Implementation of a fetal ultrasound telemedicine service: women's views and family costs.

BACKGROUND: The complexity of fetal medicine (FM) referrals that can be managed within obstetric units is dependent on the availability of specialist ultrasound expertise. Telemedicine can effectively transfer real-time ultrasound images via video-conferencing. We report the successful introduction of a fetal ultrasound telemedicine service linking a specialist fetal medicine (FM) centre and a remote obstetric unit. METHODS: Over a four-year period from October 2015, all women referred for FM consultation from the obstetric unit were seen via telemedicine, excluding cases where invasive testing, intrauterine therapy or cardiac anomalies were anticipated. The outcomes measured included the indication for FM referral; scan duration and image and sound quality during the consultation. Women's perceptions of the telemedicine consultation and estimated costs to attend the FM centre were measured by a structured questionnaire completed following the first telemedicine appointment during the Phase 1 of the project. RESULTS: Overall, 297 women had a telemedicine consultation during Phase 1 (pilot and evaluation) and Phase 2 (embedding and adoption) of the project, which covered a 4 year period 34 women completed questionnaires during the Phase 1 of the study. Travel to the telemedicine consultation took a median (range) time of 20 min (4150), in comparison to an estimated journey of 230 min (120,450) to the FM centre. On average, women would have spent approximately £28 to travel to the FM centre per visit. The overall costs for the woman and her partner/ friend to attend the FM centre was estimated to be £439. Women were generally satisfied with the service and valued the opportunity to have a FM consultation locally. CONCLUSIONS: We have demonstrated that a fetal ultrasound telemedicine service can be successfully introduced to provide FM ultrasound of sufficient quality to allow fetal diagnosis and specialist consultation with parents. Furthermore, the service is acceptable to parents, has shown a reduction in family costs and journey times.

[Anatomic pathology workflow. IHE: modeling based on current developments in HL7 and DICOM]. / Der Workflow in der Pathologie. IHE: Modellierung unter Berücksichtigung der aktuellen Entwicklungen in HL7 und DICOM.

AIMS: Consistent and complete information is essential for medical decision making. Anatomic pathology as a diagnostic discipline has a central role in the exchange of information between clinical departments throughout the diagnostic process. The IHE (Integrating the Healthcare Enterprise) has created an integration profile for information systems based on HL7 and DICOM standards. METHODS: Created by the IHE Anatomic Pathology working group, the integration profile (so-called Technical Framework) ensures the consistent management of data and material in the pathology laboratory information system (PLIS). HL7 and DICOM standards are taken into account. Communication processes both within and outside the institute are modelled using eight actors and 13 transactions. RESULTS: The IHE's Technical Framework covers basic business processes, provision of diagnostic services and includes requesting examinations, as well as image and report management. In particular, a consistent data model for incoming material, containers, cartridges and slides has been developed and approved by the standards committee.

Metanephric adenoma with embryonal hyperplasia of Bowman's capsular epithelium: previously unreported association.

We report a case of a 9-year-old boy with focal, segmental glomerulosclerosis who, following peritoneal dialysis, underwent renal transplantation and bilateral nephrectomy. The kidneys showed histological features of embryonal hyperplasia of Bowman's capsular epithelium, an uncommon lesion that is seen most often in patients with chronic renal failure who are being maintained on dialysis. In addition, a 1-cm tumor in the left kidney showed features of metanephric adenoma. Although both lesions are uncommon, they share many similarities on a morphological, immunohistochemical, and ultrastructural basis. This association has not been previously reported and may shed some light on the histogenesis of these recently described lesions.

The Heidelberg classification of renal cell tumours.

This paper presents the conclusions of a workshop entitled 'Impact of Molecular Genetics on the Classification of Renal Cell Tumours', which was held in Heidelberg in October 1996. The focus on 'renal cell tumours' excludes any discussion of Wilms' tumour and its variants, or of tumours metastatic to the kidneys. The proposed classification subdivides renal cell tumours into benign and malignant parenchymal neoplasms and, where possible, limits each subcategory to the most commonly documented genetic abnormalities. Benign tumours are subclassified into metanephric adenoma and adenofibroma, papillary renal cell adenoma, and renal oncocytoma. Malignant tumours are subclassified into common or conventional renal cell carcinoma; papillary renal cell carcinoma; chromophobe renal cell carcinoma; collecting duct carcinoma, with medullary carcinoma of the kidney; and renal cell carcinoma, unclassified. This classification is based on current genetic knowledge, correlates with recognizable histological findings, and is applicable to routine diagnostic practice.

Treatment of ectopic pregnancy: is a human chorionic gonadotropin level of 2,000 mIU/mL a reasonable threshold?

PURPOSE: To determine whether a human chorionic gonadotropin (hCG) level of 2,000 mIU/mL is a reasonable threshold for diagnosing ectopic pregnancy in the absence of ultrasound (US) findings of intrauterine pregnancy (IUP) and thus to prevent inappropriate treatment that will result in the loss of an otherwise normal pregnancy in women with early IUPs. MATERIALS AND METHODS: The authors reviewed the medical records of and US scans obtained in 676 patients in whom ectopic pregnancy was clinically suspected between January 1, 1994, and December 31, 1995. RESULTS: Five hundred forty-eight patients had evidence of a normal or abnormal IUP. Fifty-one (40%) of the 128 patients without evidence of an IUP had an hCG level of more than 2,000 mIU/mL. Of these 51 patients, 15 (29%) were treated for ectopic pregnancy; 17 (33%) were not immediately treated for ectopic pregnancy and had a normal IUP at follow-up US. CONCLUSION: An hCG level of 2,000 mIU/mL without US findings of IUP, while suggestive of an abnormal pregnancy, is not diagnostic. Per the results of recent studies, it is reasonable to closely follow up rather than treat many of these early, stable cases of ectopic pregnancy.

Failure of posttrial administration of vasopressin analogue (DDAVP) to influence memory in healthy, young, male volunteers.

The effects of intranasal treatment with DDAVP on healthy, male volunteers was assessed. Subjects were asked to learn prose passages and then were given either 60 micrograms of DDAVP or saline in a double-blind procedure. Subjects were then asked to recall the passages after a 24-h delay. Treatment had no effect on recall of passages. This suggests that treatment with vasopressin affects acquisition rather than consolidation of newly learned information.

A preliminary study of the impact of terminal illness on spouses: social support and coping strategies.

This study examined whether social support and particular coping strategies were associated with self-reported depression, anxiety, anger, and physical symptoms in spouses of terminally ill patients recently admitted to a hospice program. Forty-four spouses were assessed within two weeks of the patients' admission. Results showed that specific types of social support (namely, socialization, guidance, and cognitive information) and the coping strategy of wishful thinking were associated with self-reported level of anxiety. In addition, cognitive information and the coping strategies of wishful thinking and express emotions were associated with self-reported level of anger. Directionality and possible explanations for these findings are discussed.

Effects of smoking on memory for prose passages.

The present study examined the effects of smoking on memory for prose passages. Habitual male smokers were matched on verbal ability, impulsivity level, and habitual smoking level and were instructed to smoke either a 0.1 mg (control), a 0.7 mg, or a 1.5 mg nicotine cigarette in a controlled fashion. Immediate recall after reading expository passages was obtained. The results indicated that the subjects who smoked the 0.7 mg nicotine cigarette recalled a greater proportion of the idea units than the control group, with no difference between the 1.5 mg group and the control. In addition, blood pressure and heart rate significantly increased in all groups immediately after smoking, with heart rate increases greater in the 0.7 mg and 1.5 mg groups than the control. Interpretive hypotheses for the results include arousal theory, with optimal arousal levels being obtained in the 0.7 mg nicotine group for the prose recall task, and nicotine specific effects, including nicotine's influence on the cholinergic system.

The actions of melanin-concentrating hormone (MCH) on passive avoidance in rats: a preliminary study.

Melanin-concentrating hormone (MCH) is a hepadecapeptide hormone that is synthesized in the CNS and is responsible for melanosome aggregation in the teleost fish. Recent evidence suggests that this peptide hormone has a unique distribution in the mammalian brain, which leads to the speculation that it may serve as a neuromodulator. The present study was undertaken to explore the comparative effects of MCH to those of alpha-melanocyte-stimulating Hormone (MSH) (a neuropeptide that is known to influence learning) on the rate of extinction of a passive avoidance response in rats. Both MCH and MSH were administered SC at 10 micrograms per animal. Treatment with MCH appeared to hasten, whereas treatment with MSH appeared to delay, extinction of the passive avoidance response.

Liver involvement in Alpers disease.

Alpers disease consists of diffuse cerebral degeneration manifested as developmental delay, seizures, vomiting, and progressive neuromuscular deterioration, with liver disease and death. We report the clinical course of the liver disease, histologic progression of the hepatic lesions, and etiologic investigations in five patients (four girls, three kinships). All had grown and developed normally until seen at 6 to 36 months of age (mean 20 months), with vomiting (n = 5), progressive hypotonia (n = 3), or seizures (n = 2). All had been given anticonvulsants, including valproic acid in three. Liver disease was noted at a mean age of 35 months (range 9 to 67 months), with hepatomegaly (two patients), abnormal hepatic synthetic function (three) or transaminase values (three), and cirrhosis in one. Patients survived for a mean of 4.6 weeks (range 1 to 8 weeks) after the identification of liver disease; all died of hepatic failure. Results of evaluation for infectious and metabolic causes of liver disease and causes of degenerative neuromuscular disease were negative in all patients. Premortem liver biopsy specimens (n = 3) demonstrated an early lesion consisting of lobular disarray, microvesicular steatosis, periportal acute and chronic inflammation, and individual hepatocyte necrosis. Autopsy findings (n = 5) consisted of macrovesicular steatosis, massive hepatocyte dropout, and proliferation of bile ductular elements, with almost complete replacement of hepatocytes by proliferating bile ductular elements in two patients. Brain showed characteristic neuronal degeneration. We conclude that Alpers disease can be a cause of rapidly progressive liver failure in early childhood. Although the cause of this autosomal recessive disease is not known, it does not appear to be related to peroxisomal dysfunction.

Posttrial treatment with ethanol enhances recall of prose narratives.

A small number of studies have examined the effects of postlearning alcohol intoxication on memory for various materials. In contrast to most research examining the effects of alcohol on human memory, these studies demonstrated a facilitation of memory for information learned prior to intoxication. The present study was designed to examine the effects of alcohol on memory for two different kinds of materials. Standard word lists and narrative prose passages were employed to obtain a more detailed picture of the effects of posttrial intoxication with alcohol on memory. Intoxication with alcohol did not affect subject's ability to recall simple word lists. However, recall of prose passages was facilitated to a statistically significant degree. Results are discussed within the context of a current theory of retrograde facilitation of memory via various drugs/substances.

Effects of DDAVP on gender-specific verbal and visuospatial tasks in healthy young adults.

Although several studies have demonstrated the efficacy of the vasopressin analog DDAVP in enhancing human cognition, few previous studies have explored possible interactions of treatment with DDAVP and gender in healthy young adults. The present study was undertaken to explore the effects of treatment with DDAVP on gender-specific tasks. Male and female volunteers were treated with either DDAVP or saline and asked to recall lists of words and to perform the Paper Folding and Stroop Color Word Tests. Although treatment with DDAVP produced few effects in these tasks, the effects that were noted involved impairment of performance.

Prenatal exposure to AVP or caffeine but not oxytocin alters learning in female rats.

Rats whose mothers had been treated with 1 microgram of arginine vasopressin (AVP) or oxytocin (OXT), 15 mg of caffeine, or saline on days 13-19 of gestation were given training on a passive avoidance response as adults. Female rats whose mothers had been exposed to either AVP or caffeine demonstrated enhanced retention of the response. No effects were found for male rats or for exposure to oxytocin. These results suggest that prenatal exposure to AVP or caffeine produced sexually dimorphic effects on learning and that the effects are specific to the structure of AVP.