensions. Templates for role-rule privileges were not available and healthcare standards for security and privacy were not found in commercial products. The paper points out the urgent need for an e-health conformance label as well as a quality label for liability and confidence to gain users' trust.
Abstract: OBJECTIVES: 3D-Ultrasound reconstruction, routinely available since 1994, has brought new technical capabilities such as virtual sonography that can be tele-consulted. Our experience is summarized in the present paper. METHODS: During one year, 73 3D-US volumetric images coming from 34 patients were acquired and 68 were consulted at distance. Acquisitions were carried out through an existing 2D device adding a magnetic tracking system on the US-probe. Probe positioning and video output was introduced into a PC running software that allows the generation of 2D-orthogonal and 3D volume images, as well as tele-consultation. Several image analysis techniques for 3D-reconstruction were evaluated. RESULTS: Final volumes were small (1.5 Mb) and required about 4+/-2 min to be transmitted over one ISDN channel (64 Kbs). Good correlation (k = 0.7) was found between local and distant diagnoses. In 30%, images were considered of low quality and in 29% of good quality; diagnosis could be done with confidence in all except 7 cases. Virtual sonography, by means of oblique cuts in all space directions, improved distant diagnostic confidence. Limitations were linked to incomplete sampling due to the short acquisition time periods (26 s) and difficulties on hand-free probe movement. 3D reconstructions were time consuming (20 min to 4 h) and of limited indication. CONCLUSIONS: 3D reconstruction could reduce multiple explorations due to image constrains such as suboptimal fetal positioning, among others. Virtual sonography was important to reach confidence on distant diagnosis; it was also considered a tool for off-line local review of non-trained sonographer acquisitions.
Notes: NASA publico en NASAâÂÂs Scientific & Technical Aerospace Reports CYBERNETICS, ARTIFICIAL INTELLIGENCE AND ROBOTICS vol 44 (1) : 20060002507 del 13 Enero 2006, como articulo excelente a tener en cuenta âÂÂTelemedicine Intelligent Learning. Ontology for Agent Technologyâ de TAR vol 1(2): 47-55, 2005.
Abstract: We conducted a trial of mobile phone text messaging (short message service; SMS) for diabetes management. In an eight-month period, 23 diabetic patients used the service. Patients used SMS to transmit data such as blood glucose levels and body weight to a server. The server automatically answered with an SMS acknowledgement message. A monthly calculated glycosylated haemoglobin result was also automatically sent to the patient by SMS. During the trial the patients sent an average of 33 messages per month. Although users showed good acceptance of the SMS diabetes system, they expressed various concerns, such as the inability to enter data from previous days. Nonetheless, the trial results suggest that SMS may provide a simple, fast and efficient adjunct to the management of diabetes. It was particularly useful for elderly persons and teenagers, age groups that are known to have difficulty in controlling their diabetes.
Abstract: We developed a diabetes management system with a Web interface that allowed patients to transmit their physiological data using either a PC Web browser or a mobile phone capable of working with the WAP protocol. The system could generate automatic responses to input values in accordance with a set of ranges previously defined for each user. User analysis was carried out with personal and online questionnaires. During a nine-month study period on the island of Tenerife, 12 patients were recruited. On average, they used the system every 2.0 days (SD 2.1) and the doctors reviewed their patient data every 4.0 days (SD 3.9). The average number of visits to the Website was 477 per month. Users were satisfied with the continuity and self-efficacy of care, but lack of time was a drawback for 38% of them and 75% expressed a preference for sending their data via the mobile phone short message service (SMS).
Abstract: A non-supervised call centre was used to allow oncology patients to contact their personal doctors 24 hours a day. Incoming patient calls to the centre were automatically routed to the doctor's mobile phone or office telephone. Over four years, an average of 407 calls were made each year, by an average of 274 oncology patients. The average number of emergency hospital visits was 24 per year (0.09 per patient), compared with 42 per year (0.16 per patient) during the year before the telephone service began. The average number of outreach visits was 783 (2.9 per patient) per year during the study, in comparison with 722 (2.8 per patient) before it began. The average number of non-emergency hospital admissions was 41 (0.15 per patient) per year in comparison with 42 (0.17 per patient) before the study. Calls were short (typically 3-5 min) and the majority (88%) were made on the patient's initiative. Outreach patients in receipt of chemotherapy were the principal users (making 88% of all calls). Excluding the initial investment cost, the income received was approximately the same as the running costs of the call centre in two of the three years for which data were available.
Abstract: The number and seriousness of medical problems on passenger-carrying aircraft in flight are increasing. Medical incidents occur at a rate of approximately 10-50 per million passengers carried. Medical equipment carried on commercial aircraft is limited to three items: a first-aid kit, an emergency medical kit and sometimes an automatic external defibrillator. Telephone medicine, a lower level of telemedicine support, is well established for commercial air operations. The availability of satellite telecommunications on passenger-carrying aircraft permits more sophisticated forms of telemedicine. Recent telemedicine experiments have involved the transmission of three-lead electrocardiograms (ECGs), heart rate, blood pressure, arterial oxygen saturation, end-tidal CO2, respiratory rate, body temperature and realtime video. The challenge is to demonstrate that such techniques are practicable, improve patient outcomes and are cost-effective.
Abstract: BACKGROUND: Three-dimensional ultrasound images allow virtual sonography even at a distance. However, the size of final 3-D files limits their transmission through slow networks such as the Internet. OBJECTIVE: To analyze compression techniques that transform ultrasound images into small 3-D volumes that can be transmitted through the Internet without loss of relevant medical information. METHODS: Samples were selected from ultrasound examinations performed during, 1999-2000, in the Obstetrics and Gynecology Department at the University Hospital in La Laguna, Canary Islands, Spain. The conventional ultrasound video output was recorded at 25 fps (frames per second) on a PC, producing 100- to 120-MB files (for from 500 to 550 frames). Processing to obtain 3-D images progressively reduced file size. RESULTS: The original frames passed through different compression stages: selecting the region of interest, rendering techniques, and compression for storage. Final 3-D volumes reached 1:25 compression rates (1.5- to 2-MB files). Those volumes need 7 to 8 minutes to be transmitted through the Internet at a mean data throughput of 6.6 Kbytes per second. At the receiving site, virtual sonography is possible using orthogonal projections or oblique cuts. CONCLUSIONS: Modern volume-rendering techniques allowed distant virtual sonography through the Internet. This is the result of their efficient data compression that maintains its attractiveness as a main criterion for distant diagnosis.
Abstract: BACKGROUND: Three-dimensional ultrasound images allow virtual sonography even at a distance. However, the size of final 3-D files limits their transmission through slow networks such as the Internet. OBJECTIVE: To analyze compression techniques that transform ultrasound images into small 3-D volumes that can be transmitted through the Internet without loss of relevant medical information. METHODS: Samples were selected from ultrasound examinations performed during, 1999-2000, in the Obstetrics and Gynecology Department at the University Hospital in La Laguna, Canary Islands, Spain. The conventional ultrasound video output was recorded at 25 fps (frames per second) on a PC, producing 100- to 120-MB files (for from 500 to 550 frames). Processing to obtain 3-D images progressively reduced file size. RESULTS: The original frames passed through different compression stages: selecting the region of interest, rendering techniques, and compression for storage. Final 3-D volumes reached 1:25 compression rates (1.5- to 2-MB files). Those volumes need 7 to 8 minutes to be transmitted through the Internet at a mean data throughput of 6.6 Kbytes per second. At the receiving site, virtual sonography is possible using orthogonal projections or oblique cuts. CONCLUSIONS: Modern volume-rendering techniques allowed distant virtual sonography through the Internet. This is the result of their efficient data compression that maintains its attractiveness as a main criterion for distant diagnosis.
Abstract: We compared the costs of patient care for two groups of 10 oncology patients. The test group was treated at home and had access to 24 h telephone support, and the control group was treated in hospital, either as inpatients or as outpatients. Direct variable costs were provided by health insurance companies. The time invested by the health-care staff was recorded. The amount of time devoted to patients was more uniform in hospital than in the patients' homes, which suggests that patients at home received a less generic, more specific form of care. The nurses spent four times as long caring for home care patients as for hospital patients. The total cost of home care was 64% of that of hospital care, although this difference was not significant. The mean daily costs were three times lower at home than in hospital. All direct costs, except laboratory tests, were lower at home. Pharmaceutical costs were six times lower at home. Telephone support for home oncology care was cost saving and avoided 27 nursing home visits, which represented 35 working hours and Pta270,000 in savings to the health insurance companies.
Abstract: The information society is continuously pushing to a rapid change und updating of laws and training and qualification programs from which medicine is not excluded. This paper summarises the norms and laws applicable to telemedicine with three basic principles involved: medical practice, data management, and communication technologies. Following the subsidiary principle, the applicable legislative levels are: European Union, National, Autonomous Community, Medical Professional Colleges, and Local Medical Colleges. Contradictory and little innovative issues appear in the results and discussion sections of the deontologic codes, the pressing demand on doctors' awareness and to provide them with technical skills. An exhortation follows to work out an informative-ethic code for the telemedicine practice.
Abstract: Quantitative aspects of cytology and histology should be considered in diagnostic standardisation processes. The present paper summarises the cytological differences detected in 75 thyroid lesions using a computerized textural analysis.
Abstract: We studied the environment for telemedicine in the Canary Islands. The population's attitude to telemedicine was surveyed in 503 questionnaire interviews with doctors, nurses, paramedical staff and patients on the seven islands. Almost half the respondents (46-50% across groups) had a positive opinion of telemedicine. We also collected data about telephone medicine. A total of 479 medical-support telephone calls were made to four doctors, in psychiatry, ophthalmology and paediatrics. The telephone calls resolved the problem in 73% of cases and 86% would have come to the doctor if not made. Therapy was prescribed in 11% and 10% were just for information. The number of telephone calls per day was highest in psychiatry. Finally, we carried out a detailed analysis of the number of transfers between the islands (14,942 people in 1995 and 22,418 in 1996). According to the number of transfers and location of the referral hospital, oncology, psychiatry, dermatology and traumatology were the specialties that would be most likely to benefit from telemedicine.
Abstract: Telepsychiatry is a still relatively unknown area of Psychiatry but with a promising future according to the recent interest that has arisen. Its future potentiality and its actual applications, basically in research and in the clinical practice of certain regions with communication problems, justify its study and demand research efforts in the next future. This paper pursues a doble aim. On one side, a review of the relevant scientific literature and, on the other hand, the presentation of data from a pilot study about phone medicine in the island of Tenerife. Published papers show us an efficacious, satisfactory for its user and achievable discipline, although they reveal the need of profundizing in its study before advocating its massive use. Our pilot study of phone medicine apparently indicates that this is a relatively habitual kind of treatment with high efficacy indexes. Thus, it seems that former conclusions repeat with a cheaper and easier achievable sort of telepsychiatry. Our preliminary data pretend to be a scientific approach to a common clinical activity that needs to be characterized in future studies.
Abstract: The present series includes 75 thyroid lesions (38 goiters, 30 adenomas, 3 follicullo-papillary encapsulated carcinomas and 4 normal thyroid) that were studied by static and flow cytometry. Four cases were also analyzed by in situ hybridization (centromeric probes for chromosomes 1 and 17) and 10 cases by G-banding cytogenetics. Results demonstrate a polymorphism and genetic instability in the thyroid tissue that may be related to the spontaneous polyploidization of their cells. The most consistent finding in cytometry was the presence of two clones associated with clinical or histological hyperactivity (46% versus 23% in non-functioning cases; chi2 distribution with a p < 0.05). Chromosomal anomalies were detected in two out of 10 cases: 46, XX, t(5,19) in 87% of cells of a diffuse hyperplastic goiter and 49, XX, +7, +17, +22 in 19% of cells of thyroiditis case. Finally, the in situ hybridization technique showed hidden trisomies of clonal origin in all of the cases studied. Evaluation of clonal trisomies by the in situ hybridization technique using the confidence interval of a binomial distribution is discussed.
Abstract: Quantitative aspects of cytology and histology should be considered in diagnostic standardisation processes. The present paper summarises the cytological differences detected in 75 thyroid lesions using a computerized textural analysis. Cells stained with progressive hematoxylin and taken from paraffin blocks were overlaid with the extracted texture. This technique was based on the lineal detection of a grey level gradient of the common logarithm of the integrated optical density (IOD) of each nucleus. Diffuse and nodular goiters (36 cases) were demonstrated to be composed of small cells containing high density texture that, on microscopical visual inspection, gave a "salt and pepper" appearance. The adenomatous goiters (2 cases) and adenomas (26 cases) were composed of low texture cells with a visual "blurry or smudgy" chromatin, while the atypical adenomas with capsular invasion (4 cases) were characterised by a "woodworm" nuclear appearance that produced the highest texture of the series. Finally, encapsulated folliculo-papillary carcinomas (3 cases) were composed of large clear nuclei with high IOD, low texture, and scattered lines that resulted in an "empty grape skin" aspect. Our findings seam to confirm the suitability of computerized textural techniques that aid in recognizing cell microscopic features objectively. The one used in the present work, based on a mathematical function of the DNA content of each individual nucleus (IOD), fulfills all microscopy detection criteria.
Abstract: Abstract: The present series includes 75 thyroid lesions (38 goiters, 30 adenomas, 3 follicullo-papillary encapsulated carcinomas and 4 normal thyroid) that were studied by static and how cytometry. Four cases were also analyzed by in situ hybridization (centromeric probes for chromosomes 1 and 17) and 10 cases by G-banding cytogenetics.
Abstract: Levels of estradiol and progesterone from blood together with oestrogen (ER) and progesterone receptors (PgR) from breast tissue were studied from a total of 2500 data bank cases of breast neoplastic disease. We report here, 340 premenopausal women with recorded menstrual cycle data which enabled the study of the effect of peripheral hormone variation on ER and PgR with respect to cycle phase. The findings were also correlated with 30 immunohistochemical specimens. In the specimens with benign neoplasm (141 cases, age 28 +/- 18 years) the ER levels were low (9.2+/-9.4 fmol/mg protein) as in normal breast tissue, whereas PgR levels were high ( 76+/-102.4 fmol/mg protein). Both ER and PgR levels decreased in association with the peak of blood progesterone of the early secretory phase. In the 15 cases of benign neoplasm from the luteinic phase studied by immunohistochemistry there were few ER positive cells (29+/-15%) which were small (265+/-27 pixels) and faintly stained (MOD: 34+/-3UA), while the PgR positive cells were more numerous (79+/-15%), bigger (377+/-70 pixels), strongly stained (MOD: 48+/-5UA), and centrally located in the breast ducts. The differences in size and optical density were statistically significant indicating that both receptors are expressed by different cells. The cell cycle dependence of these differences is discussed. In the series of malignant neoplasms (199 cases, age 41+/-6 years), ER and PgR cytosol levels were both generally high (ER: 38+/-75.9, PgR: 86.6+/-137), and did not show variations due to the menstrual cycle, while blood progesterone, PgR, and the percentage of ER positive cases increased during the menstrual cycle. The 15 malignant cases in the luteinic phase showed, through immunohistochemistry, that size and staining intensities of receptor positive cells were similar to the other 199 cases and were not found to be directly influenced by hormonal activity related to the menstrual cycle. Comparisons between benign and malignant specimens showed significant biochemical and immunohistochemical differences in the degree of ER positivity while, on the contrary, PgR levels were similar.
Abstract: Levels of estradiol and progesterone from blood together with oestrogen (ER) and progesterone receptors (PgR) from breast tissue were studied from a total of 2500 data bank cases of breast neoplastic disease. We report here, 340 premenopausal women with recorded menstrual cycle data which enabled the study of the effect of peripheral hormone variation on ER and PgR with respect to cycle phase. The findings were also correlated with 30 immunohistochemical specimens. In the specimens with benign neoplasm (141 cases, age 28 +/- 18 years) the ER levels were low (9.2+/-9.4 fmol/mg protein) as in normal breast tissue, whereas PgR levels were high ( 76+/-102.4 fmol/mg protein). Both ER and PgR levels decreased in association with the peak of blood progesterone of the early secretory phase. In the 15 cases of benign neoplasm from the luteinic phase studied by immunohistochemistry there were few ER positive cells (29+/-15%) which were small (265+/-27 pixels) and faintly stained (MOD: 34+/-3UA), while the PgR positive cells were more numerous (79+/-15%), bigger (377+/-70 pixels), strongly stained (MOD: 48+/-5UA), and centrally located in the breast ducts. The differences in size and optical density were statistically significant indicating that both receptors are expressed by different cells. The cell cycle dependence of these differences is discussed. In the series of malignant neoplasms (199 cases, age 41+/-6 years), ER and PgR cytosol levels were both generally high (ER: 38+/-75.9, PgR: 86.6+/-137), and did not show variations due to the menstrual cycle, while blood progesterone, PgR, and the percentage of ER positive cases increased during the menstrual cycle. The 15 malignant cases in the luteinic phase showed, through immunohistochemistry, that size and staining intensities of receptor positive cells were similar to the other 199 cases and were not found to be directly influenced by hormonal activity related to the menstrual cycle. Comparisons between benign and malignant specimens showed significant biochemical and immunohistochemical differences in the degree of ER positivity while, on the contrary, PgR levels were similar.
Abstract: To discover the perception of telemedicine in a sample of physicians not yet participating in telemedicine networks, a questionnaire was sent to doctors in different European countries. The questions covered various general aspects of telemedicine. The percentage of questionnaires returned ranged from 12% (Central Europe) to 27% (Spain). Apart from the rather disappointing response rates the results document a strong interest in telemedicine on the part of the physicians surveyed. Knowledge of the existence of telemedicine was high. Most of the respondents would have liked to have had their clinic's telemedicine system in their own laboratory. More than 50% of the physicians thought that their work would be improved by using telemedicine. Respondents from Central Europe were significantly less enthusiastic about telemedicine than those from other regions. However, the answers to the majority of the questions were similar in the different groups.
Abstract: The present paper summarizes our 1 year's experience with the use of static high resolution videophones (9600 bauds transmission rate, lossless compression, 512 x 512 spatial resolution). The images (n = 610) belong to regular videoconsultation in cytology (160 images), (160 images), pathology (226 images), conventional radiology (50 images) and mammographies (174 images). The results showed an exponential relationship between agreement with 'gold standards' (true diagnosis of the case based on pathology, surgery and follow-up) and the time of training on screen diagnosis (r = 0.9726, P < 0.01) that increases (r = 0.983, P < 0.004) when the screen diagnosis training within the specific topic is examined. Conversely, no significant correlation is found when medical experience itself is considered (r = 0.31, P nonsignificant). Sufficient diagnostic response has been achieved after 1 year of training on screen diagnosis within a specific topic.
Abstract: To discover the perception of telemedicine in a sample of physicians not yet participating in telemedicine networks, a questionnaire was sent to doctors in different European countries. The questions covered various general aspects of telemedicine. The percentage of questionnaires returned ranged from 12% (Central Europe) to 27% (Spain). Apart from the rather disappointing response rates the results document a strong interest in telemedicine on the part of the physicians surveyed. Knowledge of the existence of telemedicine was high. Most of the respondents would have liked to have had their clinic's telemedicine system in their own laboratory. More than 50% of the physicians thought that their work would be improved by using telemedicine. Respondents from Central Europe were significantly less enthusiastic about telemedicine than those from other regions. However, the answers to the majority of the questions were similar in the different groups.
Abstract: Objective algorithms to evaluate immunocytochemistry in cytology and in histological sections are still under investigation. Clinical value, simplicity, robustness and adaptation to new technologies such as telemedicine and telequantification have to be taken into consideration. The present paper summarizes the experience of the immunoquantification of 206 cases diagnosed from 1990 to 1991, 36 clinical stage I cases, 110 stage II cases and 60 stage III cases. Initial clinical stage IV cases were excluded from the series. Quantification was done on frozen sections incubated with monoclonal estrogen and progesterone receptors (ER, PgR) by the peroxidase antiperoxidase (PAP) technique revealed with DAB. Automatic computerized measurements with a 550-nm filter were based on global scene segmentation, obtaining the parameters of percentage of positive area (p(A)) and immunoscore (ISC = sum i x pi), being the staining intensity (i) automatically evaluated in 5 grades multiple of the standard deviation (SD) of the control specimen (i x SD) stained with progressive haemathoxyline. Cut point of positive and negative specimens regarding ISC were obtained by semilogarithmic plot with biochemical receptor values (r = 0.73). The whole series showed a significant Increase of negative specimens according to clinical stage and a higher number of PgR negative-cases (44%) than ER negative cases (32%). The clinical relevance of the quantified parameters were evaluated by free interval disease survival curves being significant in the positive cutting point of ISC = 100 (ER P < 0.06; PgR P < 0.02) and the 40% negative area for the p(A) (ER P < 0.001; PgR P < 0.004). This quantification technique, which does not require individual cell segmentation, was reproducible at a distance (telequantification through high resolution videophones at 9600 bauds transmission rate; 55 cases). Coefficient of variation (CV) of the parameters in the original and transmitted cases were in the range of 0-5% in specimens with positive areas over 70%; less positive specimens require lower segmentation thresholds to get acceptable coefficients of variation. According to our results, immunohistochemical steroid receptor contents in breast cancer pathology, quantified by the technique of pixel integration, demonstrated the added value of the percentage of positive area in patient follow-up. Those having more than 40% of negative areas have recurrences mainly within the first year.
Abstract: We describe the cytogenetics of a multinodular thyroid goiter where 90% of the analyzed cells showed a diploid karyotype with a balanced translocation between chromosomes 5 and 19: 46,XX,t(5;19)(q13;q13). This translocation has been previously described in cases of thyroid adenoma. Our case is the first report of this anomaly in nodular hyperplasia. We discuss its putative role in the neoplastic transformation of thyroid lesions.
Abstract: We describe the cytogenetics of a multinodular thyroid goiter where 90% of the analyzed cells showed a diploid karyotype with a balanced translocation between chromosomes 5 and 19: 46,XX,t(5;19)(q13;q13). This translocation has been previously described in cases of thyroid adenoma. Our case is the first report of this anomaly in nodular hyperplasia. We discuss its putative role in the neoplastic transformation of thyroid lesions.
Abstract: Objective algorithms to evaluate immunocytochemistry in cytology and in histological sections are still under investigation. Clinical value, simplicity, robustness and adaptation to new technologies such as telemedicine and telequantification have to be taken into consideration. The present paper summarizes the experience of the immunoquantification of 206 cases diagnosed from 1990 to 1991, 36 clinical stage I cases, 110 stage II cases and 60 stage III cases. Initial clinical stage IV cases were excluded from the series. Quantification was done on frozen sections incubated with monoclonal estrogen and progesterone receptors (ER, PgR) by the peroxidase antiperoxidase (PAP) technique revealed with DAB. Automatic computerized measurements with a 550-nm filter were based on global scene segmentation, obtaining the parameters of percentage of positive area (pA) and immunoscore (ISC = sum i x pi), being the staining intensity (i) automatically evaluated in 5 grades multiple of the standard deviation (SD) of the control specimen (i x SD) stained with progressive haemathoxyline. Cut point of positive and negative specimens regarding ISC were obtained by semilogarithmic plot with biochemical receptor values (r = 0.73). The whole series showed a significant increase of negative specimens according to clinical stage and a higher number of PgR negative cases (44%) than ER negative cases (32%). The clinical relevance of the quantified parameters were evaluated by free interval disease survival curves being significant in the positive cutting point of ISC = 100 (ER P < 0.06; PgR P < 0.02) and the 40% negative area for the pA (ER P < 0.001; PgR P < 0.004). This quantification technique, which does not require individual cell segmentation, was reproducible at a distance (telequantification through high resolution videophones at 9600 bauds transmission rate; 55 cases). Coefficient of variation (CV) of the parameters in the original and transmitted cases were in the range of 0-5% in specimens with positive areas over 70%; less positive specimens require lower segmentation thresholds to get acceptable coefficients of variation. According to our results, immunohistochemical steroid receptor contents in breast cancer pathology, quantified by the technique of pixel integration, demonstrated the added value of the percentage of positive area in patient follow-up. Those having more than 40% of negative areas have recurrences mainly within the first year.
Abstract: With the final aim of preventing neonatal respiratory distress syndrome (RDS), the present study was carried out on premature rabbits (28 days of gestation) that showed a moderate level of RDS. These animals were treated intratracheally with 25 microliters of semisynthetic surfactant, composed of natural adult rabbit surfactant/DPC/DPPG (1/0.6/0.6 mol P) in two types of carriers, saline solution (Sf) and a calcium solution (5 mM of Cl2Ca), which were also used as controls. This was maintained throughout the experimental period at 37 degrees C or 60 degrees C, while checking the effect of temperature on their behavior. The final results in the P/V curves showed a significant increase in the maximum distention in the cases treated with semisynthetic surfactant at 60 degrees C with calcium vehicle (60.96 ml/kg) and with saline solution as the vehicle (58.51 ml/kg) with respect to the control without treatment (44.08 ml/kg) (p < 0.05). In the morphometric quantification of the lungs fixed to 10 cm H2O, the highest distention (VV) is reached by the semisynthetic surfactant in calcium solution (Mez.Ca) at 37 degrees C (56.30%) and 60 degrees C (56.31%), followed by the semisynthetic surfactant in saline solution at 37 degrees C (55.17%). The maximum compliance expressed the highest distention (with or without emphysema) and the morphometric distention together with the compliance at 10 cm H2O showed the residual trapping and/or anticollapsing effect. The temperature and the type of vehicle used for the semisynthetic mixture did not significantly influence the lung distention.(ABSTRACT TRUNCATED AT 250 WORDS)
Abstract: With the final aim of preventing neonatal respiratory distress syndrome (RDS), the present study was carried out on premature rabbits (28 days of gestation) that showed a moderate level of RDS. These animals were treated intratracheally with 25 microliters of semisynthetic surfactant, composed of natural adult rabbit surfactant/DPC/DPPG (1/0.6/0.6 mol P) in two types of carriers, saline solution (Sf) and a calcium solution (5 mM of Cl2Ca), which were also used as controls. This was maintained throughout the experimental period at 37 degrees C or 60 degrees C, while checking the effect of temperature on their behavior. The final results in the P/V curves showed a significant increase in the maximum distention in the cases treated with semisynthetic surfactant at 60 degrees C with calcium vehicle (60.96 ml/kg) and with saline solution as the vehicle (58.51 ml/kg) with respect to the control without treatment (44.08 ml/kg) (p < 0.05). In the morphometric quantification of the lungs fixed to 10 cm H2O, the highest distention (VV) is reached by the semisynthetic surfactant in calcium solution (Mez.Ca) at 37 degrees C (56.30%) and 60 degrees C (56.31%), followed by the semisynthetic surfactant in saline solution at 37 degrees C (55.17%). The maximum compliance expressed the highest distention (with or without emphysema) and the morphometric distention together with the compliance at 10 cm H2O showed the residual trapping and/or anticollapsing effect. The temperature and the type of vehicle used for the semisynthetic mixture did not significantly influence the lung distention.(ABSTRACT TRUNCATED AT 250 WORDS)
Abstract: Presence of videophones providing real time, real color will shortly be introduced as a part of the everyday work routine in hospitals. They can connect almost anywhere in the world and give the opportunity to do measurements in distant receptors. In this paper we aim to present a short experience in distant DNA and immunohistochemial quantification by image analysis through a RGB 8bits/color/pixel videophone of 512c512 pixel images. Twenty five histological case for DNA and nuclear hormone receptor were received and quantified during a fifteen day period from distant broadcaster in Zurich (Switserland) and Taunnusstein (Germany). The experience, the first in the world, showed that no major differences were found between the original and the transmitted images. Initial differences were due to a change in brightness and contrast induced when recording the images. Comparable quantifications of the images received through the videophone were achieved by gain and offset corrections.
Abstract: An automated classification of 73 thyroid lesions using a logical and mathematical approach was attempted. Densitometric, morphometric and flow cytometric parameters were used in Fisher linear discriminant functions to separate goiters or normal thyroids from adenomas and from carcinomas; the combination of this approach with binary discrimination improved the initial classification to a final efficiency of 81%. This approach, which is useful for classifying individual cells, was thus insufficient for classifying these cases. Analysis of the individual parameters showed that thyroid lesions were mainly in the near-diploid region. Two G0G1 populations were present in both benign and malignant lesions and were particularly frequent (50%) in atypical invasive follicular adenomas, probably related to the additional presence of an invasive clone. Near-triploid peaks were associated with malignancy as well as with high proliferative indexes. Nuclear and nucleolar sizes were larger in carcinomas; however, the percentage of the nucleolar area in the nucleus was greater in adenomas and nodular adenomatous goiters. A corrected staining index correlated with the nuclear size and the ploidy of abnormal cells (r = .50), being higher in malignant lesions.
Abstract: The exogenous therapy of respiratory distress syndrome with artificial surfactants is controversial. In the present work we treated premature rabbits with artificial ultrasonic obtained surfactant suspensions [dipalmitoyldiphosphatidylcholine:dipalmitoyldiphosphatidylglycerol (DPPCDPPG) 7:3] in various physical conditions produced by changing the carrier (saline solution and amniotic fluid) or incubating at 41 ðC. Nonincubated samples (S0) were nonactive, the best effect on alveolar distention being found after 8 h incubation (S8), while 16 h incubated samples (S16) were less effective. Liposomal size of the mixtures correlated with their effectiveness; small unilamellar liposomes were nonactive, large unilamellar ones were active and in presence of large multilamellar liposomes the tensioactive effect decreased. Fifty-one percent of the alveolar distention, evaluated by morphometry, was due to treatment and 11% was linearly related to body weight. The ponderal effect of body weight was mathematically excluded in order to obtain more uniform results; the resulting parameter was called true treatment influence on alveolar distention (TIAD). 15% of TIAD varied due to the carrier, with significantly better results when saline solution was used as a carrier. These findings question the hypothesis of the prevention of respiratory distress syndrome by means of intraamniotic injection of surfactants.
Abstract: The exogenous therapy of respiratory distress syndrome with artificial surfactants is controversial. In the present work we treated premature rabbits with artificial ultrasonic obtained surfactant suspensions [dipalmitoyldiphosphatidylcholine:dipalmitoyldiphosphatidylglyc erol (DPPC:DPPG) 7:3] in various physical conditions produced by changing the carrier (saline solution and amniotic fluid) or incubating at 41 degrees C. Nonincubated samples (S0) were nonactive, the best effect on alveolar distention being found after 8 h incubation (S8), while 16 h incubated samples (S16) were less effective. Liposomal size of the mixtures correlated with their effectiveness; small unilamellar liposomes were nonactive, large unilamellar ones were active and in presence of large multilamellar liposomes the tensioactive effect decreased. Fifty-one percent of the alveolar distention, evaluated by morphometry, was due to treatment and 11% was linearly related to body weight. The ponderal effect of body weight was mathematically excluded in order to obtain more uniform results; the resulting parameter was called true treatment influence on alveolar distention (TIAD). 15% of TIAD varied due to the carrier, with significantly better results when saline solution was used as a carrier. These findings question the hypothesis of the prevention of respiratory distress syndrome by means of intraamniotic injection of surfactants.
Abstract: This study presents the results of an automatic classification of six purely papillary, five purely follicular and five mixed papillary-follicular carcinomas of the thyroid. All cases were correctly classified with only two chromatin textural parameters obtained in the Olga's scan software package developed in our laboratory. Chromatin texture lines were generated by a unidirectional grey level gradient, obtained as a natural logarithmic function of the integrated optical density of each nucleus; this increased the difference between clear papillary and granular follicular nuclei. The accuracy of the method allowed a follicular carcinoma to be correctly classified as a mixed follicular-papillary. Finally a columnar-cell carcinoma of the thyroid was detected by means of its atypical DNA histogram.
Abstract: Glomerulonephritis is a very unusual feature of relapsing polychondritis. A 16-year-old woman presented with microscopic hematuria and severe renal insufficiency during the course of relapsing polychondritis. A renal biopsy specimen disclosed focal segmental proliferative glomerulonephritis with necrotizing lesions and crescent formation. Immunofluorescent studies suggested immune complex mediated glomerular injury. The renal involvement appeared during high-dose steroid therapy. Subsequently, she was treated by adding plasmapheresis and cyclophosphamide during 6 weeks, with sustained improvement. A regimen of plasmapheresis and immunosuppression warrants consideration for use in cases of relapsing polychondritis with glomerulonephritis.
Abstract: We studied a case of long-standing chondrocalcinosis that after 40 years affected almost all fibrocartilages, hyaline cartilages, and articular cavities within the subject. Massive deposits of dihydrocalcium pyrophosphate (CPP) were also found in nonfissured nucleus pulposus of the vertebral disks. To our knowledge, this is the first report of CPP deposits in these disks.
Abstract: The case of a 75-year-old man with an extramedullary plasmacytoma of the stomach with peculiar histologic aspect is summarized. The cytoplasm of the proliferated cells was full of needle-shaped crystalline inclusions that made it difficult to recognize the plasma-cell nature. Under electron microscope, the crystalline inclusions were localized in the rough endoplasmic reticulum. They have a two internal line system of 75-85 àof period in a 45 ð angle with the main edge. The laser-ray analysis demonstrates that these two systems delineate hexagonal areas.
Abstract: A multilocular cyst of the kidney in an adult with malignant papillary adenocarcinomatous transformation is described. The histogenesis and prognosis of multilocular cysts are discussed with special reference to their relationship with Wilms' tumour.
Abstract: Horizontal cleavages and lateral cysts were examined in a series of 70 menisci. The horizontal cleavage (HC) is the most frequent form of tear, occurring most often in the middle third of the lateral meniscus. Horizontal cleavages which reach the base of the meniscus triangle connect with parameniscal cysts. Extension of the horizontal cleavage into the parameniscal region seems to be, therefore, the cause of cyst formation.
Abstract: Systematic macroscopic and microscopic measurements of the tibial surface of 70 menisci helped to reveal associated minimal dysplastic lesions. The normal meniscus is divided into upper and lower areas by the middle perforating bundle. Considering its high frequency, a minimal myxoid degeneration in the center of the meniscus is normal. Classic myxoid degeneration may be divided into 2 types. Type A or parameniscal cystic degeneration, and Type B or intrameniscal myxoid degeneration. The intrameniscal myxoid degeneration is a nonspecific reaction to injury. Parameniscal mucoid degeneration constitutes the substrate of lateral meniscal cysts.
Abstract: A unique case of severe and diffuse endocardial fibroelastosis covering the entire left ventricle and associated with pseudoxanthoma elasticum is presented. The clinical picture was that of an apparently primary restrictive cardiomyopathy. Specific histologic lesions could be recognized in the endocardium.
Abstract: A case of intravascular and sclerosing bronchio-alveolar tumor is presented with ultrastructural observations. The tumor cells appear to arise from the alveolar lining and are characterized by a fibrillary cytoplasm. These cells are enmeshed in interstitial tissue containing fibrils, elastin material, amorphous intercellular substance and degenerated cytoplasmic processes. The patient, a 49-year-old white woman, is alive without treatment, with no significant increase in size or number of lung nodules 7 years after the clinical discovery.
