There are several problems on the practical use of telemedicine, for example, the difficulties involved in promoting communication between medical facilities, uncooperative clinicians, and the absence of high-speed circuits and high-resolution CRT. From the Japanese point of view, we suggest ways to resolve these problems. We will analyze and propose scenarios for realizing successful communications among medical institutions, medical communication and its characteristics, barriers to the promotion of communications among medical institutions, second-opinion centers, and separate satellites and separate circuits. We also mention the World Wide Web for teleconsultation, provision of assistance to people with data handicaps via a communications satellite, and assistance to programs designed for training telemedicine specialists. Using a communication satellite, we offer programs that explain preventive medicine, support activities for nursing at home, explain the risks of fast food, and support activities for the handicapped and women in a simple manner to computer illiterates.

Communication↗

PubMed1999

Successful cytokine treatment of aplastic anemia following living-related orthotopic liver transplantation for non-A, non-B, non-C hepatitis.

The relationship between aplastic anemia and viral hepatitis is well recognized, and such patients usually have a high mortality. We successfully treated a case of aplastic anemia following living-related orthotopic liver transplantation (LROLT) for non-A, non-B, non-C hepatitis. A 2-yr-old boy with fulminant hepatic failure from non-A, non-B, non-C hepatitis received LROLT. Before transplantation, he had pancytopenia which was probably hepatitis associated, and viral suppression was suspected after bone marrow (BM) biopsy. After the transplantation, he developed progressive pancytopenia and a diagnosis of aplastic anemia was made via BM biopsy. With immunosuppressant agents (cyclosporine, methylprednisolone), cytokine therapy (granulocyte-colony stimulating factor (G-CSF), macrophage-colony stimulating factor (M-CSF), recombinant human erythropoietin (rhEPO)) was effectual and the patient recovered from pancytopenia. He was discharged from the hospital 57 d after the liver transplantation and remains well 1 yr after LROLT. Combined cytokine therapy with high doses of G-CSF, M-CSF and rhEPO appeared to be effective in the treatment of aplastic anemia following liver transplantation for non-A, non-B, non-C hepatitis. Since M-CSF activates macrophages, it may have contributed to the graft rejection. Careful consideration should be given to the use of high-dose M-CSF in liver transplant patients.

Anemia, Aplastic↗

PubMed1999

Advantage of the uncemented total hip system with three spiked socket.

Atotal hip arthroplasty was performed on 112 joints of 110 patients from November 1983 to January 1998 using three different types of uncemented total hip systems with a three spiked socket. The clinical results of 87 joints of 85 patients, followed up 5 years or more after operation, were evaluated with the comparison among the three different types (original type [JIAT] in 6, type Y in 24, and type Y2 in 57). In 73 of the 87 patients, the age at the time of the operation was more than 60. The preoperative diagnosis was osteoarthritis with acetabular hypoplasia in 61, rapidly destructive coxarthrosis in 17, and so on. We have been receiving excellent clinical results of patients who were implanted with type Y2 compared with the other types. There was no different clinical results between patients who were less than 60 and patients who were over 60. Injuries of neurovascular bundle relating to the penetration of the tip of the spike, which was a concern in this type of socket, were not encountered. The type Y2 uncemented total hip system shows an indication of being successful even if the patients have poor bone stock in acetabulum or are elderly.

Acetabulum↗

PubMed1999

The interactive surrogate travel system.

The Interactive Surrogate Travel (IST) system is based on the super-miniaturized system of virtual technology, Cave Automatic Virtual Environment (CAVE). Using bilateral virtual reality (VR-to-VR) communications, IST enables the testing of subjects via interactive communications. It appears that IST will find practical applications in the near future. We examined the utility of IST in medical treatment and psychiatric tests. Psychiatric symptoms reflect human pathos, which in turn are greatly influenced by culture. If these culture-bound symptoms can be adequately communicated between providers and clients of different cultures, we can develop effective telepsychiatric services across different societies and cultures. IST requires high-speed transmission and gigabyte circuits. A pilot project tested the utility of IST (through the use of optical fiber communications on earth) as a basis for experiments via the Gigabit satellite, to be launched in the year 2002.

Culture↗

PubMed1999

Development of X-ray TV M-mode and reconstructed ultrasound M-mode methods for investigating tongue movement during swallowing in humans.

There were two purposes of this study. The first purpose was to introduce the "X-ray TV M-mode waveform" which is reconstructed from sequential X-ray TV images and the "reconstructed ultrasound M-mode waveform" which is delivered from ultrasound B-mode images. The second purpose was to evaluate the usefulness of these two types of waveforms in the investigation of tongue movement during swallowing. The instrument system employed in this study consisted of ultrasound and X-ray TV synchronized by a time marker. After the X-ray images and ultrasound B-mode images were recorded on an optical disk, X-ray TV M-mode waveform and ultrasound M-mode waveform were reconstructed using an MC 68030/OS-9 computer. No significant differences in quality of images were observed between the X-ray TV M-mode waveform and the reconstructed ultrasound M-mode waveform. Therefore, both waveforms of the X-ray TV M-mode and the reconstructed ultrasound M-mode are equally useful in measuring tongue movement.

Adult↗

PubMed1999

Mandibular-position sensation during sedation by administration of nitrous-oxide (N2O) gas.

Our aim was to confirm the influence of N2O gas on mandibular-position sensation. The subjects in this study were eight healthy adults. Each subject was asked to hold the reference stick for five seconds between the central tooth in his or her upper and lower jaws. Then, the reference stick was replaced by the test sticks with different thickness, each of which the subjects were again asked to hold at the same position for five seconds. The subjects were instructed to determine, based on judgement of the interincisal distance, whether the thickness of each test stick was larger or smaller than the reference stick. A series of trials was administered to each subject using all eight sizes of test sticks. We compared the ability of the subjects to discriminate mandibular position both before and after the application of a vibrating stimulus to the masticatory muscles, and before and during the administration of N2O gas. Discrimination ability was significantly decreased after the application of the vibrating stimulus. However, during the administration of N2O gas, no significant difference in discrimination ability was observed between before and after the vibrating stimulus. The results of this study indicated that N2O gas had an inhibitory effect on gamma-motor neuron activity, which is presumed to be mediated to some extent through the higher central nervous system. This is the case because the gamma-motor neurons are generally activated by vibrating stimuli applied to the muscle causing decreased discrimination ability of mandibular position. Thus, we conclude that mandibular-position sensation was influenced by N2O gas during the administration of N2O gas.

Adult↗

PubMed1999

Clinical findings in Japanese children with obstructive sleep apnea syndrome: focus on dental findings.

We evaluated clinical findings including those on dentistry and in the oral cavity of children with obstructive sleep apnea syndrome (OSA). This study examined twenty-seven OSA children, who were advised by otolaryngologists to be admitted for closer examination and showed an apnea index (AI) of 5 or more on polysomnographs. Their clinical history was obtained from their mothers, and oral findings were also evaluated. The patient consisted of 15 males (56%) and 12 females (44%). The mean body mass index (BMI) was 16.0 +/- 3.0. Of the clinical findings related to sleeping and the duration of sleeping, snoring was the most frequently observed finding (100%). The mean duration of sleep, calculated from the time they went to bed (9.2 +/- 0.8 p.m.) and the time they got up (7.1 +/- 0.8 a.m.), was 9.9 +/- 1.0 hours. Of the clinical findings obtained during the daytime, hyponasal speech was the most frequently observed finding (74%). In terms of dentistry, oral breathing was the most frequently observed finding (89%). The mean duration of meals was 31.7 +/- 13.8 minutes. Results of oral examination revealed that Hellman's dental age was most frequently IIA. According to the standardized grading classification, grade I was observed in 7%, II in 63%, and grade III in 30% of subjects.

Age Determination by Teeth↗

PubMed1999

[Goodpasture's syndrome initially presenting with alveolar hemorrhage].

A 17-year-old man was admitted to our hospital because of exertional dyspnea, fever, and hemoptysis. Chest X-ray films disclosed diffuse alveolar infiltrates and patchy shadows in both lungs. Laboratory data included a hemoglobin level of 6.7 g/dl and white blood cell count of 8,100/microliter. Urinalysis revealed microscopic hematuria with RBC cast. Bronchoalveolar lavage fluid from the right middle lobe bronchus was bloody. Anti-GBM antibodies were detected at low levels in serum (10 EU/ml) by ELISA procedures. Renal and lung biopsies were performed. Immunofluorescent studies revealed linear deposits of IgG along glomerular basement membrane of the kidney, but not in alveolar walls of the lung. This case fulfilled the criteria for Goodpasture's syndrome. The patient was treated with methylprednisolone (1,000 mg/day, for 3 days) and plasma exchange (for 2 days), and demonstrated a dramatic improvement in his clinical condition and chest X-ray findings. We were unable to identify autoantibodies to the NC domain of the alpha 3 chain of type IV collagen. Another conformational epitope may play a role in the disease.

Adolescent↗

PubMed1999

Availability of Japanese subsidies for international telemedicine projects.

In this article, the authors report the methods for obtaining subsidies for overseas telemedicine projects from Japanese sources based on their own personal experiences. The Japanese Government is already subsidizing such specialized NGOs (Non-Governmental Organizations) as the Telemedicine Society of Japan and Basic Human Needs and, Japanese trading companies are also hiring telemedicine experts. Prospective methods for obtaining subsidies are outlined as under the following headings: Assistance without compensation, Technology transfer, Grass-roots grant assistance, the Telecommunications Advancement Organization, Postal Savings for International Voluntary Aid, Venture business development funds provided by the Ministry of International Trade and Industry, Mission demonstration satellites by the National Space Development Agency of Japan, the Sasakawa Pacific Island Nations Fund, and International Communications Foundation. Key points of the applications are noted under (1) Degree of contribution to local residents, (2) Significance of project continuation and (3) Novelty and economic impact.

Humans↗

PubMed1999

Saving the cost and energy by an interactive multimedia system with ISDN 128 Kbps for telemedicine.

The telemedicine systems offer many potential advantages for health care delivery. In 1997, we implemented Phoenix, the interactive multimedia system of the Nippon Telegraph and Telephone Corporation (NTT) for clinical application involving teleconsultations over a wide area for delivery of special care in emergency medicine at Tokai University linking with eight hospitals via the Integrated Service Digital Network (ISDN) 128 Kbps. This study was designed to determine the potential saving of the cost and energy through the interactive multimedia network. By using the interactive multimedia system with some modifications, we achieved a satisfactory real-time contact regarding clinical matters. We believe that this network has allowed appropriate transfer of information between medical centers. This system has also significantly reduced the estimated cost for clinical meetings.

Humans↗