Patrizia L Moser

Publication output in telemedicine during the period January 1964 to July 2003

The MEDLINE database was used to survey the period January 1964 to July 2003 for the number of publications relating to telemedicine (n = 5911), as well as their distribution by country (n = 42). Publications per million inhabitants were then correlated with each countrys population density, gross national product, human development index (HDI) and number of PCs per 1000 inhabitants. Telemedicine publications made up 0.05% of all medical publications cited in MEDLINE. American and European countries along with others classified as industrialized produced 97% of all telemedicine publications. In terms of publications per million inhabitants, Norway and Finland took the lead. There were significant correlations between telemedicine publications per capita and HDI (r = -0.60), number of PCs per 1000 inhabitants (r = 0.73) and gross national product per capita (r = 0.69), but not population density (r = -0.12).

The influence of hyperoxia on regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV) and cerebral blood flow velocity in the middle cerebral artery (CBFVMCA) in human volunteers

Conflicting results reported on the effects of hyperoxia on cerebral hemodynamics have been attributed mainly to methodical and species differences. In the present study contrast-enhanced magnetic resonance imaging (MRI) perfusion measurement was used to analyze the influence of hyperoxia (fraction of inspired oxygen (FiO2) = 1.0) on regional cerebral blood flow (rCBF) and regional cerebral blood volume (rCBV) in awake, normoventilating volunteers (n = 19). Furthermore, the experiment was repeated in 20 volunteers for transcranial Doppler sonography (TCD) measurement of cerebral blood flow velocity in the middle cerebral artery (CBFV(MCA)). When compared to normoxia (FiO2 = 0.21), hyperoxia heterogeneously influenced rCBV (4.95 +/- 0.02 to 12.87 +/- 0.08 mL/100g (FiO2 = 0.21) vs. 4.50 +/- 0.02 to 13.09 +/- 0.09 mL/100g (FiO2 = 1.0). In contrast, hyperoxia diminished rCBF in all regions (68.08 +/- 0.38 to 199.58 +/- 1.58 mL/100g/min (FiO2 = 0.21) vs. 58.63 +/- 0.32 to 175.16 +/- 1.51 mL/100g/min (FiO2 = 1.0)) except in parietal and left frontal gray matter. CBFV(MCA) remained unchanged regardless of the inspired oxygen fraction (62 +/- 9 cm/s (FiO2 = 0.21) vs. 64 +/- 8 cm/s (FiO2 = 1.0)). Finding CBFV(MCA) unchanged during hyperoxia is consistent with the present studys unchanged rCBF in parietal and left frontal gray matter. In these fronto-parietal regions predominantly fed by the middle cerebral artery, the vasoconstrictor effect of oxygen was probably counteracted by increased perfusion of foci of neuronal activity controlling general behavior and arousal.

The influence of nitrous oxide and remifentanil on cerebral hemodynamics in conscious human volunteers.

Remifentanil is increasingly used in the context of anesthesia, e.g., in patients presenting for MRI examinations, not only as an analgesic but also to replace nitrous oxide. Therefore, a comparative analysis of the effects of commonly used doses of remifentanil and of nitrous oxide on cerebral hemodynamics is warranted. The present study used contrast-enhanced magnetic resonance (MR) perfusion measurement to compare the effects of nitrous oxide (N(2)O/O(2) = 50%; n = 9) and remifentanil (0.1 microg/kg/min; n = 10) on regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), and regional mean transit time (rMTT) in spontaneously breathing human volunteers. Remifentanil increased rCBF above all in basal ganglia, whereas in supratentorial gray matter the increase in rCBF was equal or even more pronounced when using nitrous oxide. In contrast, nitrous oxide produced a greater increase in rCBV in gray-matter regions than did remifentanil. In summary, nitrous oxide increased rCBV in all gray-matter regions more than did remifentanil. However, the increase in rCBF, especially in basal ganglia, was typically less pronounced than during infusion of remifentanil.

Routine handling of propofol prevents contamination as effectively as does strict adherence to the manufacturer’s recommendations

PurposePropofol is a potential vector of infection, because it contains no preservative. Thus, the manufacturer’s specific recommendations for preparing injections or infusions go beyond the guidelines commonly used in our operating rooms for preparing other iv drugs. The purpose of the present study was to determine whether in the daily routine of an operating theatre a modified propofol handling technique can prevent contamination as effectively as do the manufacturer’s handling recommendations.MethodsA total of 160 consecutive neurosurgical patients were allocated to either Group I (manufacturer’s handling recommendations: i.e., 1) disinfecting propofol vials and ampoules before filling syringes; 2) replacing empty syringes; 3) discarding all material at the end of surgery); or Group II (modified propofol handling protocol: i.e., I) refilling empty syringes; 2) renewing only the infusion line to the patient).ResultsTotal contamination rates were comparable in both groups (Group I: 14/160 (8.75%), Group II: 13/160 (8.13%) (χ2 = 0.074; P = 0.96). Frequency of contamination was not different between groups; either in sample I taken at the beginning of the procedure, (Group I: 5/80 (6.25%) vs Group II: 6/80 (7.5%); χ2 = 0.098; P = 0.76) or in sample 2, taken at the end, (Group I: 9/80 (11.25%) vs Group II: 7/80 (8.75%); χ2 = 0.278; P = 0.598).ConclusionWe conclude that in the daily routine of the operating theatre following a modified propofol handling protocol prevents contamination of propofol syringes as effectively as does adhering to the manufacturer’s specific handling recommendations. However, neither of the tested guidelines completely prevented contamination.RésuméObjectifLe propofol, ne contenant aucun agent de conservation, est un vecteur potentiel d’infection. C’est pourquoi les recommandations spécifiques du fabricant au sujet de la préparation d’injections ou de perfusions vont au delà des directives habituellement suivies dans nos salles d’opération pour la préparation d’autres médicaments intraveineux. Nous avons voulu déterminer si, en modifiant le maniement du propofol en salle d’opération, nous pouvions prévenir la contamination aussi efficacement qu’en suivant à la lettre les recommandations du fabricant.MéthodeUn total de 160 patients successifs de neurochirurgie ont été répartis en deux groupes. Pour le Groupe I on a suivi les recommandations du fabricant en 1) désinfectant les flacons et les ampoules de propofol avant de remplir les seringues; 2) remplaçant les seringues vides; 3) jetant tout le matériel à la fin de l’intervention chirurgicale. Pour le Groupe II, on a modifié le maniement du propofol en 1) remplissant les seringues vides et 2) en renouvelant seulement les tubulures à perfusion des patients.RésultatsLes taux de contamination totale sont comparables : 14/160 (8,75 %) dans le Groupe I et 13/160 (8,13 %) dans le Groupe II (χ2 = 0,074; P = 0,96). La fréquence de contamination ne diffère pas d’un groupe à l’autre, pour l’échantillon I prélevé au début de l’opération (Groupe I : 5/80 (6,25 %) vs Groupe II : 6/80 (7,5 %); χ2 = 0,098; P = 0,76) ou l’échantillon 2 à la fin (Groupe I : 9/80 (11,25 %)vs Groupe II : 7/80 (8,75 %); χ2 = 0,278; P = 0,598).ConclusionLusage quotidien d’un protocole modifié de maniement du propofol en salle d’opération prévient aussi efficacement la contamination des seringues que l’adhésion aux recommandations spécifiques du fabricant. Aucune des directives testées n’a permis d’éliminer complètement la contamination.

Correlation between inflammatory cells (T and B lymphocytes, macrophages) in prostate biopsies and elevated PSA levels in a PSA screening population.

OBJECTIVES To investigate the relationship between inflammatory cells in prostate biopsies and total serum prostate-specific antigen (PSA) levels in a screening population. METHODS In the study, transrectal ultrasound-guided prostate biopsy specimens from 49 patients were assessed. All patients undergoing biopsy had elevated serum PSA levels (as defined by the biopsy criteria of the Tyrol PSA Screening Project) and/or abnormal findings on digital rectal examination. The prostate biopsy specimens were histologically negative for carcinoma. Immunohistologic characterization of the inflammatory cells was performed using CD3, CD4, and CD8 antibodies for the detection of T lymphocytes, CD20 antibodies for B lymphocytes, and CD68 antibodies for macrophages. The percentage of inflammatory cells and their distribution in stromal and glandular tissue was estimated using morphometric methods. RESULTS Inflammatory cells in the stroma contained significantly larger numbers of T lymphocytes than B lymphocytes and macrophages. T lymphocytes were also predominant in the glandular region. A significant positive correlation was found between the relative volume (vol%) of macrophages and total PSA levels (P <0.05) and a significant negative correlation between the percent free PSA levels and the relative volumes of T and B lymphocytes. CONCLUSIONS The results indicate a significant positive correlation between total PSA levels and macrophages and a significant negative correlation between percent free PSA levels and T and B lymphocytes. No statistically significant correlation was found between total serum PSA levels and the presence of inflammatory cells in the stromal and glandular compartment. Additional studies are needed to compare the amount and types of inflammatory cells with the stage and grade of prostate cancer in positive biopsies and radical prostatectomy specimens.

Heparanase-1 gene expression in normal, hyperplastic and neoplastic prostatic tissue

Heparanase-1 (Hpa-1) has been implicated in tumour invasion and metastasis. In the present study, we evaluated the clinicopathological significance of Hpa-1 mRNA expression in prostate cancer and non-cancerous prostatic tissue by one-step polymerase chain reaction (PCR) of laser microdissected prostatic gland cells. In addition, cell type-specific expression of Hpa-1 mRNA in prostatic tissue was analysed by in situ hybridisation. Hpa-1 mRNA expression was found in 50% of normal and 40% of hyperplastic prostatic tissue. In situ hybridisation showed that Hpa-1 mRNA was strongly expressed in prostate gland cells. Of the 26 prostate carcinomas tested, 42% were positive for Hpa-1 mRNA. However, in non-cancerous prostatic tissue, Hpa-1 mRNA was significantly more often expressed than in less differentiated or more invasive prostate cancers (P<0.05). In situ hybridisation revealed only focal Hpa-1 mRNA expression in the neoplastic gland cells. Hpa-1 mRNA expression in the tumours significantly correlated with tumour differentiation and tumour stage (P<0.05). Our data indicate that Hpa-1 gene expression may be lost during dedifferentiation of prostatic gland cells.

Sevoflurane and nitrous oxide increase regional cerebral blood flow (rCBF) and regional cerebral blood volume (rCBV) in a drug-specific manner in human volunteers

Anesthesia for diagnostic procedures, e.g., MRI measurements, has increasingly used sevoflurane and nitrous oxide in recent years. Sevoflurane and nitrous oxide are known cerebrovasodilatators, however, which potentially interferes with MRI examination of cerebral hemodynamics. To compare the effects of relevant equianesthetic concentrations (0.4 MAC) of both drugs on regional cerebral blood flow (rCBF) and regional cerebral blood volume (rCBV) we used contrast-enhanced magnetic resonance imaging (MRI) perfusion measurement, which has the advantage of providing regional anatomic resolution. Sevoflurane increased rCBF more than did nitrous oxide in all regions except in parietal and frontal gray matter. Nitrous oxide, by contrast, increased rCBV in most of the gray matter regions more than did sevoflurane. In summary we show that, in contrast to nitrous oxide, sevoflurane supratentorially reversed the anterior-posterior gradient in rCBF and typically redistributed rCBF to infratentorial gray matter. In contrast, nitrous oxide increased rCBV more than did sevoflurane. Both inhalational anesthetics had a drug-specific influence on cerebral hemodynamics, which is of importance when interpreting MRI studies of cerebral hemodynamics in anesthetized patients.

A cost comparison of telepathology and a visiting pathologist service

We compared the costs of a dynamic, robotic telepathology service for intraoperative frozen sections with the cost of a once-weekly visiting pathologist service established between the small Reutte Hospital, located in north-western Tyrol, and the department of pathology of the University of Innsbruck. Telepathology required either 15 min or 30 min per case in order to make a diagnosis, depending on the type of tissue and the operators experience in handling the telepathology system. Costs were calculated for a five-year period. The main costs of the telepathology service were for set-up, whereas the main costs of the visiting pathologist service concerned personnel. The threshold at which telepathology was cheaper than the visiting pathologist service was 46 cases per month (15 min for diagnosis) or 135 cases per month (30 min for diagnosis). The present case-load (eight cases per month) at the study hospital was below this threshold.

Acceptance of telemedicine and new media: a survey of Austrian medical students

Telemedicine and new media (e.g. the Internet, tele-teaching and tele-learning) are increasingly being used in medicine. We surveyed the awareness and acceptance of these developments on the part of medical students (n =750) at the University of Innsbruck. A 16-item questionnaire was handed out in randomly chosen medical classes and collected immediately after completion, which resulted in a response rate of 99.9%. Nearly all of the students used the Internet regularly (68%) or at least sometimes (30%). Telemedicine was already known to most of the students, mainly from articles in magazines and newspapers (41%), but the great majority of them (95%) reported that they did not know about the telemedicine lectures offered by the University of Innsbruck. Most students (75%) thought that they would benefit from tele-teaching or tele-learning. The survey suggested that medical schools should offer more special lectures, as well as undergraduate or postgraduate qualifications in telemedicine. The marketing of such opportunities needs to be improved.

Diagnostic accuracy of remote frozen sections compared with paraffin-embedded sections: a telepathology project in Austria

The purpose of the present study was to evaluate the diagnostic accuracy of remote frozen sections examined by telepathology. The gold standard was the diagnosis made using direct examination of paraffin-embedded sections. A consecutive series of 134 frozen-section cases were examined by six qualified pathologists. We used the Zeiss telepathology system with robot microscopy, which allowed different magnifications and fields of view to be chosen. The wide-area network used the TCP/IP protocol. The diagnosis made on the frozen sections was compared with the final diagnosis in the paraffin-embedded sections. Times were recorded for each telepathology session, as well as the users comments on usability and software, and on any communication problems which occurred. In addition, we evaluated the importance of the macroscopic sampling of the surgical specimen, applied to each type of tissue. The diagnostic evaluation showed complete agreement in approximately 80% of cases, in 20% diagnosis was not possible due to insufficient quality of the slides. The median time for the telemedicine diagnosis was 14 min 30 sec.