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The purpose of this brief study was to identify the most-cited articles in the Archives of Physical Medicine and Rehabilitation based on citation counts using the 1955 through 1986 Science Citation Index (SCI) of the Institute of Scientific Information (ISI). Bibliographic coupling is one measure of a landmark or classic article. The study resulted in identifying 14 citation classics for this journal.
Picture Archiving and Communication Systems (PACS) are getting more and more important for departments of radiology with the increasing spread of digital imaging methods. To determine the demands made on such systems, we calculated the digital image data volume for all examinations carried out in 1983 at the Department of Medical Radiology of the University of Tübingen. 20.37% of all examinations were performed with digitalised equipment. Plain radiography takes the lion's share among the total number of image data. If digitalisation is based on a spatial resolution of 8 Lp/mm, the share is 98.4% of the total image data volume of 7 123 GByte. This figure is far in excess of the estimates stated in literature. The possibilities of image data reduction and feasibility of a major PACS are discussed.
For the last three years our Institute has been using a system based on a microcomputer for archiving scientifically interesting findings. This computer processes data obtained via computed tomography, sonography and angiography. Besides the coding of examination findings the system also enables compilation of efficiency statistics data. The system can be extended with comparatively little effort for processing MR data as well. Coding is not effected, as in most of the generally used systems, according to diagnosis, but according to the pathological change that can be detected via x-ray film. This prevents erroneous coding due to erroneous evaluation of the finding in question. The examinations can be stored immediately without waiting for verification. Search for defined findings is effected via screen where a search profile is set up interactively. Due to the hierarchic structure of code allocation it is possible to call for more or less detailed findings from the stored data.
The requirements for implementing a radiology imaging network are similar to those for local area networks now being designed for other purposes to manage large data films. A radiology department serving a 500-bed hospital generates about 927 megabytes of digitally formatted data per working day. These data are expected to be on line for the patient's hospitalization period. The retrieval rate of these data among the interactive diagnosis display stations requires data throughput rates of between 2 and 5 megabits per second. This throughput rate requires signaling rates of between 20 and 50 megabits per second. Analog hard-copy generation of the images on the network is required by the referring physician for selected images that support the consultation report. Digital laser recorders using paper may be quite satisfactory. Long-term archiving must be low in cost and requires a database scheme capable of managing more than a terabyte of image data. Radiology networks must be required to bridge with other hospital information systems.
Access to essential information characterising the clinical condition of a patient and the course of that condition is an advance which physicians have long expected from data Processing to meet a certain number of needs: follow up of the patient, organisation of medical secretariat, file selection, help to clinical thought, etc. This typically documentary activity raises a problem of data representation classically solved by the use of clinical information classified beforehand: questionnaires or nomenclatures. This article reports on the use of a truly medical language: REMEDE, a the end of one year's operation in a cardiac department; the automatic processing of 173 coronary angiographies shows the interest, efficiency and flexibility of such a system of automated hospital archives.
We evaluated whether proliferating cell nuclear antigen (PCNA) immunohistochemistry with antigen retrieval could be used as a measure of cell proliferation in archival, formalin-fixed, paraffin-embedded tissues and whether the staining results have long-term prognostic significance in axillary node-negative breast cancer. Primary tumor samples obtained from 109 axillary-node-negative breast cancer cases were used for the study. The best staining results were obtained with the 19A2 antibody after microwave heating in a solution of saturated lead thiocyanate. Using this method, there was a significant correlation (linear regression, r = 0.580, P < 0.001) between the proportion of PCNA19A2-positive carcinoma cells (PCNA19A2 score) and DNA flow cytometric S phase fraction. A high PCNA19A2 score was associated with high mitotic count, DNA aneuploidy, and absence of estrogen receptors. Axillary-node-negative patients with a high PCNA19A2 score (cut-point 8%) had significantly worse prognosis than those with a low PCNA19A2 score (P = 0.008). According to a Cox multivariate analysis, PCNA19A2 score had independent prognostic value but only if S phase fraction was excluded from the analysis. In our study, the PCNAPC10 score correlated weakly only with primary tumor size (analysis of variance) and prognosis (5-year univariate survival analysis), but the significance of these findings needs further evaluation. In conclusion, PCNA immunohistochemistry with the 19A2 antibody after an appropriate antigen retrieval treatment may offer a useful alternative to DNA flow cytometry for the analysis of cell proliferation activity from formalin-fixed, paraffin-embedded breast carcinomas.
The most studied biological parameter of human tumours is the DNA nuclear content. In the present study we assessed the DNA content of 197 colorectal cancers from 180 patients using archival material (tissues routinely processed and paraffin-embedded) for image analysis. The metastatic lymph nodes were also included in the study in 54 Dukes "C" stage cases and 19/25 Dukes "D" stage cases. A total of 452 sections, 5 mu thick, were submitted to image analysis in static cytometry. DNA diploid pattern was found in 72/452 samples (15.9%) and the DNA-aneuploid pattern in 380/452 (84.1%). Two different areas for each tumour were examined but we found a concordance of diploid pattern in only 23 cases. DNA-aneuploidy, regarded as presence of at least one sample with an aneuploid peak in the same tumour, reached 88% in our study. In conclusion the image analysis of several samples obtained from different areas of the same tumour clearly revealed: a pronounced heterogeneity of ploidy patterns in colon cancer; an overall prevalence of DNA-aneuploidy in colon cancer; a prevalence of diploid pattern in tumours localized in right portion of the colon and in younger patients.
The involvement of mental health professionals in determinations of dangerousness is both common and controversial. Among the various contexts for these evaluations, the release of potentially violent forensic patients from maximum security facilities evokes justified concern from involved experts and apprehension to outrage from the immediate community. We sought to examine how conclusions are reached on dangerousness at two sequential stages: clinical recommendations and Manifest Dangerousness Hearings decisions. In an archival study of 245 patients, we found that lack of progress in the institution and physical assaultiveness were the strongest correlates with dangerousness. In contrast, experts and review boards appeared to be relatively less influenced by diagnosis, types of treatment, and sociodemographic variables.
HER-2/neu oncogene amplification and overexpression of breast cancer tissue has been correlated with poor prognosis in women with both node-positive and node-negative disease. However, several studies have not confirmed this association. Review of these studies reveals the presence of considerable methodological variability including differences in study size, follow-up time, techniques and reagents. The majority of papers with clinical follow-up information are immunohistochemical studies using archival, paraffin-embedded breast cancers, and a variety of HER-2/neu antibodies have been used in these studies. Very little information, however, is available about the ability of the antibodies to detect overexpression following tissue processing for paraffin-embedding. Therefore, a series of antibodies, reported in the literature or commercially available, were evaluated to assess their sensitivity and specificity as immunohistochemical reagents. Paraffin-embedded samples of 187 breast cancers, previously characterized as frozen specimens for HER-2/neu amplification by Southern blot and for overexpression by Northern blot, Western blot, and immunohistochemistry, were used. Two multitumor paraffin-embedded tissue blocks were prepared from the previously analyzed breast cancers as a panel of cases to test a series of previously studied and/or commercially available anti-HER-2/neu antibodies. Immunohistochemical staining results obtained with 7 polyclonal and 21 monoclonal antibodies in sections from paraffin-embedded blocks of these breast cancers were compared. The ability of these antibodies to detect overexpression was extremely variable, providing an important explantation for the variable overexpression rate reported in the literature.
Patients in accelerated phase or blast crisis of chronic myeloid leukemia (CML) frequently develop clonal cytogenetic abnormalities in addition to the Philadelphia chromosome. Using a DNA probe directed to the centromere of chromosome 8, we performed fluorescence in situ hybridization (FISH) on archival Wright-stained blood and bone marrow smears of seven patients with CML and with a known +8 clone by metaphase cytogenetics to determine the distribution of +8 in interphase cells. All slides had been stored at ambient temperature for 12-26 months. The bone marrow aspirate smears of 21 non-leukemic patients served as controls. Trisomy 8 was demonstrated in all myeloid cell lines including the neutrophils, basophils, eosinophils, monocytes, and erythroid precursors, but not in the lymphocytes. The extra chromosome 8 was present in mature segmented granulocytes as well as more immature precursors. The percentage of +8 cells was highest in specimens from patients with CML in myeloid blast crisis (mean 64%), followed by those in accelerated phase (mean 39%). Three specimens from patients in morphologic chronic phase showed the lowest percentage of +8 cells (mean 13%). One patient was studied twice and showed a substantial expansion of +8 cells with progression from accelerated phase to myeloid blast crisis. Compared to metaphase cytogenetics, the proportion of +8 cells detected by FISH was often lower. We conclude that the acquisition of trisomy 8 in CML occurs in a pluripotent myeloid stem cell apparently incapable of expressing mature lymphoid phenotype, and that morphologic progression of disease is generally associated with an expansion of the +8 component.
In daily routine there is a major discrepancy between what physicians do and what they document. From a medical information processing point of view amongst the more important functions physicians perform in their daily routine is the encoding of diagnoses using a standard vocabulary such as ICD-9. This paper presents evidence that through the use of the ICD-encoding module of a computerized patient record system (PADS, Patient Archiving and Documentation System) user compliance can be improved. "Bypassing" mechanisms can be partly reversed (up to 43%), more coded diagnoses are documented (by 51%) and those diagnoses documented are more complete (increase by 57%).
The paper starts by presenting the major PACS (Picture Archiving and Communication Systems) related concepts and highlights the medical motivations which resulted in PACS developments. The authors review some PACS experiments carried out during the last decade and draw the conclusions of these experiments; the experience of the University Hospital of Rennes is also briefly presented. Finally a discussion is engaged about the future of PACS and their position within the Hospital Information System. According to the authors, this process should not be confined within the small community of PACS specialists but should concern all actors of the hospital, namely medical staff involved in the production or utilisation of medical images, technical staff in charge of equipment and the Hospital Information System, and hospital administrators. Three major lines are proposed: the first one deals with the functional capacities of PACS and their adaptation to actual user needs; the second concerns the methodology required to set up such systems to ensure adequate integration within the HIS and the third concerns economic issues.
The present state of the art and the state of practice regarding legal aspects of medical informatics are reported. Examples are taken from networking, archiving, and virtual reality. It is derived that the data protection concepts of the seventies are covering only some legal aspects of the application scene today and in the future. Thus a far wider legal approach is necessary. It can only be mastered if engineers and lawyers discuss future trends and derive together a new legal framework for medical computer systems in the late nineties. As computers will be everywhere from childhood to death the key issue is not to just protect an individual but to positively frame an information society.
The following summarize the present capability and future potential for telecommunications in radiology: 1. When used as a central archiving, reporting, and directing unit PACS principally leads to an increased economy and centralization and allows a more rational and efficient use of experienced staff and a better education for the young physicians. 2. PACS also have the capability to produce composite imaging, whereby an overall report, consisting of different radiologic examinations can be obtained. The integration of image and text data and the digital link between specialized clinical departments also makes immediate transmission of images and reports possible. 3. Analog and digital videoconferences permit long distance communication and consultation between specialists, without physicians and radiologists having to change location. These television conferences also lead to an important enhancement of education, providing interaction with specialists who might not usually be available.
This study was undertaken to evaluate a quick, reliable and cheap method of digitizing analog scintigrams. 40 whole-body bone scintigrams were obtained simultaneously in analog and genuine digital format. The analog scans on x-ray film were then digitized secondarily by three different methods: 300 dpi flat-bed scanning, high-resolution camera scanning and camcorder recording. A simple exposure approach using a light box, a cheap camcorder, a PC and image grabber hard- and software proved to be optimal. Visual interpretation showed no differences in clinical findings when comparing the analog images with their secondarily digitized counterparts. To test the possibility of quantification, 126 equivalent ROIs were drawn both in the genuine digital and the secondarily digitized images. Comparing the ROI count to whole-body count percentage of the corresponding ROIs showed the correlation to be linear. The evaluation of phantom studies showed the linear correlation to be true within a wide activity range. Thus, secondary digitalization of analog scintigrams is an easy, cheap and reliable method of archiving images and allows secondary digital quantification.
This manuscript describes a protocol for the utilization of glass slide preparations of hematologic specimens for the recovery of mRNA that is of a quality suitable for the reverse transcription-polymerase chain reaction (RT-PCR) detection of specific gene expression. Total cellular RNA obtained from archival bone marrow aspirate smears of 23 leukemia patients, which had been stored for periods of time from 1 day to 34 mo, were extracted, and 1 to 2 micrograms of each were subjected to RT-PCR using primer pairs specific for the amplification of beta-actin cDNA. Three pairs of primers for the amplification of beta-actin cDNAs of 83,260, and 540 base pairs were used to evaluate the length of mRNA that could be analyzed; the results indicate the consistent amplification of cDNA for the short- and intermediate-sized fragments as revealed by ethidium bromide fluorescence of agarose gel-resolved PCR products. To address the utility of RT-PCR analysis towards the detection of mRNA associated with specific gene alterations in such specimens, a primer pair for amplification of the E2A-PBX1 fusion cDNA was used in PCRs of RT cDNAs for each of the 23 specimens, three of which were pre-B-cell acute lymphoblastic leukemias known to have the t(1;19) karyotype alteration resulting in the fusion of the E2A and PBX1 genes. Agarose gel electrophoresis analysis of the products of these RT-PCR amplifications revealed the amplification of the fusion gene cDNA in only those cases for which there was cytogenetic documentation of t(1;19); these results were confirmed by the Southern filter hybridization of an internal E2A-PBX1 oligonucleotide.(ABSTRACT TRUNCATED AT 250 WORDS)
We used a nested polymerase chain reaction (PCR) to study the presence of human papillomavirus (HPV) DNA in stained, archival cervical cytologic smears, where MY09/MY11 served as outer primers and GP5/GP6 as inner primers. It was found to give a higher positivity rate than PCR using the E1 degenerate consensus primers, where the sensitivity was decreased to 80%. It seemed optimal to use less sample DNA (0.5%) for the reaction; larger volumes resulted in decreased reactivity. Similarly, the presence of bovine serum albumin helped to improve the reactivity. The risk of cross-contamination did not seem to be a major obstacle to a valid analysis. The prevalence of HPV in normal smears was 10%, and in the high grade squamous intraepithelial lesion group it was 80%. Smears with cytologic evidence of HPV gave 100% positivity, while those containing cancer cells gave 80%. In patients whose Southern blot had demonstrated the presence of HPV, 87% of the simultaneously taken smears were also positive with nested PCR. Similarly, in those whose Southern blot analysis was negative, the corresponding smear was positive in 41%; this reactivity was associated with simultaneous squamous intraepithelial lesions. The prevalence values indicated that this analysis is both sensitive and specific and that it can be used to evaluate the performance of other diagnostic methods. The validity is sufficient to allow retrospective cohort studies of the natural history of HPV infections during carcinogenesis.
A method for treatment of formalin-fixed and paraffin-embedded material for electron microscope examinations is described. Archive material may be examined in the electron microscope for the elucidation of some problems concerning conditions of intercellular structures, comparative size and localization in the cells of secrete granules, myofibrillar apparatus and various inclusions.