Pediatric health-related quality of life: Feasibility, reliability and validity of the PedsQL transplant module.

The measurement properties of the newly developed Pediatric Quality of Life Inventory (PedsQL) 3.0 Transplant Module in pediatric solid organ transplant recipients were evaluated. Participants included pediatric recipients of liver, kidney, heart and small bowel transplantation who were cared for at seven medical centers across the United States and their parents. Three hundred and thirty-eight parents of children ages 2-18 and 274 children ages 5-18 completed both the PedsQL 4.0 Generic Core Scales and the Transplant Module. Findings suggest that child self-report and parent proxy-report scales on the Transplant Module demonstrated excellent reliability (total scale score for child self-report alpha= 0.93; total scale score for parent proxy-report alpha= 0.94). Transplant-specific symptoms or problems were significantly correlated with lower generic HRQOL, supporting construct validity. Children with solid organ transplants and their parents reported statistically significant lower generic HRQOL than healthy children. Parent and child reports showed moderate to good agreement across the scales. In conclusion, the PedsQL Transplant Module demonstrated excellent initial feasibility, reliability and construct validity in pediatric patients with solid organ transplants.

Sublay or onlay incisional hernia repair along with abdominoplasty: which is better? Long-term results.

PURPOSE: Estimation and comparison of results after incisional hernia repair (IHR) modo onlay or sublay with abdominoplasty in patients who lost the weight following Roux-en-Y Gastric Bypass (RYGB). Analysis and comparison of changes in quality of life (QL) of these patients prior to RYGB, before and after simultaneous IHR and abdominoplasty. METHODS: Clinical analysis involved 40 patients with abdominal disfigurement (following RYGB and massive weight loss) after one-time IHR sublay method with abdominoplasty-group 1 or IHR onlay method with abdominoplasty-group 2. We evaluated postoperative results and long-term QL changes (DAS24, SF-36 scales). RESULTS: We noted abnormal wound healing (2), pneumonia (3) and dysesthesia (3) in patients from group 1, and abnormal wound healing (2), seroma (2), pneumonia (2), and dysesthesia (4) in group 2. Quality of life was improved in the functional, esthetic and psychological aspects. CONCLUSIONS: One stage incisional hernia repair by onlay as well as sublay method with abdominoplasty are safe surgical methods improving the functioning of patients after major weight loss following RYGB. Sublay hernia repair and abdominoplasty was connected with longer time of the: operation, drainage, analgesic agents use, time to mobilization and to full oral diet than the onlay method. Significant improvement of the quality of life was noted after every subsequent step of surgical treatment in both groups. Reduction of the risk of BMI re-growth after bariatric surgery is related to the need for constant, specialized care for these patients at every stage of follow-up after bariatric surgery.

Lack of Impact of Presence of Positive C4d Staining in Capillaries in Myocardial Biopsies on Long-term Survival of Heart Transplant Patients.

BACKGROUND: The long-term survival of 209 consecutive patients (mean age, 46 ± 15 years) from a single center with ≥1 diagnostic myocardial biopsy after heart transplantation was analyzed. METHODS: Patients were considered as C4d positive if a capillary staining (immunohistochemistry in paraffin samples) was observed in ≥1 myocardial biopsy. Data were analyzed according to pathologic consensus of antibody mediated rejection definition of C4d+ positivity: 2004 definition in group A and the 2013 definition in group B and compared with their respective controls, composed of patients who do not meet those criteria. Age, follow-up time, and number of biopsies were comparable between patients with C4d+ and controls in both groups. Follow-up was 100% complete with mean of observation time 2143 days. RESULTS: During the follow-up period, 62 patients died (group A: C4d+ 32% vs controls 29%; group B: C4d+ 36% vs controls 29% [P = NS]). There were no differences in survival between patients with positive staining and without C4d+ staining when Kaplan-Meier survival curves were compared. CONCLUSIONS: The presence of C4d positive staining in myocardial capillaries of heart biopsies of patients after heart transplantation, as an isolated finding, was not related to worse long-term survival.

Voice pathology classification based on High-Speed Videoendoscopy.

This work presents a method for automatical and objective classification of patients with healthy and pathological vocal fold vibration impairments using High-Speed Videoendoscopy of the larynx. We used an image segmentation and extraction of a novel set of numerical parameters describing the spatio-temporal dynamics of vocal folds to classification according to the normal and pathological cases and achieved 73,3% cross-validation classification accuracy. This approach is promising to develop an automatic diagnosis tool of voice disorders.

High propeller twist and unusual hydrogen bonding patterns from the MD simulation of (dG)6.(dC)6.

A molecular dynamics (MD) study of (dG)6.(dC)6 including counter ions and 292 water molecules was made. The hydrogen bonding pattern and propeller twist angles for the mini-helix are reported as averages for times spanning 21-30, 31-40, 41-50, and 51-60 ps. The propeller twist angles range from 18 degrees to 38 degrees. Bifurcated and interstrand neighboring base (twisted) hydrogen bonding patterns were found.

The generation of superoxide anion in blood platelets in response to different forms of Proteus mirabilis lipopolysaccharide: effects of staurosporin, wortmannin, and indomethacin.

Lipopolysaccharide (LPS), the major component of the outer membrane of Gram-negative bacteria may activate blood platelets. The aim of our study was to evaluate the effects of different forms of Proteus mirabilis LPS and isolated lipid A and polysaccharide part on the production of superoxide radicals in blood platelets and to estimate the role staurosporin, wortmannin and indomethacin on this process. We compared the generation of superoxide radicals in platelets treated with LPS after preincubation with inhibitors of the signal transduction pathways, namely staurosporin (inhibitor of protein kinase C), wortmannin (inhibitor of phosphoinositide 3-kinase), and indomethacin (inhibitor of cycloxygenase). Our results demonstrate that all LPS molecules and their fragments caused a stimulation of O2- generation in platelets (P<.5). LPSS1959 had the strongest stimulatory effect. Straurosporin and wortmannin, but not indomethacin inhibited O2- production in LPS-stimulated platelets. Staurosporin (8 nM) and wortmannin (50 nM) caused about 50% inhibition of thrombin-induced O2- generation in platelets, while indomethacin (10 microM) had only a slight inhibitory effect on this process. Our results provide support that in LPS- and thrombin-activated platelets, at least part of O2- generation in platelets, while indomethacin (10 microM) had only a slight inhibitory effect on this process. Our results provide support that in LPS- and thrombin-activated platelets, at least part of O2- is generated due to the activation of the enzymes (protein kinase C and phosphoinositide 3-kinase) involved in signal transduction pathway. Cycloxygenase seems to be not involved in this process.

Use of an inspiratory impedance threshold valve during cardiopulmonary resuscitation: a progress report.

Building upon studies on the mechanism of active compression-decompression (ACD) cardiopulmonary resuscitation, a new inspiratory impedance threshold valve has been developed to enhance the return of blood to the thorax during the decompression phase of CPR. Use of this device results in a greater negative intrathoracic pressure during chest wall decompression. This leads to improved vital organ perfusion during both standard and ACD CPR. Animal and human studies suggest that this simple device increases cardiopulmonary circulation by harnessing more efficiently the kinetic energy of the outward movement of the chest wall during standard CPR or active chest wall decompression. When used in conjunction with ACD CPR during clinical evaluation, addition of the impedance valve resulted in sustained systolic pressures of greater than 100 mmHg and diastolic pressures of greater than 55 mmHg. The new valve may be beneficial in patients in asystole or shock refractory ventricular fibrillation, when enhanced return of blood flow to the chest is needed to 'prime the pump'. The potential long-term benefits of this new valve remain under investigation.

The effect of infarct size on atrioventricular and intraventricular conduction disturbances in acute myocardial infarction.

The effect of infarct size estimated from serial CK-MB isoenzyme determinations on the incidence of atrioventricular and intraventricular conduction disturbances was examined in 250 patients suffering their first myocardial infarction. The size of the infarct was significantly greater (P less than 0.001) in 72 patients with conduction disturbances than in 178 without conduction defects (54 +/- 29 vs. 35 +/- 22 CK-MB gEq). The largest size was observed in 10 patients with bifascicular block (71 +/- 38 CK-MB gEq). Within the group of patients with intraventricular conduction disturbances, the size of the infarct was significantly greater (P less than 0.01) when localized inferiorly rather than anteriorly (91 +/- 10 vs. 58 +/- 27 CK-MB gEq). The size in those patients with complete atrioventricular block and anterior infarction was larger than in those with an inferior lesion (76 +/- 21 vs. 52 +/- 33 CK-MB gEq). The size in those patients with inferior infarction and complete block was significantly greater (P less than 0.05) than in patients with similarly positioned infarction without conduction disturbances (52 +/- 33 vs. 35 +/- 22 CK-MB gEq). There was no significant difference in the size of infarct when inferior infarction was complicated by first- and second-degree block in comparison to those without conduction defects (38 +/- 23 vs. 35 +/- 22 CK-MB gEq). A correlation was observed between the size of infarction and the incidence of conduction disturbances (P less than 0.001); the greater the size the higher the incidence of conduction disturbances.

Prognostic significance of changes in the compliance of the pulmonary venous system after isosorbiddinitrate in patients with mitral stenosis.

It is agreed that a stiff pulmonary venous bed can cause severe pulmonary hypertension. This condition can also influence the clinical and hemodynamic outcome of mitral valve replacement (MVR). This study has been aimed at assessing whether changes in the pulmonary venous compliance (PVcomp) after application of isosorbiddinitrate (ISDN) can be of prognostic value in patients 6 months after MVR. PVcomp was calculated according to the Hirakawa equation in 34 patients with isolated mitral stenosis (MS) before and after ISDN. In 19 patients (group I) there was an increase of PVcomp by more than 15% (5.3 vs. 8.1 ml/mmHg), while 15 patients (group II) showed no differences in PVcomp after ISDN, despite the significant decrease in PAP and PWP in both groups (measured with the use of Swan-Ganz thermodilution catheters). Six months after MVR a significant decrease in PAP, PWP, PVR and an increase in SVI was observed in both groups during rest. During effort (25 W), significant increases in PAP and PWP were recorded in most of patients from the group II, as opposed to group I. It is concluded that significant increase in PVcomp after ISDN in patients with MS can be a prognostic of good clinical results 6 months after MVR.

Pulmonary hemodynamics at rest and effort, 6 and 12 months after mitral valve replacement: a slow regression of effort pulmonary hypertension.

An analysis of pulmonary hemodynamics in 22 patients with postrheumatic mitral valve disease using a floating Swan-Ganz type catheter at rest and effort in supine cycloergometer test was done before, 6 and 12 months after mitral valve replacement. Pulmonary hemodynamics data were recorded and calculated at rest and during effort. The most significant changes in almost all analyzed parameters occurred between preoperative and 6 month examination values. However further modest changes mainly during effort were observed between the 6-month and 1-year follow-ups. The mean workload during the bicycle ergometer test rose significantly from 22 +/- 26 W before to 48 +/- 20 W at 6 months and 57 +/- 22 W at 12 months after mitral valve replacement (P < 0.005). We noted a significant improvement in functional class 6 months after mitral valve replacement and a further slight improvement 12 months after. There was a small statistically insignificant decrease in systolic pulmonary pressure between 6 and 12 month measurements. Systolic pulmonary pressure at rest dropped slightly from 39.0 +/- 9.4 to 34.6 +/- 9.4 mmHg. During the bicycle test after 3 min (25 W) the decrease of systolic pulmonary pressure between the 6- and 12-month measurements was statistically significant. Systolic pulmonary artery pressure dropped from 61 +/- 12.4 to 50 +/- 12.3 mmHg. At the same time the drop in pulmonary wedge pressure was smaller and statistically not significant. Pulmonary wedge pressure at rest 6 months after mitral valve replacement was 14.3 +/- 6 mmHg, and after 12 months was 12.7 +/- 4.5; at 25 W, 24.6 +/- 6 vs. 22.1 +/- 5.5, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Persistent dissection of carotid artery in patients operated on for type A acute aortic dissection--carotid ultrasound follow-up.

Over a period of 5 years, 124 patients were operated on at the National Institute of Cardiology in Warsaw for acute aortic dissection, 27 of whom died. The 97 patients discharged from the hospital were included in the present analysis. The age of the patients ranged from 25 to 73 years with a mean of 50+/-10 years. Ultrasound examination of carotid arteries was performed with the patient lying on his back using a Toshiba 340A color Doppler system with a linear array probe of 7.5 MHz. Of the 97 patients examined, 15 (15%) had a dissection of at least one of the common carotid arteries (CCA). Two had Marfan syndrome. In 11 patients the dissection involved the right common carotid artery and in four it involved both the left and right common carotid arteries. The flow in the true lumen of CCA and ICA was preserved in all patients and the degree of narrowing ranged from 30 to -70%. Only one of the 15 patients with CCA dissection had an ipsilateral neurological deficit which was already present before the aortic aneurysm operation. Ultrasound follow-up was performed in all patients with the CCA dissection found on first examination. The mean duration of follow-up was 21 months. In 14 patients the degree and extent of the dissection as well as the narrowing of the true lumen was comparable, and in one patient the false channel closed spontaneously. During follow-up there were no new major neurological events despite the persistence of the CCA dissection with different degrees of narrowing of the true lumen. Doppler ultrasound examination of the carotid arteries can supply additional information about the extent of the dissection, and help to assess the flow in the persisting 'double channel' common carotid artery during the follow-up of patients.

Influence of isosorbide dinitrate (ISDN) on compliance of the pulmonary venous system.

Irreversible poor pulmonary venous compliance can worsen the natural course of patients with high pulmonary capillary wedge pressure, especially those with mitral stenosis, but nitrates (isosorbide dinitrate--ISDN), which have venodilatory properties, could increase this compliance in most patients. The aim of this study was to assess the hemodynamic effects of ISDN in patients with mitral stenosis, with special emphasis on the pulmonary venous compliance. Pulmonary venous compliance was estimated according to the Hirakawa equation (dV/dp = 0.4 x k2 x sV/(v-d)) in 39 patients with mitral stenosis during preoperative right heart catheterization with Vygon 5155-180 thermodilution catheters at rest and during exercise (25 W) in the supine position. This procedure was repeated after the application of 3.75 mg of Iso-Mack spray. Overall, ISDN increased pulmonary venous compliance significantly both at rest and during exercise (6.0 to 7.5 ml/mmHg and 6.0 to 7.6 ml/mmHg, respectively). The patients were divided into two groups according to their level of ISDN response; those with a good response of an increase of 15% or more in pulmonary venous compliance (Group I), and those with an increase of less than 15% (Group II). There were significant differences between these two groups in stroke volume index and heart rate. In Group I, while the mean right atrial pressure, mean pulmonary artery pressure and mean pulmonary wedge pressure all decreased significantly, there was a simultaneous insignificant decrease in the stroke volume index and an also insignificant increase in the heart rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Traumatic tricuspid valve insufficiency: case report.

A 30-year old man underwent a head-on motor accident and was admitted to hospital, where he was successfully treated for several injuries. He was discharged home with slight tricuspid regurgitation, without signs of hemodynamic decompensation, and required no further treatment. Five years later he was admitted to the National Institute of Cardiology due to overt right ventricular failure secondary to tricuspid valve regurgitation. After several unsuccessful attempts at papillary muscle and chordal repair, a 33-mm SJM Biocor valve was implanted. This case history underlines the value of echocardiography, even after blunt chest trauma without cardiac symptoms. A good functional result can be achieved years after onset of traumatic valve insufficiency, but early diagnosis and surgical treatment increases the feasibility of tricuspid valve repair rather than replacement, and also prevents progressive deterioration of right ventricular function.

Valve replacement for aortic stenosis with severe congestive heart failure and pulmonary hypertension.

BACKGROUND AND AIMS OF THE STUDY: Significant pulmonary hypertension in aortic stenosis is evidence of severe dysfunction of the left ventricle. It is also a predictor of a bad prognosis in the natural course of the disease. This study was performed to evaluate the changes in the hemodynamic parameters of pulmonary circulation at rest and effort in patients who had significant pulmonary hypertension preoperatively and underwent valve replacement. MATERIALS AND METHODS: The study consists of 11 male patients with aortic stenosis with an average peak transvalvular gradient of 68 mmHg and impaired left ventricular function (mean ejection fraction 38%). Six patients were in NYHA functional class III, and five were in class IV. The patients underwent Swan-Ganz catheterization before urgent valve replacement. RESULTS: Significant pulmonary hypertension was found in all subjects, and a below normal cardiac index in eight. Urgent valve replacement was performed in all patients: two of them were operated on during pulmonary edema and cardiogenic shock which developed soon after diagnosis-one of them died. Patients were followed up six months after surgery, and all of them showed major clinical improvement (six in NYHA class I, four in class II). Mean pulmonary artery systolic pressure dropped from 77 mmHg preoperatively to 32 mmHg, and the pulmonary artery mean pressure from 47 mmHg to 17 mmHg, pulmonary wedge pressure from 32 mmHg to 9 mmHg, and pulmonary vascular resistance from 4.74 to 1.8 Wood units. The cardiac index came back to normal in all patients (2.18 vs. 3.0 l/min/m2). Swan-Ganz catheterization was also performed during exercise (work load; 50 Watts in three patients, 100 Watts in six patients). The reaction of the hemodynamic parameters on exercise in most patients was almost normal. CONCLUSION: Our data indicate that in aortic stenosis, even with severe left heart failure, pulmonary hypertension can be fully reversible and a significant improvement in both rest and effort hemodynamic parameters can be expected.

Elisa to quantify hexanal-protein adducts in a meat model system.

Monoclonal antibodies (MAb) were produced to hexanal-bovine serum albumin conjugates. An indirect competitive ELISA was developed with a detection range of 1-50 ng of hexanal/mL. Hexanal conjugated to three different proteins was recognized, whereas free hexanal and the native proteins were not detected. The antibody cross-reacted with pentanal, heptanal, and 2-trans-hexenal conjugated to chicken serum albumin (CSA) with cross-reactivities of 37.9, 76.6, and 45.0%, respectively. There was no cross-reactivity with propanal, butanal, octanal, and nonanal conjugated to CSA. The hexanal content of a meat model system was determined using MAb and polyclonal antibody-based ELISAs and compared with analysis by a dynamic headspace gas chromatographic (HS-GC) method and a thiobarbituric acid reactive substances (TBARS) assay. Both ELISAs showed strong correlations with the HS-GC and TBARS methods. ELISAs may be a fast and simple alternative to GC for monitoring lipid oxidation in meat.

The meaning of ambulatory care sensitive admissions: urban and rural perspectives.

Ambulatory care sensitive admission rates have been proposed as measures of access to health care. To test this, admissions for ambulatory care sensitive conditions (ACSC) were analyzed by multiple linear regression. The percentage of population below 200 percent of the federally defined poverty level, the percentage of black people, and the number of primary care providers per 1,000 population were found to be positively associated with ACSC admissions. Population density was negatively associated with ACSC admissions. There was no association between the location of the ZIP code in a health professional shortage area and ACSC admissions. Proximity to the hospital was found to be positively associated with ACSC admissions but was examined only in the most rural ZIP code group. The significant independent variables and the direction of their effects were the same across all ZIP code groups. The analysis suggests that high ACSC admissions may be a reflection of deficits in one or more of the following areas: primary care availability, accessibility, or appropriateness. In-depth study is needed to determine the relative importance of these factors in a given geographical area. There also may be environmental and social factors external to the health care system that contribute to ACSC admissions. The findings suggest that ACSC should be used cautiously as a measure of primary care system needs, and in conjunction with other health, demographic, or service utilization data.

[Hemodynamic effects of one administration of l-dopa in patients with left ventricular heart failure (introductory remarks)]. / Ocena efektów hemodynamicznych jednorazowej dawki L-dopy u pacjentów z lewokomorowa niewydolnoscia serca (doniesienie wstepne).

The study group consisted of 8 men with congestive heart failure. They ranged in age from 33 do 63 years (mean 48). Three patients were in class III NYHA, five in class IV. Idiopathic cardiomyopathy was diagnosed in 6 patients, one individual displayed ischemic heart disease and one patient was after mitral and aortic-valve replacement despite a normally functioning prosthetic valve. L-dopa was given orally beginning with 250 mg every six hours until a total daily dose of 4.0 g was achieved with no side effects (patients additionally received 50 mg of pyridoxine hydrochloride). Afterwards L-dopa was withheld for 24-36 hours. Having completed this washout period, patients underwent right heart catheterization, with placement of a balloon-tipped thermodilution catheter in a pulmonary artery, so that balloon inflation allowed recording of the pulmonary capillary wedge pressure. Right atrial and pulmonary arterial pressures were monitored continuously. Systemic arterial pressure was measured by mercury manometer. Cardiac output was determined by the thermodilution technique. Rest and effort hemodynamic measurements were repeated before and one, three hours after administration of 1-dopa. The base-line hemodynamic values were consistent with the clinical presentation of severe congestive heart failure. The average cardiac index (CI-1/min/m2--rest--1.93; 25 Watt-3.1) and stroke volume index (SVI-m1/m2--rest--22.2; 25 Watt-32.0) were markedly lowered. Left ventricular filling pressure and pulmonary artery pressure were elevated. The systemic vascular resistance was significantly increased (SVR -j.W.--rest--22.7; 25 Watt-14.2). Administration of 1-dopa resulted in the increase in cardiac index and stroke volume index accompanied by a substantial reduction in systemic vascular resistance.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pulmonary venous compliance. Indirect evaluation based on pulmonary capillary pressure registration]. / Podatnosc zylnego lozyska plucnego. Ocena posrednia w oparciu o rejestracje kapilarnego cisnienia plucnego.

The compliance of pulmonary venous system (PV comp) is one of the most important factors influencing left ventricular filling pressure. The decrease of PV comp could be also one of the most important factors promoting secondary pulmonary hypertension. The aim of the study was to assess diagnostic value of PV comp based on some haemodynamic data in patients (pts) with isolated mitral stenosis (MS). PV comp was estimated according to Hirakawa equation (dV/dP = 0.4 * k2 x SV/(v - d), where k2 = 0.075 * PWP + 0.9) in 78 pts with MS, during preoperative right heart catheterisation with Vygon 5155-180 thermodilution catheters. The mean PV comp for the entire group of pts was 4.5 +/- 2.4 ml/mmHg. In pts with atrial fibrillation PV comp was significantly lower as compared with pts on sinus rhythm (3.7 +/- 1.9 vs 6.4 +/- 2.3, p < 0.0001. There was also a significant difference between NYHA I/II vs III/IV class as far as PV comp was concerned (5.1 +/- 2.3 vs 3.9 +/- 2.3, (p < 0.05). In the group with low PV comp less than 4 ml/mmHg pulmonary vascular resistance, RA, PA and amplitude of V-wave of PWP were significantly higher and stroke volume index of RV was lower than in the group with PV comp above 4 ml/mmHg. PWP did not differentiate the analysed groups. A decrease of PV comp is a sign of advanced mitral stenosis.

[Surgical treatment for mitral valve defects with preponderance of mitral stenosis and high pulmonary vascular resistance. Clinical and hemodynamic observations 6 months after valve replacement]. / Leczenie operacyjne wady mitralnej z przewaga zwezenia i wysokim naczyniowym oporem plucnym. Obserwacje kliniczne i hemodynamiczne w 6 miesiecy od wymiany zastawki.

10 patients with isolated or predominant mitral stenosis (mean mitral valve area 0.9 cm) and high preoperative values of pulmonary vascular resistance (mean 7.2 Wood units) were chosen for further hemodynamic postoperation evaluation. The patients had normal function of the aortic valve and no significant stenosis of coronary arteries. Hemodynamic evaluation was done by floating Swan-Ganz catheter preoperatively at rest and 6 months after mitral valve replacement at rest and during bicycle cycloergometer test in the supine position. Significant improvement in NYHA class was noted. Preoperatively 6 patients were in NYHA III class, 4 in NYHA IV class. After mitral valve replacement 4 patients were in class III and 6 in class II. Before mitral valve replacement only 3 patients were able to perform 25 Watt test. After surgery all except one performed at least 25 W. There was a significant decrease of pulmonary vascular resistance from 7.2 +/- 2.2 preoperatively to 3.1 +/- 1.9 Wood units at rest after the operation. Post operation during exercise pulmonary vascular resistance attained 4.2 +/- 1.9 Wood units. These changes were due to a fall in mean pulmonary artery pressure 49 +/- 13 at rest preoperatively to 25 +/- 6 mm Hg (rest) and 43 +/- 14 mm Hg (23 W) postoperatively and a rise in stroke volume index from 24 +/- 7 ml (m2) beat preoperatively to 32 +/- 9 at rest and 33 +/- 6 (25 W) postoperatively. Despite clinical and hemodynamic improvement there was no full recovery of pulmonary hemodynamics.

The concept of a clinical round as a virtual, interactive web-based, e-learning model for interdisciplinary teaching.

The demonstration of patient case reports in the course of a clinical round is an essential part of teaching medicine and dentistry. However, suitable live patients with particular problems are not always available at a time when teaching is taking place. This project therefore had the objective of establishing a web-based, virtual e-learning concept for demonstrating case reports independent of time and place, with the possibility of an interactive examination, diagnosis, and interdisciplinary therapy decision making for medical and dental students. Anonymized case reports of diseases in the oral and maxillofacial region and the interdisciplinary treatment were digitized and prepared in a web-based format. The technical aspect was based on connecting flash modules with videos and animation, and monitoring through HTML and Javascript. Due to the modular concept and the programming used, the learning environment was independent of platform and open. Independent formats (.swf, .avi, .mpeg, etc.) were integrated into the individual modules. According to a hierarchic decision system, the user was guided interactively to the diagnosis through a differential diagnostic exclusion process. Sound was digitized and integrated in mp3 compressed form in the 3D models for lip-synchronous speech output. The speech output was connected with a virtual 3D tutor that acted in an advisory capacity in reaching a diagnosis and determining therapy. Further sources of information and literature with abstracts or pdf files of the subject-related publications were inserted to ensure that the teaching was objective. To conclude the virtual clinical round, a check on learning success was conducted in the form of a multimedia multiple choice test.