Postural control and the relation with cervical sensorimotor control in patients with idiopathic adult-onset cervical dystonia.

Cervical dystonia (CD) is a movement disorder characterized by involuntary muscle contractions leading to an abnormal head posture or movements of the neck. Dysfunctions in somatosensory integration are present and previous data showed enlarged postural sway in stance. Postural control during quiet sitting and the correlation with cervical sensorimotor control were investigated. Postural control during quiet sitting was measured via body sway parameters in 23 patients with CD, regularly receiving botulinum toxin treatment and compared with 36 healthy controls. Amplitude and velocity of displacements of the center of pressure (CoP) were measured by two embedded force plates at 1000 Hz. Three samples of 30 s were recorded with the eyes open and closed. Disease-specific characteristics were obtained in all patients by the Tsui scale, Cervical Dystonia Impact Profile (CDIP-58) and Toronto Western Spasmodic Rating Scale (TWSTRS). Cervical sensorimotor control was assessed with an infrared Vicon system during a head repositioning task. Body sway amplitude and velocity were increased in patients with CD compared to healthy controls. CoP displacements were doubled in patients without head tremor and tripled in patients with a dystonic head tremor. Impairments in cervical sensorimotor control were correlated with larger CoP displacements (rs ranged from 0.608 to 0.748). Postural control is impaired and correlates with dysfunction in cervical sensorimotor control in patients with CD. Treatment is currently focused on the cervical area. Further research towards the potential value of postural control exercises is recommended.

Interactive DICOM image transmission and telediagnosis over the European ATM network.

The European High-Performance Information Infrastructure in Medicine, n(o)B3014 (HIM3) project of the Trans-European Network--Integrated Broadband Communications (TEN-IBC) program, started on March 1996 and finished on February 1997, aimed to test the medical usability of the European asynchronous transfer mode (ATM) network in medical image transmission. The Department of Radiology, University of Pisa, Pisa, Italy, and St-Luc University Hospital, Brussels, Belgium, involved in the project as healthcare partners in the radiological domain, established several connection sessions finalized to test the usability of Digital Imaging and Communication (DICOM) image transmission and interactive telediagnosis tools in the daily radiological practice. The Pisa site was connected to the Italian ATM pilot (Sirius Network) through the Tuscany metropolitan area network (MAN), while St-Luc University Hospital was connected to Belgium ATM network through the Brussels MAN. By means of international connections provided by the European JAMES project, a link between the two sites was established, connecting both national ATM networks. Due to the large variety of hardware present in the medical centers, multiplatform software tools were used and tested: central test node (CTN) release 2.8 [3], VAT [6], NV-3.3 [7], and IDI (UCL homemade multiplatform teleradiology tool for interactive visualization and processing of DICOM images). During the telediagnosis session, lead by radiologists in both hospitals, each site submitted neuroradiological clinical cases to the other for remote consultation. The connection, available for a period of two weeks, at 2-Mbit/s bandwidth, allowed the transmission of MR images (256 x 256 x 12 bit) and simultaneous multimedia interactive discussion of the cases. Both off-line transmission and review of the images, using the CTN DICOM transfer routines, and on-line interactive image discussion, using the IDI telediagnosis software, were tested successfully from the technical and medical point of view.

The role of military medicine in military civic action.

We are moving into an era when U.S. military forces will be called upon frequently to perform military civic action (MCA) projects. Such projects, have been used successfully and unsuccessfully, primarily in the areas of medicine and engineering, to enhance the standing of military forces with indigenous populations. However, the available criteria for planning and assessing MCA projects are not widely known. These related and overlapping criteria are supported by facts, interpretative data, anecdotes, and common sense, but none can be considered absolute. Selected criteria are defined, reviewed, and illustrated with examples of past successes and failures.