The technical performance and clinical feasibility of telecolposcopy.

BACKGROUND: The purpose of our study was to demonstrate the technical performance and clinical feasibility of a telecolposcopic system through assessment of image transmission veracity, ease of office system implementation, and the patient's acceptance of the electronic image transmission. METHODS: We used a telecolposcopic system incorporating a custom software package that integrated patient history, current gynecologic status, epidemiologic risk factors, and colposcopic images for local medical documentation and transmission. Satisfaction questionnaires were developed to measure ease of implementation at the remote sites and the patients' acceptance of telecolposcopy. RESULTS: Seventy-nine women participated in our trial. From 3 to 20 images were captured for each woman, documenting cervical squamous intraepithelial lesions and vaginal and vulvar diseases. All images were received without distortions in color, size, or orientation. With complete visualization of the squamocolumnar junction there was an 86% agreement between the remote and review sites (kappa=.533, P=.019). The interobserver agreement for colposcopic impressions was 86% (kappa=.684, P <.001), and for colposcopic impressions with histology within one level of disease severity, 86% (kappa=.78, P <.001). Colposcopists' and patients' satisfaction with telecolposcopy was excellent. More than 95% of the women stated that they would rather have their colposcopy locally with electronic transmission if an experienced colposcopist were more than 25 miles away. CONCLUSIONS: The telecolposcopic system described in our study is technically feasible, can be implemented in an office system with limited technical support, and is preferred by women who have to travel many miles to receive referral health care.

A serious vascular complication of internal fixation of a tibial plateau fracture: a cautionary tale from which several lessons can be learned.

A serious vascular complication of internal fixation of a tibial plateau fracture is described, along with the problems encountered in revascularisation of the leg. Several lessons can be learned from this case, which illustrates the importance of on-site vascular surgery services.

Prenatal predictors of cesarean section due to labor arrest.

Cesarean section due to labor arrest occurs because the fetus is too large for the maternal outlet tract. If these women could be identified prior to labor, patient management could be optimized for both the clinician and the woman. A case-control study was designed to identify predictors of Cesarean section due to labor arrest. A five year retrospective review identified 32 cases and 329 controls with complete data for the prenatal maternal variables. Both cases and controls were considered for the stepwise logistic regression model. The prenatal variables predicting Cesarean section due to labor arrest are parity, history of past macrosomia, maternal age, term fundal height and maternal height. This model can be considered a pilot model that can be tested in a large international/inter-ethnic population.