The NASPE */BPEG ** Defibrillator Code

A new generic code, patterned after and compatible with the NASPE/BPEG Generic Pacemaker Code (NBG Code) was adopted by the NASPE Board of Trustees on January 23. 1993. It was developed by the NASPE Mode Code Committee, including members of the North American Society of Pacing and Electrophysiology (NASPE) and the British Pacing and Electrophysiology Croup (BPEC). It is abbreviated as the NBD (for NASPE/BPEC Defibrillator) Code. It is intended for describing the capabilities and operation of implanted cardioverter defibrillators (ICDs) in conversation, record keeping, and device labeling, and incorporates four positions designating: (1) shock location; (2) antitachycardia pacing location; (3) means of tachycardia detection; and (4) antibradycardia pacing location. An additional Short Form, intended only for use in conversation, was defined as a concise means of distinguishing devices capable of shock alone, shock plus antibradycardia pacing, and shock plus antitachycardia and antibradycardia pacing.     

Comparison of Titanium-Mesh and Porous Disc Electrodes for Epicardial Defibrillation

The object of this study was to compare the effectiveness of chronically implanted porous electrodes with that of smooth mesh titanium electrodes of the same diameter but smaller effective surface area. The criteria used in evaluating the electrodes were (1) acute, subacute, and chronic resistance and (2) acute, subacute, and chronic defibrillation thresholds. Electrode pairs 2.5 cm in diameter were implanted in each of 17 dogs (ten mesh and seven porous). One electrode of each pair was sutured to the right ventricle and one to the left ventricle near the cardiac apex. Defibrillalion threshold energy and total resistance were measured at the time of implantation and again 6 and 12 weeks after implantation. The mean initial resistance of the titanium electrodes was 131.7 Ω; the mean defibrillation values /or the porous electrode implant were 96.9 Ω and 7,5 joules, respectively. Three to 6 weeks after implantation, the values for the titanium mesh electrode were 88.9 Ω and 12.0 joules, while those for the porous electrode were 59.9 Ω and 8.0 joules. In the chronic state, the figures for the titanium mesh electrode were 78.1 Ω and 13.0 joules, while those for the porous electrode were 64.3 Ω and 8.3 joules. We conclude that defibrillation can be achieved successfully with small epicardial electrodes. The findings suggest that a porous electrode, with its larger effective surface area, has lower electrode/tissue interface resistance in the acute and chronic phases, and, therefore, provides lower defibrillation threshold energy.     

Behavioral influences of rectal diazepam in solution on dental patients with mentally and physically handicapping conditions

The hypothesis of this study was to determine whether the use of rectal diazepam in solution would effectively modify the uncooperative behavior of patients with mentally and physically handicapping conditions during dental treatment. The sample consisted of 42 patients with mild to severe mentally handicapping conditions, 4 to 31 years old, who live in a homecare center. Supragingival and subgingival scaling and prophylaxis were attempted during a 5-minute period and the patient's behavior was assessed. Conscious sedation using a rectal solution of diazepam (Stesolid) was used for those patients with voluntary or involuntary uncooperative behavior that prevented treatment. Twenty-two subjects (52.4%) were treated without diazepam. The rectal solution of diazepam proved to be a significantly (P < .01) effective agent for behavior modification permitting the successful treatment of 16 (80%) of the 20 remaining subjects. The following behaviors were significantly modified: places hand(s) or arm(s) in front of mouth (P < .01); does not open mouth, lips held firmly together (P < 05); turns head to one side or side to side (P < 05); attempts to grab instruments (P < .05). No relationship was found between the results and the variables of medical history, gender, age, weight, quantity of diazepam administered, routine medication, pulse rate, blood pressure, and respiration.     

Pacing Lead Survival: Performance of Different Models

Recent reports have shown poor survival of some leads currently in use. Long-term survival analysis of 2,444 leads (1,059 atrial and 1,385 ventricular) implanted in this institution since January 1980, and having at least 1 month of follow-up was performed. The survival of 123 different models was compared with the average survival of all the leads implanted in the corresponding chamber. Failure was defined as inactivation of the lead (electrical abandonment, explant, or cap) due to insulator and/or conductor fracture. Results: The mean follow-up was 33 ± 32 months. The cumulative survival for different atrial lead models was consistent with the average performance in the atrium. No atrial lead showed better or worse survival compared to the others. In the ventricular group, the Medtronic 4012 lead showed statistically significant poorer survival (P = 0.01) compared with the average survival of the ventricular leads. The Cardiac Pacemakers, Inc. (CPI) 4010 lead showed a nonsignificant (P = 0.12) worse performance than the average for ventricular leads. Conclusions: (1) The Medtronic 4012 had a significantly poorer performance than the rest of the leads. A trend in similar direction was found for the CPI 4010, also in the ventricular group; (2) Atrial lead models showed a stable survival; and (3) Frequent follow-up is required for some leads, especially in pacemaker dependent patients.     

An Alcohol Research Center in Concept and Practice: interdisciplinary collaboration at the UConn ARC

The Center for Research on the Etiology and Treatment of Alcohol Dependence is dedicated to the systematic examination of the nature, development, and clinical management of alcohol use disorders. The Center is organized around an integrated network of three basic science laboratories (Neurobiology, Neurodynamics, and Psychophysiology) and one treatment evaluation laboratory that incorporates basic science methods and concepts into its program. This paper describes the organization, programs and mission of the Center. It also discusses the conditions under which interdisciplinary collaborative research is likely to flourish.     

Lipid membrane permeability of modified c[D-Pen2, D-pen5]enkephalin peptides

Permeability coefficients of a series of analogues of a potent opioid peptide, c[D-Pen², D-Pen⁵]enkephalin, were measured in a model membrane system. The analogues included hydrophobic amino acid substitutions on position 3. Liposomes of a mixed composition consisting of zwitterionic lipids and cholesterol served as the model membranes. The obtained permeability coefficients range between 0.38 × 10^?12 and 2.9 × l0^?12 cm/s. These data were correlated with the hydrophobicity scale of Nozaki and Tanford (J. Biol. Chem. 246, 1971, 2211-2217) (correlation coefficient = 0.9933) and with determinations of lipid order perturbation by differential scanning calorimetry (correlation coefficient = -0.9779). The reasonably good correlation obtained within the family of analogues substituted on position 3 (Gly, Ala, Leu, Phe) indicates that changes in permeabilities are primarily related to increases in the partition coefficient of the peptide. However, Phe residue added on the N-terminal end of the peptide (position 0) does not appear to follow the observed trend, showing stronger lipid perturbation and lower permeability compared to the Phe³ analog. This observation demonstrates that each class of peptide modifications requires a new basis of permeability analysis and predictions. © Munksgaard 1996.     

ERYTHEMA NODOSUM VERSUS NODULAR VASCULITIS

Background. Erythema nodosum (en ) is usually considered to be a septal panniculitis, and nodular vasculitis (nv ) a lobular panniculitis. We tested the usefulness of this histologic classification in clarifying a frequent clinical dilemma: en versus nv . Methods. Over 3 years 109 patients with panniculitis were included in this study. After a history and a physical examination, a clinical diagnosis was made according to well-established criteria. Results. From the study of 88 patients, we concluded that in the clinically typical cases, the clinico-pathologic agreement was 93% and 94% for en and nv respectively, whereas it diminished to 79%, 72%, and 67% in the cases clinically diagnosed as en migrans, atypical en , and atypical nv , respectively. Moreover, septal and lobular panniculitis were always two clear-cut, different, opposite patterns of hypodermal inflammation to these conditions. Conclusions. In the absence of a known pathogenetic mechanism, the histopathology remains the most objective discriminating marker between en and nv , mainly in the clinically atypical and doubtful cases.     

Long-Term Performance of Epimyocardial Pacing Leads in Adults: Comparison with Endocardial Leads

The long-term performance of epimyocardiaJ pacing leads in children is well established, but few studies have analyzed the performance in adults. This issue has clinical relevance in view of the increased use of epimyocardial leads with implantable cardioverter defibrillator and antitachycardia pacing systems. We analyzed 93 epimyocardial pacing "systems" (121 leads: 65 unipolar, 28 bipolar) in adult patients (age 57 ± 16 years), implanted since January 1980. Two different models were studied: Medtronic 4951 "Stab–on" (n = 35) and Medtronic 6917/6917A "Screw-in" (n = 58). A control group was created by randomly matching each epimyocardial system with two endocardial leads, according to age and year of implant. Epimyocardial and endocardial leads were followed-up for 44 ± 35 and 43 ± 35 months, respectively (P = NS). Freedom from failure for epimyocardial leads was 0.91 (95% Confidence Interval [95% CI] = 0.82 to 0.96) at 5 years, and 0.91 f95% CI = 0.69 to 0.98) at 10 years. No difference was found between the two analyzed models. Freedom from failure for endocardial leads was 0.97 (95% CI = 0.93 to 0.99) and 0.90 (95% CI = 0.61 to 0.97) at 5 and 10 years, respectively. Epimyocardial Jeads had a significantly poorer short-term survival than endocardiaJ leads, secondarily to earlier "technique related" failures (P = 0.03; relative riskc 3.0; Wilcoxon test). However, overall long-term performance was similar to endocardial leads. Epimyocardial pacing leads, meticulously implanted and tested, have a long-term performance similar to endocardial pacing leads.