Endocrine disorders and osteoporosis

INTRODUCTION: The use of computers has yielded new diagnostic techniques (US, CT, MRI and computed radiography) that can successfully replace conventional film in data acquisition, image display and image interpretation. Thanks to the Picture Archiving and Communication System (PACS), we can now manage the whole of diagnostic data because the images are acquired, coupled to the patient data stored in the Radiology Information System (RIS), sent to display workstations and finally sent to the archives. PURPOSE: To present the configuration and functions of a new PACS used in radiology and nuclear medicine departments and to evaluate its efficacy one year after implementation. Particular attention is paid to the objective difficulties radiologists found in approaching the system. RESULTS: Secretarial work reduction and a more rational archiving organization are two of the advantages of automation. PACS permits rapid image display, retrieval nd archiving for both scientific and statistical purposes; however, its correct use is hindered by a series of problems, namely: a) reluctance to use PACS by many members of the medical staff, due to the complexity of its procedures; b) lack of panoramicity on the display monitor in multi-image examinations and c) underuse of viewing workstations in several wards of our institution due to lack of know-how. CONCLUSIONS: Although the use of PACS has improved the workload management in our departments, the system still needs to be customized to the radiologist to optimize its use. Workstations must be user-friendly, with simultaneous display of more images. On the other hand, radiologists need to expand their knowledge of new techniques, thus modifying obsolete working procedures.     

Exchange of medical imaging and data information in radiotherapy: needs, methods and current limits

Extension of the image network within radiotherapy departments provides the technical infrastructure which is made necessary by the rapid evolution of techniques in the field of diagnosis and treatment in radiotherapy. The system is aimed at managing the whole set of data (textual data and images) that are needed for planning and control of treatments. The radiotherapy network addresses two objectives: managing both the information necessary for treatment planning (target volumes definition, planning dosimetry) and the control of all parameters involved during the patient's treatment under the treatment unit. The major challenge is to improve the quality of treatment. Multimodal imaging is a major advance as it allows the use of new dosimetry and simulation techniques. The need for standards to exchange medical imaging information is now recognized by all the institutions and a majority of users and manufacturers. It is widely accepted that the lack of standard has been one of the fundamental obstacles in the deployment of operational "Picture Archiving Communication Systems". The International Standard Organisation Open System Interconnection model is the standard reference mode used to describe network protocols. The network is based on the Ethernet and TCP/IP protocol that provides the means to interconnect imaging devices and workstations dedicated to specific image processing or machines used in radiotherapy. The network uses Ethernet cabled on twisted-pair (10 BaseT) or optical fibres in a star-shaped physical layout. Dicom V3.0 supports fundamental network interactions: transfer of images (computerized tomography magnetic resonance imaging query and retrieve of images), printing on network attached cameras, support of HIS/RIS related interfacing and image management. The supplement to the Dicom standard, Dicom RT, specifies five data objects known in Dicom as Information Object Definition for relevant radiotherapy. Dicom RT objects can provide a mean for standardized transfer of most of the information wich circulates in a radiotherapy department. A wide range of device types are represented, (treatment planning systems, portal imaging devices, linear accelerators, recording and verifying systems, conventional and virtual simulators). There will be additions and perhaps new developments in dataflow management, more complete integration with HIS/RIS system and printing, but the lion's share of the work has now been done. A project to integrate some security features into the Dicom protocol has begun.     

Modelling of radiological services in the context of a hospital information system: does the DICOM standard meet the requirements?

PROBLEM: The data model given in the DICOM standard is examined under the aspect of system integration. Semantic properties of the IODs (information object definitions) and their relationships are investigated. METHOD: Starting from the entities defined in Part 3 of the DICOM standard, we explored how the classes defined there can be integrated into a common data model of the electronic patient record implemented by the HIS (Hospital Information System). Based on the IODs we investigated the definitions and semantics of entities being relevant for structured recording of image data. RESULTS: Because semantic definitions are incomplete, a proposal is made for the core domain of structured radiologic service recording. Its definition of semantics goes beyond the application domain of radiologic imaging to avoid structural conflicts during HIS/RIS/PACS integration. Differentiation between treatment and billing provides an independent temporal mapping of services concerning medical and billing aspects. Two groups of radiologic services are distinguished: radiologic imaging and additional services. CONCLUSION: The incomplete definition of IOD semantics leads to potential conflicts during system integration. Complete covering of this topic is necessary for implementation of the electronic patient record.     

Effects of extract from Clerodendron trichotomum on blood pressure and renal function in rats and dogs

A number of factors may determine the diagnostic accuracy of digitized intraoral radiographs. Conventional film radiographs were digitized with three different digitizers, a laser-scanner, a drum-scanner and a TV camera. Digital images, varying in pixel size, grey level and image processing, were displayed on three different video-monitors and assessed by 10 dentists. The detectability of incipient proximal surface caries was used as an index of the diagnostic accuracy and the effect of the different factors compared by means of receiver operating characteristic (ROC) analysis. Images digitized by the drum-scanner were found to have the best diagnostic accuracy. Sufficient diagnostic accuracy could be attained on the low-cost video monitor of a personal computer. Digital images with a pixel size of 100 microns and 32 grey levels were found to be acceptable for intraoral radiographs for diagnostic purposes. These results provide a practical guide for establishing a digital image acquiring system for any intraoral radiographs, reducing demands on data storage to a minimum.     

Effects of the K+ channel blockers paspalitrem-C and paxilline on mammalian smooth muscle

The UNIDOC system of computer-based medical records that was developed and made operational within the DIOGENE-2 Hospital Information System (HIS), is based upon a fully standardized and distributed open systems architecture. It should also be emphasized that UNIDOC illustrates a feasible marriage of the two technologies, UNIX and MS-DOS, is in many respects successful enough to be recommended as a sound general solution to medical office integration into a HIS.     

Walking to happiness

The paper describes a system able to combine conventional techniques of diagnostic x-ray imaging with direct digital imaging on the original receiver with a resolution of 1.2 lin/mm. Digital roentgenography may be introduced into medical practice basing on the system of computers at the working places of roentgenologist and his assistant. Data base of long-term storage of x-ray images and input software for each x-ray picture are outlined. The authors have some experience of utilizing the system in the random sequence of patients (20,000) in general and specialized hospitals of Novosibirsk.     

Utilization of outpatient diagnostic imaging. Does the physician's gender play a role?

OBJECTIVE: To examine physician and patient characteristics related to the ordering of imaging studies in a general medicine practice and to determine whether physician gender influences ordering patterns. DESIGN: Retrospective cohort study. SETTING: Hospital-based academic general medicine practice of 29 attending physicians. PATIENTS: All 8,203 visits by 5,011 patients during a 6-month period. METHODS: For each visit the following variables were abstracted from the electronic patient record: patient age, patient gender, visit urgency, visit type, and physician seen. All diagnostic imaging studies performed within 30 days of each outpatient visit were identified from the hospital's Radiology Information System. Screening mammography was not included in the analysis. Physician variables included gender and years since medical school graduation. Logistic regression analysis was used to evaluate the effect of various patient, physician, and visit characteristics on the probability of a diagnostic imaging study being ordered. RESULTS: Patient age, urgent visits, visit frequency, and the gender of the physician were all significantly related to the ordering of an imaging study. Correcting for all other factors, the ordering of an imaging study during an outpatient medical visit was 40% more likely if the physician was female (odds ratio = 1.40; 95% confidence interval [CI] 1.01, 1.95). Female physicians were 62% more likely (95% CI 0.99, 2.64) than male physicians to order an imaging study for a male patient and 21% more likely (95% CI 0.87, 1.69) to order an imaging study for a female patient. CONCLUSIONS: Physician gender is a predictor of whether an outpatient medical visit generates an imaging study. Reasons for this observation are unclear, but may be the result of different practice styles of male and female physicians or unmeasured patient characteristics.     

Magnetic resonance imaging of the normal mouse brain: comparison with histologic sections

Details in the living animal can be compared with respective histologic section taken after death. In less than 35 min, 12 to 16 coronal and transverse images through the brain can be obtained, each with an in-plane resolution of 100 x 200 microns and a slice thickness of 900 microns. The experimental parameters can be manipulated not only to achieve different tissue contrast but also to access any desired plane.     

N2-amination of guanine to 2-hydrazinohypoxanthine, a novel in vivo nucleic acid modification produced by the hepatocarcinogen 2-nitropropane

OBJECTIVE: Over the last twenty years, imaging modalities featuring new image production methods (ultrasound, nuclear magnetic resonance, etc.) have appeared on the market. Nevertheless, conventional radiology still accounts for 70% of the image examinations carried out in most western countries, including France. The conventional radiological image is in the process of evolving from analog to digital form. Digitalization of radiology means that image acquisition, archiving and distribution functions that were previously carried out by hand can now be automated using a Picture Archiving and Communication System. Decision-makers are having to decide whether or not to promote the development of PACS which, while they considerably modernize the way in which images are managed, also require heavy capital outlays. METHOD: A critical appraisal of the literature allowed us to evaluate the relative cost and the efficiency of these image networks in comparison with film-based archiving and communication systems. RESULTS: It is clear from the economic evaluation that a PACS strategy involves greater costs than a film system. While PACS systems do generate savings on film and on storage space and obviate the need for certain staff, these savings do not offset the extra equipment and maintenance costs. This situation is likely to persist for some years yet, even when future price reductions are taken into account. The objective of this new radiological information management method is to improve organizational efficiency and hospital productivity. However, the economic evaluations that have been published to date are cost studies which do not take the efficiency criterion into account. A number of potential organizational benefits such as the fact that medical decisions can be made more quickly or that the average length of hospital stays can be reduced, are often claimed for PACS. However, for methodological reasons, these results cannot be generalised to cover all PACS. It is difficult to compare PACS and film systems because the PACS technology is continuously evolving and because each PACS is specific to a site. CONCLUSION: After having weighted these different points, the ANAES has made the following recommendations concerning the development of PACS. A strategic analysis should be carried out before any decision is made to install a PACS. Moreover, hospitals will have to define the precise functions of their PACS in relation to the objectives of their medical project and each network must be configurated coherently.     

Management of radiologic archive in a diagnostic imaging department

One of the major and demanding problems in the management of a modern department of Radiology is undoubtedly the organization of a radiologic archive. Its management has been increasingly difficult in last years both for the increase in procedures and the number of radiologic exams. At the Radiology department of UCSC, since some years, this problem has been tackled. Major objectives have been identified in focusing on responsibilities, global management and planning of radiologic film retrieval and archiving integrated with health care activities (scheduling of admissions and exam appointments, reporting, discharge). Based on these assumptions, the archive has been divided into 3 sections, each dynamically integrated with the others. The 3 archives should be integrated with RIS and supported by information technology. RIS is considered the starting point of the process. In fact the system ensures communication to the archiving workstation and to the radiology room of patient admission and consequent execution of the exam which involves image production. This user-friendly procedure enables consistent information between RIS and archiving system and correct association of images to the patient medical report, for subsequent consultation.     

Present status of medical care for foreigners in Tochigi Prefecture, Japan (1). Survey at all clinics and hospitals

The number of foreign workers in Japan has rapidly increased during the last several years, because of the nation's insufficient work force. The influx of laborers into Japan has brought various issues to the forefront of society, one of the most serious being their medical care. To clarify the present status of their medical care, we sent a questionnaire to 1,004 clinics and hospitals in Tochigi Prefecture. The response rate was 55.6%, and the results are summarized as follows: 1. Clinics were rather reluctant to accept foreign patients because of the language barrier and the consequent time-consuming medical care. 2. Two-thirds of foreign patients did not enroll in any health insurance system. Most clinics and hospitals requested foreign patients with no health insurance to pay 100% of the medical cost set by the national insurance system of Japan. Some hospitals required more than 200% of the set cost, while some clinics reduced the cost. 3. Only a few doctors can communicate with patients in English. It is very difficult for doctors to communicate with foreign patients, who speak only their own native language, but not English. Most doctors felt it necessary to have the assistance of translators or booklets for translation. 4. Foreign patients endured illness, that is, ignored illness, delayed or stopped medical care at clinics and hospitals, because of communication problems and high medical costs. Labor injury cases among foreign workers were more frequent than among Japanese workers. 5. The medical cost for foreign workers per year has been estimated to be 44 billion yen (370 million dollars).(ABSTRACT TRUNCATED AT 250 WORDS)     

Ultrastructural changes in liver damage induced by carbon tetrachloride in spontaneously hypertensive rats and Wistar-Kyoto rats

The establishment of a better local area medical centre containing hospitals and clinics is thought to be a very important issue. The medical information system, which should be accepted by both hospitals and clinics, has been studied using graphic user interface (GUI) and a three dimensional structure. Our system files medical records and blood examination data as well as diagnostic images, which may be the first attempt in the world. It has been favourably evaluated by physicians through clinical evaluation.     

Enteric coccidia (Apicomplexa) in the small intestine of the northern spotted owl (Strix occidentalis caurina)

Sporulated oocysts (mean dimensions = 13.0 x 10.8 microns) and sporocysts (11.3 x 5.5 microns) of a coccidian resembling Frenkelia sp. or Sarcocystis sp. were present in the lamina propria of the small intestine of a naturally-infected northern spotted owl (Strix occidentalis caurina) collected near Medford, Oregon (USA). Dimensions of these oocytes and sporocysts appear to be considerably smaller than those from other sarcocystid species with avian definitive hosts. Additionally, numerous developmental stages and unsporulated oocysts (mean dimensions 22.8 x 17.8 microns) of a possible species of Isospora also were observed in the intestinal epithelium. This constitutes the first report of enteric coccidia from spotted owls. Neither parasite appeared to cause the death of the bird.     

Potential for non-shivering thermogenesis in perfused chicken (Gallus domesticus) muscle

The state of Oregon decided to cover all potentially eligible Medicaid citizens to 100% of poverty. Previously, Oregon had covered persons up to 67% of poverty. In order to keep overall program costs in check. Oregon decided to limit the number of services that its Medicaid program would cover. Oregon's normative choice was to contain program costs by covering all eligible persons up to 100% of poverty, while at the same time uniformly limiting access to certain services for everyone in the overall group of eligible persons. The state developed a prioritization list of medical services and priced the components on the list. The amount of money ultimately available for the Medicaid program was a political decision informed by data about the cost of different services and influenced by the priorities set through an independent process of priority-setting. Physicians were asked to determine what works medically, how well it works, and what benefits accrue to patients. Recognizing that physician perspectives on efficacy might vary from patients' perspectives on valuation of benefits, Oregon's planners developed a method for valuing medical outcomes that stemmed from particular medical interventions. This blend of medical fact and value to patients allowed for comparing valuations by introducing cost considerations. Condition-treatment (CT) pairs linked a medical condition with one or more courses of treatment. The goal was to determine the likely incremental medical benefit from a given treatment. In addition, Oregon developed a Quality-of-Well-Being scale to determine the net patient benefit from medical intervention and used a telephone survey to value that net benefit. A cost-benefit ratio was derived, and a prioritization of CT pairs was developed. The article analyzes and evaluates Oregon's use of cost-benefit calculations in the allocation of Medicaid funds, noting that Oregon itself backed away from many of the implications of its cost-benefit analysis and that the Americans with Disabilities Act has constrained use of quality-of-life judgments in Medicaid resource allocation decision-making.     

Phorbol ester modulation of rabbit corneal endothelial permeability

PURPOSE: Phorbol esters have been shown to have a profound influence on cellular activity in many cell types. The purpose of this study was to examine the influence of phorbol esters on the function and structure of corneal endothelial cells. METHODS: Corneas were placed under a specular microscope, and the endothelium was superfused with glutathione bicarbonate Ringer's solution (GBR); with GBR and 10 nM, 100 nM, or 1 microM 4 beta-phorbol 12-myristate 13-acetate (PMA); or with 100 nM 4-alpha-PMA. Corneal swelling curves were generated, and endothelial permeability was determined. Corneal endothelial structure was examined with a scanning electron microscope. RESULTS: Significant increases in swelling and endothelial permeability were found in corneas perfused with 100 nM PMA versus that observed in controls (swelling rate = 26 microns/hr versus 6.9 microns/hr; permeability = 6 x 10(-4) cm/min versus 3.4 x 10(-4) cm/min) and in corneas receiving 1 microM PMA versus that in controls (swelling rate = 26.3 microns/hr versus 0.12 micron/hr; permeability = 6.9 x 10(-4) cm/min versus 4.9 x 10(-4) cm/min). Application of 10 nM PMA did not significantly alter either parameter. Study with transmission electron microscope demonstrated significant morphologic changes in cells perfused with all concentrations of PMA. Corneas perfused with 100 nM 4-alpha-PMA versus 100 nM PMA had significantly lower slope and permeability values (swelling rate = 5.9 microns/hr versus 25.1 microns/hr; permeability = 3 x 10(-4) cm/min versus 6.7 x 10(-4) cm/min). CONCLUSIONS: Phorbol esters are detrimental for corneal endothelial function, creating significant corneal swelling, increases in endothelial permeability, and changes in endothelial cell structure. This effect appears to be mediated through a protein kinase C pathway.     

Electronic data processing system for clinical microbiology

A computerized clinical microbiology data storage and retrieval system, which was introduced at the Institute of Medical Microbiology 14 month ago, is described. This institute has to perform routine diagnostic microbiology for hospitals in the Kanton of Zuerich including the university hospital. In addition, it serves as a public health laboratory for Zuerich and adjacent districts. Patient and physician data are entered into a data station IBM 3741 and stored on discettes. Each afternoon, these data are printed on special report forms, which then are transferred to the diagnostic laboratories. After completion of the investigation, a copy of this form containing the results is sent to the physician. Every two weeks, the information stored on the discettes are converted onto the magnetic tape "discette". In addition, the original report form, containing the codified results and the fees, are read by an optic reader, which transfers the information onto the tape "report". Both tapes then serve the computer to print the accounts as well as to summarize the results monthly in form of the medical statistics. These provide valuable information to enhance patient care. All data are stored in a cumalative microbiology data bank for later retrieval.     

Eimeria from bats of the world: two new species from Myotis spp. (Chiroptera: Vespertilionidae)

Between 1986 and 1995, 548 fecal samples were collected from 41 species of bats (Molossidae, Mormoopidae, Phyllostomidae, Thyropteridae, and Vespertilionidae) from New Mexico, California, Baja California Sur (Mexico), and Bolivia. Of these, the feces of 28 (5%) bats, including Antrozous pallidus, Myotis ciliolabrum, Myotis lucifugus, and Myotis yumanensis (Vespertilionidae), contained oocysts representing at least 3 species of Eimeria. A new species of eimerian from M. lucifugus (3/27, 11%) and M. yumanensis (8/70, 11%) is described. Sporulated oocysts are ellipsoidal, 22.3 x 14.8 (18-25 x 13-16) microns with micropyle (approximately 2 microns) and polar granules (1-4), but an oocyst residuum is absent. The oocyst wall is slightly rough exteriorly and has 2 layers (total < or = 1 micron thick). Football-shaped sporocysts are 8.1 x 6.6 (8-11 x 5-7) microns, each with a Stieda body and granular sporocyst residuum present. A new eimerian from M. yumanensis (4/70, 6%) and M. ciliolabrum (1/12, 8%) also is described. Sporulated oocysts are spheroidal to subspheroidal, 15.0 x 14.1 (14-16 x 14-16) microns, with micropyle and oocyst residuum absent; a polar granule is present. The wall is smooth and has 2 layers (total < 1 micron thick). Sporocysts are football-shaped, 7.1 x 5.9 (6-9 x 5-7) microns, each with a Stieda body and sporocyst residuum. The sporulated oocysts of a third morphotype, found in A. pallidus (12/85, 14%), were indistinguishable from those of Eimeria arizonensis, a species typically found in murid rodents. The currently recognized species of bat Eimeria are listed, and a dichotomous key is provided.