No abstract

The authors evaluated a site-independent telemedicine system. Telemedicine may be limited by the need for fixed connectivity. Wireless and site-independent technologies eliminate this limitation. Twenty-five stroke patients underwent evaluations by remote and bedside examiners. Ten of 15 (67%) NIH Stroke Scale and 9 of 11 (82%) Modified NIH Stroke Scale items showed excellent interrater reliability. Spearman correlations were > or =0.93. This Internet system is reliable and valid. Further studies should assess its use in acute stroke.

Hematogenous metastases to the limb skeletal muscles are extremely rare. Better understanding of the mechanisms resulting in the relative resistance of skeletal muscle to metastases could have bearing on therapeutic interventions for prevention of metastases. Three patients with non-small cell lung cancer and metastases in the proximal limb muscles are presented. Skeletal muscle metastases may present as painful masses in the proximal skeletal muscles. Subcutaneous and osseous metastases which are more frequent must be excluded by careful physical examination, bone scan and x-rays. Computed tomography (CT) can confirm the location of the tumor within the fascial planes of skeletal muscles and may help in the accurate delineation of the radiation portal. The tumor can be diagnosed and more common causes, such as hematoma or abscess, can be excluded by thin needle aspiration with cytologic examination. Clinical recognition of metastases in this unusual site is important based on our report that total tumor dose of 3600 to 4200 cGy of radiation in fractions of 300 cGy, 5 days a week, is effective in palliation of swelling and pain.

In psoriasis, there is increased expression of involucrin, which leads to abnormal keratinocyte differentiation and hence to the formation of psoriatic plaques. The therapeutic effect of PTU in psoriasis may be attributable to the downregulation of involucrin. Larger trials should further elucidate the mechanism and therapeutic potential of PTU in psoriasis.

The primary outcome measure is whether there was a 'correct decision to treat or not to treat using rt-PA' at each of three adjudication levels (primarily at Level #2). Secondary outcomes include the number of thrombolytic recommendations, intracerebral hemorrhage, and 90-day outcomes. Using the STRokE DOC system (or telephone evaluation), medical history, neurologic scales, CT interpretations, and recommendations have been completed on over 200 participants to date. Of the initial 11, nonrandomized, 'run-in' patients, six (65%) were evaluated wirelessly, and five (45%) were evaluated with a site-independent LAN or cable modem. Three (27%) received rt-PA. The adjudication methodology was able to show both agreements and disagreements in these 11 cases. It is feasible to perform site-independent stroke consultations, and adjudicate those cases, using the STRokE DOC system and trial design. Telemedicine efficacy remains to be proven.