Giant Kidney Worm: Novel Report of Dioctophyma Renale in the Kidney of a Dog in Greece.

Dioctophyma renale is the largest nematode that infects domestic mammals and is the aetiologic agent of a serious renal disease, dioctophymatosis. It has an indirect life cycle with carnivores serving as final hosts and earthworms as intermediate hosts. The parasite can infect humans with signifi cant zoonotic potential. The pathogenesis of dioctophymatosis is mainly associated with the extent of renal atrophy caused by the parasites, the risk of bilateral renal infestation and the location of the parasite (extrarenal cases). Clinical diagnosis is challenging, and the only treatment option is nephrectomy or nephrotomy to remove the adult nematode. A 6-year-old female crossbreed dog presented with tachypnea, tachycardia and severe hematuria, but died shortly after presentation. Postmortem examination found the right kidney was enlarged and two adult nematodes were found in the renal pelvis. The left kidney was normal. The nematodes were collected and submitted for identifi cation. The two specimens were identifi ed as D. renale using specific identifi cation keys. Herein we present the first case of renal parasitosis by the nematode D. renale in a dog from Greece. This case highlights the need for investigation of the actual prevalence of the parasite and the use of measures for the control of its expansion aiming the protection of dogs and public health.

Families with deaf members: American Annals of the Deaf, 1996 to 2000.

The authors provide an overview of 21 articles from several countries focusing on families with deaf members published in the literary issues of the American Annals of the Deaf from 1996 to 2000. Four categories were identified: Interaction and Involvement, Support Services, Stress and Coping, and Decision Making. The articles represent a commendable expansion of focus from the mother-child dyad to increased attention to fathers, siblings, extended family members, and significant nonfamily members such as deaf adults. The heterogeneity of families was a striking factor, even within those studies dealing with relatively homogeneous populations. Services appeared to be most effective within middle-class, educated family units, illustrating the need for more comprehensive services sensitive to the needs of families from less affluent backgrounds and with lower levels of education. In general, services to families with deaf children may be characterized as better than in the past but still in need of significant sensitivity and improvement. The presence of a deaf child in a family with hearing parents may cause stress, but parents have the flexibility to respond in a positive and beneficial way, especially when provided adequate information and support. The idea that hearing parents go through a grieving process involving the identification of deafness in their child seems to be an overstatement.

Is telemedicine a subset of medical informatics?

Informatics has a key characteristic of a new discipline in a technically transient environment--there is no universal definition of it. This is not surprising, given its complex and diverse nature. In a broad sense informatics is the interface between developing technologies and the decision sciences, in particular clinical sciences. Telemedicine has no universally accepted definition either. Telemedicine requires the use of electronic communication networks for the transmission of information and data related to the diagnosis and treatment of, as well as education about, medical conditions. The debate ensues over whether it is or is not a subset of medical informatics. The care of the elderly diploma programme is a telemedicine project within the department of family medicine at the University of Alberta; it is a distance learning programme directed towards educating and training physicians in rural Alberta. This project provided us with the practical experience of addressing both informatics and telemedicine issues jointly.

Self-expanding esophageal metallic stents in the treatment of esophageal obstruction.

Esophageal obstruction from any cause is debilitating. In patients with malignant obstruction palliation to relieve pain and dysphagia is the primary goal. Conventional endoluminal prostheses allow variable palliation. Covered expandable metallic stents with an 18-mm lumen allow improved deglutition. From December 1994 through December 1998, 59 patients underwent placement of self-expanding silicone-covered esophageal stents for esophageal obstruction. There were 36 men and 23 women ranging in age from 41 to 94. All patients underwent esophageal dilation using a flexible gastroscope and Savary bougies. After dilation placement of the stent was performed under fluoroscopic control. Follow-up was complete in all patients. Technical success was achieved in all patients. There was one postoperative death (bronchopulmonary fistula), one migration of the stent requiring removal, and one recurrent obstruction. The remaining stents were well tolerated even in the cervical region (four patients). All patients returned to a diet of solid foods. We conclude that covered self-expanding esophageal metallic stents are technically simple and safe to insert and appear to provide durable excellent palliation of esophageal obstruction due to either benign or malignant conditions.

Laparoscopic bladder 'wrap' technique for repair of vesicoureteric reflux in a porcine model.

PURPOSE: The aim of this study was to determine if vesicoureteric reflux (VUR) can be successfully corrected laparoscopically by a bladder "wrap" technique in a pig model. METHODS: In 15 female piglets (mean weight, 22.5 kg) bilateral VUR was created by an open technique (11 grade 3, 2 each of grades 2 and 4). Eight weeks later (range, 4to 16 weeks) VUR was confirmed by fluoroscopic cystogram, and unilateral laparoscopic correction was performed. The contralateral ureter was used as a control. The bladder was emptied, and a 3F ureteric catheter was inserted on the repair side. Four 11-mm ports were inserted transperitoneally. The ureter was dissected to the ureterovesical junction (UVJ). Commencing at the UVJ, 2 (n = 9) or 3 (n = 6) black silk sutures were placed through the bladder muscle on either side of the ureter creating a bladder wrap around the distal 2 to 4 cm of ureter. At a mean of 16 weeks (range, 4 to 24 weeks) cystograms were repeated. The animals were killed the bladder and ureters underwent histopathology examination. RESULTS: VUR was corrected in 12 animals (80%). There was persistence of VUR in 2 and ureteric obstruction in 1. The wrap was intact in all animals. CONCLUSIONS: Laparoscopic correction of VUR by the bladder wrap technique is successful in pigs. Long-term follow-up studies will determine if this will be a satisfactory alternative surgical treatment for correction of VUR in children.

Assessment of physician performance in Alberta: the physician achievement review.

The College of Physicians and Surgeons of Alberta, in collaboration with the Universities of Calgary and Alberta, has developed a program to routinely assess the performance of physicians, intended primarily for quality improvement in medical practice. The Physician Achievement Review (PAR) provides a multidimensional view of performance through structured feedback to physicians. The program will also provide a new mechanism for identifying physicians for whom more detailed assessment of practice performance or medical competence may be needed. Questionnaires were created to assess an array of performance attributes, and then appropriate assessors were designated--the physician himself or herself (self-evaluation), patients, medical peers, consultants and referring physicians, and non-physician coworkers. A pilot study with 308 physician volunteers was used to evaluate the psychometric and statistical properties of the questionnaires and to develop operating policies. The pilot surveys showed good statistical validity and technical reliability of the PAR questionnaires. For only 28 (9.1%) of the physicians were the PAR results more than one standard deviation from the peer group means for 3 or more of the 5 major domains of assessment (self, patients, peers, consultants and coworkers). In post-survey feedback, two-thirds of the physicians indicated that they were considering or had implemented changes to their medical practice on the basis of their PAR data. The estimated operating cost of the PAR program is approximately $200 per physician. In February 1999, on the basis of the operating experience and the results of the pilot survey, the College of Physicians and Surgeons of Alberta implemented this innovative program, in which all Alberta physicians will be required to participate every 5 years.

Postgraduate training positions. Follow-up survey of third-year residents in family medicine.

OBJECTIVE: To survey all family medicine programs in Canada to determine how many positions for third-year training were available. DESIGN: The survey instrument contained questions to determine how many second-year positions and how many third-year positions each program had. Descriptions of third-year positions were requested. One survey question asked about the percentage of people with third-year training who initially went into rural or small-town practice. Last, each program director was asked for an opinion on how many third-year positions should be available for further training. SETTING: The survey was administered to the program directors of all 16 family medicine programs in Canada. PARTICIPANTS: Program directors of departments of family medicine. RESULTS: The survey indicated that the number of third-year positions was 18% of the number of second-year positions currently available (an increase over the 10% determined in Busing's study in 1989). The largest proportion of third-year training was in emergency medicine, and approximately 30% of third-year positions were primarily reserved for physicians intending to go into rural practice. Academic family physicians and residents are in fairly close agreement that third-year positions should represent 40% of second-year positions. CONCLUSION: A survey of Canadian family medicine programs during the 1996-1997 academic years indicated that third-year positions available for family medicine residents have almost doubled since Busing's original survey in 1989.