Robert O. Rainer

Effects of estrogen and progestin replacement on the urogenital tract of the ovariectomized cynomolgus monkey

Menopause is presumed to have a causative role in the development of female urinary incontinence. While some clinical trials have shown that estrogen can affect urinary tract function, our knowledge of the pathophysiologic changes resulting from menopause and hormone replacement therapy is poor.

Progression of a myelodysplastic syndrome to pre-B acute lymphoblastic leukemia: a case report and cell lineage study

Abstract The evolution of acute lymphoblastic leukemia from a myelodysplastic syndrome is a very uncommon event. We describe a 46-year-old man in whom refractory anemia with excess blasts (RAEB) evolved to a pre-B acute lymphocytic leukemia. Trisomy 8 was one of the cytogenetic abnormalities in the dysplastic clone and was detected in both peripheral blood and bone marrow smears of interphase cells by the fluorescence in situ hybridization (FISH) technique. Using a chromosome 8 centromeric specific DNA probe we identified the trisomy 8 to be present in lymphoblasts, erythroid precursors, myeloblasts, promyelocytes, myelocytes, metamyelocytes, granulocytes, and monocytes. Our case supports the hypothesis that in MDS the pluripotent precursor cell is affected, and we examine the potential role of FISH for the study and follow-up of some hematological diseases.

Study of clonality in myelodysplastic syndromes: Detection of trisomy 8 in bone marrow cell smears by fluorescence in situ hybridization

The lineage involvement in myelodysplastic syndromes (MDS) is still unclear. To determine the clonality and the evolution of the disorder, a retrospective study on bone marrow smears from seven MDS patients with trisomy 8 was performed using fluorescence in situ hybridization (FISH). We observed that the trisomy of chromosome 8 was selectively expressed in the myeloid-derived cells. No mature lymphocytes or plasma cells expressed three signals. Our studies demonstrate here the value of FISH for identifying the affected cell lineage. Furthermore, the easy quantification of the abnormal cells can help in assessing the progression of the disease.

Usefulness and limitations of serum and urine lysozyme levels in the classification of acute myeloid leukemia: an analysis of 208 cases.

The revised French-American-British (FAB) classification system for acute myeloid leukemia (AML) recommends the determination of serum lysozyme (SL) or urine lysozyme (UL) levels as an aid in distinguishing acute myeloblastic leukemia with maturation (FAB M2) from acute myelomonocytic leukemia (M4). We reviewed retrospectively 208 cases of adult leukemia in which SL and/or UL were obtained. Elevated lysozyme levels were not found in any of the M0, M3, or M7 cases, but were increased (false positive) in three (14%) M1 cases, 18 (19%) M2 cases and one (20%) M6 case. Although a UL value in excess of 3x normal was found in most cases of AML M4 and M5, only five (11%) M4 cases and three (20%) M5 cases had SL elevations of this magnitude. Lysozyme levels need to be interpreted in conjunction with other parameters for FAB classification.

An architecture for Naval telemedicine

Navy fleets have a defined overall objective for mission readiness impacted by the health of personnel aboard the ships. Medical treatment facilities on the ships determines the degree of mission readiness. The paper describes the concepts and technologies necessary to establish a Naval telemedicine system, which can drastically improve health care delivery. It consists of various combinations of the following components: Fleet Naval Medical Consultation and Diagnostic Centers, Shipboard Naval Medical Consultation and Diagnostic Centers (hospital ship or combatant ships with medical specialists on board), and Remote Medical Referring Centers such as a ship, a small Naval station annex, or a field hospital. This Naval telemedicine architecture delivers clinical medicine and continuing medical education (CME) by means of computers, video-conferencing systems, or telephony to enhance the quality of care through improved access to research, medical and nonmedical imaging, remote consultations, patient clinical data, and multimedia medical education programs. It integrates the informatics infrastructure and provides a medical telepresence among participants.

Architecture for a high-performance tele-ultrasound system

Clinical prototypes of digital tele-ultrasound systems at the Bowman Gray School of Medicine have provided insight into various design architectures. Until network equipment costs decrease, hybrid systems often provide good cost/feature mixes by using high-cost networking equipment only when digital networking is required. Within the hospital using remote ultrasound system, a video and audio router interconnects the video output of ultrasound modalities and technologist communications subsystems. This is done either manually or by remote signaling, depending on the size of the ultrasound infrastructure and the cost of a remote signaling subsystem. For extramural sites and in hospital areas too distant for cost- effective analog switching techniques, an appropriate coder/decoder (CODEC), with echo cancellation, is used to transfer the audio and visual information to a CODEC in the viewing station location. The CODECs can be T1 (1.544 Mbps) CODECs for areas that cannot be reached economically at asynchronous transfer mode (ATM) data rates. This is contingent upon the diagnostic quality of the output of the T1 CODECs. Otherwise, high-speed CODECs are used with 45 Mbps DS-3 or ATM transmission facilities. This system allows full use of existing hospital infrastructures while adapting to emerging data communications infrastructures being implemented.

A flexible telepathology system

Telepathology systems involving robotic controls are often very expensive and hard to justify by telepathology providers. In this paper, a telepathology system is discussed which costs less than

Multimedia features of a dynamically adaptive telemedicine system

25,000 while supplying excellent diagnostic-functionality and network connectivity. The architecture proposed allows for dynamic interaction between pathologists that scales to the network bandwidth. Three important factors influence diagnostic accuracy in a telepathology system. First, preliminary data supports that dynamic systems perform better than static ones mainly because of better physician interaction and the ability to visualize the proper subset of diagnostic clues. Second, a frame rate below 8 frames/sec will not convey sufficient information for real-time interaction. Last, synchronization of the video between the 2 sites ensures that proper fields are transmitted. When considering telepathology systems, one must weigh the benefits, and the costs involved in the implementation. This design represents the compromise between robotic control and static systems.

Effects of motion-JPEG compression on the diagnostic quality of pediatric echocardiograms

A dynamically adaptive multidisciplinary workstation (DAMDW) architecture delivers very good multimedia telemedicine service. The DAMDW is a Unix workstation with software components that operate on various computer architectures. It adapts to the speciality of the physician and to the bandwidth available to the participating health care centers. The network flexibility of the DAMDW makes it usable in an existing telecommunications infrastructure while incorporating advances in computer and communication technology. This feature prevents early obsolescence. The DAMDW utilizes most telecommunications services. This allows multimedia features that improve with increased bandwidth without discarding capital equipment. It also simplifies connectivity to standard local area networks (LANs) in hospitals.

CD 45 gating correlates with bone marrow differential.

Congenital heart disease is infrequent and often is apparent in the immediate newborn period. Accurate diagnosis delivered in real-time or near-real-time is important to provide appropriate care to avoid patient morbidity and mortality. Color-flow Doppler echocardiograms are an essential part of the diagnostic assessment of the newborn, however, few hospitals have the staff to interpret these studies appropriately. Transmission of these studies to a regional center with subspecialists will allow interpretation of the studies by physicians with expertise in this subspecialty. Transmission of these studies to a regional center with subspecialists will allow interpretation of the studies by physicians to appropriately and rapidly triage neonates with high-risk congenital heart disease. To make a teleradiology service affordable in the near future, the 73 million bit per second transmission speed must be reduced to affordable bandwidths using compression. The purpose of this study is to evaluate the impact of motion JPEG on the diagnostic quality of pediatric echocardiograms.