A patient centered electronic health: eHealth system development.

BACKGROUND: Medical practice and patient-doctor relationship will continue improving while technology is integrated in our everyday life. In recent years the term eHealth landmarked a new era with improved health provider's skills and knowledge, and increased patient participation in medical care activities. OBJECTIVE: To show why the design and implementation of a healthcare system needs to follow a specific philosophy dictated by the level of eHealth maturity of a country and its citizens. METHODS: Based on the maturity level, an adaptable framework for implementing an Electronic Health System at national level is derived, guided by the Patient Centered Philosophy as defined and introduced by the EU directives. Implementation prerequisites are analyzed together with guiding principles for identifying the maturity level of an organization or country. RESULTS: Cyprus being a small EU country, it can be used as pilot site for the whole Europe, was chosen for this study and its maturity level analysis is presented. Recommendations that determine general steps needed to prepare the ground for an adequate patient-centered national healthcare system are accompanied. CONCLUSION: The implementation of an integrated Electronic Health Record at National level, as a prerequisite for a patient-centered eHealth environment is evidently demonstrated.

A patient centered electronic health system: an example for cyprus.

The design and implementation of a healthcare system needs to follow a specific philosophy regarding its operational structure and must be adapted gradually with one step at a time, depending on the level of maturity of a country on certain key issues. The main goal of this paper is to present an overall recommendations framework for implementing an Electronic Health System at national level, guided by the Patient Centered Philosophy. Certain prerequisites for implementing such systems are analyzed together with guiding principles for identifying the maturity level of an organization or country. The maturity level analysis for Cyprus is presented and is accompanied by some recommendations that determine the steps needed to prepare the ground for a complete patient centered national healthcare system.

Immunohistochemical study of inhibin A and B expression in placentas from normal and pathological gestations.

OBJECTIVE: The aim of the study was to examine, by an immunohistochemical method, the distribution of Inhibin-A and -B, in placentas from normal and pathological gestations. MATERIALS AND METHODS: Sixty-two specimens of placental tissue were examined: i) ten cases from early gestations, ii) 28 cases from mature placentas, iii) six cases associated with intrauterine growth restriction, iv) four cases associated with diabetes mellitus and v) 14 placentas from gestations with fetal chromosome abnormalities. The expression of Inhibin A and B was studied by automatic Ventana method. RESULTS: i) Early gestation specimens: Inhibin A (+) immunoreaction was observed in the syncytiotrophoblast (8/10 cases) and in the intermediate trophoblast (6/10 cases). Inhibin B (+) immunoreaction was observed in the syncytiotrophoblast (10/10 cases) and in the intermediate trophoblast (4/10 cases), ii) Normal mature placentas: Inhibin A (+) immunostain was observed in 2/28 cases in the syncytiotrophoblast and in 7/28 cases in the intermediate trophoblast. Inhibin B (+) immunostain was observed in 28/28 cases in the syncytiotrophoblast and in 18/28 cases in the intermediate trophoblast. iii) Placentas associated with intrauterine growth restriction: Inhibin A (+) immunostain was observed in the intermediate trophoblast in 2/6 cases. Inhibin B (+) immunostain was observed in 5/6 cases in the syncytiotrophoblast and in 4/6 cases in the intermediate trophoblast. iv) Placentas associated with gestational diabetes mellitus: Inhibin A (+) immunostain was observed in 2/4 cases in the intermediate trophoblast. Inhibin B (+) immunostain was observed in 2/4 cases in the syncytiotrophoblast. v) Placentas from gestations with fetal chromosome abnormalities: no Inhibin A immunoreaction was observed. Inhibin B (+) immunostain was observed in 13/14 cases in the syncytiotrophoblast and in 9/14 cases in the intermediate trophoblast. The cytotrophoblast, the umbilical cord, and the membranes do not participate in the production of Inhibins. DISCUSSION: Inhibin A and B are located in the syncytiotrophoblast and the intermediate trophoblast of the placenta, during early pregnancy (Inhibin A) and present throughout pregnancy (Inhibin B). No remarkable findings in placentas of pathological gestations support the evidence that Inhibins do not participate in processes that affect the development of the placenta or the fetus, but may participate in,the mechanism of labor.

Autopsy findings in fetuses with cystic hygroma: a literature review and our center's experience.

PURPOSE OF INVESTIGATION: To report our experience of autopsied cases of fetal cystic hygroma (CH) and discuss the role of fetal autopsy in genetic counseling. METHODS: A review of autopsy reports at our institution revealed 18 cases of fetal CH over a 10-year period (from 2000 to 2010). The clinical data, results of cytogenetic analysis and prenatal ultrasound findings were also retrieved and compared to the autopsy findings. RESULTS: Fetal death was due to intrauterine death in eight cases, therapeutic abortion in eight cases and spontaneous abortion in two cases. Cytogenetic analysis was available in 12 cases, and the results showed an abnormal karyotype in seven cases (5 cases of Turner syndrome and 2 cases of trisomy 21). The mean size of CH was 5.4 cm. Other malformations or findings suggestive of the cause of fetal death were diagnosed in 10/18 cases (55.6%). The most common autopsy findings were hydrops and central nervous system anomalies. The autopsy findings were in agreement with the prenatal ultrasound findings in 13/18 cases (72.2%), while in five cases (27.8%) additional findings were detected during autopsy. The most common placental abnormalities were infarcts and calcifications. CONCLUSION: In addition to prenatal diagnostic studies, fetal autopsy and pathologic examination of fetal and placental tissues may help to establish the exact cause of death and disclose important information as to the presence of various fetal malformations or placental abnormalities.

Peritoneal mesotheliomas mimicking adnexal tumors. Clinicopathological characteristics of four cases and a short literature review.

Three cases of peritoneal benign cystic mesotheliomas in women 32-34 years of age and one case of peritoneal malignant mesothelioma in a 47-year-old woman are reported. All cases presented with abdominal discomfort and/or pain and the physical and radiological diagnostic methods showed adnexal tumors. The cystic mesotheliomas developed in the cul-de-sac and the right pelvic sidewall, presented as multiple small cysts or large multilocular cystic mass. The malignant mesothelioma showed extensive infiltration of the omentum the intestinal loops and the surface of the uterus and adnexa, with bilateral hydrosalpinx and ascites. All cases presented histological and immunohistochemical characteristics consistent with tumors of mesothelial origin. No history of asbestos exposure was reported. The correct diagnostic and therapeutic approaches to these neoplasms are discussed.

A rare ovarian Leydig cell tumor (hilar type) causing virilization in a postmenopausal woman.

All patients with virilization signs, increased levels of androgen hormones and rapidly progressive hirsutism should be evaluated for an androgen-producing tumor. The ovarian origin of virilization can be suspected by the presence of elevated levels of circulating androgens, with normal levels of cortisol metabolites and a negative dexamethasone suppression test. A case report of a 50-year-old postmenopausal patient with rapidly progressive hirsutism is presented. After an extensive preoperative investigation a right oophorectomy was performed and a Leydig-hilus cell tumor was diagnosed.

Extraovarian mature cystic teratoma of the mesentery. A case report and literature review.

A case is reported of a 60-year old woman who had intermittent abdominal pain due to a mesenteric teratoma which was misdiagnosed by the standard methods of abdominal tumor diagnosis as an ovarian tumor. The neoplasm measured 9 x 8 x 8 cm, was filled by hair and sebum, and histologically presented the typical features of a mature cystic teratoma. The mesentery and overlying small intestine showed an extensive inflammatory granulomatous reaction. The uterus and adnexa were free of neoplasmatic disease. This case of extra ovarian mature cystic teratoma which developed in the mesentery is unique among > 2000 ovarian tumors examined during a 30-year period at Aretaieion Hospital Pathology Laboratory.

Epithelial ovarian tumors in adolescents: a retrospective pathologic study and a critical review of the literature.

OBJECTIVES: The aim of this study was to further evaluate the pathologic features of epithelial ovarian neoplasms and their relative frequency among all ovarian tumors in the adolescent population. DESIGN: We conducted a retrospective pathologic study of all cases of epithelial ovarian neoplasms in adolescents (aged 11-19 years) diagnosed in the pathology laboratory of our hospital over the past 25 years. RESULTS: A total of 86 ovarian tumors were identified, including 23 epithelium-derived ovarian neoplasms (26.7%), 53 germ cell tumors (61.6%), 9 sex-cord stromal tumors (10.5%) and 1 benign Brenner tumor (1.2%). Most cases of epithelial tumors were found in patients 17 years of age or older (14/23 cases, 60.9%). All tumors were unilateral, and their size ranged from 2.5-21 cm (mean 11.7 cm). Epithelial tumors were further histologically subtyped into 21 benign cystadenomas (14 serous and 7 mucinous) and 2 mucinous borderline tumors. CONCLUSIONS: A relatively high frequency of epithelial ovarian neoplasms among all ovarian tumors in a purely adolescent population was found in our study. Age-related selection bias may account at least in part for the discrepancy between our data and most previous reports. The most common subtype of epithelial ovarian tumor in our series was the benign serous cystadenoma.

Virilizing ovarian Krukenberg tumor in a 27-year-old pregnant woman. A case report and literature review.

A case is reported of a 27-year-old pregnant woman with ovarian tumors, measuring 12 cm and 11.5 cm in the greatest diameter, discovered during investigation for virilization symptoms. Termination of the pregnancy at the 22nd week of gestation and tumorectomy with both adnexa were performed, with the provisional diagnosis of arrhenoblastoma. Pathological examination of the tumors showed typical Krukenberg neoplasms and subsequent upper GI tract endoscopy revealed a gastric cancer that was excised. The pathological examination revealed a diffuse type gastric adenocarcinoma with signet ring morphology, similar to ovarian tumors. In any case of ovarian tumor with unusual hormonal manifestations, in addition to hormonally active sex cord-stromal neoplasms, metastatic ovarian tumors must be considered as well, especially in cases of bilateral tumors.

Monodermal teratomas (struma ovarii). Clinicopathological characteristics of 11 cases and literature review.

During the last 15 years in the Pathology Laboratory of Aretaieion University Hospital, 256 cases of teratomas were examined and 11 cases (4.3%) presented characteristics of struma ovarii. Eight patients aged 19-34 years and four 41-74 years (median 41 years). One 74-year-old patient presented with virilization signs but pain and a pelvic mass were the most frequent symptoms. The tumors were unilateral in 9/11 cases, the size ranged from 5-17 cm, and they were compact or microcystic in 10/11 cases and cystic in one case. Histological pattern was microfollicular in 5/11 cases, solid in 3/11 cases, pseudoglandular in 2/11 cases, with focal clear and oxyphil cell changes, and infiltration of the fibrous wall in one case. Tumorectomy was performed in 9/11 cases and total hysterectomy with adnexa in two cases with large tumors (16-17 cm in diameter). Immunohistochemistry is useful in the recognition of struma in atypical cases. No malignant struma ovarii was observed in our cases. Tumorectomy is the appropriate therapeutic approach because of the benign nature of these tumors despite atypical histological features and the young age of the patients.