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G Kopp

Publications and source records attributed to G Kopp.

7 recordsLinked to original sources
PubMed1997

Dobutamine stress tele-echocardiography for evaluation of emergency department patients with chest pain.

OBJECTIVES: The practically and accuracy of dobutamine stress tele-echocardiography (DSTE) were assessed in patients presenting to the emergency department with chest pain. BACKGROUND: Many patients evaluated for chest pain in the emergency department (ED) are admitted to the hospital needlessly because of the difficulty in differentiating noncardiac chest pain from myocardial ischemia. METHODS: One hundred sixty-three patients with no evidence of myocardial infarction on initial blood studies or the electrocardiogram who were recommended for hospital admission to rule out myocardial infarction or myocardial ischemia were enrolled in this four-phase study. Rest echocardiography was performed in the ED, and the images were transmitted to a cardiologist for interpretation. If the results were normal, DSTE was then administered by a trained nurse. In the first three phases, all patients were admitted for observation regardless of the results of DSTE. In the fourth phase, those having normal DSTE results were able to be released. RESULTS: The test was completed within an average of 5.4 h of presentation to the ED. The sensitivity and specificity of DSTE versus clinical and cardiac catheterization findings were 89.5% and 88.9%, respectively, with a negative predictive value for DSTE of 98.5%. Patients experienced frequent mild side effects (54.7%), but few (6.3%) caused the test to be discontinued prematurely. In phase 4 of the study, 72% of those slated for hospital admission because of cardiac risk factors and chest pain suggesting myocardial ischemia were discharged after normal DSTE results. CONCLUSIONS: The use of DSTE in the evaluation of patients presenting with chest pain may improve screening for those who can be safely released from the ED.

Adult↗
PubMed1996

Emergency echocardiography telemedicine: an efficient method to provide 24-hour consultative echocardiography.

OBJECTIVES: This study sought to assess the clinical utility of interpreting emergency echocardiograms after regular working hours through a telemedicine connection to on-call cardiologists. BACKGROUND: Physician interpretation of emergency echocardiograms is often delayed during weekends, evenings or night hours. This delay places undue responsibility on less qualified personnel to interpret echocardiograms of vital importance. METHODS: Digital quad-screen cine-loop format was transmitted over standard telephone lines. Clinical data and conventional and telemedicine interpretations were collected prospectively for 187 emergent or semiemergent tele-echocardiograms after regular working hours. RESULTS: Indications for the echocardiogram included assessment of left ventricular function, ischemia, pericardial effusion, valvular disease, heart donor status and arrhythmia. Three off-site echocardiographers received the standard echocardiogram and spectral, gray-scale and color flow Doppler images in cineloop format using a laptop computer. Laptop interpretation showed 19 technically limited studied, 153 abnormal studies and 54% with wall motion abnormalities. Overall mean agreement rate between telemedicine laptop interpretation and conventional workstation interpretation performed in blinded manner for serious disorders with classic echocardiographic findings (pulmonary hypertension, left ventricular thrombus, aortic dissection, severe valvular insufficiency and large pericardial effusion) was 99.0% (95% confidence interval [CI] 96% to 99%). For serious wall motion abnormalities, the agreement rate was 96.3% (95% CI 92% to 99%). The following mean times elapsed after completion of the echocardiogram: to laptop fax report, 2.14 (range 10 min to 8 h); to dictation of videotape, 11.74 h (p < 0.001); to transcription of videotape diction, 56.6 h (p < 0.0001). CONCLUSIONS: After-hours emergency echocardiography telemedicine using a laptop computer is more rapid than scheduled conventional interpretation from a videotape workstation, yet diagnostic accuracy is comparable.

Adolescent↗
PubMed1990

Intraoperative radiation with external irradiation: an alternative for nonresectable non-small-cell lung cancer?

In 15 patients with nonresectable non-small-cell lung carcinoma (NSCLC) (10 squamous, 1 large cell, 4 adenocarcinomas; T1-T3, N0-N2, all M0), lymph node dissection and intraoperative irradiation of the tumour (IORT) with doses between 10 and 20 Gy (11-20 MeV electron beam) was performed. Four weeks postoperatively 46-56 Gy external irradiation (8 or 23 MeV photons) was delivered to the mediastinum and 46 Gy to the tumour-bearing area. Four weeks postoperatively, 8 minor responses (MR, tumour regression between 4% and 45%) and 6 partial responses (PR, 50%-84%) were found. In 1 case, CT was inconclusive. Eighteen weeks after IORT, volumetry showed 3 CR, 9 PR (62% to 94%) and 1 28% MR. One patient died from intrabronchial hemorrhage 7 weeks after IORT (50% PR). Two others (both CR) died from unrelated causes, 6 and 12 months, respectively, after IORT. One patient (62% PR) died after 14 months from an unknown cause. Another patient died at 15 months from local relapse after CR. The latest CT volume assessment between 7.5 and 21.5 months, respectively, yielded 8 CR, and 1 63% PR. One further case of local CR has developed contralateral pulmonary metastasis after 10 months. All these patients are alive and well. The median time elapsed since IORT is 12.5 months, 10 patients have survived more than 12 months.

Aged↗
PubMedDate not supplied

The feasibility of dobutamine stress echocardiography in the emergency department with telemedicine interpretation.

Dobutamine stress echocardiography (DSE) was performed on 26 patients admitted for chest pain deemed at low risk for myocardial infarction. Pharmacologic stress in the emergency department on a 24-hour basis was administered by nurses and echocardiographic ultrasonographers with electrocardiograms and echocardiograms being interpreted through telemedicine relay by an off-site cardiologist. Target heart rate was achieved in 84% of patients with an average peak dobutamine dose of 48 microg/kg/min. Echocardiographic transmission to the cardiologist over standard telephone lines took 9 minutes per quad-screen cine-loop display. The entire protocol added 2.2 hours to the emergency room evaluation. The one patient out of 26 who had incipient myocardial infarction was diagnosed by resting echocardiography. The remaining 25 patients were found clinically to have no infarction or ischemia. Of these, 22 out of 25 had normal DSE in the emergency department; three had wall motion abnormalities on peak stress images. Another three patients had other cardiac diseases documented by echocardiography. Evaluation of chest pain on a 24-hour basis with DSE with telemedicine interpretation appears to be a rapid and safe means of screening patients at low risk in the emergency department. Further experience with this modality is needed before all patients should be enrolled or early discharge of patients on the basis of DSE can be advised.

Adult↗