We investigated the feasibility of telemonitoring services for patients with severe respiratory illness. In the first phase of the study, patients were observed and treated using face-to-face medical visits for 12 months. In the second phase of the study, the patients were monitored at home for 12 months, during which time determinations of arterial oxygen saturation and heart rate were performed twice a week, and the data were automatically transmitted to the hospital's processing centre via a normal telephone line. Thirty patients on long-term oxygen therapy were enrolled in the study; 23 completed the 12 months of home telemonitoring. The numbers of hospital admissions and of acute home exacerbations during the telemonitoring phase of the study decreased by 50% and 55%, respectively, in comparison with the first phase. Estimates of hospitalization costs for the patients during the second phase were approximately 17% lower than those for the first phase. Patients were satisfied with the quality of the personal telemonitoring process in 96% of cases. We believe that telemedicine can enable the provision of high-quality home care for patients with severe respiratory illness.

We studied the effect of the combination of streptozotocin-induced diabetes and spontaneous renal injury in male MWF rats. Renal hemodynamics was studied by micropuncture 1 month after streptozotocin administration, and kidney morphological evaluation was performed after 4 months of diabetes. We also studied the effect of angiotensin II antagonism on development of renal lesions. Untreated animals developed mild hypertension, proteinuria, and glomerulosclerosis. Induction of diabetes, and maintenance of a moderate hyperglycemic state, was associated with slight but significant elevation in systemic and glomerular capillary blood pressure. Development of proteinuria was not accelerated or exacerbated by diabetes. Glomerular and tubular structural changes were also not worsened by diabetes. Antihypertensive treatment with an ACE inhibitor (benazepril) or with an AII receptor antagonist (valsartan) almost completely prevented systemic and glomerular capillary hypertension, proteinuria and renal structural changes. No significant differences in glomerular volume were observed among the four groups. That induction of experimental diabetes, although associated with glomerular capillary hypertension, did not aggravate the rate of progression of renal dysfunction would suggest that glomerular injury is not directly influenced by glomerular hemodynamic conditions in these animals. Prevention of renal functional and structural abnormalities by antagonism of AII activity in diabetic MWF rats suggests a pathogenetic role for angiotensin in inducing the renal disease in these animals.