[Simplified production of multimedia based radiological learning objects using the flash format].

Purpose: Evaluation of the applicability of the Flash Format for the production of radiological learning objects used in an e-learning environment.

Material And Methods: Five exemplary learning objects with different didactic purposes referring to radiological diagnostics are presented. They have been intended for the use within the multimedia, internet-based e-learning environment LaMedica.

Virtual reality and 3D visualizations in heart surgery education.

Background: Computer assisted teaching plays an increasing role in surgical education. The presented paper describes the development of virtual reality (VR) and 3D visualizations for educational purposes concerning aortocoronary bypass grafting and their prototypical implementation into a database-driven and internet-based educational system in heart surgery.

Materials And Methods: A multimedia storyboard has been written and digital video has been encoded.

The CardioOP-Data Clas (CDC). Development and application of a thesaurus for content management and multi-user teleteaching in cardiac surgery.

Objectives: Self-directed and customized medical education programs are gaining importance in health care instruction. We prototypically implemented a repository-driven online computer system (CardioOP) for teleteaching in Heart Surgery. It supports authoring and multiple re-use of multimedia data for different user groups in different instructional applications and therefore requires a process of content management.

[LaMedica. The medical education academy on the internet].

At present, "modern media" are still a novelty in medical education. The "LaMedica Project"--a program supported by the Federal Ministry for Education and Research--intends to provide an Internet-based education and training system for the entire field of medicine, using all available media resources. This online educational program will provide subjects for medical laypersons as well as medical experts.

CardioOp: an integrated approach to teleteaching in cardiac surgery.

Introduction/purpose: The complexity of cardiac surgery requires continuous training, education and information addressing different individuals: physicians (cardiac surgeons, residents, anaesthesiologists, cardiologists), medical students, perfusionists and patients. Efficacy and efficiency of education and training will likely be improved by the use of multimedia information systems. Nevertheless, computer-based education is facing some serious disadvantages: 1) multimedia productions require tremendous financial and time resources; 2) the obtained multimedia data are only usable for one specific target user group in one specific instructional context; 3) computer based learning programs often show deficiencies in the support of individual learning styles and in providing individual information adjusted to the learner's individual needs.

Incidence, outcome and prediction of early clinical events following percutaneous transluminal coronary angioplasty. A comparison between treatment with reviparin and unfractionated heparin/placebo (results of a substudy of the REDUCE trial).

Background: Unfractionated heparin and its low molecular weight fragments possess antithrombotic properties, properties that are routinely exploited in coronary angioplasty (PTCA).

Objectives: In the setting of the REDUCE trial, a randomized, double-blind, multicentre trial, the occurrence of acute or early clinical events was compared in patients treated with either unfractionated heparin/placebo or low molecular weight heparin (reviparin).

Methods And Results: Six hundred and twelve patients with native coronary artery obstructions randomized between unfractionated heparin/placebo and reviparin, were analysed.

[The influence of coronary artery dissection on long-term outcome after percutaneous transluminal coronary angioplasty].

Unlabelled: The influence of a coronary dissection on long-term outcome after PTCA has been controversely discussed in the past. Whereas diverse experimental studies have shown a positive relation between dissection and the incidence of restenosis, clinical trials could not document an influence of dissection on long-term outcome. However, most of the trials did not distinguish between the different morphologic configuration of the vascular dissection.

[Low molecular weight heparin, reviparin, after PTCA: results of a randomized double-blind, standard heparin and placebo controlled multicenter study (REDUCE Study].

Background: Unfractionated heparin and its low molecular fragments possess antiproliferative effects and have been shown to reduce neointimal smooth muscle cell migration and proliferation in response to vascular injury in experimental studies.

Objectives: The specific objective of the REDUCE trial was to evaluate the effect of a low molecular weight heparin on the incidence and occurrence of restenosis in patients undergoing percutaneous transluminal coronary angioplasty.

Methods: The REDUCE trial is an international prospective, randomized, double-blind, multicenter study.

Success and Procedural Outcome of Excimer Laser Coronary Angioplasty Compared to Conventional Balloon Angioplasty.

BACKGROUND: Coronary excimer laser angioplasty was suggested to be superior for treatment of lesions with complex lesion morphology. METHODS: In this study, 134 consecutive patients undergoing excimer laser angioplasty (ELCA) were compared to 203 patients treated with conventional balloon angioplasty (PTCA) in the same study period. Baseline characteristics did not differ between both groups except the distribution of target vessel (LAD: ELCA 72% vs.

Low molecular weight heparin (reviparin) in percutaneous transluminal coronary angioplasty. Results of a randomized, double-blind, unfractionated heparin and placebo-controlled, multicenter trial (REDUCE trial). Reduction of Restenosis After PTCA, Early Administration of Reviparin in a Double-Blind Unfractionated Heparin and Placebo-Controlled Evaluation.

Objectives: The specific objective of the REDUCE trial was to evaluate the effect of low molecular weight heparin on the incidence and occurrence of restenosis in patients undergoing percutaneous transluminal coronary angioplasty (PTCA).

Background: Unfractionated heparin and its low molecular weight fragments possess antiproliferative effects and have been shown to reduce neointimal smooth muscle cell migration and proliferation in response to vascular injury in experimental studies.

Methods: The REDUCE trial is an international prospective, randomized, double-blind, multicenter study.

[-Diagnostic shunt oximetry of atrial septal defect in adulthood-].

Unlabelled: There are several circumstances in which data obtained at catheterization should alert the cardiologist to look for a shunt that had not been suspected previously. Aim of the study was to explore the most sensitive parameter which is easily practicable and which gives strong evidence for an atrial septal defect (ASD). Moreover, a simplified method for quantifying left-to-right shunts was analyzed.

Low molecular weight heparin in prevention of restenosis after PTCA.

Late restenosis occurring after successful PTCA continues to represent a major problem limiting the clinical efficacy of the procedure. It has been shown that smooth muscle cell proliferation plays a major role in this accelerated atherosclerotic process. In vitro and in vivo experiments with the low molecular weight heparin reviparin showed a pronounced inhibitory effect by this compound on smooth muscle cell proliferation.

Early luminal deterioration following successful percutaneous transluminal coronary angioplasty. Frequency, prediction and clinical implications.

In order to develop a predictive model for the risk of early lesion deterioration following successful coronary balloon angioplasty (PTCA) based on clinical, pre-angioplasty and procedural characteristics, 154 lesions in 146 consecutive patients undergoing successful PTCA for stable/unstable angina were examined by quantitative coronary analysis immediately after and within 24 h of angioplasty. An angiographic complication score was used prospectively, classifying the lesion morphology post-PTCA into class 0: no complication and classes 1 to 3, according to purely descriptive morphological characteristics. Significant deterioration, defined as a decrease in minimal luminal diameter of more than 2 standard deviations of duplicate measurements post-intervention (0.

Experimental and early clinical experience with reviparin-sodium for prevention of restenosis after percutaneous transluminal coronary angioplasty.

Restenosis after successful percutaneous transluminal coronary angioplasty (PTCA) remains a major problem limiting the clinical efficacy of the procedure. It has been shown that smooth muscle cell proliferation plays a major role in this accelerated atherosclerotic process. In vitro and in vivo experiments with a low molecular weight heparin, reviparin-sodium suggest a pronounced inhibitory effect of this compound on smooth muscle cell proliferation.

Acute vessel closure following excimer laser coronary angioplasty: can we predict it?

Of 124 consecutive patients undergoing elective excimer laser coronary angioplasty, 33 (26%) had periprocedural occlusion following excimer laser irradiation. Successful management (reopened vessel, no death, no myocardial infarction, no emergency bypass surgery) including repeat lasing, subsequent percutaneous transluminal coronary angioplasty, use of intracoronary nitroglycerin or streptokinase was achieved in 32 of the patients with acute occlusion following excimer laser coronary angioplasty. In one patient a nonfatal anterior myocardial infarction occurred.

The paradigm of restenosis following percutaneous transluminal coronary angioplasty.

Restenosis after successful percutaneous transluminal coronary angioplasty remains a major clinical problem limiting the long-term efficacy of this treatment for coronary artery disease. All clinical attempts to reduce the incidence of restenosis have failed. Recent advances in the understanding of the cellular biology of restenosis indicate that intimal hyperplasia is the predominant cause for restenosis.

Reliability of quantitative coronary angiography of the target lesion immediately and 1 day after coronary balloon and excimer laser angioplasty.

Objectives: This prospective trial was performed to evaluate the impact of the morphologic complications of angioplasty on the reliability and results of quantitative angiographic assessment of the residual stenosis.

Background: Postintervention quantitative coronary analysis is limited by a variety of such complications.

Methods: In 199 patients undergoing an early control angiographic study within 24 h after coronary balloon or excimer laser angioplasty (24-h study), detailed quantitative angiographic measurements were performed on the target lesion immediately after intervention and at the 24-h study.

Acute closure during coronary excimer laser angioplasty and conventional balloon dilatation: a comparison of management outcome and prediction.

Of 523 consecutive patients undergoing elective percutaneous transluminal coronary angioplasty (PTCA) and 83 patients treated with coronary excimer laser angioplasty (ELCA), 17 (3.3%) had in-laboratory occlusion following PTCA and 25 (30%) following ELCA; they were enrolled into a prospective study. Successful management (reopened vessel, patency at repeat angiography within 24 h, no death, no myocardial infarction (MI), no emergency bypass surgery) including repeat lasing, subsequent PTCA, use of intracoronary nitroglycerin or streptokinase was achieved in 24 (96%) of the 25 patients with acute occlusion during ELCA.

First clinical experience with low molecular weight heparin LU 47311 (reviparin) for prevention of restenosis after percutaneous transluminal coronary angioplasty.

Restenosis after successful percutaneous transluminal coronary angioplasty (PTCA) remains a major problem limiting the clinical efficacy of the procedure. It has been shown that SMC proliferation plays a predominant role in this accelerated atherosclerotic process. In vitro and in vivo experiments with the LMWH reviparin (LU 47311) suggest a pronounced inhibitory effect of this compound on SMC proliferation.

Case report: formation of vessel aneurysm after stand alone coronary excimer laser angioplasty.

Formation of aneurysms in coronary arteries can be observed following percutaneous transluminal balloon angioplasty but has not been reported previously after coronary excimer laser angioplasty in humans. Stand alone coronary excimer laser angioplasty was performed in a 49-year-old man with a 75% left anterior descending artery stenotic lesion and exertional angina, documenting a good angiographic result postintervention. Control angiography 6 months after the procedure revealed an aneurysm distal to a 90% restenosis in the area of ablation.

Ultrafast imaging of tissue ablation by a XeCl excimer laser in saline.

To determine the temporal evolution of laser induced tissue ablation, arterial wall specimens with either hard calcified or fatty plaques and normal tissue were irradiated in a 0.9% saline solution using a XeCl excimer laser (wavelength 308 nm, energy fluence 7 J/cm2, pulse width 30 ns) through a 600 microns fused silica fiber pointing perpendicular either at a 0.5 mm distance or in direct contact to the vascular surface.