La telemedicina: ¿ciencia o ficción? / Telemedicina: science or fiction

La telemedicina se ha considerado una disciplina científica a medio camino entre la medicina y la tecnología. De esta forma, a lo largo de la última década ha estado influenciada en gran medida por el incesante desarrollo de las tecnologías de la información y las comunicaciones. Superada la fase de investigación en laboratorio, se puede considerar como una técnica en estado maduro por lo que tanto desde el punto de vista de los proveedores de tecnología como del de los usuarios de la medicina, pacientes y profesionales, se demanda su despegue en la arena de la implantación, es decir, la necesidad de nuevos servicios de salud basados en telemedicina.Este artículo pretende dar una visión actual del estado del arte de la telemedicina sin entrar a valorar y describir en profundidad ni la tecnología ni las diferentes aplicaciones de la misma. Por el contrario, la idea es transmitir a los usuarios y las diferentes organizaciones de la sanidad incluidos sus gestores, que las condiciones para su desarrollo están ya disponibles. De esta forma, es una labor de todos los actores involucrados el éxito o fracaso de su implantación. Bien es cierto que a la vista de la experiencia y resultados de su aplicación durante la última década, tanto en nuestro entorno geográfico más próximo como en los Estados Unidos, hay signos inequívocos de que la telemedicina está aquí para quedarse

Telemedicine has been considered to be a scientific discipline midway between medicine and technology. Thus, over the last decade it has been largely influenced by the continuous development of computer and communications technologies. Now that the phase of its laboratory investigation has been completed, it can be considered to be a technique in a mature state. Hence, both from the point of view of technology suppliers and of the users of medicine –patients and professionals– there is a demand for a takeoff in the arena of its implantation, that is to say, the need for new health services based on telemedicine.This article offers an up-to-date view of the state of the art of telemedicine but without entering into an in-depth evaluation and description of the technology and its applications. On the contrary, our aim is to make it known to users and to the different health organisations, including their managers, that the conditions for its development are now available. Thus the success or failure of its implantation is a task for all of the actors involved. What is certain is that in the light of the experience and results of its application during the last decade, both in our surrounding geographical milieu and in the United States, there are unmistakable signs that telemedicine is here to stay

[Telemedicine: science or fiction?]. / La telemedicina: ¿ciencia o ficción?

Telemedicine has been considered to be a scientific discipline midway between medicine and technology. Thus, over the last decade it has been largely influenced by the continuous development of computer and communications technologies. Now that the phase of its laboratory investigation has been completed, it can be considered to be a technique in a mature state. Hence, both from the point of view of technology suppliers and of the users of medicine -patients and professionals- there is a demand for a takeoff in the arena of its implantation, that is to say, the need for new health services based on telemedicine. This article offers an up-to-date view of the state of the art of telemedicine but without entering into an in-depth evaluation and description of the technology and its applications. On the contrary, our aim is to make it known to users and to the different health organisations, including their managers, that the conditions for its development are now available. Thus the success or failure of its implantation is a task for all of the actors involved. What is certain is that in the light of the experience and results of its application during the last decade, both in our surrounding geographical milieu and in the United States, there are unmistakable signs that telemedicine is here to stay.

[Moyamoya disease and primary intraventricular hemorrhage in an adult patient. A case report]. / Enfermedad de moyamoya y hemorragia intraventricular primaria en paciente adulto. A propósito de un caso.

INTRODUCTION: Moyamoya disease is generally considered to be paediatric cerebrovascular pathology, but in some cases the symptoms are seen in adults. Primary intraventricular hemorrhage, as a consequence of this disorder, is rare. One should be clear as to the diagnostic and neuroimaging criteria of 'definite moyamoya disease'. CLINICAL CASE: A 52 year old man with a family history of two brothers having died of hemorrhagic cerebrovascular accidents and a personal history of headaches for many years and arterial hypertension. He was sent to us with stroke, headache, neck stiffness+4, disorientation in time and space and stuporous. On cranial CAT scan a small left intraventricular subependymal hemorrhage and intraventricular hemorrhage were seen. Cerebral angiography showed the angiographic pattern of moyamoya disease and the arterial circulation of the posterior territory was highly developed and thus supplemented the blood supply to the brain. CONCLUSION: In few of the rare occurrence of this disorder in our setting and as a cause of primary intraventricular hemorrhage, we reviewed certain neuroradiological peculiarities of interest, such as the evolution, diagnostic criteria, angiographic classification and differential diagnosis of the moyamoya syndrome in relation to our case.

Enfermedad de moyamoya y hemorragia intraventricular primaria en paciente adulto. A propósito de un caso / Moyamoya disease and primary intraventricular hemorrhage in an adult patient. A case report

Introducción. La enfermedad de moyamoya es considerada generalmente como una patología cerebrovascular pediátrica pero en algunos casos los síntomas se manifiestan en adultos. Es rara la hemorragia intraventricular primaria (HIVP) como consecuencia de esta enfermedad. Deben tenerse claros los criterios diagnóstico y neuroimaginológico de la enfermedad de moyamoya definitiva. Caso clínico. Varón de 52 años con antecedentes familiares de dos hermanos fallecidos por accidente cerebrovascular hemorrágico y antecedentes patológicos personales de cefaleas de años de evolución e hipertensión arterial. Es remitido por cuadro de ictus, con cefalea, rigidez nucal ++++, desorientación temporospacial y estupor. En la TAC craneal se evidencia pequeño hematoma subependimario paraventricular izquierdo y hemorragia panventricular. La angiografía cerebral muestra un patrón angiográfico moyamoya y circulación arterial en territorio posterior con importante desarrollo que suple la irrigación del encéfalo. Conclusiones. Dada la presentación tan infrecuente de la enfermedad a esta edad, en nuestro medio y como responsable de una HIVP, se revisaron determinadas peculiaridades neurorradiológicas de interés como es la evolución, características diagnósticas, clasificaciones angiográficas y diagnóstico diferencial con el síndrome de moyamoya a propósito de este caso (AU)

No disponible

Data exchange in the European pharmacovigilance.

Recent research work on feasible solutions for electronic data exchanges in the european pharmacovigilance domain (EPhV) has facilitated a better understanding on strategic and operational factors inherent to such a class of transnational vigilance information systems. Most of the material presented here has resulted from the CARE-Pharmacovigilance Pilot project of the ENS-Telematics Programme, and from other subsequent research activities like the IDA feasibility study and the TEDIS-EuroSCape project. Attention has been paid to design principles and features of a communication scheme that must be used to support cooperative problem solving within a network of loosely connected autonomous and hetereogeneous agents. Experience confirmed two key-success factors: a) the users leading role, and b) the Pilot approach putting the focus on standardized electronic data interchange for communicating existing different local systems.

Effect of low-level pulsed electromagnetic fields on human chromosomes in vitro: analysis of chromosomal aberrations.

The effects of extremely-low-frequency pulsed magnetic fields on human chromosomes with respect to the capacity of inducing chromosome breakage were studied. After human peripheral lymphocytes were exposed in vitro to pulsed electromagnetic fields at different intensities, a significant effect was observed for one of the intensities tested (40 Gauss), relative to the control group with respect to the yield of chromosome breakages.

Effect on SCE in human chromosomes in vitro of low-level pulsed magnetic field.

We analyzed sister chromatid exchanges (SCE) frequencies as an indicator of DNA damage induced in human lymphocytes in vitro by a low-level pulsed electromagnetic field. We studied the effect of low-level pulsed electromagnetic fields on human chromosomes with the cytogenetic assay of sister chromatid exchange (SCE) analysis. After the human peripheral lymphocyte cultures were exposed in vitro to the electromagnetic field at different intensities, no significant differences were observed when comparing with the control group as to the number of SCE.

Oviposition and development of Drosophila modified by magnetic fields.

Drosophila flies placed in a habitat with two lateral boxes demonstrated sensitivity to magnetic fields: Oviposition decreased by exposure to pulsated (extremely low frequency (ELF) (100 Hz, 1.76 miliTesla (mT) ) and sinusosidal fields (50 Hz, 1 mT), while there was no initial effect of exposure to a static magnetic field (4.5 mT). Drosophila eggs treated for 48 h with the above described fields showed that 1) mortality of eggs was lower in controls than in eggs exposed to all tested magnetic fields; 2) mortality of larvae increased when a permanent magnet was used; 3) mortality of pupae was highest when a permanent magnet was used; and 4) general adult viability was highest in controls (67%) and diminished progressively when eggs were exposed to pulsated (55%), sinusoidal (45%), and static (35%) magnetic fields.

Embryological changes induced by weak, extremely low frequency electromagnetic fields.

Fertilized chicken eggs were incubated for 48 hours while exposed to extremely low frequency magnetic fields (ELMF) of 10 Hz, 100 Hz and 1000 Hz with intensities of 0.12, 1.2 and 12 micro T. Gross morphological and histological analysis of the exposed embryos revealed the following effects: (1) ELMF of 100 Hz/1.2 micro T had the most consistent and powerful inhibitory effect on embryogenesis. Development of embryos was reduced to the formation of the three primitive layers. Brain vesicles, auditory pit, neural tube, foregut, heart, vessels, and somites were not developed. Glycosaminoglycans were almost absent. (2) The above results demonstrate a window effect because embryos exposed to 100 Hz/1.2 micro T were less developed than embryos exposed at lower and higher intensities and frequencies. (3) Developing organs reacted with different sensitivity to ELMF of specific frequencies and intensities. Somites were not disturbed by exposure to 10 Hz with any of the intensities used. Formation of blood vessels was completely blocked by ELMF of 1000 Hz/12 micro T while traces of other organs were present. (4) The drastic embryological disturbances described were obtained with much lower intensities (1 micro T = 0.01 Gauss) than those used in studies by other investigators. (5) Embryological alterations induced by ELMF may depend on disturbances in the presence and structure of glycosaminoglycans which are essential elements in cellular activities, including cell migration. (6) The use of ELMF of low intensity may be a powerful method to investigate embryogenetic mechanisms and may also be a useful technique for investigation of other biological systems.