Biomedical subjects

C Espinola-Klein

Publications and source records attributed to C Espinola-Klein.

17 recordsLinked to original sources

PubMed2005

Sequential femorodistal composite bypass with second generation glutaraldehyde stabilized human umbilical vein (HUV).

OBJECTIVE: To evaluate the performance of sequential composite bypasses with second generation glutaraldehyde stabilized human umbilical vein (HUV) and autologous vein. DESIGN: Retrospective study of consecutive patients, in a single centre. PATIENTS: From January 1998 to December 2003, 54 femoro-distal HUV-autologous vein sequential composite bypasses were constructed in 52 patients with critical leg ischemia and absence of sufficient length of autologous vein. METHODS: All infra-inguinal bypass operations were registered in a computerized database and prospectively followed. Bypasses using sequential HUV-composite technique were reviewed for graft patency, limb salvage and patient survival. RESULTS: Primary patency and secondary patency rates at 1, 2, 3 and 4 years were 71, 61, 53 and 53% and 89, 80, 73 and 67%, respectively. Corresponding limb salvage rates were 96, 92, 88 and 88%. Patient survival was 56% at 4 years. After 30 days additional procedures to maintain graft patency were necessary in six bypasses. Asymptomatic occlusion of one sequential anastomosis was found in five patients. CONCLUSION: Graft patency and limb salvage rate support the use of the sequential composite technique with second generation HUV in femorodistal bypass surgery, when autologous vein of sufficient length is not available.

Aged↗

PubMed2004

[Acute coronary syndrome (without ST-elevation)].

Antithrombotic therapy in acute coronary syndrome without ST-segment elevation should be initiated with aspirin 100 mg/day (loading dose 250-500 mg) and Clopidogrel 75 mg/day (loading dose 300 mg). In addition, anticoagulation with unfractionated heparin or low molecular weight heparin should be started. A GP IIb/IIIa receptor blocker can be given either upfront (Eptifibatide/Tirofiban) or directly in the cathlab preceding PCI (Abciximab). Aspirin should be given in the chronic phase lifelong, Clopidogrel for at least nine months. An invasive strategy is recommended in high-risk patients within 48 hours.

Acute Disease↗

PubMed2004

[Genetic variation of the cholesterol ester transfer protein gene and the prevalence of coronary artery disease. The AtheroGene case control study].

BACKGROUND: Various functional polymorphisms of the cholesteryl ester transfer protein ( CETP) gene influence CETP activity and the concentration of high-density lipoprotein (HDL) cholesterol. Beside other functional variants mainly the promoter polymorphism CETP/C-629A is currently discussed as a risk factor of coronary artery disease (CAD). We evaluated in a large case-control study the impact of various CETP genotypes and haplotypes on HDL concentration and the prevalence of CAD. METHODS AND RESULTS: In 1214 patients with documented CAD as well as 754 population controls we determined the CETP/C-629A, TaqIB, I405V, R451Q, and A373P polymorphisms. All genotypes have an impact on the HDL concentration; univariate genotype and haplotype analyses demonstrate a significant effect of A-allel carriers on the elevation of HDL concentration. In addition, among all genotypes determined, the C-629A polymorphism is associated with the prevalence of CAD in a codominant fashion. Homozygous A-allel carriers reveal a relative risk of 0.6 (95% CI 0.44-0.82; P = 0.005) compared to the wild type. Adjustment for classical risk factors did not alter this association significantly, whereas after controlling for HDL concentration no independent significance between CETP/C-629A genotype and prevalence of CAD was observed anymore. CONCLUSION: CETP genotypes have an significant but moderate impact on systemic HDL-cholesterol concentration. The A-allel of the CETP/C-629A polymorphism is associated with a reduced CAD risk. This risk reduction is probably mediated by elevated HDL-concentration. Whether genotyping of the CETP/C-629A polymorphism provides information over and above that obtained by HDL-cholesterol measurement has to be further investigated in various prospective studies.

Carrier Proteins↗

PubMed2004

[Influence of impaired fasting glucose on the incidence and prognosis of atherosclerosis in various vascular regions].

UNLABELLED: Patients with cardiovascular disease have a poorer diagnosis if they are diabetic. The risk for cardiovascular events is already increased in individuals with impaired fasting glucose (IFG). The aim of this study was to evaluate the impact of diabetes mellitus (DM) and IFG on the incidence of atherosclerotic manifestations and on the long-term prognosis of patients with atherosclerosis in various vascular regions. METHODS: In a prospective study we included 906 patients (72.5% men, mean age 62 +/- 9 years) preceding heart catheterization. All patients were evaluated for the presence of peripheral stenosis by carotid duplex sonography (pathologic: stenosis >50%) and evaluation of the ankle-brachial index (pathologic <0.9). Blood samples were drawn from each subject after an overnight fasting period and serum glucose was evaluated. RESULTS: Patients were compared with regard to the presence of DM (known DMor fasting glucose > or =126 mg/dL, N = 283, 31.2%) or IFG (fasting glucose >110 and <126 mg/dL, N = 89, 9.8%). Patients with IFG and DM had a higher prevalence of atherosclerotic manifestations in the coronary, carotid and peripheral vessels. Diabetics had the highest prevalence of atherosclerotic manifestations in multiple vascular regions (=advanced atherosclerosis). Cardiovascular events (death, myocardial infarction and stroke) after a median follow-up of 4.1 years were evaluated in 901 patients (99.4%). Presence of IFG and DM significantly increased the incidence of cardiovascular events (event rate: no DM 10.9%, IFG 13.6%, DM 23.4%, P < 0.0001). Moreover, patients with advanced atherosclerosis suffered significantly more often from cardiovascular events (event rate: no stenosis 4.1%, coronary artery disease without peripheral stenosis 9.7%, advanced atherosclerosis 23.9%). Prognosis was worst in patients with DM and advanced atherosclerosis with an event rate of 35%.Patients with cardiovascular disease have a poorer prognosis if they are diabetic. The risk for cardiovascular events is already increased in individuals with impaired fasting glucose (IFG). The aim of this study was to evaluate the impact of diabetes mellitus (DM) and IFG on the incidence of atherosclerotic manifestations and on the long-term prognosis of patients with atherosclerosis in various vascular regions.

Aged↗

PubMed2003

External reinforcement of varicose veins with PTFE prosthesis in infrainguinal bypass surgery -- clinical results.

OBJECTIVE: Segmental varicose degeneration of the autogenous greater saphenous vein may limit its use in infrainguinal bypass surgery. Wrapping a PTFE prosthesis around dilated veins has emerged as an option to create externally reinforced vein bypasses. Results regarding graft patency and limb salvage were analyzed. METHODS: Between September 1995 and January 2001, 35 infrainguinal bypass operations in 33 patients were performed with greater saphenous veins exhibiting segmental varicose dilatation. Grafts were followed by duplex scan and retrospective analysis of graft patency and limb salvage was performed. RESULTS: One bypass prompted successful revision for early occlusion. Four bypasses required additional reintervention during follow-up. 48 months primary, primary assisted and secondary patency rates were 66%, 82% and 82%, respectively, with a limb salvage rate of 97%. Duplex scan failed to demonstrate stenosis of the reinforced vein segments or aneurysmal degeneration of the residual vein. CONCLUSION: External reinforcement with a PTFE prosthesis allows the use of autogenous greater saphenous veins with varicose dilatation and enables the construction of all autogenous bypasses with promising graft patency and limb salvage.

Aged↗

PubMed2003

[Limb salvage in diabetic foot syndrome with pedal bypass using the in-situ technique].

INTRODUCTION: Treatment of the ischemic diabetic foot syndrome still represents a medical and economic challenge. Contrary to the aims of the Saint Vincent declaration a dramatic reduction of major amputations in Germany was not noted, although in the diabetic patients the predominant type of tibial artery occlusion allows construction of pedal bypasses for limb salvage. METHOD: In patients with ischemic diabetic foot syndrome following angiographic evaluation of the ischemic limb, the indication for surgical revascularisation of patent pedal arteries was established. The in-situ technique was preferred in the presence of a suitable ipsilateral greater saphenous vein whenever possible. Revascularisation was followed by treatment of foot ulcerations or, if necessary, minor amputations. Patients were followed by clinical examination and duplex scan investigation of the bypass in regular intervals. RESULTS: From 01/89 to 12/01 in 79 patients (59 men and 20 women) with non healing ulcerations or established gangrene from a total of 175 pedal bypasses 84 pedal bypass operations in 84 limbs were performed using the in-situ technique. All patients were diabetic and in addition 13.9% were dependent on hemodialysis for end stage renal disease. 59.5% of the bypasses originated from the popliteal artery (distal origin bypass). The dorsalis pedis artery was chosen for the distal anastomosis in 83% and the posterior tibial artery in 17%. Two patients (2.4%) died postoperatively from cardiac events. Early bypass occlusion occurred in 8.4% resulting in a major amputation rate of 6%. After 60 months primary, primary assisted and secondary patency was 67.7%, 71.5% and 75.3% respectively with a limb salvage rate of 78%. CONCLUSION: Pedal bypass using the in-situ technique provides excellent long term limb salvage rates in a disease with a generally unjustified bad prognosis with respect to limb salvage.

Adult↗

PubMed2002

Endovenous treatment of the greater saphenous vein with a 940-nm diode laser: thrombotic occlusion after endoluminal thermal damage by laser-generated steam bubbles.

PURPOSE: Despite a rapid spread of the technique, very little is known about the laser-tissue interaction in endovenous laser treatment (EVLT). We evaluated EVLT of the incompetent greater saphenous vein (GSV) for efficacy, treatment-related adverse effects, and putative mechanisms of action. METHODS: Twenty-six patients with 31 limbs of clinical stages C(2-6), E(P), A(S,P), P(R) with incompetent GSV proven by means of duplex scanning were selected for EVLT in an outpatient setting. A 600-microm fiber was entered into the GSV via an 18-gauge needle below the knee and proceeded to the saphenofemoral junction (SFJ). After infiltration of tumescent local anesthesia, multiple laser pulses of 15 J energy and a wavelength of 940 nm were administered along the vein in a standardized fashion. D-dimers were determined in peripheral blood samples 30 minutes after completion of EVLT in 16 patients and on postoperative day 1 in 20 patients. One GSV that was surgically removed after EVLT was examined by means of histopathology. Additionally, an experimental in vitro set-up was constructed as a means of investigating the mechanism of laser action within a blood-filled tube. RESULTS: A median of 80 laser pulses (range, 22-116 laser pulses) were applied along the treated veins. On days 1, 7, and 28, all limbs except one (97%) showed a thrombotically occluded GSV. In one patient, the vessel showed incomplete occlusion. The distance of the proximal end of the thrombus to the SFJ was a median 1.1 cm (range, 0.2-5.9 cm) in the remaining patients. Adverse effects in all 26 patients were ecchymoses and palpable induration along the thrombotically occluded GSV that lasted for 2 to 3 weeks. In two limbs (6%), thrombophlebitis of a varicose tributary required oral treatment with diclofenac. D-dimers in peripheral blood were tested with normal results in 14 of 16 patients 30 minutes after completion of the procedure and elevated results in 7 of 20 patients at day 1 after EVLT. However, an increase of D-dimers from day 0 to day 1 was observed in 15 of the 16 patients undergoing tests 30 minutes after EVLT and on day 1. The 940-nm laser was demonstrated by means of in vitro experiments and the histopathological examination of one explanted GSV to act by means of indirect heat damage of the inner vein wall. CONCLUSION: EVLT of the GSV with a 940-nm diode laser is effective in inducing thrombotic vessel occlusion and is associated with only minor adverse effects. Laser-induced indirect local heat injury of the inner vein wall by steam bubbles originating from boiling blood is proposed as the pathophysiological mechanism of action of EVLT.

Female↗

PubMed2001

Cytomegalovirus infection with interleukin-6 response predicts cardiac mortality in patients with coronary artery disease.

BACKGROUND: Prospective data relating previous exposure to cytomegalovirus (CMV) to the risk of cardiac mortality are controversial. We investigated the effect of previous exposure to CMV infection on the risk of future cardiac disease-related death in relation to an underlying inflammatory response. METHODS AND RESULTS: coronary angiography was performed in 1134 subjects, and 989 patients with documented coronary artery disease were studied prospectively. CMV-IgG titers and interleukin (IL)-6 levels were measured before angiography. Increasing titers of CMV correlated with the elevation of IL-6 levels (P<0.001) after adjustment for possible confounders. All patients were followed up for a median of 3.1 years (maximum 4.3 years). During follow-up, 96 patients died, 70 of cardiac disease. Overall, CMV seropositivity was not related to cardiac mortality after adjustment for confounding variables (P=0.19). In contrast, in patients with elevated IL-6 levels (>/=11.9 pg/mL, median level), CMV seropositivity was independently associated with a 3.2-fold (95% CI 1.4 to 7.3, P=0.007) increase in risk of future cardiac death, whereas in individuals without IL-6 elevation, previous CMV infection had no effect on cardiac mortality. CONCLUSIONS: MV seropositivity in patients with an inflammatory response is independently associated with future cardiac mortality, whereas this association is lost in patients who do not demonstrate an inflammatory response. These data support the hypothesis that the atherosclerotic effects of CMV are mediated through an underlying inflammatory response.

Aged↗

PubMed2000

Ten-year outcome after coronary angioplasty in patients with single-vessel coronary artery disease and comparison with the results of the Coronary Artery Surgery Study (CASS).

The 10-year results of randomized trials comparing percutaneous transluminal coronary angioplasty (PTCA) in patients with single-vessel coronary artery disease (CAD) with coronary artery bypass grafting (CABG) and medical treatment are not available yet. The aim of this evaluation was to compare our 10-year follow-up results after PTCA in patients with single-vessel CAD with the 10-year follow-up results after CABG and medical treatment in the Coronary Artery Surgery Study (CASS) trial. We evaluated the clinical outcome of 509 patients with single-vessel CAD 10 years after coronary angioplasty. The data were compared with the results of 214 patients with single-vessel CAD after CABG or medical treatment from the CASS trial. End points were defined as death and myocardial infarction. Statistical evaluation was performed by life-table analysis and 2-sided Fisher's exact test. The rate of survival was 86% 10 years after PTCA compared with 85% after CABG and 82% after medical treatment in patients from the CASS trial (p = NS). Survival free from myocardial infarction was 77% after coronary angioplasty, 70% after CABG, and 72% after medical treatment (p = NS). Thus, in patients with single-vessel CAD, infarct-free survival 10 years after coronary angioplasty compared favorably with the results after bypass surgery or medical treatment from the CASS trial.

Adrenergic beta-Antagonists↗

PubMed2000

Are morphological or functional changes in the carotid artery wall associated with Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus, or herpes simplex virus infection?

BACKGROUND AND PURPOSE: Chronic infection with Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus (CMV), and herpes simplex virus (HSV) has been implicated in the pathogenesis of atherosclerosis. The carotid intima-media thickness (IMT) can be taken to indicate early atherosclerosis, the presence of a carotid stenosis is a marker of a manifest carotid atherosclerosis, and an increase in arterial stiffness is used as marker of structural and functional changes in an atherosclerotic vessel wall. METHODS: In 504 patients (75% men; mean age 62.9 [SD 10] years), we measured the IMT and the elastic pressure modulus (EP; n=445) of the common carotid artery and the prevalence of a internal or external carotid artery stenosis. Blood samples were taken, and antibodies against C pneumoniae, H pylori, CMV, and HSV types 1 and 2 were evaluated. Statistical evaluation was performed with regression procedures and multivariate logistic regression analyses. RESULTS: Seropositivity for C pneumoniae was an independent predictor for a combined end point of highest category of IMT and carotid artery stenosis (OR 1.8, 95% CI 1.1 to 3.1; adjusted) for IgG titers. Independently, CMV increased the risk for the combined end point (OR 1.7, 95% CI 1.1 to 2.8; adjusted) for IgG titers and for IgA titers (OR 2.3, 95% CI 1.1 to 4. 9; adjusted). We found a significant correlation between IgG antibodies against CMV and EP; HSV type 2 IgG titers were associated with IMT and carotid stenosis, but the latter results were no longer significant after adjustment. There was no association with H pylori or HSV type 1. CONCLUSIONS: We found a significant association of IgG antibodies against C pneumoniae and CMV with early and advanced carotid atherosclerosis. CMV was also correlated to functional changes of the carotid artery, but this could not be confirmed after adjustment.

Arteriosclerosis↗

PubMed1999

Predictors of adverse outcome 10 years after coronary angioplasty.

UNLABELLED: To determine which factors before percutaneous transluminal coronary angioplasty (PTCA) predict long-term outcome, we evaluated the clinical follow-up data from 535 patients 10 years after single-vessel PTCA. Events were defined as death, myocardial infarction, bypass surgery or repeat PTCA. During the follow-up period 79 patients (15%) died, 59 patients (11%) suffered a myocardial infarction, 107 patients (20%) had coronary artery bypass surgery and 141 patients (26%) underwent a redilatation. To determine the predictors of 10-year follow-up, 12 patient-related and 9 lesion parameters were analyzed by logistic regression analysis. Mortality was independently increased in patients with diabetes, with multi-vessel disease, after a previous myocardial infarction and in smokers. The presence of multi-vessel disease, symptoms of a higher angina class and younger age increased the risk for undergoing bypass surgery. In the statistical model with lesion parameters, the risk of bypass surgery was decreased if the stenosis was located in the distal segment of the coronary vessel and by a higher minimal luminal diameter before PTCA. CONCLUSION: Logistic regression analysis identified multi-vessel disease, diabetes, smoking and a previous myocardial infarction as independent clinical predictors of an adverse outcome 10 years after coronary angioplasty. Lesion parameters before PTCA seem to be less important with regard to the long-term outcome after PTCA.

Angioplasty, Balloon, Coronary↗

PubMed1998

Impact of routine angiographic follow-up after angioplasty.

BACKGROUND: There is an ongoing controversy as to whether repeat coronary angiography should be routinely performed after successful percutaneous transluminal coronary angioplasty (PTCA). METHODS: We examined the 10-year outcome in 400 patients who had or had not undergone an angiographic control 6 months after successful PTCA and a subsequent event-free 6-month period. Our comparison was based on data gathered by questionnaire and telephone interview in 315 patients with (group A) and 85 patients without (group B) a routine 6-month angiographic control. Multivariate analysis (Cox model) was performed to identify predictors of adverse events. RESULTS: During the 10-year follow-up period, 22 (7%) of the 315 patients in group A died, compared with 16 (19%) patients in group B (P= .003). In groups A and B, respectively, acute myocardial infarction occurred in 28 (9%) and 10 (12%) patients (not significant [NS]); coronary artery bypass grafting (CABG) was performed in 42 (13%) and 14 (16%) patients (NS); repeat PTCA was performed in 89 (28%) and 11 (13%) patients (P= .012); and serious adverse events (death, myocardial infarction, CABG) occurred in 76 (24%) and 32 (38%) patients (P= .02). Absence of a 6-month angiographic follow-up was identified as an independent predictor of death associated with a 2.7 times higher mortality rate during the 10-year follow-up period. Previous myocardial infarction increased the risk of death 2.5 times. Any increase of residual diameter stenosis by 10% was combined with a 1.4 times higher mortality rate. The chance of bypass surgery was higher in patients with multivessel disease (2.9 times), in patients with unstable angina (2.1 times), and in case of an increase of residual diameter stenosis by 10% (1.3 times). No predictor for the risk of myocardial infarction was found. Angiographic follow-up increased the likelihood of PTCA 2.5 times. CONCLUSIONS: A routinely performed angiographic control 6 months after successful PTCA is associated with a significantly higher rate of repeat PTCA but, most important, is correlated with a significantly lower mortality rate during the 10-year follow-up period.

Adult↗

PubMed1998

Impact of restenosis 10 years after coronary angioplasty.

AIMS: The aim of the study was to compare the 10-year follow-up results of patients with or without restenosis following single-vessel percutaneous transluminal coronary angioplasty (PTCA). METHODS AND RESULTS: A total of 313 patients with successful PTCA (> or = 20% reduction in luminal diameter narrowing without acute complications) and a control angiography 6 months after PTCA were included in the study. Events during the follow-up period were defined as death, myocardial infarction, bypass surgery, or repeat PTCA. Statistical evaluation was performed by the Fisher test, logistic regression, and life-table analysis. Restenosis (loss of > 50% of the initial gain and diameter stenosis of 50%) was found in 87 (28%) patients. During follow-up, 11 patients (5%) without restenosis (group A) and 11 (13%) patients with restenosis (group B) died (P < 0.05). In group A, 17 (8%) patients and in group B, 11 (13%) patients suffered myocardial infarction (ns); 17 group A (8%) patients and 25 (29%) group B patients had bypass surgery (P < 0.0001), and 34 (15%) group A patients and 55 (63%) group B patients underwent repeat PTCA (P < 0.0001). Logistic regression analysis identified restenosis as an independent risk factor that increases the risk of death 2.8-fold (P = 0.02), bypass surgery 5.6-fold (P < 0.0001), and repeat PTCA 10-fold (P < 0.0001). CONCLUSION: We conclude that patients with restenosis had a poorer long-term outcome than patients without restenosis. Although most patients with restenosis underwent repeat PTCA, the survival rate without any serious adverse events was only 59%, compared with 83% in patients without restenosis (P < 0.0001).

Adult↗

PubMed1997

[Quantitative effect of a standardized pressure bandage on arterial and venous circulation in the lower extremities after heart catheter examination].

AIM: The aim of the study was to evaluate the effect of a conventional pressure dressing on arterial and venous blood flow of the legs after cardiac catheterization. METHODS: Duplexsonographic measurements were performed of both legs in 100 consecutive patients before catheterization and with a pressure dressing after the procedure. The pressure dressing was applied by means of a pressure pad on the punctured leg, so that the ankle-arm-index (blood pressure at the leg/blood pressure at the arm) was not influenced. Arterial and venous blood flow of the superficial femoral artery and vein were registered. We evaluated both legs by means of duplex sonography to detect arterial or venous complications after cardiac catheterization. Statistical evaluation was performed using the 1-sample Wilcoxon test. RESULTS: There was a significant reduction of venous blood flow in the punctured leg from a mean of 119 ml/min before puncture to 84 ml/min during pressure dressing (29% flow reduction, p < 0.01), and a reduction of arterial blood flow from a mean of 132 ml/min before puncture to 84 ml/min during pressure dressing (36% flow reduction, p < 0.01). In the contralateral leg, venous blood flow was reduced from about 118 ml/min to 96 ml/min during pressure dressing (19% flow reduction, p < 0.01), and arterial blood flow was reduced from about 129 ml/min to 93 ml/min during pressure dressing (28% flow reduction, p < 0.01). There were no venous complications, 5 patients suffered false aneurysm (5%), and one patient had an arteriovenous fistula (1%). CONCLUSION: A conventional pressure dressing caused a significant reduction of arterial as well as venous blood flow of both the punctured leg and the contralateral leg. This is of clinical relevance especially in patients with known peripheral arterial disease or patients at risk for deep venous thrombosis.

Adult↗

PubMed1996

[Long term course over 10 years after balloon dilatation in stable and unstable angina pectoris].

OBJECTIVE: To assess the cardiac status of patients ten years after percutaneous transluminal coronary artery angioplasty (PTCA). PATIENTS AND METHODS: Data of 534 patients (436 men, 98 women; mean age 53.2 +/- 8 years) in whom a PTCA had been performed between 1983 and 1986 were analysed, based on a questionnaire answered 121 +/- 11 months after the initial procedure. At the time of PTCA 184 patients (35%) had unstable angina, 350 (65%) stable angina. RESULTS: 116 patients (63%) with unstable angina and 164 (47%) with stable angina had at least one cardiac event after the initial PTCA (repeat PTCA, bypass operation, myocardial infarction, death). None of these events occurred in 68 patients (37%) with unstable or in 186 (53%) with stable angina (P < 0.001). After 10 years 196 of the 302 surviving patients with stable angina (65%) and 104 of the 153 surviving patients with unstable angina (68%) were symptom-free. CONCLUSIONS: Ten-year follow-up after PTCA has shown that cardiac events are significantly more frequent in patients who had had unstable angina than in those with stable angina. This difference already develops in the first year post-PTCA, with no increase later. Symptoms are lastingly improved after 10 years in both groups of patients.

Angina Pectoris↗

PubMed1996

[Automatic report documentation in cardiology using a speech recognition system].

Computer systems that can convert spoken text into written text have recently become available. In one such system, the phonetics of spoken words are compared with those of 32 000 stored words, with a statistical program helping to choose the word with the highest probability of being correct. We evaluated the practicability of the IBM Voice Type system for writing medical reports using a cardiologic vocabulary. A total of 200 medical documents were generated with a mean of 301 +/- 52 words. In the mean, 12 +/- 5 words were falsely recognized in each document, resulting in a rate of correct recognition of 95.1 +/- 2.5%. It is possible to correct a falsely recognized word by choosing an alternative word from a provided list, which worked in our case in 51% (6.1 +/- 2.8 words in each document). Correction of falsely recognized words had to be done by manual input 49% of the time (5.9 +/- 2.9 words in each document). The mean time demand for word correction amounted to 57 +/- 15 s for each document, whereas correction by manual input needed more time (37 +/- 14 s) than choosing from a list of alternative words (20 +/- 4s). A requirement for use of the Voice Type system is a reduced speech rate. Dictation of our documents took on average 260 s when done with a normal speech rate, and 400 s when done at a reduced speech rate. In conclusion, automatic writing of cardiologic reports can be done easily and with a low failure rate using the IBM Voice Type system with a cardiologic vocabulary. It takes about 3 min longer to create a medical text 1 1/2 pages long which is free of mistakes by using the Voice Type system than to simply dictate the text. Time can be saved by eliminating the need to check a preliminary report. The major advantage of automated reporting is that the written report is immediately available. For each discipline, specific vocabularies should be validated.

Cardiology↗

PubMed1993

[Complications after coronary angiography and balloon dilatation].

All major complications within four weeks after diagnostic cardiac catheterization (DCCA; n = 4,778) or percutaneous transluminal coronary angioplasty (PTCA; n = 3,073) were analysed prospectively in 7,851 patients (5,769 men, 2,082 women; mean age 59.4 [16-88] years). There were 116 such complications in 114 patients, 46 (0.9%) after DCCA, 70 (2.3%) after PTCA. 76% of all complications occurred during the first two days after the procedure: bleeding in 29 patients, false aneurysms in 15, arterial occlusions in 12, venous ones in three, cerebral ischaemia in 12, fulminant pulmonary emboli in three, cardiac complications in 27, and others in 15. There were five deaths in connection with a DCCA, 18 with PTCA. Complications were twice as common in women as in men (DCCA: 1.5% vs 0.7%, P < 0.05; PTCA: 4.2% vs 1.7%, P < 0.001). Complications after DCCA were more frequent in those aged over 55 years (1.2% vs 0.3%, P < 0.05); after PTCA they were more frequent in those aged over 65 years (4.1% vs 1.3%, P < 0.05). Other risk factors for complications were: peripheral arterial occlusive disease for arterial occlusion (P < 0.001), high heparin dosage with DCCA (P < 0.05), and additional venous puncture with DCCA (P < 0.01).

Adolescent↗