One hundred and four articles, published from 1966 to 2000, were reviewed to investigate telemedicine evaluation studies in terms of methods and outcomes. A total of 112 evaluations were reported in ...these 104 articles. Two types of evaluations were evaluated: clinical and nonclinical. Within the clinical evaluations, three were on clinical effectiveness, 26 on patient satisfaction, 49 on diagnostic accuracy, and nine on cost. In the non-clinical evaluations, 15 articles discussed technical issues relating to digital images, such as bandwidth, resolution, and color, and 10 articles assessed management issues concerning efficiency of care, such as avoiding unnecessary patient transfer, or saving time. Of the 112 evaluations, 72 were descriptive in nature. The main methods used in the remaining 40 articles used quantitative methods. Nineteen articles employed statistical techniques, such as receiver operating characteristics curve (three evaluations) and kappa values (seven evaluations). Only one article utilized a qualitative approach to describe a telemedicine system. Currently, there are a number of good reports on diagnostic accuracy, satisfaction, and technological evaluation. However, clinical effectiveness and cost-effectiveness are important parameters, and they have received limited attention. Since telemedicine evaluations tend to explore various outcomes, it may be appropriate to evaluate from a multidisciplinary perspective, and to utilize various methodologies.
The protective effects of preinfarction angina were evaluated in acute myocardial infarction (AMI) treated by primary percutaneous transluminal coronary angioplasty (PTCA) and stenting. We studied ...613 patients with AMI. Group 1 (n = 306) was treated by conventional medical therapies and coronary thrombolysis and group 2 (n = 307) was treated by primary PTCA supported by stenting. Each group was subdivided into those with and without preinfarction angina within 24 hours before the onset of AMI. There was no significant difference in clinical characteristics between the subgroups of groups 1 and 2. In group 1, there were differences between patients with preinfarction angina (n = 84) and those without (n = 222) in in-hospital mortality (11% vs 18%), pump failure (Killip classes 3 and 4) (11% vs 21%, p <0.05), left ventricular ejection fraction at discharge (52 ± 13% vs 48 ± 14%, p <0.05), and peak creatine kinase (2,106 ± 1,637 vs 2,764 ± 2,154 U/L, p <0.02). In group 2, however, there was no significant difference between those with preinfarction angina (n = 82) and those without (n = 225) in mortality (6% vs 6%), pump failure (12% vs 12%), left ventricular ejection fraction (50 ± 13% vs 50 ± 13%) and peak creatine kinase (3,285 ± 2,306 vs 3,291 ± 2,262 U/L). Multivariate analysis indicated that preinfarction angina was an independent determinant of in-hospital death and pump failure in group 1, but not in group 2. We conclude that the protective effects of preinfarction angina in AMI are not evident in those treated by primary PTCA and stenting, possibly because of the overwhelming protective effects of complete coronary revascularization provided by primary PTCA and stenting.
The influence of a magnetic field on the classical dynamics in ballistic cavities is investigated by analyzing conductance fluctuations that result from quantum interference effects. The magnetic ...field transforms the exponential decay of the probability distributions of the dwell time and the enclosed area to a power‐law decay. The conductance fluctuations correspondingly exhibit a transition from a nonfractal to a fractal behavior. We also identify two additional states that take place when the magnetic field is weaker or stronger than that required to achieve the power‐law probability distributions.
Structural studies on a hereditarily abnormal plasminogen, plasminogen Tochigi, have been performed to identify the difference responsible for its lack of proteolytic activity. The plasminogen sample ...used was from a heterozygote and thus consisted of apparently equal amounts of normal and defective plasminogen molecules. Amino acid sequence analysis of a tryptic peptide isolated from the abnormal plasminogen indicated that Ala-600 (equivalent to Ala-55 in the chymotrypsin numbering system) had been replaced by Thr. No other substitutions in the active-site residues--namely, His-57, Asp-102, and Ser-195--were found. Molecular models for chymotrypsin and the bovine trypsin--pancreatic trypsin inhibitor complex indicate that Ala-55 is very near the active-site His. The Thr at position 55 in plasminogen (plasmin) Tochigi may perturb His-57 such that the proton transfers associated with the normal catalytic process cannot occur in the abnormal plasmin.
Recombinant Factor VIIa (rFVIIa) has been used to decrease bleeding in a number of settings, including hemophilia, liver transplantation, intractable bleeding, and cirrhosis. It has also been shown ...to reduce bleeding in coagulopathic pigs with Grade V liver injuries when used as an adjunct to packing. This study was performed to determine if rFVIIa would reduce blood loss after a Grade V liver injury in noncoagulopathic pigs when used as sole therapy.
Thirty normothermic animals were randomized to receive either 150 microg/kg of rFVIIa or normal saline intravenously. After laparotomy and splenectomy, a standardized Grade V liver injury was made with a liver clamp. Thirty seconds after injury, blinded therapy was given. Blood loss was measured 15 minutes after injury and the abdomen was closed. Animals were resuscitated to their baseline blood pressure and the study was continued for 2 hours. Serial coagulation parameters were obtained. Following the study period, blood loss was measured and an autopsy was performed. Grossly normal areas of lung were examined for evidence of intravascular thrombosis.
Mean Factor VII:C levels increased 155-fold in the treatment group after infusion of rFVIIa. The mean prothrombin time in the treatment group decreased from 9.8 +/- 0.4 seconds to 7.3 +/- 0.2 seconds and remained significantly different from the control group throughout the study (p < 0.01). There were no differences in other coagulation parameters. Mean initial blood loss was 822 +/- 266 mL in the treatment group and 768 +/- 215 mL in the control group (p = 0.6). Rebleeding blood volume was 397 +/- 191 mL in the treatment group and 437 +/- 274 mL (p = 0.6) in the control group. Lung histology revealed no evidence of abnormal microvascular thrombosis.
rFVIIa does not reduce blood loss after Grade V liver injury when it is used as sole therapy in warm noncoagulopathic pigs.
Sugarcane (Saccharum spp.) is a major crop grown for sucrose production. In Japan, its sucrose concentration is highest in winter. We examined the effects of the temperature lowered in the daytime ...and nighttime (LDT and LNT, respectively) on sugar assimilation. Since photosynthetic and respiration rates change with temperature, we assumed that plants under LNT (LNT plants) would have low respiration rates and thus high sugar yields, whereas those under LDT (LDT plants) would have low rates of photosynthesis and thus low sugar yields. However, because of their acclimatization to the reduced temperatures, LNT and LDT plants had sugar yields that were similar, or superior, to those of control plants. Sugar yield depends on biomass and sugar concentration; the stems of LNT and LDT plants did not grow as tall as those of the controls, but the sucrose concentrations in their stems were higher than in the controls. sup(13)C analysis revealed no difference in the partitioning of photosynthates to the soluble sugar fraction between control plants and those treated with low temperature. Control plants had higher glucose concentrations in the stem than treated plants, in which new photosynthates appeared to be partitioned preferentially into sucrose. Low temperature enhanced the sucrose concentration in the sugarcane stem not by improving the carbon budget, but by promoting the partitioning of carbon to stored sucrose.
A 76-year-old woman with a history of total thyroidectomy for a thyroid carcinoma at the age of 63 was admitted to our hospital for the treatment of a renal rupture induced by a tumor of about 3 cm ...in diameter. High levels of blood thyroglobulin (Tg >1,000 ng/ml) led us to suspect a recurrence of thyroid carcinoma. Strong accumulation in whole-body 123I and 201Tl scintigraphy scans after the nephrectomy revealed tumors in the right lung and left thigh muscle measuring 5 cm and 9 cm in diameter, respectively. The tumors of the kidney and thigh muscle were pathologically diagnosed as poorly differentiated follicular thyroid carcinoma, and the lung tumor was also suggested to be a metastasis of the thyroid carcinoma based on the scintigraphy findings. We report this rare case of follicular thyroid carcinoma associated with metastases to the thigh muscle and kidney leading to a rupture 13 years after a total thyroidectomy. Care should be taken to determine whether unknown tumors are thyroid carcinoma metastases.
PDF
