There is very little published information about the outcomes of patients treated by telemedicine in developing countries. Over a two-year period, seven medical students from five universities spent their electives at a hospital in Papua New Guinea. They assisted with the review of a total of 44 e-referrals made by local doctors; the referrals resulted in 61 queries in a wide range of specialties. The major categories of these queries were internal medicine, paediatrics and surgery. Follow-up data were obtained in 22 of the 44 cases (50%) after a median period of 13 weeks (interquartile range 3-19). The cases were reviewed by an independent doctor. Telemedicine was considered to have assisted with the diagnosis in all cases (median score 5 on a five-point scale from 1 = not helpful at all to 5 = very good/excellent). The advice to the referring doctor for further action was considered helpful in all except one case (median score 5 on the same scale). The outcome for the patient was considered to be good in 15 of the cases (median score 4 on the same scale). Medical students were able to facilitate e-referrals by relieving the pressure on the local doctor to undertake the necessary clerical and technical work. The students reported a rewarding elective experience. The follow-up data showed that low-cost telemedicine can provide useful advice in a low resource setting.

Tumor cell membrane glycoproteins may be involved in the induction of tumor immunity or in the escape of tumors from immunologic defense mechanisms. Previous investigations have suggested a role for blood group antigens and their precursors, in the generation of the immune response to neoplasia. In this study, 44 benign and malignant breast lesions were examined for the presence of a carbohydrate precursor antigen (T-antigen) of the human blood group system MN. T-antigen was demonstrated using an immunohistochemical technique to detect tissue binding of a plant lectin (PNA) with specificity for T-antigen. Of the 22 benign breast lesions examined, 19 showed T-antigen present along the luminal cytoplasmic membrane and occasionally on intraluminal secretions. T-antigen, as demonstrated by lectin binding, was confined to this region in all benign lesions except one, which also showed cytoplasmic positivity. Malignant breast lesions showed a pattern of T-antigen expression markedly different from that of benign breast tissues. Of 22 breast carcinomas, 17 showed diffuse cytoplasmic T-antigen. Five carcinomas showed no evidence of T-antigen by this technique. These malignancies tended to be the most poorly differentiated when judged by histologic criteria. A possible role for T-antigen in the modulation of the immune response to breast carcinoma is suggested.

No abstract

No abstract